1
|
Strenth C, Wani A, Alla R, Khan S, Schneider FD, Thakur B. Obstructive Sleep Apnea and Its Cardiac Implications in the United States: An Age-Stratified Analysis Between Young and Older Adults. J Am Heart Assoc 2024; 13:e033810. [PMID: 38842290 PMCID: PMC11255750 DOI: 10.1161/jaha.123.033810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 05/02/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is a common sleep disorder associated with cardiovascular risks. This study aimed to assess the prevalence of probable OSA and its relationship with cardiovascular risks and diseases focusing on age-stratified young adults (20-40 years) and older (>40 years). METHODS AND RESULTS The study used a cross-sectional design, analyzing data from the National Health and Nutrition Examination Survey conducted between 2013 and 2018, comprising 9887 community-dwelling adults aged ≥20 years. Probable OSA was determined on the basis of self-report of OSA-related symptoms (eg, snoring, gasping/breath cessation while sleeping). Cardiovascular risk factors, including hypertension, diabetes, hyperlipidemia, and metabolic syndrome, were evaluated according to established guidelines. Cardiovascular diseases (CVDs) included self-reported heart conditions, including congestive heart failure, coronary heart disease, angina, heart attacks, and strokes. Individuals with probable OSA showed a significantly higher prevalence of health conditions, including hypertension (adjusted prevalence ratio [aPR], 1.19; P<0.001), diabetes (aPR, 1.17; P: 0.01), metabolic syndrome (aPR, 1.14; P<0.001), heart attack (aPR, 1.63; P<0.01), stroke (aPR, 1.41; P: 0.03), and any CVD event (aPR, 1.36; P: 0.01) after adjusting for relevant factors. Young adults with probable OSA showed higher prevalence rates of any CVD events (aPR, 3.44; P<0.001), hypertension (aPR, 1.45; P<0.001), metabolic syndrome (aPR, 1.25; P<0.001), and angina (aPR, 10.39; P<0.001). CONCLUSIONS The study suggests early identification and management of OSA in individuals at risk for CVD. While cross-sectional, it emphasizes that health care providers should recognize OSA as significantly associated with CVDs and its precursor risks in young adults, stressing proactive care and screening to reduce CVD risk in this population.
Collapse
Affiliation(s)
- Chance Strenth
- Department of Family and Community MedicineUniversity of Texas Southwestern Medical Center DallasDallasTX
| | - Anna Wani
- Department of Family and Community MedicineUniversity of Texas Southwestern Medical Center DallasDallasTX
| | - Rupini Alla
- Department of Family and Community MedicineUniversity of Texas Southwestern Medical Center DallasDallasTX
| | - Safia Khan
- Department of Family and Community MedicineUniversity of Texas Southwestern Medical Center DallasDallasTX
| | - Frank David Schneider
- Department of Family and Community MedicineUniversity of Texas Southwestern Medical Center DallasDallasTX
| | - Bhaskar Thakur
- Department of Family and Community MedicineUniversity of Texas Southwestern Medical Center DallasDallasTX
| |
Collapse
|
2
|
Hoang-Anh T, Duong-Minh Q, Nguyen-Thi-Y N, Duong-Quy S. Study of the obstructive sleep apnea syndrome in cerebral infarction patients. Front Neurol 2023; 14:1132014. [PMID: 37416312 PMCID: PMC10321128 DOI: 10.3389/fneur.2023.1132014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 05/02/2023] [Indexed: 07/08/2023] Open
Abstract
Introduction Obstructive Sleep Apnea Syndrome (OSAS) is the most common respiratory disorder during sleep. Many studies have shown an association between obstructive sleep apnea syndrome and stroke, and OSAS has not been adequately considered in Vietnam compared to the actual clinical dangers. This study aims to assess the prevalence and general characteristics of obstructive sleep apnea syndrome in patients with cerebral infarction and investigate the relationship between obstructive sleep apnea syndrome and the severity of cerebral infarction. Methods Descriptive cross-sectional study. We identified 56 participants from August 2018 to July 2019. Subacute infarcts were identified by neuroradiologists. For each participant, vascular risk factors, medications, clinical symptoms, and neurological examination were abstracted from the medical record. Patients were taken for history and clinical examination. The patients were divided into two groups according to their AHI (Apnea-Hypopnea Index) (<5 and ≥5). Results A total of 56 patients were registered for the study. The mean age is 67.70 ± 11.07. The proportion of men is 53.6%. AHI has a positive correlation with neck circumference (r = 0.4), BMI (r = 0.38), the Epworth Sleepiness Scale (r = 0.61), LDL cholesterol (r = 0.38), the Modified Rankin Scale (r = 0.49), NIHSS (National Institutes of Health Stroke Scale) (r = 0.53), and an inverse correlation with SpO2 (r = 0.61). Conclusion Obstructive sleep apnea Syndrome is a factor in the prognosis of cerebral infarction as well as cardiovascular diseases such as hypertension. Thus, understanding the risk of stroke in people with sleep apnea is necessary and working with a doctor to diagnose and treat sleep apnea is important.
Collapse
Affiliation(s)
- Tien Hoang-Anh
- Cardiology Department of University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Quy Duong-Minh
- Cardiology Department of University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Nhi Nguyen-Thi-Y
- Cardiology Department of University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Sy Duong-Quy
- Sleep Lab Center, Lam Dong Medical College and Bio-Medical Research Center, Dalat, Vietnam
- Immuno-Allergology Division, Hershey Medical Center, Penn State Medical College, Hershey, PA, United States
- Department of Outpatient Expert Consultation, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| |
Collapse
|
3
|
Chiu HY, Chou KT, Su KC, Lin FC, Liu YY, Shiao TH, Chen YM. Obstructive sleep apnea in young Asian adults with sleep-related complaints. Sci Rep 2022; 12:20582. [PMID: 36447027 PMCID: PMC9708676 DOI: 10.1038/s41598-022-25183-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/25/2022] [Indexed: 12/03/2022] Open
Abstract
This study aimed to investigate the proportion of young OSA adults with sleep-related complaints in a sleep center, affiliated with a tertiary medical center for over a decade. This study presents a chronicle change in the numbers of young adults receiving polysomnography (PSG) and young patients with OSA from 2000 to 2017. We further analyzed 371 young patients with OSA among 2378 patients receiving PSG in our sleep center from 2016 to 2017 to capture their characteristics. Young adults constituted a substantial and relatively steady portion of examinees of PSG (25.1% ± 2.8%) and confirmed OSA cases (19.8 ± 2.4%) even though the total numbers increased with the years. Young adults with OSA tend to be sleepier, have a greater body mass index, and have a higher percentage of cigarette smoking and alcohol consumption. They also complained more about snoring and daytime sleepiness. They had a higher apnea-hypopnea index on average and experienced more hypoxemia during their sleep, both in terms of duration and the extent of desaturation. Even though the prevalence of comorbidities increased with age, hypertension in young male adults carried higher risks for OSA. Young adults with OSA have constituted a relatively constant portion of all confirmed OSA cases across time. The young adults with OSA were heavier, more symptomatic, and with more severe severity.Clinical trial: The Institutional Review Board of Taipei Veterans General Hospital approved the study (VGHIRB No. 2018-10-002CC). The study is registered with ClinicalTrials.gov, number NCT03885440.
Collapse
Affiliation(s)
- Hwa-Yen Chiu
- grid.278247.c0000 0004 0604 5314Center of Sleep Medicine, Taipei Veterans General Hospital, 14F, No. 201, Sec. 2, Shih-Pai Road, Taipei, 112 Taiwan ,grid.278247.c0000 0004 0604 5314Division of Clinical Respiratory Physiology, Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan ,grid.278247.c0000 0004 0604 5314Department of Internal Medicine, Taipei Veterans General Hospital Hsinchu Branch, Zhudong, Hsinchu County Taiwan ,grid.260539.b0000 0001 2059 7017Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan ,grid.260539.b0000 0001 2059 7017Institute of Biophotonics, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Kun-Ta Chou
- grid.278247.c0000 0004 0604 5314Center of Sleep Medicine, Taipei Veterans General Hospital, 14F, No. 201, Sec. 2, Shih-Pai Road, Taipei, 112 Taiwan ,grid.278247.c0000 0004 0604 5314Division of Clinical Respiratory Physiology, Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan ,grid.260539.b0000 0001 2059 7017Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Kang-Cheng Su
- grid.278247.c0000 0004 0604 5314Center of Sleep Medicine, Taipei Veterans General Hospital, 14F, No. 201, Sec. 2, Shih-Pai Road, Taipei, 112 Taiwan ,grid.278247.c0000 0004 0604 5314Division of Clinical Respiratory Physiology, Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan ,grid.260539.b0000 0001 2059 7017Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Fang-Chi Lin
- grid.278247.c0000 0004 0604 5314Center of Sleep Medicine, Taipei Veterans General Hospital, 14F, No. 201, Sec. 2, Shih-Pai Road, Taipei, 112 Taiwan ,grid.278247.c0000 0004 0604 5314Division of Clinical Respiratory Physiology, Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan ,grid.260539.b0000 0001 2059 7017Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yung-Yang Liu
- grid.278247.c0000 0004 0604 5314Center of Sleep Medicine, Taipei Veterans General Hospital, 14F, No. 201, Sec. 2, Shih-Pai Road, Taipei, 112 Taiwan ,grid.278247.c0000 0004 0604 5314Division of Clinical Respiratory Physiology, Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan ,grid.260539.b0000 0001 2059 7017Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tsu-Hui Shiao
- grid.278247.c0000 0004 0604 5314Center of Sleep Medicine, Taipei Veterans General Hospital, 14F, No. 201, Sec. 2, Shih-Pai Road, Taipei, 112 Taiwan ,grid.278247.c0000 0004 0604 5314Division of Clinical Respiratory Physiology, Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan ,grid.260539.b0000 0001 2059 7017Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yuh-Min Chen
- grid.278247.c0000 0004 0604 5314Center of Sleep Medicine, Taipei Veterans General Hospital, 14F, No. 201, Sec. 2, Shih-Pai Road, Taipei, 112 Taiwan ,grid.260539.b0000 0001 2059 7017Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| |
Collapse
|
4
|
Park DY, Gu G, Han JG, Park B, Kim HJ. Validating respiratory index of auto-titrating positive airway pressure device with polysomnography. Sleep Breath 2021; 25:1477-1485. [PMID: 33398794 DOI: 10.1007/s11325-020-02278-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 12/10/2020] [Accepted: 12/16/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Positive airway pressure (PAP) devices have been widely used as the first line of treatment in obstructive sleep apnea (OSA). Most advanced PAP devices support the estimation of respiratory index (RI) using the patient's mask airflow. In addition to the compliance factor for PAP device use, which is important for monitoring patient sleep health, RI is also becoming important for monitoring. However, there are few reports that validate RI of a PAP device with polysomnography. METHODS Between January 2015 and December 2017, 50 participants were enrolled who were diagnosed with OSA and prescribed auto-titration PAP (APAP) devices. The RIs of participants were measured at night using APAP devices, concurrently with electroencephalography, respiratory inductance plethysmography sensors, and other polysomnographic sensors in a sleep laboratory. The respiratory-related data of APAP were prospectively analyzed with the manually scored polysomnographic data. RESULTS The apnea-hypopnea index and apnea index showed a statistically close relationship between the auto-scored respiratory data from the APAP device and the manually scored respiratory data from polysomnographic sensors. Obstructive apnea and central apnea indices showed relatively low correlations. The differences between the auto-scored RI and manually scored RI were influenced by BMI, waist circumference, weight, oxygen saturation, and respiratory distress indices of diagnostic polysomnographic factors. CONCLUSIONS The RIs of APAP devices have a tendency to be underestimated or mismatched when compared with polysomnography. Sleep specialists are advised to consider additional anthropometric and diagnostic factors to account for these differences during PAP treatment.
Collapse
Affiliation(s)
- Do-Yang Park
- Department of Otolaryngology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, 16499, Republic of Korea.,Sleep Center, Ajou University Hospital, Suwon, Republic of Korea
| | - Gayoung Gu
- Department of Otolaryngology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, 16499, Republic of Korea
| | - Jang Gyu Han
- Department of Otolaryngology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, 16499, Republic of Korea
| | - Bumhee Park
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Republic of Korea.,Office of Biostatistics, Ajou Research Institute for Innovative Medicine, Ajou University Medical Center, Suwon, Republic of Korea
| | - Hyun Jun Kim
- Department of Otolaryngology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, 16499, Republic of Korea. .,Sleep Center, Ajou University Hospital, Suwon, Republic of Korea.
| |
Collapse
|
5
|
Jinchai J, Khamsai S, Chattakul P, Limpawattana P, Chindaprasirt J, Chotmongkol V, Silaruks S, Senthong V, Sawanyawisuth K. How common is obstructive sleep apnea in young hypertensive patients? Intern Emerg Med 2020; 15:1005-1010. [PMID: 31970622 DOI: 10.1007/s11739-019-02273-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 12/30/2019] [Indexed: 11/26/2022]
Abstract
Obstructive sleep apnea (OSA) has been reported to be a cause of hypertension in 40-80% of hypertensive patients. However, there are limited data available on the prevalence and predictors of OSA in young hypertensive patients. This study was conducted between October 2017 and October 2018. The inclusion criteria were (1) age over 18 and under 35 years (2) diagnosis with hypertension and (3) available respiratory polysomnography results. Patients with other causes of secondary hypertension were excluded. Predictors for OSA were analyzed using multivariate logistic regression analysis. There were 593 consecutive young patients who were diagnosed with hypertension during the study period. Of those, 475 (80.10%) were excluded due to their hypertension having renal causes (429; 90.32%), endocrine-related causes (40; 8.42%), or cardiovascular causes (6; 1.26%). Of the remaining patients (118 patients) who were eligible for the study, 105 (88.98%) of whom were diagnosed with OSA. The median age of the patients with OSA did not differ from those without OSA (29 vs 23 years; p value 0.065). There were two independent predictors for OSA: age and body mass index with adjusted odds ratios (95% confidence interval) of 1.280 (1.049, 1.562) and 1.258 (1.083, 1.462), respectively. In conclusion, after excluding other possible causes of hypertension, we found OSA to be highly prevalent in hypertensive patients younger than 35 years old. Increasing age and high body mass index were predictors for OSA in young hypertensive patients.
Collapse
Affiliation(s)
- Jittirat Jinchai
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
- Sleep Apnea Research Group, and Research Center in Back, Neck and Other Joint Pain and Human Performance, Khon Kaen University, Khon Kaen, Thailand
| | - Sittichai Khamsai
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Paiboon Chattakul
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Panita Limpawattana
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Jarin Chindaprasirt
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Verajit Chotmongkol
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Songkwan Silaruks
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Vichai Senthong
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Kittisak Sawanyawisuth
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand.
- Sleep Apnea Research Group, and Research Center in Back, Neck and Other Joint Pain and Human Performance, Khon Kaen University, Khon Kaen, Thailand.
| |
Collapse
|
6
|
Khan MA, Mathur K, Barraza G, Sin S, Yang CJ, Arens R, Sutton N, Mahgerefteh J. The relationship of hypertension with obesity and obstructive sleep apnea in adolescents. Pediatr Pulmonol 2020; 55:1020-1027. [PMID: 32068974 DOI: 10.1002/ppul.24693] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 01/30/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To assess the independent relationships of obesity and obstructive sleep apnea (OSA) with hypertension/elevated blood pressure (EBP) in adolescent patients. STUDY DESIGN A retrospective cohort analysis was performed on 501 patients (age 13-21 years) with three separate blood pressure measurements within 6 months of polysomnography. EBP was defined as average systolic blood pressure (SBP) ≤120 mm Hg; obesity as body mass index Z-score ≤1.65; and OSA as obstructive apnea-hypopnea index <1. Pearson correlations and multivariable analyses were performed to assess the independent effects of the apnea-hypopnea index and body mass index Z-score on SBP. RESULTS Of 501 patients (mean age 16 ± 2 years), 246 (49%) were male. OSA was present in 329 (66%) patients, obesity in 337 (67%), and EBP in 262 (52%). EBP was present in 70% of obese adolescents and 60% of adolescents with OSA. Univariable correlation showed a significant relationship between SBP, body mass index Z-score, and apnea-hypopnea index. Multivariable linear regression analysis showed blood pressure was significantly associated with body mass index Z-score (β = .46; P < .01), age (β = .25; P < .01), and height Z-score (β = .14; P < .01), but not apnea-hypopnea index (β = .01; P = .72). CONCLUSIONS The relationship between OSA and EBP in adolescents is most closely associated with the degree of obesity. Further studies are needed to assess the effect of the treatment of obesity and OSA on blood pressure in adolescents.
Collapse
Affiliation(s)
- Masrur A Khan
- Department of Pediatrics, Division of Pediatric Cardiology, Children's Hospital at Montefiore/Albert Einstein College of Medicine, Bronx, New York
| | - Kanika Mathur
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Heart Center/Mount Sinai School of Medicine, New York, New York
| | - Giselle Barraza
- Division of Respiratory and Sleep Medicine, Department of Pediatrics, Children's Hospital at Montefiore/Albert Einstein College of Medicine, Bronx, New York
| | - Sanghun Sin
- Division of Respiratory and Sleep Medicine, Department of Pediatrics, Children's Hospital at Montefiore/Albert Einstein College of Medicine, Bronx, New York
| | - Christina J Yang
- Department of Otorhinolaryngology-Head and Neck Surgery, Division of Pediatric Otorhinolaryngology, Children's Hospital at Montefiore/Albert Einstein College of Medicine, Bronx, New York
| | - Raanan Arens
- Division of Respiratory and Sleep Medicine, Department of Pediatrics, Children's Hospital at Montefiore/Albert Einstein College of Medicine, Bronx, New York
| | - Nicole Sutton
- Department of Pediatrics, Division of Pediatric Cardiology, Children's Hospital at Montefiore/Albert Einstein College of Medicine, Bronx, New York
| | - Joseph Mahgerefteh
- Department of Pediatrics, Division of Pediatric Cardiology, Children's Hospital at Montefiore/Albert Einstein College of Medicine, Bronx, New York
| |
Collapse
|
7
|
Han B, Chen WZ, Li YC, Chen J, Zeng ZQ. Sleep and hypertension. Sleep Breath 2019; 24:351-356. [PMID: 31402441 PMCID: PMC7127991 DOI: 10.1007/s11325-019-01907-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 06/28/2019] [Accepted: 07/23/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE Hypertension is a global public issue, and sleep status was regarded as its risk factor; however, the results were inconsistent. This study aims to deeply investigate the correlation between sleep status and hypertension. METHODS The electronic databases Cochrane Library, Pubmed, and Embase updated to May 31, 2019, were retrieved. Studies were selected according to the predefined screening criteria, and their qualities were assessed by using quality check scales. Based on Stata 15.1 software, the associations between sleep status and hypertension were analyzed by meta-analyses, using odds ratio and 95% confidence interval as effect indexes. Furthermore, publication bias and small study bias were evaluated using Begg and Egger's test. In addition, sensitivity analysis was conducted through ignoring one study per time and then observing its influences on the pooled results. RESULTS A total of 54 studies (involving 1,074,207 subjects) were eligible for this meta-analysis. Six factors were included in this study. Raised blood pressure was associated with obstructive sleep apnea (OSA), oxygen desaturation index (ODI), short sleep duration, and long sleep duration. The differences in ≤ 5 h, 6 h, ≥ 9 h, and 10 h groups had statistical significances, while there was no significant difference in ≥ 8 h group. Snoring is a risk factor of hypertension (OR = 1.94, 95%CI 1.41-2.67). Subgroup analysis was conducted and results were varied. CONCLUSIONS The hypertension risk might be reduced by treated OSA, ODI, and snoring, as well as appropriate sleep duration. More studies with large sample sizes and high qualities should be included to support the findings further.
Collapse
Affiliation(s)
- B Han
- Department of Preventive Medicine, Chengdu Medical College, Chengdu, China
| | - W Z Chen
- Department of Epidemiology and Statistics, Chengdu Medical College, Chengdu, China
| | - Y C Li
- Department of Epidemiology and Statistics, Chengdu Medical College, Chengdu, China
| | - J Chen
- Department of Epidemiology and Statistics, Chengdu Medical College, Chengdu, China
- School of Public Health, Chengdu Medical College, Chengdu, China
| | - Z Q Zeng
- Department of Epidemiology and Statistics, Chengdu Medical College, Chengdu, China.
| |
Collapse
|
8
|
Yalım SD, Görgülü FF. MORPHOLOGICAL ANALYSIS OF OBSTRUCTIVE SLEEP APNOEA PATIENTS USING COMPUTED TOMOGRAPHY. ENT UPDATES 2019. [DOI: 10.32448/entupdates.528269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
|
9
|
Predictors of Sleep Apnea in the Canadian Population. Can Respir J 2018; 2018:6349790. [PMID: 30228832 PMCID: PMC6136476 DOI: 10.1155/2018/6349790] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 06/14/2018] [Accepted: 07/19/2018] [Indexed: 02/06/2023] Open
Abstract
Older age, obesity, hypertension, snoring, and excessive daytime sleepiness have been associated with sleep apnea. The objective of this study was to determine the prevalence (crude and adjusted), as well as the risk factors, of sleep apnea in the adult Canadian population. Data from the 2009 Sleep Apnea Rapid Response (SARR) questionnaire were used to identify the risk factors, and all sleep-related questions in the SARR questionnaire were used. The outcome variable of interest was health professional-diagnosed sleep apnea. Covariates of interest were demographic variables, population characteristics, respiratory and cardiovascular diseases, and enabling resources. The multiple logistic regression model adjusted for the clustering effect was used to analyze the data. Sleep apnea was diagnosed in 858,913 adults (3.4% of the population), and more men (65.4%) than women (34.6%) were diagnosed with sleep apnea. Multivariable logistic regression analysis indicated that age (45 and older), loud snoring, sudden awakening with gasping/choking (rare/sometimes and once or more a week), and nodding off/falling asleep in driving in the past 12 months were significantly associated with diagnosed sleep apnea. Predictive probability demonstrated that in overweight and obese persons, ≥15 minutes of daily exercise significantly decreased the risk of diagnosed sleep apnea. The conclusion of this study is that in the Canadian population, sleep apnea is associated with older age, loud snoring, and sleeping problems. The protective effect of exercise warrants further investigation.
Collapse
|
10
|
Lee SK, Choi K, Chang YH, Kim J, Shin C. Increased risk for new-onset hypertension in midlife male snorers: The 14-year follow-up study. J Sleep Res 2018; 28:e12757. [PMID: 30252172 DOI: 10.1111/jsr.12757] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 07/18/2018] [Accepted: 07/21/2018] [Indexed: 11/28/2022]
Abstract
While the association between sleep-related breathing disorders such as snoring and hypertension has been well established, it still remains unclear whether the association differs by age and gender. Therefore, in this 14-year follow-up study, we examined the independent association between self-reported snoring and the incidence of hypertension by gender and age groups in a large cohort of Korean adults. A total of 4,954 adults, aged 40-69 years, free of hypertension at baseline were enrolled. Participants were divided into three groups based on a self-reported snoring frequency: never; occasional (snoring <4 nights per week); and habitual snorer (snoring ≥4 nights). At baseline and biennial follow-up visits, blood pressure was measured by trained examiners. Incident hypertension was defined as the first occurrence at any follow-up examination where the participants had blood pressure ≥140/90 mmHg or were being treated with antihypertensive medication. After adjusting for known cardiovascular risk factors, only in men aged ≤45 years was habitual snoring significantly associated with a 1.5 times higher risk for incident hypertension than never snoring. In this age group, habitual snoring was significantly associated with increased risk for the development of hypertension, regardless of the presence of excessive daytime sleepiness. In women, snoring was not significantly associated with hypertension incidence in any age group. The present study suggests that young male snorers may be at high risk for the future development of hypertension, which has important clinical implications for early detection and treatment of snoring to reduce the burden of cardiovascular disease.
Collapse
Affiliation(s)
- Seung Ku Lee
- Institute of Human Genomic Study, College of Medicine, Korean University Ansan Hospital, Ansan, South Korea
| | - Kanghoon Choi
- Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Yoon Hee Chang
- Center for Sleep and Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Division of Sleep Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jinyoung Kim
- Division of Sleep Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Chol Shin
- Institute of Human Genomic Study, College of Medicine, Korean University Ansan Hospital, Ansan, South Korea.,Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Korea University, Seoul, South Korea
| |
Collapse
|
11
|
Sharples L, Glover M, Clutterbuck-James A, Bennett M, Jordan J, Chadwick R, Pittman M, East C, Cameron M, Davies M, Oscroft N, Smith I, Morrell M, Fox-Rushby J, Quinnell T. Clinical effectiveness and cost-effectiveness results from the randomised controlled Trial of Oral Mandibular Advancement Devices for Obstructive sleep apnoea-hypopnoea (TOMADO) and long-term economic analysis of oral devices and continuous positive airway pressure. Health Technol Assess 2015; 18:1-296. [PMID: 25359435 DOI: 10.3310/hta18670] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Obstructive sleep apnoea-hypopnoea (OSAH) causes excessive daytime sleepiness (EDS), impairs quality of life (QoL) and increases cardiovascular disease and road traffic accident risks. Continuous positive airway pressure (CPAP) treatment is clinically effective but undermined by intolerance, and its cost-effectiveness is borderline in milder cases. Mandibular advancement devices (MADs) are another option, but evidence is lacking regarding their clinical effectiveness and cost-effectiveness in milder disease. OBJECTIVES (1) Conduct a randomised controlled trial (RCT) examining the clinical effectiveness and cost-effectiveness of MADs against no treatment in mild to moderate OSAH. (2) Update systematic reviews and an existing health economic decision model with data from the Trial of Oral Mandibular Advancement Devices for Obstructive sleep apnoea-hypopnoea (TOMADO) and newly published results to better inform long-term clinical effectiveness and cost-effectiveness of MADs and CPAP in mild to moderate OSAH. TOMADO A crossover RCT comparing clinical effectiveness and cost-effectiveness of three MADs: self-moulded [SleepPro 1™ (SP1); Meditas Ltd, Winchester, UK]; semibespoke [SleepPro 2™ (SP2); Meditas Ltd, Winchester, UK]; and fully bespoke [bespoke MAD (bMAD); NHS Oral-Maxillofacial Laboratory, Addenbrooke's Hospital, Cambridge, UK] against no treatment, in 90 adults with mild to moderate OSAH. All devices improved primary outcome [apnoea-hypopnoea index (AHI)] compared with no treatment: relative risk 0.74 [95% confidence interval (CI) 0.62 to 0.89] for SP1; relative risk 0.67 (95% CI 0.59 to 0.76) for SP2; and relative risk 0.64 (95% CI 0.55 to 0.76) for bMAD (p < 0.001). Differences between MADs were not significant. Sleepiness [as measured by the Epworth Sleepiness Scale (ESS)] was scored 1.51 [95% CI 0.73 to 2.29 (SP1)] to 2.37 [95% CI 1.53 to 3.22 (bMAD)] lower than no treatment (p < 0.001), with SP2 and bMAD significantly better than SP1. All MADs improved disease-specific QoL. Compliance was lower for SP1, which was unpopular at trial exit. At 4 weeks, all devices were cost-effective at £20,000/quality-adjusted life-year (QALY), with SP2 the best value below £39,800/QALY. META-ANALYSIS A MEDLINE, EMBASE and Science Citation Index search updating two existing systematic reviews (one from November 2006 and the other from June 2008) to August 2013 identified 77 RCTs in adult OSAH patients comparing MAD with conservative management (CM), MADs with CPAP or CPAP with CM. MADs and CPAP significantly improved AHI [MAD -9.3/hour (p < 0.001); CPAP -25.4/hour (p < 0.001)]. Effect difference between CPAP and MADs was 7.0/hour (p < 0.001), favouring CPAP. No trials compared CPAP with MADs in mild OSAH. MAD and CPAP reduced the ESS score similarly [MAD 1.6 (p < 0.001); CPAP 1.6 (p < 0.001)]. LONG-TERM COST-EFFECTIVENESS An existing model assessed lifetime cost-utility of MAD and CPAP in mild to moderate OSAH, using the revised meta-analysis to update input values. The TOMADO provided utility estimates, mapping ESS score to European Quality of Life-5 Dimensions three-level version for device cost-utility. Using SP2 as the standard device, MADs produced higher mean costs and mean QALYs than CM [incremental cost-effectiveness ratio (ICER) £6687/QALY]. From a willingness to pay (WTP) of £15,367/QALY, CPAP is cost-effective, although the likelihood of MADs (p = 0.48) and CPAP (p = 0.49) being cost-effective is very similar. Both were better than CM, but there was much uncertainty in the choice between CPAP and MAD (at a WTP £20,000/QALY, the probability of being the most cost-effective was 47% for MAD and 52% for CPAP). When SP2 lifespan increased to 18 months, the ICER for CPAP compared with MAD became £44,066. The ICER for SP1 compared with CM was £1552, and for bMAD compared with CM the ICER was £13,836. The ICER for CPAP compared with SP1 was £89,182, but CPAP produced lower mean costs and higher mean QALYs than bMAD. Differential compliance rates for CPAP reduces cost-effectiveness so MADs become less costly and more clinically effective with CPAP compliance 90% of SP2. CONCLUSIONS Mandibular advancement devices are clinically effective and cost-effective in mild to moderate OSAH. A semi-bespoke MAD is the appropriate first choice in most patients in the short term. Future work should explore whether or not adjustable MADs give additional clinical and cost benefits. Further data on longer-term cardiovascular risk and its risk factors would reduce uncertainty in the health economic model and improve precision of effectiveness estimates. TRIAL REGISTRATION This trial is registered as ISRCTN02309506. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 18, No. 67. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Linda Sharples
- University of Leeds Clinical Trials Research Unit, Leeds, UK
| | - Matthew Glover
- Health Economics Research Unit, Brunel University, Uxbridge, UK
| | | | - Maxine Bennett
- Medical Research Council Biostatistics Unit, Cambridge, UK
| | - Jake Jordan
- Health Economics Research Unit, Brunel University, Uxbridge, UK
| | - Rebecca Chadwick
- Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, UK
| | - Marcus Pittman
- Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, UK
| | - Clare East
- Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, UK
| | - Malcolm Cameron
- Maxillofacial Unit, Addenbrooke's NHS Foundation Trust, Cambridge, UK
| | - Mike Davies
- Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, UK
| | - Nick Oscroft
- Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, UK
| | - Ian Smith
- Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, UK
| | - Mary Morrell
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | - Timothy Quinnell
- Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, UK
| |
Collapse
|
12
|
Park DY, Kim HJ, Kim CH, Kim YS, Choi JH, Hong SY, Jung JJ, Lee KI, Lee HS. Reliability and validity testing of automated scoring in obstructive sleep apnea diagnosis with the Embletta X100. Laryngoscope 2014; 125:493-7. [PMID: 25124863 DOI: 10.1002/lary.24878] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 06/10/2014] [Accepted: 07/21/2014] [Indexed: 01/21/2023]
Abstract
OBJECTIVES/HYPOTHESIS To verify the reliability and validity of automated scoring and compare it to that of manual scoring for diagnosing obstructive sleep apnea using an Embletta X100 level 2 portable device. STUDY DESIGN Retrospective study. METHODS A total of 116 patients with suspected obstructive sleep apnea who had successfully received portable polysomnography with the Embletta X100 were examined. All polysomnography data were analyzed by automated and manual methods. Manual scoring was performed according to the revised American Academy of Sleep Medicine 2012 criteria. Automated scoring was analyzed using the automatic algorithm, which was updated with the American Academy of Sleep Medicine 2012 criteria. All parameters were evaluated statistically using correlation analysis and paired t tests. RESULTS The apnea-hypopnea index for automated scoring and manual scoring with the Embletta X100 were moderately correlated (r = 0.76, P < .001). However, there was poor agreement (Bland-Altman plot, κ = 0.34, 0.33, and 0.26; cutoff value = 5, 15, and 30), and the apnea-hypopnea index data were generally excessively underestimated based on diagnostic agreement and disagreement criteria. Furthermore, the apnea-hypopnea index severity (Kendall tau-b = 0.62) between automated and manual scoring lacked good concordance. CONCLUSIONS Automated scoring using the Embletta X100 was statistically moderately related to the manual scoring results. However, automated scoring tended to excessively underestimate the apnea-hypopnea index data compared to manual scoring. Thus, manual scoring by a sleep expert is essential for obstructive sleep apnea diagnosis with the Embletta X100. LEVEL OF EVIDENCE 4.
Collapse
Affiliation(s)
- Do Y Park
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Pensuksan WC, Chen X, Lohsoonthorn V, Lertmaharit S, Gelaye B, Williams MA. High risk for obstructive sleep apnea in relation to hypertension among southeast Asian young adults: role of obesity as an effect modifier. Am J Hypertens 2014; 27:229-36. [PMID: 24132995 DOI: 10.1093/ajh/hpt194] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) has been linked to hypertension among middle-aged and older adults in Western countries. Few studies have focused on young adults, especially those in Southeast Asian countries undergoing epidemiologic transitions and experiencing elevated noncommunicable disease burden. We investigated associations of high risk for OSA with hypertension among Asian young adults. METHODS A total of 2,911 college students in Thailand participated in this study. The high risk for OSA was assessed using the Berlin Questionnaire. Blood pressure (BP) and anthropometric measurements were taken by trained research staff. Elevated BP and hypertension were defined as BP ≥ 120/80 mm Hg and ≥ 140/90 mm Hg, respectively. Multivariable logistic regression models were fit to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of elevated BP and hypertension. Stratified analyses were conducted to examine whether observed associations varied by weight status. RESULTS High risk for OSA was significantly associated with elevated BP (OR = 2.38; 95% CI = 1.68-3.39) and hypertension (OR = 2.55; 95% CI = 1.57-4.15) after adjustment for demographic and lifestyle factors. When body mass index was further controlled for, observed associations were greatly attenuated. The associations were only evident among overweight and obese students. CONCLUSIONS The high risk for OSA among overweight and obese young adults is associated with elevated BP and hypertension. Enhanced efforts directed toward screening and diagnosing OSA and weight control among young adults could be one strategy for improving cardiovascular health.
Collapse
|