Effect of mean apnea-hypopnea duration in patients with obstructive sleep apnea on clinical and polysomnography parameter

Using Apnea-Hypopnea Duration per Hour to Predict Hypoxemia Among Patients with Obstructive Sleep Apnea

Purpose

To explore the role of the mean apnea-hypopnea duration (MAD) and apnea-hypopnea duration per hour (HAD) in hypoxemia and evaluate whether they can effectively predict the occurrence of hypoxemia among adults with OSA.

Patients and Methods

A total of 144 participants underwent basic information gathering and polysomnography (PSG). Logistic regression models were conducted to evaluate the best index in terms of hypoxemia. To construct the prediction model for hypoxemia, we randomly divided the participants into the training set (70%) and the validation set (30%).

Results

The participants with hypoxemia tend to have higher levels of obesity, diabetes, AHI, MAD, and HAD compared with non-hypoxemia. The most relevant indicator of blood oxygen concentration is HAD (r = 0.73) among HAD, MAD, and apnea-hypopnea index (AHI). The fitness of HAD on hypoxemia showed the best. In the stage of establishing the prediction model, the area under the curve (AUC) values of both the training set and the validation set are 0.95. The increased HAD would elevate the risk of hypoxemia [odds ratio (OR): 1.30, 95% confidence interval (CI): 1.13-1.49].

Conclusion

The potential role of HAD in predicting hypoxemia underscores the significance of leveraging comprehensive measures of respiratory disturbances during sleep to enhance the clinical management and prognostication of individuals with sleep-related breathing disorders.

Application study of apnea-hypopnea duration for assessing adult obstructive sleep apnea

BACKGROUND

Obstructive sleep apnea (OSA) is a common sleep disordered breathing disorder, which can cause serious damage to multiple human systems. Although polysomnography (PSG) is the current gold standard for diagnosis, it is complex and expensive. Therefore, it is of great significance to find a simple, economical and rapid primary screening and diagnosis method to replace PSG for the diagnosis of OSA.

OBJECTIVE

The purpose of this study is to propose a new method for the diagnosis and classification of OSA, which is used to automatically detect the duration of sleep apnea hypopnea events (AHE), so as to estimate the ratio(S) of the total duration of all-night AHE to the total sleep time only based on the sound signal of sleep respiration, and to identify OSA.

METHODS

We performed PSG tests on participants and extracted relevant sleep breathing sound signal data. This study is carried out in two stages. In the first stage, the relevant PSG report data of eligible subjects were recorded, the total duration of AHE in each subject's data was extracted, and the S value was calculated to evaluate the severity of OSA. In the second stage, only the sleep breath sound signal data of the same batch of subjects were used for automatic detection, and the S value in the sleep breath sound signal was extracted, and the S value was compared with the PSG diagnosis results to calculate the accuracy of the experimental method.

RESULTS

Among 225 subjects. Using PSG as the reference standard, the S value extracted from the PSG diagnostic data report can accurately diagnose OSA(accuracy rate 99.56%) and distinguish its severity (accuracy rate 95.11%). The accuracy of the S value detected in the sleep breathing sound signal in the diagnosis of severe OSA reached 100%.

CONCLUSION

The results show that the experimental parameter S value is feasible in OSA diagnosis and classification. OSA can be identified and evaluated only by sleep breathing sounds. This method helps to simplify the diagnostic grading of traditional OSA and lays a foundation for the subsequent development of simple diagnostic grading equipment.

Maxillomandibular advancement for obstructive sleep apnea: a retrospective prognostic factor study for surgical response

PURPOSE

To identify potential predictors of surgical response to maxillomandibular advancement (MMA) in patients with obstructive sleep apnea (OSA) from the most common clinically available data (patient-related, polysomnographic, cephalometric, and surgical variables).

METHODS

This was a retrospective study comprised of consecutive patients who underwent MMA for moderate to severe OSA. Relevant clinical, polysomnographic, cephalometric, and surgical variables were collected as independent variables (predictors). The association of the independent variables with a favorable surgical response to MMA was assessed in univariate and multivariate analyses.

RESULTS

In 100 patients (82% male; mean age 50.5 years), the mean apnea hypopnea index [AHI] was 53.1 events/h. The rate of favorable surgical response was 67%. Based on multivariate analysis, patients with cardiovascular disease (CVD) had 0.140 times lower odds of a favorable response to MMA (OR: 0.140 [0.038, 0.513], P = 0.003). For each 1-unit increase in central apnea index (CAI) and superior posterior airway space (SPAS), there were 0.828 and 0.724 times lower odds to respond favorably to MMA (OR: 0.828 [0.687, 0.997], P = 0.047; and 0.724 [0.576, 0.910], P = 0.006), respectively.

CONCLUSION

The findings of this study suggest that the surgical outcome of MMA may be less favorable when patients with OSA have certain phenotypic characteristics: the presence of CVD, higher CAI and larger SPAS. If confirmed in future studies, these variables may guide patient selection for MMA.

Obstructive sleep apnea related to mental health, health-related quality of life and multimorbidity: A nationwide survey of a representative sample in Republic of Korea

OBJECTIVES

This study assessed the effects of obstructive sleep apnea (OSA) on mental health, health-related quality of life (HRQoL), and multimorbidity in Korean adults.

METHODS

The study included 8030 participants from the Korea National Health and Nutrition Examination Survey Ⅷ (2019-2020). The risk of OSA was assessed using STOP-BANG questionnaire. Depression was measured using the Patient Health Questionnaire-9 (PHQ-9), and stress was measured using a questionnaire. HRQoL was determined by EuroQol 5-dimension (EQ-5D) and Health-related Quality of Life Instrument with 8 Items (HINT-8) scores. Multimorbidity was defined as the presence of 2 or more chronic diseases. A complex sample multivariate logistic regression analysis was conducted.

RESULTS

Participants with a high OSA risk were more likely to a have high PHQ-9 score (OR 4.31, 95% confidence interval [CI] 2.80-6.65), total depression (OR 4.07, 95% CI 2.67-6.19) stress (OR 2.33, 95% CI 1.85-2.95), lower EQ-5D (OR 2.88, 95% CI 2.00-4.15) and HINT-8 scores (OR 2.87, 95% CI 1.65-4.98), and multimorbidity (OR 2.62, 95% CI 2.01-3.41) than participants with low OSA risk. High OSA risk was significantly associated with all EQ-5D and HINT-8 items.

CONCLUSIONS

This study adds to the few population-based studies showing associations between mental health, HRQoL, and multimorbidity using nationwide data. OSA prevention might be helpful for good mental health, improving HRQoL, and comorbidity burdens. The results provide novel insights regarding the association between sleep apnea and multimorbidity.

Factors determining the therapeutic level of positive airway pressure in patients with obstructive sleep apnea syndrome

Objectives

In daily practice, we encounter with obstructive sleep apnoea syndrome (OSAS) patients who require different levels of positive airway pressure (PAP) despite having a similar apnoea-hypopnea index (AHI). We aimed to determine the parameters contributing to the determination of the therapeutic level of PAP.

Methods

Data on 548 patients who underwent polysomnography and PAP titration were analysed retrospectively. Patients were divided into groups according to OSAS severity (mild, moderate, and severe) and the mean pressure in each group was determined, after which patients were further divided into those who required a PAP below the mean and those who required a PAP above the mean.

Results

The mean optimal PAP level in the mild, moderate, and severe OSAS groups was 7.4 ± 2.3, 8.6 ± 2.4, and 9.8 ± 2.9 cm H2O, respectively. In the moderate and severe OSAS group, the subgroup that needed high pressure had a higher supine AHI, a longer apnoea time, and a longer SaO2 <90% time as compared with the subgroup that needed low pressure.

Conclusion

A longer apnoea duration and a higher supine AHI are associated with a higher PAP level in patients with moderate and severe OSAS.

Duration of respiratory events in obstructive sleep apnea: In search of paradoxical results

Research related to the duration of respiratory events in obstructive sleep apnea (OSA) has been scarce, perhaps due to the dominant role played by the apnea-hypopnea index (AHI) in the diagnosis and severity estimation of OSA. Lately, however, researchers and clinicians have started to acknowledge the importance of this overlooked parameter. Intuitively, 40-s-long apneas have more harmful physiological and health consequences than 10-s-long apneas. But is this the case? Here, we review the research-based evidence showing physiological, hemodynamic, clinical, sleep quality, and health consequences of long vs. short respiratory events. Most of the reviewed studies support the idea that longer respiratory events have more severe physiological and clinical consequences than shorter events, most probably due to the higher hypoxic burden associated with longer respiratory events. However, a few but highly qualified studies provide clear evidence that short respiratory events have also a deleterious effect on sleep and the physiological and clinical aspects of OSA. The somewhat paradoxical findings that short respiratory events are also associated with a high risk of all-cause mortality is a serious concern. From these results, it is therefore evident that the duration of respiratory events should be quantified when diagnosing and assessing the severity of OSA.

Sleep medicine: Practice, challenges and new frontiers

Sleep medicine is an ambitious cross-disciplinary challenge, requiring the mutual integration between complementary specialists in order to build a solid framework. Although knowledge in the sleep field is growing impressively thanks to technical and brain imaging support and through detailed clinic-epidemiologic observations, several topics are still dominated by outdated paradigms. In this review we explore the main novelties and gaps in the field of sleep medicine, assess the commonest sleep disturbances, provide advices for routine clinical practice and offer alternative insights and perspectives on the future of sleep research.

Negative impact of the hypopnea index or duration increase after a non-frame work surgery in patients with very severe obstructive sleep apnea

A non-framework surgery could change the postoperative components of breathing disturbances and increase the frequency or duration of hypopnea in patients with very severe obstructive sleep apnea (OSA). Either an increase of hypopnea index, which increases apnea–hypopnea index (AHI), or an increase of its duration raises the concern of worsening the oxygen desaturation and so morbidity and mortality associated with OSA. It is unclear how the oxygen saturation would change in those having increased frequency or duration of hypopneas after the surgery. Here in 17 patients with AHI ≥ 60 events/h, having increased frequency or duration of hypopneas after the non-framework surgery, the results show that the surgery improved oxygen saturation by reducing obstructive-apnea index (36.1 events/h) and duration (8.6 s/event), despite it increased hypopnea index (16.8 events/h) and duration (9.8 s/event). The surgery improved the average of the mean oxyhemoglobin saturation of pulse oximetry (SpO2) by 2.8% (toward a ceiling mean of 94.3%), mean minimal SpO2 by 7.5%, and mean desaturation by 5%. The results suggest sufficient apnea reduction and shift from apnea to hypopnea may mask the negative impact of the increase of hypopnea index or duration and improve postoperative mean SpO2, minimal SpO2, and mean desaturation.

Sleep Apnoea and AF: Where Do We Stand? Practical Advice for Clinicians

AF is the most common sustained arrhythmia encountered in clinical practice. Among the largest contributing factors to the rapid increase in the incidence of AF are aging and obesity within the global population. Obstructive sleep apnoea (OSA) is a risk factor for AF that is clearly linked to obesity. Guidelines have advocated interrogation for clinical signs of OSA in all AF patients. The aim of this article is to provide practical advice for clinicians seeking to manage patients with AF and OSA. The authors discuss questionnaires to screen for OSA, various types of tests available for the diagnosis of OSA and data to assess the impact of treatment of OSA after various treatment options in AF patients. Finally, they outline the many areas that warrant further investigation in this patient population.

Cardiovascular and somatic comorbidities and sleep measures using three hypopnea criteria in mild obstructive sleep-disordered breathing: sex, age, and body mass index differences in a retrospective sleep clinic cohort

STUDY OBJECTIVES

To describe sex, age, and body mass index (BMI) differences in comorbidities and polysomnography measures, categorized using 3 different apnea-hypopnea index (AHI) criteria in sleep clinic patients with mild obstructive sleep-disordered breathing.

METHODS

A retrospective cohort of 305 (64% female) adult sleep clinic patients who underwent full-night in-laboratory polysomnography having been diagnosed with mild sleep-disordered breathing and prescribed positive airway pressure. Effects of sex, age, and BMI on comorbidities and polysomnography measures, including rates of AHI defined by ≥ 3% desaturations (AHI_3%), with arousals (AHI_3%A), by ≥ 4% desaturations (AHI_4%), and by respiratory disturbance index, were evaluated.

RESULTS

Sixty-nine (23%), 116 (38%), 258 (85%), and 267 (88%) patients had AHI_4%, AHI_3%, AHI_3%A, and respiratory disturbance index ≥ 5 events/h, respectively. Ninety-day positive airway pressure adherence rates were 45.9% overall and higher in women > 50-years-old (51.2%, P = 0.013) and men (54.5%, P = 0.024) with no difference whether AHI_4% or AHI_3%A was < 5 or ≥ 5 events/h. Men and women had similar rates of daytime sleepiness (43.3%), anxiety (44.9%), and hypertension (44.9%). Women were more likely to have obesity, anemia, asthma, depression, diabetes, fibromyalgia, hypothyroidism, migraine, and lower rates of coronary artery disease. More patients with AHI_4% < 5 events/h had depression, migraines, and anemia, and more patients with AHI_4% ≥ 5 events/h had congestive heart failure. Women were more likely to have higher sleep maintenance and efficiency, shorter average obstructive apnea and hypopnea durations, and less supine-dominant pattern. Average obstructive apnea and hypopnea duration decreased with increasing BMI, and average hypopnea duration increased with age. Obstructive apnea duration and obstructive hypopnea with arousal duration decreased with increasing BMI. More women had AHI_4% < 5 (81.5% vs 69.1%), AHI_3% < 5 (68.7% vs 49.1%), and AHI_3%A < 5 events/h (18.5% vs 10.0%). Greater age and higher BMI were associated with higher AHI.

CONCLUSIONS

Current AHI criteria do not predict comorbidities or adherence in mild sleep-disordered breathing patients. In this hypothesis-generating descriptive analysis, sex, BMI, and age may all be factors that should be accounted for in future research of mild sleep-disordered breathing patients. Different sleep study measures may weigh differently in calculations of risk for cardiovascular versus somatic comorbidities.

Participation in physical activity is associated with reduced nocturnal hypoxaemia in males

Moderate to vigorous physical activity (MVPA) interventions reduce the severity of obstructive sleep apnoea (OSA); however, little epidemiological research exists to confirm these findings.

789 participants from the population-based Men Androgen Inflammation Lifestyle Environment and Stress (MAILES) Study underwent polysomnography. MVPA was assessed using the Active Australia questionnaire, which was completed when participants were first recruited to the MAILES study (2002–2006), and again in 2010. Multinomial logistic regressions established odds ratio between OSA severity categories with MVPA, whilst adjusted linear models determined associations between OSA metrics with MVPA.

Cross-sectionally, each hour of MVPA was associated with reduced severity of mean oxygen desaturation (unstandardised β (B)=−0.002, p=0.043) and reduced time below 90% oxygen saturation (B=−0.03, p=0.034).

Longitudinally, each hour increase in MVPA was associated with a 4% reduction in the odds of severe OSA and less severe mean oxygen desaturation (B=−0.003, p=0.014), time below 90% oxygen saturation (B=−0.02, p=0.02), and mean duration of apnoeas (B=−0.004, p=0.016).

MVPA is associated with reduced hypoxaemia in a cohort of community dwelling males, approximately half of whom had untreated OSA. As nocturnal intermittent hypoxaemia is associated with cardiometabolic disorders, MVPA may offer protection for patients with OSA.

This study provides epidemiological evidence that moderate to vigorous physical activity is associated with less severe OSA-induced hypoxaemia. This result suggests that MVPA should be actively implemented in treatment regimens for people with OSA.https://bit.ly/3a9asiZ

Impact of Obstructive Sleep Apnea on Gestational Diabetes Mellitus

INTRODUCTION

Obstructive sleep apnea (OSA) increases the risk of type 2 diabetes, and hyperinsulinemia. Pregnancy increases the risk of OSA; however, the relationship between OSA and gestational diabetes mellitus (GDM) is unclear. We aimed (1) to evaluate OSA prevalence in GDM patients; (2) to assess the association between OSA and GDM; and (3) to determine the relationships between sleep parameters with insulin resistance (IR).

METHODS

A total of 177 consecutive women (89 with GDM, 88 controls) in the third trimester of pregnancy underwent a hospital polysomnography. OSA was defined when the apnea-hypopnea index (AHI) was ≥5h-1.

RESULTS

Patients with GDM had higher pregestational body mass index (BMI) and neck circumference than controls, but no differences in snoring or OSA-symptoms, or AHI (3.2±6.0 vs. 1.9±2.7h-1, p=.069). OSA prevalence was not significantly different in both groups. We did not identify OSA as a GDM risk factor in the crude analysis 1.65 (95%CI: 0.73-3.77; p=.232). Multiple regression showed that total sleep time (TST), TST spent with oxygen saturation<90% (T90), and maximum duration of respiratory events as independent factors related with homeostasis model assessment of IR, while T90 was the only independent determinant of quantitative insulin sensitivity check index.

CONCLUSION

OSA prevalence during the third trimester of pregnancy was not significantly different in patients with GDM than without GDM, and no associations between OSA and GDM determinants were found. We identified T90 and obstructive respiratory events length positive-related to IR, while TST showed an inverse relationship with IR in pregnant women.

A novel parameter is better than the AHI to assess nocturnal hypoxaemia and excessive daytime sleepiness in obstructive sleep apnoea

To evaluate whether the percentage of total sleep time spent with apnoea and hypopnoea duration time (AHT%) is better than the apnoea-hypopnoea index (AHI) for the assessment of nocturnal hypoxaemia and excessive daytime sleepiness (EDS) in patients with obstructive sleep apnoea (OSA). Patients with suspected OSA were enrolled. Polysomnography, Epworth Sleepiness Scale, self-administered surveys and anthropometric measures were performed. The efficiency of AHT% and the AHI was evaluated for nocturnal hypoxaemia and EDS. A total of 160 eligible participants were analysed. The median AHT% in normal, mild, moderate and severe OSA patients was significantly different in the four-group patients with OSA. Spearman rank correlations analysis found that the associations were stronger between AHT% with percentage of total sleep time and O₂ saturation of < 90% and minimum nocturnal oxygen saturation than these parameters with the AHI. AHT% had a greater area under the curve than the AHI for predicting EDS in patients with OSA. AHT% was significantly higher in the EDS group. We present a novel parameter, AHT%, to evaluate nocturnal hypoxaemia and EDS in OSA patients. AHT% partially compensates for the shortcomings of the AHI. AHT% is better than the AHI for assessing nocturnal hypoxaemia and EDS. AHT% reflects different clinical characteristics associated with OSA from a new perspective.

Ganglion cell layer thickening in patients suffering from Obstructive Sleep Apnea-Hypopnea syndrome with long Mean Apnea-Hypopnea Duration during sleep

PURPOSE

To study the effects of mean apnea-hypopnea duration (MAD), a useful indicator of blood oxygenation, on peripapillary retinal nerve fiber layer (RNFL), macular ganglion cell to inner plexiform layer (GC-IPL) and macular retinal thickness in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS).

METHODS

Sixty-five patients recently diagnosed with OSAHS and 35 healthy individuals were enrolled in this cross-sectional study. OSAHS patients were divided according to their MAD values into group 1 with 16 participants (MAD:10-15.5 s), group 2 with 17 participants (MAD:15.5-19 s), group 3 with 17 participants (MAD:19-30 s) and group 4 with 15 participants (MAD > 30 s). The average and sectorial values of RNFL, GC-IPL and retinal thickness were measured by SS-OCT (DRI OCT Triton, Topcon). Intraocular pressure was recorded by Goldmann Applanation and Pascal Dynamic Contour Tonometer (DCT-IOP).

RESULTS

The average RNFL and retinal thickness values were higher in group 4, but did not reach statistical significance. With the exception of the central 1 mm at the fovea, GC-IPL was always thickened in group 4, and significant differences were evident when its average value was compared with group 2 (p = 0.03), its superior and inferior-nasal values were compared with group 2 (p = 0.02, p = 0.006, respectively) and group 3 (p = 0.01, p = 0.02, respectively), its superior-temporal value was compared with group 3 (p = 0.003) and the control group (p = 0.03), and its superior-nasal value was compared with group 2 (p = 0.03), group 3 (p = 0.001) and the control group (p = 0.03). DCT-IOP was significantly positively correlated with the duration of sleep in which oxygen saturation (SaO₂ ) was decreased under 90% (r = 0.359, p = 0.01).

CONCLUSION

We report a novel observation of GC-IPL thickening in OSAHS patients experiencing long MAD, a parameter which incorporates the severity of breathing events during sleep. Higher DCT-IOP was noted with advancing hypoxemia.