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Rimpilä V, Lampio L, Kalleinen N, Vahlberg T, Virkki A, Saaresranta T, Polo O. Evolution of sleep-disordered breathing and blood pressure during menopausal transition. J Sleep Res 2023:e13829. [PMID: 36737407 DOI: 10.1111/jsr.13829] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/20/2022] [Accepted: 01/04/2023] [Indexed: 02/05/2023]
Abstract
The purpose of this study was to investigate how the blood pressure increase observed during menopausal transition is affected by sleep-disordered breathing and the menopause itself. Further, we aimed to find new sleep-disordered breathing related markers that would predict the development of hypertension. Sixty-four community-dwelling premenopausal women aged 45-47 years were studied. Polysomnography, serum follicle stimulating hormone, forced expiratory volume in 1 s, and a physical examination were performed at baseline and again after 10 years of follow-up. Indices for sleep apnea/hypopnea and inspiratory flow-limitation were determined. Regression models were used to study the relationships between variables. Changes in the apnea-hypopnea index or serum follicle stimulating hormone were not significant for blood pressure change. An increase in morning blood pressure during the follow-up period was associated with a body mass-index increase. An increase in evening blood pressure was associated with an increase in inspiratory flow-limitation during non-rapid eye movement sleep. Incident hypertension during the follow-up was associated with hypopnea (median hypopnea index 7.6/h, p = 0.048) during rapid eye movement sleep at baseline. Users of menopausal hormone therapy had a lower rapid eye movement sleep apnea-hypopnea index (1.6/h vs. 6.9/h, p = 0.026) at baseline whereas at follow-up users and non-users did not differ in any way. The progression of menopause or the use of menopausal hormone therapy had a minimal effect on blood pressure in our population. The effects of inspiratory flow-limitation on blood pressure profile should be studied further.
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Affiliation(s)
- Ville Rimpilä
- Sleep Research Centre, Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland
| | - Laura Lampio
- Sleep Research Centre, Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland.,Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Nea Kalleinen
- Sleep Research Centre, Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland.,Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Tero Vahlberg
- Department of Clinical Medicine, Biostatistics, University of Turku, Turku, Finland
| | - Arho Virkki
- Department of Mathematics and Statistics, University of Turku, Turku, Finland.,Auria Clinical Informatics, Turku University Hospital, Turku, Finland
| | - Tarja Saaresranta
- Sleep Research Centre, Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland.,Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, Turku, Finland
| | - Olli Polo
- Bragée ME/CFS Center, Bragée Kliniker, Stockholm, Sweden
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Aro M, Saaresranta T, Vahlberg T, Anttalainen U. Medication of comorbidities in females with sleep-disordered breathing during long-term CPAP therapy. Respir Med 2020; 169:106014. [PMID: 32442111 DOI: 10.1016/j.rmed.2020.106014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/07/2020] [Accepted: 05/08/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Treating sleep disordered breathing (SDB) with nasal continuous positive airway pressure (CPAP) may reduce mortality, but the studies on the effect on medication use are few. Women tend to have more mild sleep apnoea and partial airway obstruction and are therefore expected to have less co-morbidity. The purpose of this study was to evaluate the effect of CPAP therapy on medication use in women as overall medication, and in different subcategories of diseases, and to evaluate the impact of nocturnal airway obstruction type as partial or complete. METHODS From the database of the Department of Pulmonary Diseases in Turku University Hospital from 1994 to 1998, 601 consecutive females with SDB were enrolled, and the type of SDB was evaluated. All were offered CPAP therapy. The medication use measured as defined daily doses (DDD) in overall medication and in nine subcategories were collected three years before and three years after CPAP initiation. RESULTS In final analyses, 182 women were included. In CPAP users (n = 66), comorbidities were more frequent and DDDs higher overall, in asthma, in chronic obstructive pulmonary disease, and in severe mental disorders, both before and after CPAP initiation. The medication use was similar regardless of the type of SDB. The change in medication use was similar as in controls. CONCLUSIONS CPAP therapy did not decrease medication use in three-year follow-up. However, possibly continuous rise in medication use was prevented, as the change in medication use was similar in controls. Complete and partial obstruction had similar effects.
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Affiliation(s)
- Miia Aro
- Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, PO Box 52, FIN-20520, Turku, Finland; Department of Pulmonary Diseases and Clinical Allergology, University of Turku, PO Box 52, FIN-20520, Turku, Finland; Sleep Research Centre, Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Lemminkäisenkatu 3b, 20520, TURKU, Finland.
| | - Tarja Saaresranta
- Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, PO Box 52, FIN-20520, Turku, Finland; Department of Pulmonary Diseases and Clinical Allergology, University of Turku, PO Box 52, FIN-20520, Turku, Finland; Sleep Research Centre, Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Lemminkäisenkatu 3b, 20520, TURKU, Finland.
| | - Tero Vahlberg
- Department of Clinical Medicine, Biostatistics, University of Turku, Biostatistiikka, 20014, Turun Yliopisto, Turku, Finland.
| | - Ulla Anttalainen
- Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, PO Box 52, FIN-20520, Turku, Finland; Department of Pulmonary Diseases and Clinical Allergology, University of Turku, PO Box 52, FIN-20520, Turku, Finland; Sleep Research Centre, Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Lemminkäisenkatu 3b, 20520, TURKU, Finland.
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3
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Anttalainen U, Grote L, Fietze I, Riha RL, Ryan S, Staats R, Hedner J, Saaresranta T. Insomnia symptoms combined with nocturnal hypoxia associate with cardiovascular comorbidity in the European sleep apnea cohort (ESADA). Sleep Breath 2018; 23:805-814. [PMID: 30467691 PMCID: PMC6700053 DOI: 10.1007/s11325-018-1757-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 10/01/2018] [Accepted: 11/13/2018] [Indexed: 01/03/2023]
Abstract
Purpose The aim of the current study was to further investigate the concept of previously reported high occurrence of comorbidities in obstructive sleep patients (OSA) with insomnia-like symptoms. We hypothesized that this finding at least partly is mediated by nocturnal hypoxia. Moreover, we speculated that the spectrum of the clinical OSA phenotypes differs between European geographical regions. Methods Cohort of the European Sleep Apnea Database (n = 17,325; 29.9% females) was divided into five subcohorts according to geographical region (North, East, South, West, Central) and further into four clinical presentation phenotypes based on daytime symptoms (EDS) and characteristics suggestive of insomnia. Results The insomnia phenotype (alone or together with EDS) dominated in all European regions. Isolated insomnia, however, was less common in the West. Insomnia phenotype was associated with the highest proportion of cardiovascular comorbidity (51.7% in the insomnia vs. 43.9% in the EDS type). Measures of nocturnal hypoxemia were independently associated with cardiovascular comorbidity in phenotypes with insomnia-like symptoms. The burden of comorbidities was high across all geographical regions and clinical phenotypes. Regional differences were clinically relevant for age (48 vs. 54 years), BMI (29 vs. 34 kg/m2), and ODI (15 vs. 32/h). Conclusion High prevalence of particularly cardiovascular comorbidity among patients with insomnia-like symptoms was linked to nocturnal hypoxemia. Considerable differences in clinical presentation were found among OSA patients across Europe. Our data underline that physicians should ask their patients with suspected OSA also for insomnia symptoms. It remains to be explored if a reduction of nocturnal hypoxemia predicts the improvement of insomnia symptoms. Electronic supplementary material The online version of this article (10.1007/s11325-018-1757-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ulla Anttalainen
- Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, P.O. Box 52, SF-20521, Turku, Finland.
- Sleep Research Centre, Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland.
| | - L Grote
- Department of Sleep Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - I Fietze
- Center of Sleep Medicine, Charité - Universitätsmedizin Berlin, Luisenstrasse 13, 101 17, Berlin, Germany
| | - R L Riha
- Department of Sleep Medicine, Royal Infirmary Edinburgh, 51 Little France Crescent EH, Edinburgh, 164 SA, Scotland
| | - S Ryan
- Department of Respiratory Medicine, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - R Staats
- Department of Respiratory Medicine, Hospital de Santa Maria, Lisbon, Portugal
| | - J Hedner
- Department of Sleep Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - T Saaresranta
- Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, P.O. Box 52, SF-20521, Turku, Finland
- Sleep Research Centre, Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland
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4
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Bonsignore MR, Pepin JL, Anttalainen U, Schiza SE, Basoglu OK, Pataka A, Steiropoulos P, Dogas Z, Grote L, Hedner J, McNicholas WT, Marrone O. Clinical presentation of patients with suspected obstructive sleep apnea and self-reported physician-diagnosed asthma in the ESADA cohort. J Sleep Res 2018; 27:e12729. [PMID: 29998568 DOI: 10.1111/jsr.12729] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 05/19/2018] [Accepted: 06/07/2018] [Indexed: 12/31/2022]
Abstract
Obstructive sleep apnea (OSA) and asthma are often associated and several studies suggest a bidirectional relationship between asthma and OSA. This study analyzed the characteristics of patients with suspected OSA from the European Sleep Apnea Database according to presence/absence of physician-diagnosed asthma. Cross-sectional data in 16,236 patients (29.1% female) referred for suspected OSA were analyzed according to occurrence of physician-diagnosed asthma for anthropometrics, OSA severity and sleepiness. Sleep structure was assessed in patients studied by polysomnography (i.e. 48% of the sample). The prevalence of physician-diagnosed asthma in the entire cohort was 4.8% (7.9% in women, 3.7% in men, p < 0.0001), and decreased from subjects without OSA to patients with mild-moderate and severe OSA (p = 0.02). Obesity was highly prevalent in asthmatic women, whereas BMI distribution was similar in men with and without physician-diagnosed asthma. Distribution of OSA severity was similar in patients with and without physician-diagnosed asthma, and unaffected by treatment for asthma or gastroesophageal reflux. Asthma was associated with poor sleep quality and sleepiness. Physician-diagnosed asthma was less common in a sleep clinic population than expected from the results of studies in the general population. Obesity appears as the major factor raising suspicion of OSA in asthmatic women, whereas complaints of poor sleep quality were the likely reason for referral in asthmatic men.
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Affiliation(s)
- Maria R Bonsignore
- Biomedical Department of Internal and Specialistic Medicine (DIBIMIS), University of Palermo, Palermo, Italy.,CNR Institute of Biomedicine and Molecular Immunology, Palermo, Italy
| | - Jean-Louis Pepin
- Université Grenoble Alpes, INSERM U1042, CHU de Grenoble, Grenoble, France
| | - Ulla Anttalainen
- Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, Turku, Finland.,Department of Physiology, Sleep Research Centre, University of Turku, Turku, Finland
| | - Sophia E Schiza
- Sleep Disorders Unit, Department of Respiratory Medicine, Medical School, University of Crete, Heraklion, Greece
| | - Ozen K Basoglu
- Department of Chest Diseases, Ege University Faculty of Medicine, Izmir, Turkey
| | - Athanasia Pataka
- Department of Respiratory Medicine, G. Papanikolaou Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Paschalis Steiropoulos
- Sleep Unit, Department of Pneumonology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Zoran Dogas
- Split Sleep Medicine Center and Department of Neuroscience, University of Split School of Medicine, Split, Croatia
| | - Ludger Grote
- Department of Sleep Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.,Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Jan Hedner
- Department of Sleep Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.,Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Walter T McNicholas
- Department of Respiratory and Sleep Medicine, St. Vincent's University Hospital, Dublin, Ireland.,Conway Research Institute, University College Dublin, Dublin, Ireland
| | - Oreste Marrone
- CNR Institute of Biomedicine and Molecular Immunology, Palermo, Italy
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Saaresranta T, Hedner J, Bonsignore MR, Riha RL, McNicholas WT, Penzel T, Anttalainen U, Kvamme JA, Pretl M, Sliwinski P, Verbraecken J, Grote L. Clinical Phenotypes and Comorbidity in European Sleep Apnoea Patients. PLoS One 2016; 11:e0163439. [PMID: 27701416 PMCID: PMC5049787 DOI: 10.1371/journal.pone.0163439] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 09/08/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Clinical presentation phenotypes of obstructive sleep apnoea (OSA) and their association with comorbidity as well as impact on adherence to continuous positive airway pressure (CPAP) treatment have not been established. METHODS A prospective follow-up cohort of adult patients with OSA (apnoea-hypopnoea index (AHI) of ≥5/h) from 17 European countries and Israel (n = 6,555) was divided into four clinical presentation phenotypes based on daytime symptoms labelled as excessive daytime sleepiness ("EDS") and nocturnal sleep problems other than OSA (labelled as "insomnia"): 1) EDS (daytime+/nighttime-), 2) EDS/insomnia (daytime+/nighttime+), 3) non-EDS/non-insomnia (daytime-/nighttime-), 4) and insomnia (daytime-/nighttime+) phenotype. RESULTS The EDS phenotype comprised 20.7%, the non-EDS/non-insomnia type 25.8%, the EDS/insomnia type 23.7%, and the insomnia phenotype 29.8% of the entire cohort. Thus, clinical presentation phenotypes with insomnia symptoms were dominant with 53.5%, but only 5.6% had physician diagnosed insomnia. Cardiovascular comorbidity was less prevalent in the EDS and most common in the insomnia phenotype (48.9% vs. 56.8%, p<0.001) despite more severe OSA in the EDS group (AHI 35.0±25.5/h vs. 27.9±22.5/h, p<0.001, respectively). Psychiatric comorbidity was associated with insomnia like OSA phenotypes independent of age, gender and body mass index (HR 1.5 (1.188-1.905), p<0.001). The EDS phenotype tended to associate with higher CPAP usage (22.7 min/d, p = 0.069) when controlled for age, gender, BMI and sleep apnoea severity. CONCLUSIONS Phenotypes with insomnia symptoms comprised more than half of OSA patients and were more frequently linked with comorbidity than those with EDS, despite less severe OSA. CPAP usage was slightly higher in phenotypes with EDS.
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Affiliation(s)
- Tarja Saaresranta
- Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, Turku, Finland
- Sleep Research Centre, Department of Physiology, University of Turku, Turku, Finland
- * E-mail:
| | - Jan Hedner
- Department of Sleep Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
- Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Maria R. Bonsignore
- Biomedical Department of Internal and Specialistic Medicine (DIBIMIS), University of Palermo, Palermo, Italy
- CNR Institute of Biomedicine and Molecular Immunology, Palermo, Italy
| | - Renata L. Riha
- Department of Sleep Medicine, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Walter T. McNicholas
- Department of Respiratory and Sleep Medicine, St. Vincent´s University Hospital, Dublin, Ireland
- Conway Research Institute, University College Dublin, Dublin, Ireland
| | - Thomas Penzel
- Schlafmedizinisches Zentrum, Charité –Universitätsmedizin Berlin, Berlin, Germany
- International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
| | - Ulla Anttalainen
- Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, Turku, Finland
- Sleep Research Centre, Department of Physiology, University of Turku, Turku, Finland
| | | | - Martin Pretl
- Centre for Sleep and Waking Disorders, Department of Neurology, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Inspamed, Neurology and Sleep Laboratory, Prague, Czech Republic
| | - Pawel Sliwinski
- Institute of Tuberculosis and Lung Diseases, 4th Department of Respiratory Medicine, Warsaw, Poland
| | - Johan Verbraecken
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Antwerp, Belgium
- University of Antwerp, Antwerp, Belgium
| | - Ludger Grote
- Department of Sleep Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
- Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
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Anttalainen U, Tenhunen M, Rimpilä V, Polo O, Rauhala E, Himanen SL, Saaresranta T. Prolonged partial upper airway obstruction during sleep - an underdiagnosed phenotype of sleep-disordered breathing. Eur Clin Respir J 2016; 3:31806. [PMID: 27608271 PMCID: PMC5015642 DOI: 10.3402/ecrj.v3.31806] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 08/10/2016] [Indexed: 12/31/2022] Open
Abstract
Obstructive sleep apnea syndrome (OSAS) is a well-recognized disorder conventionally diagnosed with an elevated apnea-hypopnea index. Prolonged partial upper airway obstruction is a common phenotype of sleep-disordered breathing (SDB), which however is still largely underreported. The major reasons for this are that cyclic breathing pattern coupled with arousals and arterial oxyhemoglobin saturation are easy to detect and considered more important than prolonged episodes of increased respiratory effort with increased levels of carbon dioxide in the absence of cycling breathing pattern and repetitive arousals. There is also a growing body of evidence that prolonged partial obstruction is a clinically significant form of SDB, which is associated with symptoms and co-morbidities which may partially differ from those associated with OSAS. Partial upper airway obstruction is most prevalent in women, and it is treatable with the nasal continuous positive pressure device with good adherence to therapy. This review describes the characteristics of prolonged partial upper airway obstruction during sleep in terms of diagnostics, pathophysiology, clinical presentation, and comorbidity to improve recognition of this phenotype and its timely and appropriate treatment.
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Affiliation(s)
- Ulla Anttalainen
- Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, Turku, Finland
- Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland
- Sleep Research Centre, Department of Physiology, University of Turku, Turku, Finland;
| | - Mirja Tenhunen
- Department of Clinical Neurophysiology, Medical Imaging Centre and Hospital Pharmacy, Pirkanmaa Hospital District, Tampere University Hospital, Tampere, Finland
- Department of Medical Physics, Medical Imaging Centre and Hospital Pharmacy, Pirkanmaa Hospital District, Tampere University Hospital, Tampere, Finland
| | - Ville Rimpilä
- School of Medicine, University of Tampere, Tampere, Finland
| | - Olli Polo
- Unesta Research Center, Tampere, Finland
- Department of Pulmonary Diseases, Tampere University Hospital, Tampere, Finland
| | - Esa Rauhala
- Department of Clinical Neurophysiology, Satakunta Hospital District, Pori, Finland
| | - Sari-Leena Himanen
- Department of Clinical Neurophysiology, Medical Imaging Centre and Hospital Pharmacy, Pirkanmaa Hospital District, Tampere University Hospital, Tampere, Finland
- School of Medicine, University of Tampere, Tampere, Finland
| | - Tarja Saaresranta
- Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, Turku, Finland
- Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland
- Sleep Research Centre, Department of Physiology, University of Turku, Turku, Finland
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7
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Saaresranta T, Anttalainen U, Polo O. Sleep disordered breathing: is it different for females? ERJ Open Res 2015; 1:00063-2015. [PMID: 27730159 PMCID: PMC5005124 DOI: 10.1183/23120541.00063-2015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 10/11/2014] [Indexed: 01/28/2023] Open
Abstract
Obstructive sleep apnoea (OSA) is no longer considered to be a disease of males only. The latest prevalence estimates of moderate-to-severe OSA in women range from 6% to 20% [1, 2], resulting in male/female ratio from 3/1 to 2/1 [1]. These figures may still underestimate the prevalence of sleep disordered breathing (SDB) in women, in whom the upper airway obstruction often manifests as noncountable, nonapnoeic respiratory events (snoring, flow limitation or partial upper airway obstruction) [3–6]. Failure to recognise the distinct clinical presentation and partial obstruction in sleep studies may lead to under-recognition of SDB in females [7, 8]. For instance, prior to diagnosing OSA, women are twice as likely as men to be treated for depression [7]. Predominance of low AHI and partial upper airway obstruction may lead to undertreatment of female SDBhttp://ow.ly/TKN7d
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Affiliation(s)
- Tarja Saaresranta
- Division of Medicine, Dept of Pulmonary Diseases, Turku University Hospital, Turku, Finland; Sleep Research Centre, Dept of Physiology, University of Turku, Turku, Finland
| | - Ulla Anttalainen
- Division of Medicine, Dept of Pulmonary Diseases, Turku University Hospital, Turku, Finland; Sleep Research Centre, Dept of Physiology, University of Turku, Turku, Finland
| | - Olli Polo
- Department of Pulmonary Medicine, Tampere University Hospital, Tampere, Finland; Unesta Research Centre, Tampere, Finland
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8
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Heart rate variability evaluation of Emfit sleep mattress breathing categories in NREM sleep. Clin Neurophysiol 2014; 126:967-74. [PMID: 25241203 DOI: 10.1016/j.clinph.2014.08.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Revised: 08/18/2014] [Accepted: 08/20/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Heart rate variability (HRV) analysis of obstructive sleep apnea patients reveals an increase in sympathetic activity. Sleep disordered breathing (SDB) can be also assessed with sleep mattress sensors, as the Emfit sensor, by dividing the signal into different breathing categories. In addition to normal breathing (NB) and periodic apneas/hypopneas (POB), the sleep mattress unveils a breathing category consisting of sustained partial obstruction (increased respiratory resistance, IRR). The aim of our study was to evaluate HRV during these three breathing categories in NREM sleep. METHODS 53 patients with suspected SDB underwent an overnight polysomnography with an Emfit mattress. The Emfit signal was scored in 3-min epochs according to the established rules. The NB, POB, and IRR epochs were combined to as long NB, POB and IRR periods as possible and HRV was calculated from at least 6-min epochs. RESULTS The meanHR did not differ between the breathing categories. HRV parameters revealed an increase in sympathetic activity during POB. The mean LF/HF ratio was highest during POB (3.0) and lowest during IRR (1.3). During NB it was 1.7 (all p-values ⩽ 0.001). Interestingly sympathetic activity decreased and parasympathetic activity increased during IRR as compared to NB (the mean HF power was 1113.8 ms(2) during IRR and 928.4 ms(2) during NB). CONCLUSIONS The HRV findings during POB resembled HRV results of sleep apnea patients but during sustained prolonged partial obstruction a shift towards parasympathetic activity was achieved. SIGNIFICANCE The findings encourage the use of sleep mattresses in SDB diagnostics. In addition the findings suggest that sustained partial obstruction represents its own SDB entity.
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9
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Screening sleep disordered breathing in stroke unit. SLEEP DISORDERS 2014; 2014:317615. [PMID: 24991437 PMCID: PMC4058514 DOI: 10.1155/2014/317615] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 05/12/2014] [Accepted: 05/14/2014] [Indexed: 12/16/2022]
Abstract
In acute stroke, OSA has been found to impair rehabilitation and increase mortality but the effect of central apnea is more unclear. The aim of the present study was to evaluate the feasibility of using limited ambulatory recording system (sleep mattress to evaluate nocturnal breathing and EOG-electrodes for sleep staging) in sleep disordered breathing (SDB) diagnostics in mild acute cerebral ischemia patients and to discover the prevalence of various SDB-patterns among these patients. 42 patients with mild ischemic stroke or transient ischemic attack were studied. OSA was found in 22 patients (52.4%). Central apnea was found in two patients (4.8%) and sustained partial obstruction in only one patient (2.4%). Sleep staging with EOG-electrodes only yielded a similar outcome as scoring with standard rules. OSA was found to be common even after mild stroke. Its early diagnosis and treatment would be favourable in order to improve recovery and reduce mortality. Our results suggest that OSA can be assessed by a limited recording setting with EOG-electrodes, sleep mattress, and pulse oximetry.
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10
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Tenhunen M, Elomaa E, Sistonen H, Rauhala E, Himanen SL. Emfit movement sensor in evaluating nocturnal breathing. Respir Physiol Neurobiol 2013; 187:183-9. [PMID: 23583829 DOI: 10.1016/j.resp.2013.03.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 02/22/2013] [Accepted: 03/21/2013] [Indexed: 10/27/2022]
Abstract
Obstructive sleep apnea (OSA) diagnostics by the movement sensors static charge-sensitive bed (SCSB) and electromechanical film transducer (Emfit) is based on dividing the signal into different breathing patterns. The usage of non-invasive mattress sensors in diagnosing OSA is particularly tempting if patient has many other non sleep-related monitoring sensors. However, a systematic comparison of the apnea-hypopnea index (AHI) with Emfit-parameters is lacking. In addition to periodic breathing, SCSB and Emfit visualize episodes of sustained negative increases in intrathoracic pressure (increased respiratory resistance, IRR), of which relevance is still ambiguous. Our aim is to compare Emfit-parameters with the AHI and to provide a description of the patients suffering from IRR. Time percentage with all obstructive periodic Emfit breathing patterns (OPTotal%) showed the best correlation with the AHI. The OPTotal percentage of 21 yielded to excellent accuracy in detecting subjects with an AHI of 15/h or more. Patients with IRR received high scores in GHQ-12-questionnaire. An Emfit movement sensor might offer additional information in OSA diagnostics especially if nasal pressure transducer cannot be used.
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Affiliation(s)
- Mirja Tenhunen
- Department of Clinical Neurophysiology, Medical Imaging Centre and Hospital Pharmacy, Pirkanmaa Hospital District, Tampere, Finland.
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11
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Anttalainen U, Polo O, Vahlberg T, Saaresranta T. Women with partial upper airway obstruction are not less sleepy than those with obstructive sleep apnea. Sleep Breath 2012; 17:873-6. [PMID: 22733532 DOI: 10.1007/s11325-012-0735-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Revised: 03/12/2012] [Accepted: 06/14/2012] [Indexed: 11/25/2022]
Abstract
PURPOSE Sleep-disordered breathing (SDB) differs between genders in terms of the type, signs, and symptoms of the disease. Partial upper airway obstruction is underdiagnosed and undertreated. METHODS In this study, we retrospectively investigated respiratory sleep recordings of 601 women, ending up with 240 women for the final statistical analyses. We hypothesized that there are differences between the signs and symptoms of sleep-disordered breathing whether women had partial upper airway obstruction or obstructive sleep apnea. RESULTS The results showed no difference in sleepiness between women with partial upper airway obstruction or obstructive sleep apnea. Also, the other main symptoms of SDB were the same between the groups. Micrognathia was more common in women with partial upper airway obstruction than with obstructive sleep apnea. CONCLUSION These results indicate that partial upper airway obstruction in women should be clinically recognized like obstructive sleep apnea.
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Affiliation(s)
- Ulla Anttalainen
- Department of Pulmonary Diseases, Turku University Hospital, Turku, Finland.
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