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Morey BN, Shi Y, Ryu S, Redline S, Kawachi I, Park HW, Lee S. Risk of sleep apnea associated with higher blood pressure among Chinese and Korean Americans. ETHNICITY & HEALTH 2024; 29:295-308. [PMID: 38303653 PMCID: PMC10987275 DOI: 10.1080/13557858.2024.2311417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 01/23/2024] [Indexed: 02/03/2024]
Abstract
OBJECTIVE This study examines associations between sleep apnea risk and hypertension in a sample of immigrant Chinese and Korean Americans. DESIGN The dataset included Chinese and Korean patients ages 50-75 recruited from primary care physicians' offices from April 2018 to June 2020 in the Baltimore-Washington DC Metropolitan Area (n = 394). Hypertension risk was determined using a combination of blood pressure measurements, self-reported diagnosis of hypertension by a medical professional, and/or self-reported use of antihypertensive medications. Linear regression models examined the associations between sleep apnea risk and blood pressure (systolic blood pressure [SBP] and diastolic blood pressure [DBP]). Poisson regression models examined associations sleep apnea risk and hypertension. Models controlled for body mass index (BMI), demographic, and socioeconomic risk factors. We further examined models for potential effect modification by age, gender, Asian subgroup, and obesity, as well as effect modification of daytime sleepiness on the association between snoring and hypertension risk. RESULTS High risk of sleep apnea appeared to be associated positively with SBP (β = 6.77, 95% CI: 0.00-13.53), but not with DBP. The association was positive for hypertension, but it was not statistically significant (PR = 1.11, 95% CI: 0.87-1.41). We did not find effect modification of the associations between sleep apnea and hypertension risk, but we did find that daytime sleepiness moderated the effect of snoring on SBP. Snoring was associated with higher SBP, primarily in the presence of daytime sleepiness, such that predicted SBP was 133.27 mmHg (95% CI: 126.52, 140.02) for someone with both snoring and daytime sleepiness, compared to 123.37 mmHg (95% CI: 120.40, 126.34) for someone neither snoring nor daytime sleepiness. CONCLUSION Chinese and Korean immigrants living in the U.S. who are at high risk of sleep apnea have higher SBP on average, even after accounting for sociodemographic characteristics and BMI. CLINICAL TRAIL REGISTRATION : NCT03481296, date of registration: 3/29/2018.
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Affiliation(s)
- Brittany N. Morey
- University of California, Irvine, Program in Public Health, Department of Health, Society, & Behavior, Irvine, CA, U.S.A
| | - Yuxi Shi
- University of California, Irvine, School of Medicine, Department of Medicine, Irvine, CA, U.S.A
| | - Soomin Ryu
- University of Michigan School of Public Health, Department of Epidemiology, Ann Arbor, MI, U.S.A
| | - Susan Redline
- Harvard Medical School, Brigham and Women’s Hospital, Department of Medicine, and Harvard T.H. Chan School of Public Health, Department of Epidemiology, Boston, MA, U.S.A
| | - Ichiro Kawachi
- Harvard T.H. Chan School of Public Health, Department of Social and Behavioral Sciences, Boston, MA, U.S.A
| | - Hye Won Park
- University of California, Irvine, School of Medicine, Department of Medicine, Irvine, CA, U.S.A
| | - Sunmin Lee
- University of California, Irvine, School of Medicine, Department of Medicine, Irvine, CA, U.S.A
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Shi X, Chen H, Lobbezoo F, de Lange J, van der Stelt P, Berkhout E, Guo J, Ge S, Li G, Li Y, Aarab G. Comparison of the upper airway morphology between Dutch and Chinese adults with obstructive sleep apnea. Sleep Breath 2023; 27:2223-2230. [PMID: 37093512 PMCID: PMC10656314 DOI: 10.1007/s11325-023-02834-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 03/22/2023] [Accepted: 04/14/2023] [Indexed: 04/25/2023]
Abstract
PURPOSE The pathogenesis of obstructive sleep apnea (OSA) is complex and may vary between different races. It has been suggested that the anatomical balance between skeletal tissues and soft tissues around the upper airway is a key pathophysiologic factor of OSA. Therefore, the aim of this study was to compare the anatomical balance of the upper airway between Dutch and Chinese patients with OSA based on cone beam computed tomography (CBCT) images. METHODS This was a cross-sectional study performed in two centers and included Dutch and Chinese adults with OSA. CBCT scans in the supine position were obtained for both Dutch and Chinese OSA groups. The primary outcome variable was the anatomical balance of the upper airway, defined as the ratio of the tongue area and the maxillomandibular enclosure area. RESULTS A total of 28 Dutch adults (mean age ± SD of 46.6 ± 14.1 years, body mass index [BMI] of 26.8 ± 3.5 kg/m2, and apnea-hypopnea index [AHI] of 15.7 ± 7.1 events/h) and 24 Chinese adults (age 41.0 ± 12.4 years, BMI 26.5 ± 3.3 kg/m2, and AHI 16.5 ± 7.8 events/h). There were no significant differences in AHI, age, BMI, and sex between the two groups (P = 0.14-0.76). The Dutch group had a significantly larger tongue area and tongue length compared to the Chinese group (P = 0.01 and P < 0.01). On the other hand, the Chinese group had a smaller maxilla length compared to the Dutch group (P < 0.01). However, the anatomical balance of the upper airway of both groups was not significantly different (P = 0.16). CONCLUSION Within the limitations of this study, no significant difference was found in the anatomical balance of the upper airway between Dutch and Chinese patients with mild to moderate OSA. TRIAL REGISTRATION The present study was registered at the ClinicalTrials.gov identifier NCT03463785.
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Affiliation(s)
- Xiaoxin Shi
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Oral Radiology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Centers/Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, The Netherlands
| | - Hui Chen
- Department of Orthodontics and Periodontics and Oral Radiology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, No. 44-1 Wenhua Road west, Jinan, 250012, China.
| | - Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jan de Lange
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Centers/Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, The Netherlands
| | - Paul van der Stelt
- Department of Oral Radiology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Erwin Berkhout
- Department of Oral Radiology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jing Guo
- Department of Orthodontics and Periodontics and Oral Radiology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, No. 44-1 Wenhua Road west, Jinan, 250012, China
| | - Shaohua Ge
- Department of Orthodontics and Periodontics and Oral Radiology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, No. 44-1 Wenhua Road west, Jinan, 250012, China
| | - Guoju Li
- Department of Orthodontics and Periodontics and Oral Radiology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, No. 44-1 Wenhua Road west, Jinan, 250012, China
| | - Yanzhong Li
- Department of Otorhinolaryngology, Qilu Hospital of Shandong University, NHC Key Laboratory of Otorhinolaryngology, Jinan, China
| | - Ghizlane Aarab
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Gueye-Ndiaye S, Williamson AA, Redline S. Disparities in Sleep-Disordered Breathing: Upstream Risk Factors, Mechanisms, and Implications. Clin Chest Med 2023; 44:585-603. [PMID: 37517837 PMCID: PMC10513750 DOI: 10.1016/j.ccm.2023.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
Sleep-disordered breathing (SDB) refers to a spectrum of disorders ranging from habitual snoring without frank episodes of obstructed breathing or desaturation during sleep to obstructive sleep apnea, where apneas and hypopneas repetitively occur with resultant intermittent hypoxia, arousal, and sleep disruption. Disparities in SDB reflect its overall high prevalence in children and adults from racially and ethnically minoritized or low socioeconomic status backgrounds coupled with high rates of underdiagnosis and suboptimal treatment.
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Affiliation(s)
- Seyni Gueye-Ndiaye
- Brigham and Women's Hospital and Harvard Medical School, 221 Longwood Avenue, Boston, MA 02115, USA
| | - Ariel A Williamson
- Children's Hospital of Philadelphia, 2716 South Street Boulevard, Philadelphia, PA 19104, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Susan Redline
- Brigham and Women's Hospital and Harvard Medical School, 221 Longwood Avenue, Boston, MA 02115, USA.
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Azarbarzin A, Sands SA, Han S, Sofer T, Labarca G, Stone KL, Gottlieb DJ, Javaheri S, Wellman A, White DP, Redline S. Relevance of cortical arousals for risk stratification in sleep apnea: a 3 cohort analysis. J Clin Sleep Med 2023; 19:1475-1484. [PMID: 37086050 PMCID: PMC10394366 DOI: 10.5664/jcsm.10598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 04/23/2023]
Abstract
STUDY OBJECTIVES There is uncertainty on best approaches for defining apnea-hypopnea events. To clarify the contributions of desaturation vs arousal to defining hypopneas, we examined the associations of events with desaturation (≥ 3%) but not arousal (apnea-hypopnea index [AHI]≥3%Only) vs events with arousals but no desaturation (AHIArOnly) with obstructive sleep apnea-related comorbidities and incident cardiovascular disease across multiple cohorts. METHODS In the Sleep Heart Health Study (n = 5,473), the Multi-Ethnic Study of Atherosclerosis (n = 1,904), and the Osteoporotic Fractures in Men Study (n = 2,685), we examined the independent associations of AHI≥3%Only and AHIArOnly with hypertension, diabetes, and daytime sleepiness, and incident cardiovascular disease. RESULTS After adjusting for covariates and AHI based on events with electroencephalogram arousal (regardless of desaturation), AHI≥3%Only was associated with hypertension in Sleep Heart Health Study (odds ratio: 1.12; 95% confidence interval: 1.04,1.21), per 1 standard deviation increase). Similar associations were observed in the Multi-Ethnic Study of Atherosclerosis and Osteoporotic Fractures in Men Study, as well as for associations with diabetes (odds ratio: 1.30; 1.09,1.54, and 1.25; 1.07,1.47, respectively), sleepiness (odds ratio: 1.19; 1.00,1.41; and 1.17; 1.01-1.35), and incident cardiovascular disease (hazard ratio: 1.37; 1.05,1.77 and 1.14; 1.00,1.29). In contrast, after adjusting for events with desaturation (regardless of arousal), AHIArOnly was unassociated with these outcomes. In Sleep Heart Health Study, greater baseline obstructive sleep apnea severity was associated with a reduction in arousal frequency over 5 years (P < .0001). CONCLUSIONS In middle-aged and older individuals, addition of events with arousals does not improve the strength of associations with comorbidities or incident cardiovascular disease. Research is needed to understand generalizability to younger individuals and the mechanistic role of arousals in obstructive sleep apnea. CITATION Azarbarzin A, Sands SA, Han S, et al. Relevance of cortical arousals for risk stratification in sleep apnea: a 3 cohort analysis. J Clin Sleep Med. 2023;19(8):1475-1484.
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Affiliation(s)
- Ali Azarbarzin
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Scott A. Sands
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Shaoling Han
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Tamar Sofer
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Gonzalo Labarca
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Katie L. Stone
- Research Institute, California Pacific Medical Center, San Francisco, California
| | - Daniel J. Gottlieb
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Shahrokh Javaheri
- University of Cincinnati College of Medicine and the Bethesda North Hospital, Cincinnati, Ohio
| | - Andrew Wellman
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - David P. White
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
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5
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Kim JW, Cho SW. Response to "In reference to 'Prediction of Oxygen Desaturation by Using Sound Data From a Noncontact Device'". Laryngoscope 2023; 133:E22. [PMID: 36317742 DOI: 10.1002/lary.30472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 10/14/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Jeong-Whun Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea.,Sensory Organ Research Institute, Seoul National University Biomedical Research Center, Seoul, South Korea
| | - Sung-Woo Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
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Lucchini M, Rayport Y, Valeri L, Jelic S, St-Onge MP, O'Brien LM, Alcantara C. Racial/ethnic disparities in sleep-disordered breathing during pregnancy in the nuMoM2b study. Obesity (Silver Spring) 2023; 31:923-933. [PMID: 36863765 DOI: 10.1002/oby.23697] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 12/07/2022] [Accepted: 12/09/2022] [Indexed: 03/04/2023]
Abstract
OBJECTIVE The aim of this study was to assess the prevalence and severity of sleep-disordered breathing (SDB) across racial/ethnic groups in 3702 pregnant people at 6 to 15 and 22 to 31 weeks gestational age, examine whether BMI modifies the association between race/ethnicity and SDB, and investigate whether interventions to reduce weight might reduce racial/ethnic disparities in SDB. METHODS Differences by race/ethnicity in SDB prevalence and severity were quantified via linear, logistic, or quasi-Poisson regression. Controlled direct effect was used to estimate whether intervening on BMI would remove/diminish differences by race/ethnicity in SDB severity. RESULTS This study comprised 61.2% non-Hispanic White (nHW), 11.9% non-Hispanic Black (nHB), 18.5% Hispanic, and 3.7% Asian people. SDB prevalence was higher for nHB compared with nHW pregnant people at 6 to 15 weeks (odds ratio [OR] 1.81, 95% CI [1.07, 2.97]), whereas at 21 to 32 weeks, Asian pregnant people had a higher SDB prevalence than nHW (OR 2.2, 95% CI [1.1, 4.0]). The severity of SDB differed across racial/ethnic groups in early pregnancy, with nHB pregnant people having a higher apnea-hypopnea index (AHI) (OR 1.35, 95% CI [1.07, 1.69]) compared with nHW. Having overweight/obesity was associated with a higher AHI (β = 2.36, 95% CI [1.97, 2.84]). Controlled direct effect analyses indicated that in early pregnancy, nHB and Hispanic pregnant people would have a lower AHI compared with nHW people had they had normal weight. CONCLUSIONS This study extends knowledge on racial/ethnic disparities in SDB to a pregnant population.
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Affiliation(s)
- Maristella Lucchini
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Yael Rayport
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Linda Valeri
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Sanja Jelic
- Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Marie-Pierre St-Onge
- Division of General Medicine and Sleep Center of Excellence, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Louise M O'Brien
- Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, Michigan Medicine, Ann Arbor, Michigan, USA
- Division of Sleep Medicine, Department of Neurology, Michigan Medicine, Ann Arbor, Michigan, USA
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Li Z, Daniel S, Fujioka K, Umashanker D. Obesity among Asian American people in the United States: A review. Obesity (Silver Spring) 2023; 31:316-328. [PMID: 36695056 PMCID: PMC10108164 DOI: 10.1002/oby.23639] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 10/10/2022] [Accepted: 10/27/2022] [Indexed: 01/26/2023]
Abstract
Standard measures of obesity, i.e., body weight and BMI, suggest that Asian American people have a lower obesity prevalence than other racial groups in the United States. However, Asian American people face a unique challenge in their pattern of adiposity with central obesity, which raises the risk for multiple comorbidities, such as type 2 diabetes, metabolic syndrome, and cardiovascular disease, at a lower BMI compared with other populations. Several organizations recommend lower BMI cutoffs for obesity in Asian people (BMI ≥25.0 or ≥27.5 kg/m2 ) instead of the standard ≥30.0 kg/m2 threshold. The risks of obesity and related comorbidities in this population are further influenced by diet, physical activity, perceptions of health, and access to information and therapies. Asian-specific parameters for assessing obesity should become a standard part of clinical practice. Asian American people should equally be offered subgroup-specific tailored interventions owing to heterogeneity of this population. Access to medications and surgery should be improved, in part by updating US indications for therapies to reflect race-specific obesity thresholds and through inclusion of Asian American people of all subtypes with lower BMI values in clinical trials.
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Affiliation(s)
- Zhaoping Li
- Center for Human Nutrition, UCLA, Los Angeles, California, USA
| | | | - Ken Fujioka
- Scripps Clinic Del Mar, San Diego, California, USA
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Morey BN, Ryu S, Shi Y, Redline S, Kawachi I, Lee S. Associations between sleep apnea risk and cardiovascular disease indicators among Chinese and Korean Americans. SLEEP EPIDEMIOLOGY 2022; 2:100037. [PMID: 36250200 PMCID: PMC9555314 DOI: 10.1016/j.sleepe.2022.100037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
STUDY OBJECTIVES While sleep apnea has been associated with cardiovascular disease (CVD) risk factors in white individuals in the U.S., these associations in Chinese and Korean Americans are less well-understood, particularly how these associations vary by age, gender, Asian origin, obesity, chronic conditions, and daytime sleepiness. METHODS We used a sample of Chinese and Korean Americans ages 50-75 (n = 394) from the Baltimore-Washington DC Metropolitan Area to examine the associations of high risk (HR) sleep apnea with diagnoseable hypercholesterolemia and diabetes, as well as the following biomarkers: total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), total cholesterol/HDL-C ratio, triglycerides, and glucose (non-fasting). Poisson models included demographic factors, socioeconomic status, and body mass index (BMI). We tested for potential effect modifiers. RESULTS HR-sleep apnea was associated with higher LDL-C level (β = 14.56, p < 0.05) and higher total cholesterol/HDL ratio (β = 0.64, p < 0.01). Younger respondents had higher levels of triglycerides associated with HR-sleep apnea than older respondents. For men, HR-sleep apnea was associated with higher total cholesterol, total cholesterol/HDL-C ratio, and triglycerides. Obese and overweight respondents had positive associations between HR-sleep apnea and total cholesterol, total cholesterol/HDL ratio, and triglycerides, while underweight/normal weight individuals did not. The interactions between snoring and daytime sleepiness were associated with hypercholesterolemia and diabetes. CONCLUSIONS This study demonstrates associations between sleep apnea risk and dyslipidemia among Chinese and Korean Americans. Associations were particularly pronounced among younger, male, overweight/obese, and sicker individuals. Future research should examine how to improve sleep health in Asian American populations to improve CVD risk.
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Affiliation(s)
- Brittany N. Morey
- Department of Health, Society, & Behavior, Program in Public Health, University of California Irvine, 653 E. Peltason Dr., Anteater Instruction and Research Building (AIRB) 2022, Irvine, CA 92697-3957, USA
| | - Soomin Ryu
- School of Public Policy, University of Maryland, College Park, USA
| | - Yuxi Shi
- University of California, Irvine, USA
| | - Susan Redline
- Department of Medicine, and Harvard T.H. Chan School of Public Health, Department of Epidemiology, Harvard Medical School, Brigham and Women’s Hospital, USA
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, USA
| | - Sunmin Lee
- Department of Medicine, School of Medicine, University of California, Irvine, USA
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Matsumoto T, Murase K, Tabara Y, Minami T, Kanai O, Takeyama H, Sunadome H, Nagasaki T, Takahashi N, Nakatsuka Y, Hamada S, Handa T, Tanizawa K, Nakamoto I, Wakamura T, Komenami N, Setoh K, Kawaguchi T, Tsutsumi T, Morita S, Takahashi Y, Nakayama T, Sato S, Hirai T, Matsuda F, Chin K. Sleep disordered breathing and haemoglobin A1c levels within or over normal range and ageing or sex differences: the Nagahama study. J Sleep Res 2022; 32:e13795. [PMID: 36437403 DOI: 10.1111/jsr.13795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/12/2022] [Accepted: 11/10/2022] [Indexed: 11/29/2022]
Abstract
Recently an association between blood glucose dysregulation and sleep disruption was suggested. The association between sleep disordered breathing, most of which is due to obstructive sleep apnea (OSA) in the general population, and diabetic severity, as well as the impact of antidiabetic treatment, remains unclear. This study aimed to investigate these associations as well as age and sex differences. This cross-sectional study evaluated 7,680 community participants as the main cohort (population-based cohort). OSA was assessed by the 3% oxygen desaturation index from pulse oximetry, which was corrected for sleep duration obtained by wrist actigraphy. For arguing the limitations for using pulse oximetry, 597 hospitalised patients, who were assessed by the apnea-hypopnea index from attended polysomnography, were also evaluated as the validation cohort (hospital-based cohort). Moderate-to-severe OSA was more prevalent as haemoglobin A1c (HbA1c) levels increased (<5.6%/5.6%-<6.5%/6.5%-<7.5%/≥7.5%, respectively) in both cohorts (p < 0.001), but only in those without antidiabetic treatment. The HbA1c level was an independent factor for moderate-to-severe OSA (population-based cohort, odds ratio [OR] 1.26, 95% confidence interval [CI] 1.10-1.45; hospital-based cohort, OR 1.69, 95% CI 1.22-2.33, per 1% increase). These associations were more prominent in the middle-aged (aged <60 years) than in the elderly (aged ≥60 years) and in women than in men in both cohorts. The prevalence of moderate-to-severe OSA in patients with antidiabetic treatment in the hospital-based cohort was ≥75% regardless of HbA1c levels. In conclusion, an association between the prevalence of OSA and HbA1c level even within or over the normal range was found only in patients without antidiabetic treatment and was more prominent in the middle-aged and in women.
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Affiliation(s)
- Takeshi Matsumoto
- Department of Respiratory Medicine, Graduate School of Medicine Kyoto University Kyoto Japan
- Department of Respiratory Medicine Saiseikai‐Noe Hospital Osaka Japan
| | - Kimihiko Murase
- Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine Kyoto University Kyoto Japan
| | - Yasuharu Tabara
- Center for Genomic Medicine, Graduate School of Medicine Kyoto University Kyoto Japan
- Graduate School of Public Health Shizuoka Graduate University of Public Health Shizuoka Japan
| | - Takuma Minami
- Department of Primary Care and Emergency Medicine, Graduate School of Medicine Kyoto University Kyoto Japan
| | - Osamu Kanai
- Department of Respiratory Medicine, Graduate School of Medicine Kyoto University Kyoto Japan
| | - Hirofumi Takeyama
- Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine Kyoto University Kyoto Japan
| | - Hironobu Sunadome
- Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine Kyoto University Kyoto Japan
| | - Tadao Nagasaki
- Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine Kyoto University Kyoto Japan
| | - Naomi Takahashi
- Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine Kyoto University Kyoto Japan
| | - Yoshinari Nakatsuka
- Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine Kyoto University Kyoto Japan
| | - Satoshi Hamada
- Department of Advanced Medicine for Respiratory Failure, Graduate School of Medicine Kyoto University Kyoto Japan
| | - Tomohiro Handa
- Department of Advanced Medicine for Respiratory Failure, Graduate School of Medicine Kyoto University Kyoto Japan
| | - Kiminobu Tanizawa
- Department of Respiratory Medicine, Graduate School of Medicine Kyoto University Kyoto Japan
| | - Isuzu Nakamoto
- Nursing Science, Human Health Sciences, Graduate School of Medicine Kyoto University Kyoto Japan
| | - Tomoko Wakamura
- Nursing Science, Human Health Sciences, Graduate School of Medicine Kyoto University Kyoto Japan
| | - Naoko Komenami
- Department of Food and Nutrition Kyoto Women's University Kyoto Japan
| | - Kazuya Setoh
- Center for Genomic Medicine, Graduate School of Medicine Kyoto University Kyoto Japan
| | - Takahisa Kawaguchi
- Center for Genomic Medicine, Graduate School of Medicine Kyoto University Kyoto Japan
| | - Takanobu Tsutsumi
- Center for Genomic Medicine, Graduate School of Medicine Kyoto University Kyoto Japan
| | - Satoshi Morita
- Department of Biomedical Statistics and Bioinformatics, Graduate School of Medicine Kyoto University Kyoto Japan
| | - Yoshimitsu Takahashi
- Department of Health Informatics Kyoto University School of Public Health Kyoto Japan
| | - Takeo Nakayama
- Department of Health Informatics Kyoto University School of Public Health Kyoto Japan
| | - Susumu Sato
- Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine Kyoto University Kyoto Japan
| | - Toyohiro Hirai
- Department of Respiratory Medicine, Graduate School of Medicine Kyoto University Kyoto Japan
| | - Fumihiko Matsuda
- Center for Genomic Medicine, Graduate School of Medicine Kyoto University Kyoto Japan
| | - Kazuo Chin
- Center for Genomic Medicine, Graduate School of Medicine Kyoto University Kyoto Japan
- Department of Sleep Medicine and Respiratory Care, Division of Sleep Medicine Nihon University of Medicine Tokyo Japan
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Obesity as a mediator linking sleep-disordered breathing to both impaired fasting glucose and type 2 diabetes. Sleep Breath 2022; 27:1067-1080. [DOI: 10.1007/s11325-022-02705-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 08/24/2022] [Accepted: 08/30/2022] [Indexed: 10/14/2022]
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Chung J, Goodman M, Huang T, Wallace ML, Johnson DA, Bertisch S, Redline S. Racial-ethnic Differences in Actigraphy, Questionnaire, and Polysomnography Indicators of Healthy Sleep: The Multi-Ethnic Study of Atherosclerosis. Am J Epidemiol 2021; 193:kwab232. [PMID: 34498675 DOI: 10.1093/aje/kwab232] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 08/11/2021] [Accepted: 09/02/2021] [Indexed: 11/14/2022] Open
Abstract
A paradigm shift in sleep science argues for a systematic, multidimensional approach to investigate sleep's association with disease and mortality and to address sleep disparities. We utilized the comprehensive sleep assessment of the Multi-Ethnic Study of Atherosclerosis (2010- 2013), a cohort of U.S. White, Black, Chinese, and Hispanic adults and older adults (n=1,736; mean age=68.3), to draw 13 sleep dimensions and create composite Sleep Health Scores to quantify multidimensional sleep health disparities. After age and sex adjustment in linear regression, compared to White participants, Black participants showed the greatest global sleep disparity, then Hispanic and Chinese participants. We estimated relative 'risk' of obtaining favorable sleep compared to White adults at the component level by race/ethnicity (lower is worse). The largest disparities were in objectively-measured sleep timing regularity (RRBlack [95% CI]: 0.37 [0.29,0.47], RRHispanic: 0.64 [0.52,0.78], RRChinese: 0.70 [0.54,0.90]) and duration regularity (RRBlack: 0.55 [0.47,0.65], RRHispanic: 0.76 [0.66,0.88], RRChinese: 0.74 [0.61,0.90]), after sex and age adjustment. Disparities in duration and continuity were also apparent, and Black adults were additionally disadvantaged in %N3 (slow wave sleep), sleepiness, and sleep timing (24-hour placement). Sleep timing regularity, duration regularity, duration, and continuity may comprise a multidimensional cluster of targets to reduce racial-ethnic sleep disparities.
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Affiliation(s)
- Joon Chung
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Matthew Goodman
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Tianyi Huang
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Meredith L Wallace
- Department of Psychiatry, University of Pittsburgh, PA
- Department of Biostatistics, University of Pittsburgh, PA
| | - Dayna A Johnson
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Suzanne Bertisch
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
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12
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Sleep Disordered Breathing and Cardiovascular Disease: JACC State-of-the-Art Review. J Am Coll Cardiol 2021; 78:608-624. [PMID: 34353537 DOI: 10.1016/j.jacc.2021.05.048] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 05/11/2021] [Indexed: 12/23/2022]
Abstract
Sleep disordered breathing causes repetitive episodes of nocturnal hypoxemia, sympathetic nervous activation, and cortical arousal, often associated with excessive daytime sleepiness. Sleep disordered breathing is common in people with, or at risk of, cardiovascular (CV) disease including those who are obese or have hypertension, coronary disease, heart failure, or atrial fibrillation. Current therapy of obstructive sleep apnea includes weight loss (if obese), exercise, and positive airway pressure (PAP) therapy. This improves daytime sleepiness. Obstructive sleep apnea is associated with increased CV risk, but treatment with PAP in randomized trials has not been shown to improve CV outcome. Central sleep apnea (CSA) is not usually associated with daytime sleepiness in heart failure or atrial fibrillation and is a marker of increased CV risk, but PAP has been shown to be harmful in 1 randomized trial. The benefits of better phenotyping, targeting of higher-risk patients, and a more personalized approach to therapy are being explored in ongoing trials.
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13
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Ahn S, Lobo JM, Logan JG, Kang H, Kwon Y, Sohn MW. A scoping review of racial/ethnic disparities in sleep. Sleep Med 2021; 81:169-179. [PMID: 33713923 DOI: 10.1016/j.sleep.2021.02.027] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 02/08/2021] [Accepted: 02/11/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Despite remarkable achievements in ensuring health equity, racial/ethnic disparities in sleep still persist and are emerging as a major area of concern. Accumulating evidence has not yet been well characterized from a broad perspective. We conducted a scoping review of studies on sleep disparities by race/ethnicity to summarize characteristics of existing studies and identify evidence gaps. METHODS We searched PubMed, CINAHL, PsycINFO, and Web of Science databases for studies of racial/ethnic disparities in sleep. Studies that met inclusion criteria were retrieved and organized in a data charting form by study design, sleep measuring methods, sleep features, and racial/ethnic comparisons. RESULTS One hundred sixteen studies were included in this review. Most studies focused on disparities between Whites and Blacks. Disproportionately fewer studies examined disparities for Hispanic, Asian, and other racial/ethnic groups. Self-reported sleep was most frequently used. Sleep duration, overall sleep quality, and sleep disordered breathing were frequently studied, whereas other features including sleep efficiency, latency, continuity, and architecture were understudied, particularly in racial minority groups in the US. Current study findings on racial/ethnic disparities in most of sleep features is mixed and inconclusive. CONCLUSIONS This review identified significant evidence gaps in racial/ethnic disparities research on sleep. Our results suggest a need for more studies examining diverse sleep features using standardized and robust measuring methods for more valid comparisons of sleep health in diverse race/ethnicity groups.
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Affiliation(s)
- Soojung Ahn
- School of Nursing, University of Virginia, Charlottesville, VA, USA
| | - Jennifer M Lobo
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Jeongok G Logan
- School of Nursing, University of Virginia, Charlottesville, VA, USA
| | - Hyojung Kang
- College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Younghoon Kwon
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Min-Woong Sohn
- Department of Health Management and Policy, College of Public Health, University of Kentucky, Lexington, KY, USA.
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14
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Qin H, Chen C, Steenbergen N, Cheng Y, Penzel T. Time-dependence and comparison of regional and overall anthropometric features between Asian and Caucasian populations with obstructive sleep apnea: a cumulative meta-analysis. J Thorac Dis 2021; 13:1746-1759. [PMID: 33841965 PMCID: PMC8024799 DOI: 10.21037/jtd-20-1799] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background Anthropometric measurements are simple and reachable tools for self-evaluating and screening patients with a high risk of obstructive sleep apnea (OSA). However, the accumulated relationship of obesity on the anthropometric characteristics of OSA is not well understood. The aim of the study was to show the time-dependent trend of OSA patients and compare overall and regional anthropometric between two ethnicities. Methods A cumulative meta-analysis was performed to assess obesity metrics in patients with and without OSA between Asians and Caucasians. We searched PubMed, Web of Science, Embase, and Scopus up to Jun 2020. Included studies used body mass index (BMI), neck circumference (NC), waist circumference (WC) and waist-to-hip ratio (WHR) as measures of anthropometric features in the adult OSA population and controls, utilized in-lab polysomnography or home sleep testing with apnea-hypopnea index (AHI) or respiratory disturbance index (RDI) classification, reported ethnicity/race, and were published in English. Any studies lacking one of these criteria or sufficient data were excluded. Results Forty studies with a total of 19,142 subjects were investigated. Comparison of changes between patients with and without OSA showed that OSA patients had a higher BMI [mean difference (MD) 3.12, 95% confidence interval (CI): 2.51–3.73], NC (MD 3.10, 95% CI: 2.70–3.51), WC (MD 9.84, 95% CI: 8.42–11.26) and waist-hip ratio (MD 0.04, 95% CI: 0.03–0.05) than the control subjects. The accumulated time-dependent increase in population with OSA was significantly apparent with all anthropometric features. BMI increased from 2000 (MD 0.50) to 2012 (MD 3.08–3.48) and remained stable afterwards (MD 2.70–3.17), NC increased from 2000 (MD 0.40) to 2013 (MD 3.09) and remained stable afterwards too (MD 3.06–3.21). WC increased from 2000 (MD 2.00) to 2012 (MD 9.37–10.03) and also remained stable afterwards (MD 8.99–9.84). WHR was stable from 2000 to 2004 with an MD of 0.01 and then stable from 2007 onwards with an increased MD of 0.03–0.04. Compared with Caucasian patients, Asian patients had lower obesity relevant variates. Conclusions BMI, NC, WC and WHR are associated with OSA in both ethnic groups. Anthropometry for overall and regional obesity could facilitate differentiation of patients with OSA from individuals without OSA by ethnicity.
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Affiliation(s)
- Hua Qin
- Interdisciplinary Center of Sleep Medicine, Charité University Hospital, Berlin, Germany
| | - Chongxiang Chen
- Guangzhou Institute of Respiratory Diseases, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, Guangzhou, China
| | | | - Yang Cheng
- Department of Respiratory and Critical Care Medicine, Beijing Jishuitan Hospital, the Fourth Medical College of Peking University, Beijing, China
| | - Thomas Penzel
- Interdisciplinary Center of Sleep Medicine, Charité University Hospital, Berlin, Germany.,Saratov State University, Saratov, Saratov Oblast, Russia
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15
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Sa J, Samuel T, Chaput JP, Chung J, Grigsby-Toussaint DS, Lee J. Sex and racial/ethnic differences in sleep quality and its relationship with body weight status among US college students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2020; 68:704-711. [PMID: 31039082 DOI: 10.1080/07448481.2019.1594829] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 12/19/2018] [Accepted: 03/11/2019] [Indexed: 06/09/2023]
Abstract
Objective: To examine sex and racial/ethnic differences in sleep quality and the association between sleep quality and body weight status among US college students. Participants: A nationally representative sample (N = 324,767) of college students from 2011 to 2015. Methods: A secondary data analysis of cross-sectional data. Results: Women showed poorer sleep quality (nights per week getting enough sleep to feel rested) than men (4.00 versus 4.34 days; p < .001). In both men and women, compared with non-Hispanic whites, racial/ethnic minorities showed lower sleep quality (p < .001). Compared with normal weight participants, overweight participants had poorer sleep quality (p = .007) among men, and both overweight (p = .004) and obese participants (p < .001) had lower sleep quality among women. Conclusions: Understanding sex and racial/ethnic sleep differences and the association between sleep and body weight status is important for colleges to promote college students' healthy sleep.
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Affiliation(s)
- Jaesin Sa
- College of Education and Health Sciences, Touro University, Vallejo, California, USA
| | - Tonya Samuel
- College of Nursing and Public Health, Adelphi University, Garden City, New York, USA
| | - Jean-Philippe Chaput
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Joon Chung
- Department of Sociology, Emory University, Atlanta, Georgia, USA
| | - Diana S Grigsby-Toussaint
- Department of Kinesiology and Community Health, Division of Nutritional Sciences, University of Illinois Urbana-Champaign, Champaign, Illinois, USA
| | - Jounghee Lee
- Department of Nutrition Education, Graduate School of Education, Kyonggi University, Suwon-si, Gyeonggi-do, South Korea
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16
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Gaston SA, McWhorter KL, Parks CG, D'Aloisio AA, Rojo-Wissar DM, Sandler DP, Jackson CL. Racial/Ethnic Disparities in the Relationship Between Traumatic Childhood Experiences and Suboptimal Sleep Dimensions Among Adult Women: Findings from the Sister Study. Int J Behav Med 2020; 28:116-129. [PMID: 32725587 DOI: 10.1007/s12529-020-09905-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Traumatic childhood experiences (TCEs) are associated with poor adulthood sleep, but racial/ethnic disparities have not been well-studied. We investigated the TCE-adulthood sleep relationship among non-Hispanic (NH)-White, NH-Black, and Hispanic/Latina women. METHOD Women enrolled in the Sister Study from 2003 to 2009 reported the following TCEs in a follow-up interview (2008-2012): natural disasters; major accidents; household dysfunction; and sexual, physical, and psychological/emotional abuse. Sleep characteristics included short sleep duration (< 7 h vs. 7-9 h), long sleep onset latency (SOL) (> 30 vs. ≤ 30 min), frequent night awakenings (≥ 3 times/night ≥ 3 times/week [yes vs. no]), and frequent napping (≥ 3 vs. < 3 times/week). Using log-binomial regression to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) for sleep characteristics among women with vs. without TCEs, we investigated racial/ethnic-specific associations and race/ethnicity as a moderator. RESULTS Among 40,082 participants (mean age = 55 ± 8.8 years), 55% reported ≥ 1 TCE (NH-White, 54%; NH-Black, 62%; Hispanic/Latina, 57%). NH-White, NH-Black, and Hispanic/Latina women reporting any TCE had a higher prevalence of short sleep compared with their within-race/ethnicity counterparts without TCEs. Associations were strongest among NH-Whites. Compared to NH-Whites with no TCEs, racial/ethnic minorities who reported any TCEs had a higher prevalence of short sleep (PRBlacks = 2.13 [95% CI 2.02-2.24], PRHispanics/Latinas = 1.47 [1.35-1.60]) and long SOL. When comparing racial/ethnic minorities with TCEs to NH-Whites with TCEs, PRs for short sleep (PRBlacks = 1.98 [1.88-2.08] and PRHispanics/Latinas = 1.36 [1.25-1.48]) and long SOL were weaker. CONCLUSION TCEs were positively associated with poor sleep characteristics among women, and TCEs appear to contribute to short sleep duration and long SOL disparities.
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Affiliation(s)
- Symielle A Gaston
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, 111 TW Alexander Drive, Research Triangle Park, Durham, NC, 27709, USA
| | - Ketrell L McWhorter
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, 111 TW Alexander Drive, Research Triangle Park, Durham, NC, 27709, USA
| | - Christine G Parks
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, 111 TW Alexander Drive, Research Triangle Park, Durham, NC, 27709, USA
| | | | - Darlynn M Rojo-Wissar
- Department of Mental Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Dale P Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, 111 TW Alexander Drive, Research Triangle Park, Durham, NC, 27709, USA
| | - Chandra L Jackson
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, 111 TW Alexander Drive, Research Triangle Park, Durham, NC, 27709, USA. .,Intramural Program, National Institute on Minority Health and Health Disparities, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA.
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17
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Jindal RD. Publishing in the Journal of Clinical Sleep Medicine: tips from an associate editor. J Clin Sleep Med 2020; 16:997-998. [PMID: 32329433 DOI: 10.5664/jcsm.8504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Ripu D Jindal
- Birmingham VA Medical Center, University of Alabama at Birmingham, Birmingham, Alabama
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18
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Hill EA, Sawatari H, Nishizaka MK, Fairley DM, Chishaki A, Funakoshi K, Riha RL, Ando SI. A Cross-Sectional Comparison of the Prevalence of Obstructive Sleep Apnea Symptoms in Adults With Down Syndrome in Scotland and Japan. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2020; 125:260-273. [PMID: 32609806 DOI: 10.1352/1944-7558-125.4.260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 11/04/2019] [Indexed: 06/11/2023]
Abstract
Small studies in Western populations report a high prevalence of obstructive sleep apnea (OSA) in adults with Down syndrome. To date, ethnic differences have not been explored. A questionnaire sent to 2,752 adults with Down syndrome aged ≥16 years in Scotland and Japan (789 valid responses) estimated OSA prevalence based on reported symptoms. Symptoms were common in both countries, with snoring (p = 0.001) and arousals (p = 0.04) more prevalent in Japan. Estimated OSA prevalence in adults with Down syndrome was similar in the two countries, and raised in comparison with the general adult population (19.6% in Scotland and 14.3% in Japan; p = 0.08), though BMI was a confounder. Identification and treatment of OSA is recommended in adults with Down syndrome, regardless of ethnicity.
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Affiliation(s)
- Elizabeth A Hill
- The University of Edinburgh and NHS Lothian, Edinburgh, United Kingdom
| | - Hiroyuki Sawatari
- Kyushu University, Fukuoka, Japan, and Hiroshima University, Hiroshima, Japan
| | - Mari K Nishizaka
- Kyushu University Hospital and Kyushu University, Fukuoka, Japan
| | | | | | | | - Renata L Riha
- The University of Edinburgh, Edinburgh, United Kingdom
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19
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Matsumoto T, Murase K, Tabara Y, Minami T, Kanai O, Takeyama H, Takahashi N, Hamada S, Tanizawa K, Wakamura T, Komenami N, Setoh K, Kawaguchi T, Tsutsumi T, Morita S, Takahashi Y, Nakayama T, Hirai T, Matsuda F, Chin K. Sleep disordered breathing and metabolic comorbidities across sex and menopausal status in East Asians: the Nagahama Study. Eur Respir J 2020; 56:13993003.02251-2019. [DOI: 10.1183/13993003.02251-2019] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 04/20/2020] [Indexed: 01/07/2023]
Abstract
It is well known that the prevalence of sleep disordered breathing (SDB) is increased in patients with obesity or metabolic comorbidities. However, the way in which the prevalence of SDB increases in relation to comorbidities according to the severity of obesity remains unclear.This cross-sectional study evaluated 7713 community participants using nocturnal oximetry ≥2 nights. SDB was assessed by the 3% oxygen desaturation index corrected for sleep duration obtained by wrist actigraphy (acti-ODI3%). SDB severity was defined by acti-ODI3%. Obesity was defined as body mass index ≥25 kg·m−2.The prevalence of SDB was 41.0% (95% CI 39.9–42.1%), 46.9% (45.8–48.0%), 10.1% (9.5–10.8%) and 2.0% (1.7–2.3%) in normal, mild, moderate and severe SDB, respectively, with notable sex differences evident (males>post-menopausal females>premenopausal females). Comorbidities such as hypertension, diabetes and metabolic syndrome were independently associated with the prevalence of moderate-to-severe SDB, and coincidence of any one of these with obesity was associated with a higher probability of moderate-to-severe SDB (hypertension OR 8.2, 95% CI 6.6–10.2; diabetes OR 7.8, 95% CI 5.6–10.9; metabolic syndrome OR 6.7, 95% CI 5.2–8.6). Dyslipidaemia in addition to obesity was not additively associated with the prevalence of moderate-to-severe SDB. The number of antihypertensive drugs was associated with SDB (p for trend <0.001). Proportion of a high cumulative percentage of sleep time with oxygen saturation measured by pulse oximetry <90% increased, even among moderate-to-severe SDB with increases in obesity.Metabolic comorbidities contribute to SDB regardless of the degree of obesity. We should recognise the extremely high prevalence of moderate-to-severe SDB in patients with obesity and metabolic comorbidities.
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20
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Jackson CL, Powell-Wiley TM, Gaston SA, Andrews MR, Tamura K, Ramos A. Racial/Ethnic Disparities in Sleep Health and Potential Interventions Among Women in the United States. J Womens Health (Larchmt) 2020; 29:435-442. [PMID: 32096683 PMCID: PMC7097680 DOI: 10.1089/jwh.2020.8329] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
While essential for health and wellness, the various dimensions of sleep health are generally not equitably distributed across the population, and reasons for racial/ethnic sleep disparities are not fully understood. In this review, we describe racial/ethnic sleep disparities and subsequent implications for health from prior and recently conducted epidemiological and clinical studies as well as the potential sleep interventions presented at the 2018 Research Conference on Sleep and the Health of Women at the National Institutes of Health. Given the clear connection between sleep and poor health outcomes such as cardiovascular disease, we concluded that future studies are needed to focus on sleep health in general, sleep disorders such as insomnia and obstructive sleep apnea in particular, and disparities in both sleep health and sleep disorders among women using an intersectional framework. Future research should also integrate sleep into interventional research focused on women's health as these results could address health disparities by informing, for example, future mobile health (mHealth) interventions prioritizing women beyond the clinical setting.
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Affiliation(s)
- Chandra L. Jackson
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Sciences, Research Triangle Park, North Carolina
- Intramural Program, National Institute on Minority Health and Health Disparities, National Institutes of Health, Department of Health and Human Sciences, Bethesda, Maryland
| | - Tiffany M. Powell-Wiley
- Intramural Program, National Institute on Minority Health and Health Disparities, National Institutes of Health, Department of Health and Human Sciences, Bethesda, Maryland
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Symielle A. Gaston
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Sciences, Research Triangle Park, North Carolina
| | - Marcus R. Andrews
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Kosuke Tamura
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Alberto Ramos
- Department of Neurology, University of Miami, Miller School of Medicine, Miami, Florida
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21
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Sutherland K, Keenan BT, Bittencourt L, Chen NH, Gislason T, Leinwand S, Magalang UJ, Maislin G, Mazzotti DR, McArdle N, Mindel J, Pack AI, Penzel T, Singh B, Tufik S, Schwab RJ, Cistulli PA. A Global Comparison of Anatomic Risk Factors and Their Relationship to Obstructive Sleep Apnea Severity in Clinical Samples. J Clin Sleep Med 2019; 15:629-639. [PMID: 30952214 DOI: 10.5664/jcsm.7730] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 01/09/2019] [Indexed: 12/14/2022]
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) is a global health issue and is associated with obesity and oropharyngeal crowding. Global data are limited on the effect of ethnicity and sex on these relationships. We compare associations between the apnea-hypopnea index (AHI) and these risk factors across ethnicities and sexes within sleep clinics. METHODS This is a cross-sectional, multicenter study of patients with OSA from eight sleep centers representing the Sleep Apnea Global Interdisciplinary Consortium (SAGIC). Four distinct ethnic groups were analyzed, using a structured questionnaire: Caucasians (Australia, Iceland, Germany, United States), African Americans (United States), Asians (Taiwan), and South Americans (Brazil). Regression analyses and interaction tests were used to assess ethnic and sex differences in relationships between AHI and anthropometric measures (body mass index [BMI], neck circumference, waist circumference) or Mallampati score. RESULTS Analyses included 1,585 individuals from four ethnic groups: Caucasian (60.6%), African American (17.5%), Asian (13.1%), and South American (8.9%). BMI was most strongly associated with AHI in South Americans (7.8% increase in AHI per 1 kg/m2 increase in BMI; P < .0001) and most weakly in African Americans (1.9% increase in AHI per 1 kg/m2 increase in BMI; P = .002). In Caucasians and South Americans, associations were stronger in males than females. Mallampati score differed between ethnicities but did not influence AHI differently across groups. CONCLUSIONS We demonstrate ethnic and sex variations in associations between obesity and OSA. For similar BMI increases, South American patients show greatest AHI increases compared to African Americans. Findings highlight the importance of considering ethnicity and sex in clinical assessments of OSA risk.
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Affiliation(s)
- Kate Sutherland
- Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Charles Perkins Centre, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Brendan T Keenan
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lia Bittencourt
- Disciplilna de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Ning-Hung Chen
- Sleep Center, Department of Pulmonary and Critical Care Medicine; Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Thorarinn Gislason
- Department of Respiratory Medicine and Sleep, Landspitali -The National University Hospital of Iceland and Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Sarah Leinwand
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ulysses J Magalang
- Division of Pulmonary, Critical Care, and Sleep Medicine, The Ohio State Wexner Medical Center, Columbus, Ohio
| | - Greg Maislin
- Division of Sleep Medicine, Perelman School of Medicine at the University of Pennsylvania
| | - Diego R Mazzotti
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nigel McArdle
- West Australian Sleep Disorders Research Institute; Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital; University of Western Australia, Perth, Western Australia, Australia
| | - Jesse Mindel
- Division of Pulmonary, Critical Care, and Sleep Medicine, The Ohio State Wexner Medical Center, Columbus, Ohio
| | - Allan I Pack
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Thomas Penzel
- Center of Sleep Medicine, Charité University Hospital, Berlin, Germany
| | - Bhajan Singh
- West Australian Sleep Disorders Research Institute; Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital; University of Western Australia, Perth, Western Australia, Australia
| | - Sergio Tufik
- Disciplilna de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Richard J Schwab
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Peter A Cistulli
- Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Charles Perkins Centre, Sydney Medical School, University of Sydney, Sydney, Australia
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22
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Bove C, Jain V, Younes N, Hynes M. What You Eat Could Affect Your Sleep: Dietary Findings in Patients With Newly Diagnosed Obstructive Sleep Apnea. Am J Lifestyle Med 2018; 15:305-312. [PMID: 34025323 DOI: 10.1177/1559827618765097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Rationale. We hypothesized that certain dietary components such as increased fat intake are associated with severity of obstructive sleep apnea (OSA). Methods. A total of 104 patients, diagnosed with OSA completed a validated dietary survey. The apnea-hypopnea index (AHI) was used to measure the severity of OSA. Subjects were divided using body mass index (BMI) into obese and overweight categories. Regression analysis was performed to predict severity of OSA from gender, BMI, age, % energy from fat, and the individual dietary components of the survey. Results. Overweight subjects who ate a diet high in fat (>35% of their total diet) had twice the severity of sleep apnea (AHI 18.2 ± 10.1 vs 36.6 ± 27.5; P = .001). There was a strong trend (P = .056) in OSA severity between subjects eating processed meats "often" (AHI 42.5 ± 30.7) versus those eating "rarely/never" (AHI 28.9 ± 22.7). Eating greater than 2 servings of dairy daily was associated with worsening severity of OSA (AHI 26.2 ± 15.6 vs 39.7 ± 31; P = .04]. Conclusions. Dietary components such as fat intake and processed meats were associated with increased risk of OSA severity. In addition, 2 servings of dairy foods were associated with a decreased severity of OSA at presentation.
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Affiliation(s)
- Caitlin Bove
- George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Vivek Jain
- George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Naji Younes
- George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Marijane Hynes
- George Washington University School of Medicine and Health Sciences, Washington, DC
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Associations of obstructive sleep apnea with truncal skeletal muscle mass and density. Sci Rep 2018; 8:6550. [PMID: 29695811 PMCID: PMC5916913 DOI: 10.1038/s41598-018-24750-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 04/10/2018] [Indexed: 12/21/2022] Open
Abstract
Sarcopenia has been associated with several conditions relevant to obstructive sleep apnea (OSA), such as aging and obesity, but a direct relationship between OSA and skeletal muscle alterations has not been identified. This study investigated associations between computed tomography (CT)-measured skeletal muscle indices and OSA severity. Analyzed were 334 patients who underwent polysomnography to diagnose OSA. Lumbar skeletal muscles were assessed with CT for the skeletal muscle mass index (SMI, cross-sectional area, normalized for height squared) and skeletal muscle density (SMD, fat infiltration). The apnea-hypopnea index (AHI) correlated positively with the SMI and negatively with SMD in both men and women. The AHI was weakly associated with SMI only in men (β = 0.11, P = 0.017) after adjustment for the body mass index (BMI) (BMI: β = 0.61, P < 0.001 in men, β = 0.65, P < 0.001 in women). The association of AHI and SMD was not significant after adjustment for BMI (BMI: β = −0.42, P < 0.001 in men, β = −0.64, P < 0.001 in women). Severity of OSA correlated with increases in skeletal muscle mass rather than muscle depletion and skeletal muscle adiposity. These associations were limited compared with the stronger associations between obesity and skeletal muscles.
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Abstract
Racial/ethnic minorities experience a disproportionate risk of both suboptimal sleep and obesity, and the relationship between sleep and obesity may differ by race/ethnicity for modifiable and non-modifiable reasons. Because many people of color have historically lived and continue to largely live in disadvantaged, obesogenic physical and social environments, these greater adverse exposures likely negatively affect sleep, resulting in physiological dysregulation. Physiological dysregulation may, in turn, lead to increased obesity risk and subsequent health consequences, which are likely more influential than potential genetic differences in race, a social construct. The purpose of this article is to describe potential environmental, genetic, and epigenetic determinants of racial/ethnic differences in the sleep-obesity relationship and to review current epidemiological findings regarding either racial/ethnic minority specific estimates of the association or disparities in the relationship. Using the socioecological framework as a conceptual model, I describe sleep and obesity as socially patterned and embedded in modifiable physical and social contexts with common causes that are influenced by upstream social conditions. I also provide examples of sleep and obesity-related studies that correspond with the downstream, intermediate, and upstream factors that likely contribute to commonly observed racial/ethnic disparities in the sleep-obesity relationship. The review concludes with broad recommendations for (1) advancing research methodology for epidemiological studies of disparities in the link between sleep and obesity, (2) future research topics, as well as (3) several broad policies and structures needed to address racial/ethnic disparities in sleep health and obesity.
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Affiliation(s)
- Chandra L Jackson
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC, USA.
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25
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Smith HA, Smith ML. The Role of Dentists and Primary Care Physicians in the Care of Patients with Sleep-Related Breathing Disorders. Front Public Health 2017; 5:137. [PMID: 28664155 PMCID: PMC5471315 DOI: 10.3389/fpubh.2017.00137] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 05/30/2017] [Indexed: 11/27/2022] Open
Affiliation(s)
- Harold A Smith
- Dental Sleep Medicine of Indiana, Indianapolis, IN, United States
| | - Matthew Lee Smith
- Department of Health Promotion and Behavior, College of Public Health, The University of Georgia, Athens, GA, United States.,Department of Health Promotion and Community Health Sciences, School of Public Health, Texas A&M University, College Station, TX, United States
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26
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McNicholas WT, Bonsignore MR, Lévy P, Ryan S. Mild obstructive sleep apnoea: clinical relevance and approaches to management. THE LANCET RESPIRATORY MEDICINE 2016; 4:826-834. [PMID: 27245915 DOI: 10.1016/s2213-2600(16)30146-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 02/03/2016] [Accepted: 02/08/2016] [Indexed: 12/18/2022]
Abstract
Obstructive sleep apnoea is highly prevalent in the general population worldwide, especially in its mild form. Clinical manifestations correlate poorly with disease severity measured by the apnoea-hypopnoea index (AHI), which complicates diagnosis. Full polysomnography might be more appropriate to assess suspected mild cases because limited ambulatory diagnostic systems are least accurate in mild disease. Treatment options in mild obstructive sleep apnoea include continuous positive airway pressure (CPAP) and oral appliance therapy, in addition to positional therapy and weight reduction when appropriate. The superior efficacy of CPAP in reducing AHI is offset by greater tolerance of oral appliances, especially in mild disease. Although severe obstructive sleep apnoea is associated with adverse health consequences, including cardiometabolic comorbidities, the association with mild disease is unclear, and reports differ regarding the clinical relevance of mild obstructive sleep apnoea. Improved diagnostic techniques and evidence-based approaches to management in mild obstructive sleep apnoea require further research.
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Affiliation(s)
- Walter T McNicholas
- Department of Respiratory and Sleep Medicine, St Vincent's University Hospital, Dublin, Ireland; School of Medicine and Medical Science, University College Dublin, Dublin, Ireland.
| | - Maria R Bonsignore
- DiBiMIS, University of Palermo, Palermo, Italy; CNR Institute of Biomedicine and Molecular Immunology (IBIM), Palermo, Italy
| | - Patrick Lévy
- Univ Grenoble Alpes, Inserm U1042, and Grenoble University Hospital, Grenoble, France
| | - Silke Ryan
- Department of Respiratory and Sleep Medicine, St Vincent's University Hospital, Dublin, Ireland; School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
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