Alcohol and the risk of sleep apnoea: a systematic review and meta-analysis

Treatment of insomnia associated with alcohol and opioid use: a narrative review

Substance use disorders (SUDs) are associated with profound sleep disturbances, including insomnia, sleep fragmentation, and circadian rhythm dysfunction resulting in serious mental and physical consequences. This minireview presents an overview of the neurocircuitry underlying sleep disturbances in SUDs and elaborates on treatment options with emphasis on alcohol use disorder (AUD) and opioid use disorder (OUD). A PubMed, Embase, CINAHL Plus, Cochrane, and Scopus search were conducted using sleep- and AUD/OUD related keywords from January 1st, 2000, to January 31st, 2023, with preferences for recent publications and randomized-controlled trials. A bidirectional relationship exists between insomnia and addiction with the status of each condition impacting the other in dictating clinical outcome. Existing evidence points to a resurgence of insomnia during detoxification, and unless treated satisfactorily, insomnia may lead to relapse. The discussion summarizes the strengths and limitations of cognitive behavioral therapy and pharmacological treatment for insomnia in SUDs covering evidence from both animal and clinical studies. The assumption of reestablishing normal sleep patterns by attaining and maintaining sobriety is misguided. Comorbid insomnia in patients with SUDs should be approached as an independent condition that requires its own treatment. Future clinical trials are needed with the aim of providing a resource for guiding clinical management of the many patients with insomnia and SUD.

Neuropathology of deaths due to acute alcohol toxicity in Australia, 2011-2022

BACKGROUND

A major alcohol-related harm is structural pathology affecting the brain. The study aimed to: 1. Determine the frequency and nature of neuropathology amongst cases of death due to acute alcohol toxicity; 2. Compare diagnoses of brain atrophy with pathology in other organs; 3. Determine the demographic, clinical and organ pathology correlates of brain atrophy.

METHODS

Retrospective study of 500 cases of death attributed to acute alcohol toxicity in Australia, 2011-2022. Data on clinical characteristics, toxicology, neuropathology and other organ pathology were retrieved from police reports, autopsies, toxicology and coronial findings.

RESULTS

Mean age was 49.5 years, 69.4 % were male, with alcohol use problems documented in 70.2 %. Brain atrophy was diagnosed in 60 cases (12.0 %), most commonly in the cerebellum (32 cases, 6.4 %). Atrophy at other sites was present in 37 (7.4 %). The presence of brain atrophy was lower than other major pathologies: cardiomegaly (32.6 %, p<.001), nephro/arteriosclerosis (30.2 %, p<.001), and chronic obstructive pulmonary disease (21.8 %, p<.001) but not hepatic cirrhosis (11.9 % p=1.0). Those diagnosed with atrophy were older (53.4v 49.0 years, p<.001), more likely to have documented alcohol problems (85.0v 68.2 %, Odds ratio: OR 2.53) and seizure history (10.0v 3.0 %, OR 2.92), to have cardiomegaly (43.3v 31.0 %, OR 1.90, COPD (48.3v 18.2 %, 3.57) and nephro/arteriosclerosis (50.0 v 27.4 %, OR 2.27).

CONCLUSIONS

Despite the majority of cases having a history of alcohol problems, the level of neuropathology amongst cases of death due to acute alcohol toxicity was comparatively low.

Sleep Apnea, Autonomic Disturbances, and Blood Pressure Variability

Augmented blood pressure variability has emerged as a quantity predictive of adverse cardiovascular outcomes. Among the range of intrinsic and extrinsic factors shown to increase night-time, circadian, short-term, and long-term blood pressure variations, the presence and severity of obstructive sleep apnea have emerged as one of the most prevalent and potent. Obstructive sleep apnea alters acutely the normal nocturnal equilibrium between sympathetic and parasympathetic tone, magnifying nocturnal blood pressure oscillations, and induces sustained autonomic aftereffects with the capacity to amplify short-term and intersessional blood pressure variabilities. The object of this brief review is to synthesize the current understanding of the potential interrelations between obstructive sleep apnea, the acute and sustained autonomic disturbances that it elicits, and beat-to-beat blood pressure fluctuation during sleep, nocturnal dipping status, and day-to-day blood pressure variability and the consequences of these perturbations for cardiovascular risk.

Recent advances in managing obstructive sleep apnea

Obstructive sleep apnea (OSA) is a rapidly increasing global concern. If it remains untreated, it can lead to cardiovascular, metabolic, and psychiatric complications and may result in premature death. The efficient and effective management of OSA can have a beneficial effect and help reduce the financial burden on the health sector. There has been constant development in OSA management, and numerous options are available. The mainstay of therapy is still the conventional measures and behavioral modifications. However, in cases of failure of these modalities, surgical therapy is the only option. Numerous studies have shown that proper management of OSA has beneficial effects with good long-term outcomes.

Association between triglyceride glucose-body mass index and obstructive sleep apnea: a study from NHANES 2015-2018

Background

The association between TyG-BMI index and the risk of obstructive sleep apnea (OSA), a recently identified biomarker indicating insulin resistance, has yet to be elucidated. Therefore, this study aimed to investigate the association between TyG-BMI index and the risk of OSA using the NHANES database.

Methods

Analyses were performed on NHANES data conducted between 2015 and 2018. Logistic regression, stratified analyses, curve-fitting analyses, and threshold effects analyses were utilized to assess the association between TyG-BMI index and the risk of OSA.

Results

The study included 4,588 participants. Multifactorial logistic regression analyses found a significant association between TyG-BMI and increased risk of OSA [OR: 1.54 (CI:1.39-1.70)]. In stratified analyses, age interacted with the association, with TyG-BMI being associated with increased risk of OSA only in a subgroup of subjects younger than 60 years [1.31 (1.14-1.50)], but gender, smoking status, and alcohol use, did not influence the association. The presence of diabetes, hypertension, and cardiovascular diseases also modified the association, but the number of the included subjects with such conditions was significantly lower, therefore the significance of associations was not observed in those subgroups. Additionally, the risk was non-linearly associated, with the inflection point of TyG-BMI at 12.09, after which the lower slope in the risk was observed.

Conclusion

This study demonstrates that elevated levels of the TyG-BMI index are correlated with risk for OSA, underscoring the significance of these findings in facilitating early prevention or timely intervention for OSA.

When the Clock Strikes A-fib

Within the broad spectrum of atrial fibrillation (AF) symptomatology, there is a striking subset of patients with predominant or even solitary nocturnal onset of the arrhythmia. This review covers AF with nocturnal onset, with the aim of defining this distinctive subgroup among patients with AF. A periodicity analysis is provided showing a clear increased onset between 10:00 pm and 7:00 am. Multiple interacting mechanisms are discussed, such as circadian modulation of electrophysiological properties, vagal tone, and sleep disorders, as well as the potential interaction and synergism between these factors, to provide a better understanding of this clinical entity. Lastly, potential therapeutic targets for AF with nocturnal onset are addressed such as upstream therapy for underlying comorbidities, type of drug and timing of drug administration and pulmonary vein isolation, ablation of the ganglionated plexus, and autonomic nervous system modulation. Understanding the underlying AF mechanisms in the individual patient with nocturnal onset will contribute to patient-specific therapy.

Association between alcohol use disorder and risk of obstructive sleep apnea

Obstructive sleep apnea (OSA) is a common sleep disorder characterised by recurrent upper airway collapse during sleep. Alcohol consumption has been linked to an increased risk of OSA due to its effects on the upper airway and body mass index (BMI). We aimed to investigate the correlation between alcohol use disorders and OSA. We used 11,859 participants data from Korean National Health and Nutrition Examination Surveys. The variable of interest was alcohol use disorder, measured using the Alcohol Use Disorders Identification Test, and the dependent variable was the risk of OSA, measured using the Snoring, Tiredness, Observed apnea, high blood Pressure, BMI, age, neck circumference, and male gender questionnaires. Multiple logistic regression was used to assess the association between alcohol use disorder and OSA risk after adjusted analysis. A significant association was found between alcohol use disorder and OSA (adjusted odds ratio [aOR] 2.14, 95% confidence interval [CI] 1.93-2.37). In the unemployed group, those with alcohol use disorder had the highest odds of being at risk of OSA compared with those who did not have this disorder (aOR 2.45, 95% CI 2.04-2.95). The OSA risk increased as the snoring frequency, amount of alcohol consumed, and frequency of binge drinking increased. This study suggests an association between alcohol use disorders and the risk of OSA. The frequency of alcohol consumption, quantity of alcohol consumed, and snoring frequency were associated with the risk of OSA. Therefore, ceasing alcohol consumption is recommended as an effective approach to enhancing sleep quality.

Prevalence of and factors associated with likely obstructive sleep apnea in individuals with airflow limitation

Introduction

Obstructive sleep apnea (OSA) is frequently associated with airflow limitation (AFL). However, information on the prevalence of and factors associated with likely OSA in individuals with AFL in Korea is limited.

Methods

Data from the 2019 Korea National Health and Nutrition Examination Survey (KNHANES) were used, and 3,280 individuals (2,826 individuals without AFL and 454 individuals with AFL) were included. AFL was defined as forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) < 0.7. A score ≥ 5 on the STOP-BANG questionnaire was used to identify individuals with likely OSA. The prevalence of likely OSA was compared between individuals with and without AFL. In addition, factors associated with likely OSA in individuals with AFL were evaluated using multivariable logistic regression analysis.

Results

Of 3,280 individuals, 13.8% had an AFL. The prevalence of likely OSA was significantly higher in individuals with AFL than in individuals without AFL (9.2% vs. 5.0%, p = 0.014). Among 454 individuals with AFL, obesity (adjusted odds ratio [aOR] = 14.78, 95% confidence interval [CI] = 4.20-52.02) was most strongly associated with likely OSA, followed by heavy alcohol consumption (aOR = 4.93, 95% CI = 1.91-12.70), hypertension (aOR = 4.92, 95% CI = 1.57-15.46), overweight (aOR = 4.71, 95% CI = 1.76-12.64), college graduate (aOR = 4.47, 95% CI = 1.10-18.22), and history of pulmonary tuberculosis (aOR = 3.40, 95% CI = 1.06-10.96).

Conclusion

In Korea, approximately 1 in 10 individuals with AFL had likely OSA. Overweight and obesity, heavy alcohol consumption, high educational level, hypertension, and history of pulmonary tuberculosis were associated with likely OSA in individuals with AFL.

A Systematic Review of Risk factors for Sleep Apnea

Background

Sleep apnea, a prevalent global health issue, is characterized by repeated interruptions in breathing during sleep. This systematic review aggregates global data to outline a comprehensive analysis of its associated risk factors.

Purpose

The systematic review underscores the global prevalence of sleep apnea and the universal importance of its early detection and management by delineating key risk factors contributing to its development.

Material and Methods

We conducted a thorough systematic review of international medical databases up to July 31, 2023, including PubMed, Medline, and Cochrane Library, to ensure a wide-ranging collection of data reflective of various populations.

Results

The systematic review identifies several risk factors such as obesity, age, gender, neck circumference, family history, smoking, alcohol use, underlying medical conditions, and nasal congestion, highlighting their prevalence across diverse demographics globally.

Conclusion

Emphasizing lifestyle modifications and proactive interventions, our findings advocate for global health strategies to mitigate the risk of sleep apnea and enhance sleep health worldwide.

The Effects of Obstructive Sleep Apnea on the Cardiovascular System: A Comprehensive Review

Obstructive sleep apnea (OSA) is an increasingly relevant cause of cardiovascular morbidity worldwide. Although the association between OSA and the cardiovascular system is well-known, the extent of its effects is still a topic of interest, including pathophysiologic mechanisms, cardiovascular sequelae, and OSA therapies and their effects. Commonly described mechanisms of cardiovascular etiologies revolve around sympathetic activation, inflammation, and intermittent hypoxia resulting from OSA. Ultimately, these effects lead to manifestations in the cardiovascular system, such as arrhythmias, hypertension, and heart failure, among others. The resulting sequelae of OSA may also have differential effects based on gender and age; several studies suggest female gender to have more susceptibility to cardiovascular mortality, as well as an increase in age. Furthermore, several therapies for OSA, both established and emerging, show a reduction in cardiovascular morbidity and may even reduce cardiovascular burden. Namely, the establishment of CPAP has led to improvement in hypertension and cardiac function in patients with heart failure and even reduced the progression of early stages of atherosclerosis. Effective management of OSA decreases abnormal neural sympathetic activity, which results in better rhythm control and blood pressure control, both in waking and sleep cycles. With newer therapies for OSA, its effects on the cardiovascular system may be significantly reduced or even reversed after long-term management. The vast extent of OSA on the cardiovascular system, as well as current and future therapeutic strategies, will be described in detail in this review.

Sleep Apnea and Heart Failure-Current State-of-The-Art

Sleep-disordered breathing (SDB), including obstructive and central sleep apnea, significantly exacerbates heart failure (HF) through adverse cardiovascular mechanisms. This review aims to synthesize existing literature to clarify the relationship between SDB and HF, focusing on the pathophysiological mechanisms, diagnostic challenges, and the effectiveness of treatment modalities like continuous positive airway pressure (CPAP) and adaptive servo-ventilation ASV. We analyzed peer-reviewed articles from 2003 to 2024 sourced from PubMed, EMBASE, Scopus, and Web of Science databases. The prevalence of SDB in HF patients is high, often underdiagnosed, and underappreciated. Management strategies, including CPAP and ASV, have been shown to mitigate symptoms and improve cardiac function. However, despite the availability of effective treatments, significant challenges in screening and diagnosis persist, affecting patient management and outcomes. DB significantly impacts HF prognosis. Enhanced screening strategies and broader utilization of therapeutic interventions like CPAP and ASV are essential to improve the management and outcomes of HF patients with concomitant SDB. Future research should focus on refining diagnostic and treatment protocols to optimize care for HF patients with SDB.

Pharmacological interventions for the treatment of obstructive sleep apnea syndrome

Obstructive Sleep Apnea Syndrome (OSAS) affects 13-33% of males and 6-9% of females globally and poses significant treatment challenges, including poor adherence to Continuous Positive Airway Pressure (CPAP) and residual excessive sleepiness (RES). This review aims to elucidate the emerging interest in pharmacological treatments for OSAS, focusing on recent advancements in this area. A thorough analysis of extensive clinical trials involving various drugs, including selective dopamine reuptake inhibitors, selective norepinephrine inhibitors, combined antimuscarinic agents, and orexin agonists, was conducted. These trials focused on ameliorating respiratory metrics and enhancing sleep quality in individuals affected by OSAS. The studied pharmacological agents showed potential in improving primary outcomes, notably the apnea-hypopnea index (AHI) and the Epworth sleepiness scale (ESS). These improvements suggest enhanced sleep quality and symptom management in OSAS patients. With a deeper understanding of OSAS, pharmacological interventions are emerging as a promising direction for its effective management. This review provides a comprehensive overview of the current state of drug research in OSAS, highlighting the potential of these treatments in addressing the disorder's complex challenges.

Approach the Patient With Obstructive Sleep Apnea and Obesity

Obstructive sleep apnea (OSA) and obesity are highly prevalent and bidirectionally associated. OSA is underrecognized, however, particularly in women. By mechanisms that overlap with those of obesity, OSA increases the risk of developing, or having poor outcomes from, comorbid chronic disorders and impairs quality of life. Using 2 illustrative cases, we discuss the relationships between OSA and obesity with type 2 diabetes, dyslipidemia, cardiovascular disease, cognitive disturbance, mood disorders, lower urinary tract symptoms, sexual function, and reproductive disorders. The differences in OSA between men and women, the phenotypic variability of OSA, and comorbid sleep disorders are highlighted. When the probability of OSA is high due to consistent symptoms, comorbidities, or both, a diagnostic sleep study is advisable. Continuous positive airway pressure or mandibular advancement splints improve symptoms. Benefits for comorbidities are variable depending on nightly duration of use. By contrast, weight loss and optimization of lifestyle behaviors are consistently beneficial.

Smoking and alcohol consumption with the risk of 11 common otolaryngological diseases: a bidirectional Mendelian randomization

PURPOSE

In this study, a bidirectional mendelian randomization was applied to evaluate the association of smoking and alcohol consumption with 11 otolaryngological diseases.

METHODS

A total of 85,22,34 and 7 single nucleotide polymorphisms were used as instrumental variables for smoking initiation, cigarettes per day, alcoholic drinks per week and alcohol consumption, respectively. Genetic associations with 11 common otolaryngological diseases were obtained from the UK Biobank and FinnGen dataset. IVW, weighted median, MR-Egger, MR-PRESSO and leave-one-out method were used in this analysis.

RESULTS

Smoking initiation increased the risk of vocal cord and larynx diseases (OR 1.002; 95% CI 1.001-1.004; P = 4 × 10-4), head and neck cancer (OR 1.001; 95% CI 0.999-1.003; P = 0.027), thyroid cancer (OR 1.538; 95% CI 1.006-2.351; P = 0.047) and sleep apnoea (OR 1.286; 95% CI 1.099-1.506; P = 0.002). Cigarettes per day was associated with chronic sinusitis (OR 1.152; 95% CI 1.002-1.324; P = 0.046), chronic rhinitis and pharyngitis (OR 1.200; 95% CI 1.033-1.393; P = 0.017), vocal cord and larynx diseases (OR 1.001; 95% CI 0.999-1.002; P = 0.021) and head and neck cancer (OR 1.001; 95% CI 0.999-1.003; P = 0.017). Alcoholic drinks per week only was significantly associated with the risk of head and neck cancer (OR 1.003; 95% CI 1.001-1.006; P = 0.014). However, there was no evidence to support that genetically predicted alcohol consumption increased the risk of otolaryngological diseases. Reverse MR also did not find outcomes effect on exposures.

CONCLUSION

This study shows that smoking and heavy alcohol consumption promote the occurrence of some otolaryngological diseases indicating that lifestyle modification might be beneficial in preventing otolaryngological diseases.

Longitudinal risk factors for obstructive sleep apnea: A systematic review

Despite substantial disease burden, existing evidence on the risk factors for obstructive sleep apnea (OSA) have been derived primarily from cross-sectional studies without determining temporality. Therefore, we aimed to systematically synthesize the literature on longitudinal risk factors for sleep study-assessed OSA and questionnaire-assessed probable OSA from cohort studies in the general adult population settings. We systematically searched Embase and Medline (on OVID) databases. Eleven studies met the inclusion criteria. Meta-analyses were not conducted due to methodological heterogeneity of exposure and outcome measurements. There was consistent evidence that weight gain was associated with incident (n = 2) and greater severity (n = 2) of OSA. One study each observed an association of higher baseline body-mass index, male sex, asthma, a specific genetic polymorphism in rs12415421, and insulin resistance/hyperglycemia, with incident OSA. Long-term exposure to ambient air pollution (NO2, n = 1) was associated with OSA, and menopausal transitions (n = 1) with higher apnea-hypopnea index. There were no eligible studies on long-term smoking or alcohol use. In conclusion, approximately 10% increase in weight, especially in males, might alert clinicians to consider potential or worsening OSA. Large, well-designed longitudinal studies are needed to consolidate knowledge on other associations with OSA development, especially on potentially modifiable risk factors.

Five-year changes in alcohol intake and risk of atrial fibrillation: a Danish cohort study

AIMS

Alcohol intake is a well-established risk factor for atrial fibrillation (AF). However, evidence on the effects of changes in alcohol intake to primary AF prevention is sparse. The aim of this study was to examine the association between 5-year changes in alcohol intake and the risk of incident AF.

METHODS AND RESULTS

This study was based on the Danish cohort study Diet, Cancer and Health. Lifestyle factors were assessed using questionnaires at a recruitment research examination and a second examination 5 years later. Diagnoses of AF and comorbidities were retrieved from the Danish National Patient Registry. 43 758 participants without prior AF were included. The median age was 61 (25th-75th percentile 58-66) years and 54% were female. Over a median follow-up time of 15.7 years, 5312 participants had incident AF (incidence rate 8.6/1000 person-years). Compared with stable intake, increases in alcohol intake to ≥21 drinks/week from ≤6.9 drinks/week (HR: 1.38, 95% CI: 1.09-1.72) or 14-20.9 drinks/week (HR: 1.27, 95% CI: 1.01-1.59) at baseline were associated with a higher risk of AF. In contrast, we did not observe a statistically significant association between reductions in alcohol intake and the risk of AF.

CONCLUSION

A 5-year increase in alcohol intake was associated with a greater risk of AF compared with a stable low/moderate intake.

An Update on Obstructive Sleep Apnea Syndrome-A Literature Review

Obstructive sleep apnea syndrome (OSAS) is the most common breathing-related sleep disorder. It is characterized by recurrent episodes of partial or complete airway obstruction during sleep, resulting in a reduction in or the total cessation of airflow, despite ongoing respiratory efforts, leading to oxygen desaturation and arousal. The purpose of this literature review is to evaluate the most common characteristics of this pathology, as well as to investigate the most effective treatment options, providing an update on the management of OSA patients.

Sleep Duration, Sleep Quality, and Insomnia in Association With Self-Rated Health: A Systematic Review and Meta-Analysis

Background and Objective This study undertook a systematic review and meta-analysis of the relationship between sleep duration, sleep quality, and insomnia in association with self-rated health.Methods Studies that had examined the relationship between sleep duration, sleep quality, and insomnia with self-rated health were eligible. PubMed and Scopus were the two main databases for searching for studies related to this meta-analysis. The Google Scholar database as a source of gray literature was also searched by hand. This search was from the beginning of the formation of databases until the end of January 2022, and the search language was limited to articles published in English. The Effective Public Health Practice Project Quality Assessment Tool was used to assess the quality of studies. For this meta-analysis, odds ratio and 95% confidence interval were extracted or calculated. The pool of studies was processed by the random effects method.Results Twenty-six studies were included in this meta-analysis. Sleep duration of ≤ 8 hours per day (h/d) (odds ratio = 1.58 and 95% confidence interval = [1.41–1.77]) and sleep duration of > 8 h/d (odds ratio = 1.32 and 95% confidence interval = [1.17–1.50]) are associated with poor self-rated health. Poor sleep quality and insomnia are associated with poor self-rated health. Conclusions Sleep problems have a negative effect on self-rated health, and therefore, effective interventions can help improve sleep.

Obstructive sleep apnea risk and determinant factors among type 2 diabetes mellitus patients at the chronic illness clinic of the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia

Introduction

Obstructive sleep apnea is a sleep complaint among type 2 diabetes mellitus patients that has a deleterious effect on health with immediate and long-term impacts. Despite its impacts, data on the magnitude and predictors of obstructive sleep apnea among type 2 diabetes mellitus patients in Ethiopia is still limited. Thus, this study was conducted to determine how common a high risk of obstructive sleep apnea is and its predictors among type 2 diabetes mellitus patients receiving follow-up care at the chronic illness follow-up clinic at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, 2022.

Methods

An institution-based cross-sectional study was conducted. Interviewer-administered questionnaires and physical measurements with standard instruments were used to collect the required data. The collected data were entered into EpiData 4.6 and exported into STATA 14. Both Bivariable and multivariable binary logistic regression analyses were done to identify factors associated with a high risk of obstructive sleep apnea. Variables with a p-value ≤0.05 in the multivariable logistic regression analysis were declared as significantly associated with a high risk of obstructive sleep apnea.

Results

A total of 319 type 2 diabetes mellitus patients with a median age of 58 years participated in our current study. The overall prevalence of a high risk of obstructive sleep apnea among the study participants was 31.97% (95%CI: 27.06, 37.32). On multivariable logistic analysis, a neck circumference of ≥40 cm (AOR=4.33, 95%CI 1.37, 13.72), physical inactivity (AOR=2.29, 95%CI 1.15, 4.53), comorbid hypertension (AOR=4.52, 95%CI 2.30, 9.18), and male sex (AOR=8.01, 95%CI 3.02, 21.24) were associated with a high risk of obstructive sleep apnea.

Conclusion and recommendation

The prevalence of a high risk of obstructive sleep apnea among type 2 diabetes mellitus patients remains high. A neck circumference of ≥40 cm, physical inactivity, comorbid hypertension, and male sex were significantly associated with a high risk of obstructive sleep apnea among type 2 diabetes mellitus patients. Screening and evaluation of type 2 diabetes mellitus patients for obstructive sleep apnea are recommended to avoid the negative impacts.

Alcohol and Cardiac Arrythmias: A Review of the Current Data

Background

Alcohol is a pervasive substance in the US and the world in general. Cardiac arrythmias, specifically atrial fibrillation, are also a critical health issue. The interplay between alcohol and arrythmia is explored here.

Methods

Original research, editorials and other literature reviews were searched and assessed for candidacy for inclusion and ability to contribute to this article.

Conclusions

Alcohol consumption has a significant interplay with cardiac arrhythmia.

Prevalence of risk and factors associated with obstructive sleep apnea-hypopnea syndrome in an adult population in Kinshasa, Democratic Republic of Congo

Obstructive sleep apnea-hypopnea syndrome (OSAHS) is an underdiagnosed and lesser known disease in sub-Saharan Africa. We believe that this is the first descriptive and analytical cross-sectional study in Kinshasa (from February 1 to October 31, 2021), which included respondents aged ≥18 years. The study aimed to determine the prevalence of the risk and factors associated with OSAHS. Each participant signed a free and informed consent. Statistical analyses were performed using XLStat 2020 and the Statistical Package for the Social Sciences version 24 for Windows. Odds ratios (ORs) were calculated to determine the degree of association between these variables and a high risk of OSAHS. The significance threshold was p < 0.05 and confidence interval (CI) at 95%. There were 4,162 participants, including 2,287 men (54.9%), with an mean (SD) age of 32 ± 12.6 years. The prevalence of OSAS risk was 17.4% and 7.9% for men and women, respectively. The associated risk factors were male sex (OR 4, 95% CI 3.20-5.54), hypertension (OR 6.7, 95% CI 4.87-9.30), age ≥60 years (OR 8.7, 95% CI 4.07-18.88), obesity/overweight (OR 1.94, 95% CI 1.13-3.78), and excessive daytime sleepiness (OR 2.63, 95% CI 2.05-3.56). The risk of OSAS in Kinshasa is high and it increases with age, male sex, obesity, and hypertension. The Snoring, Tiredness, Observed apnea, high blood Pressure, Body mass index, Age, Neck circumference, and male Gender (STOP-BANG) questionnaire is an easy-to-use tool for diagnostic orientation.

Obstructive sleep apnoea-hypopnoea syndrome: state of the art

Obstructive sleep apnoea-hypopnoea syndrome (OSAHS) is an extremely common sleep-related breathing disorder (SRBD) characterised by complete or partial collapse of the upper airways. These nocturnal phenomena cause high-frequency hypoxemic desaturations (or intermittent hypoxia, IH) during sleep and alterations in gas exchange. The result of IH is the development or worsening of cerebro-cardio-vascular, metabolic and other diseases, which cause a high risk of death. Hence, OSAHS is a multifactorial disease affecting several organs and systems and presenting with various clinical manifestations involving different medical branches. Although it has been estimated that about one billion individuals worldwide are affected by OSAHS, this SRBD remains underestimated also due to misinformation regarding both patients and physicians. Therefore, this review aims to provide information on the main symptoms and risk factors for the detection of individuals at risk of OSAHS, as well as to present the diagnostic investigations to be performed and the different therapeutic approaches. The scientific evidence reported suggest that OSAHS is an extremely common and complex disorder that has a large impact on the health and quality of life of individuals, as well as on healthcare expenditure. Moreover, given its multifactorial nature, the design and implementation of diagnostic and therapeutic programmes through a multidisciplinary approach are necessary for a tailor-made therapy for each patient.

A Scoping Review of Sleep Apnea: Where Do We Stand?

Obstructive sleep apnea (OSA), a condition in which there is a recurrent collapse of the upper airway while sleeping, is a widespread disease affecting 5% to 10% people worldwide. Despite several advances in the treatment modalities for OSA, morbidity and mortality remain a concern. Common symptoms include loud snoring, gasping for air during sleep, morning headache, insomnia, hypersomnia, attention deficits, and irritability. Obese individuals, male gender, older age (65+), family history, smoking, and alcohol consumption are well recognized risk factors of OSA. This condition holds the ability to increase inflammatory cytokines, cause metabolic dysfunction, and increase the sympathetic output, all of which exacerbate OSA due to their effect on the cardiovascular system. In this review, we discuss its brief history, risk factors, complications, treatment modalities, and the role of clinicians in curbing its risk.

Evaluation of Blood Levels of Omentin-1 and Orexin-A in Adults with Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis

Background and objective: Obstructive sleep apnea (OSA) can be related to changes in the levels of adipokines and neuropeptides, which in turn may affect the energy balance components of neuronal cells. Herein, a systematic review and meta-analysis checked the changes in serum/plasma levels of omentin-1 (OM-1: an adipokine) and orexin-A (OXA: a neuropeptide) in adults (age > 18 years old) with OSA (aOSA) compared to controls. Materials and methods: Four databases (Cochrane Library, PubMed, Web of Science, and Scopus) were systematically searched until 14 November 2022, without any restrictions. The Joanna Briggs Institute (JBI) critical appraisal checklist adapted for case−control studies was used to assess the quality of the papers. The effect sizes were extracted using the Review Manager 5.3 software for the blood levels of OM-1 and OXA in aOSA compared with controls. Results: Thirteen articles, with six studies for OM-1 levels and eight for OXA levels, were included. The pooled standardized mean differences were −0.85 (95% confidence interval (CI): −2.19, 0.48; p = 0.21; I2 = 98%) and −0.20 (95%CI: −1.16, 0.76; p = 0.68; I2 = 96%) for OM-1 and OXA levels, respectively. Among the studies reporting OM-1, five were high and one was moderate quality. Among the studies reporting OXA, six were moderate, one was high, and one was low quality. Based on the trial sequential analysis, more participants are needed to confirm the pooled results of the analyses of blood levels of OM-1 and OXA. In addition, the radial plot showed outliers as significant factors for high heterogeneity. Conclusions: The main findings indicated a lack of association between the blood levels of OM-1 and OXA and OSA risk. Therefore, OM-1 and OXA did not appear to be suitable biomarkers for the diagnosis and development of OSA.

Increased incidence of alcohol use disorder and alcohol-related psychiatric disorders in patients with obstructive sleep apnea: A nationwide population-based cohort study

BACKGROUND

Obstructive sleep apnea (OSA) and alcohol-related diseases (ARDs), including alcohol use disorder, alcohol-related psychiatric disorders, alcoholic liver disease, alcoholic polyneuropathy alcoholic cardiomyopathy, and alcoholic gastritis, are both highly prevalent conditions. Alcohol consumption is associated with a higher risk of sleep apnea. However, whether OSA increases the risk of ARD has not, as yet, been studied comprehensively. Our study aimed to determine whether OSA increases the subsequent risk of ARD.

METHODS

This study utilized the data from Taiwan's National Health Insurance Database between 2000 and 2015. We identified 7722 individuals newly diagnosed with OSA and randomly selected sex-, age-, and index date-matched (1:3) 22,166 controls without OSA, with a total of 29,888 subjects. We used the Fine and Gray's survival analysis to estimate the effects of OSA on ARD.

RESULTS

The OSA cohort had an adjusted hazard ratio of subsequent ARDs as 1.486 (95% Confidence Interval: 1.301-1.698), when comparing the cohort without OSA. The Kaplan-Meier analysis showed that the cumulative incidence of ARDs was significantly higher in the OSA cohort than in the controls in the first year of follow-up, till the end of the follow-up. A post-hoc analysis showed that OSA was associated with alcohol use disorder, alcohol-related psychiatric disorders, and alcoholic liver disease, but not alcoholic polyneuropathy, alcoholic cardiomyopathy, and alcoholic gastritis. The use of psychoactive medication, including the sedative-hypnotics, antidepressants or antipsychotics were associated with a lower risk of ARDs.

CONCLUSIONS

Our study demonstrates that the OSA patients are at a higher risk of developing ARDs.

Polysomnographic Assessment of Effects of Tobacco Smoking and Alcohol Consumption on Sleep Bruxism Intensity

Background: Sleep bruxism (SB) is a common sleep-related movement behavior with a complex etiology. A recent hypothesis suggests psychoactive substance usage, tobacco smoking, and alcohol intake are risk factors for SB. This study aimed to evaluate SB intensity in tobacco smokers and alcohol drinkers. Methods: A total of 133 adults underwent full-night audio- and video-polysomnography, and the polysomnograms were evaluated using the American Academy of Sleep Medicine guidelines. The study group was divided into smoker and nonsmoker groups as well as drinker and non-drinker groups. Results: The results of the polysomnographic analysis confirmed that tobacco smoking has a significant effects on SB. Tobacco smokers showed increased bruxism intensity (5.50 ± 4.71 vs. 3.83 ± 3.26, p < 0.05), especially the mixed phenotype (0.93 ± 1.00 vs. 0.59 ± 0.59, p < 0.05), in the N1 sleep stage (22.84 ± 20.45 vs. 15.66 ± 13.60, p < 0.05) and the nonsupine position (4.93 ± 5.56 vs. 2.50 ± 2.31, p < 0.05). They also showed a higher number of bruxism episodes with arousal compared with nonsmokers (2.91 ± 2.83 vs. 1.61 ± 1.49, p < 0.05), indicating increased sleep fragmentation. However, no significant effect of alcohol on SB intensity was observed, and the bruxism episode index was similar in alcohol drinkers and nondrinkers. In addition, electrolyte disturbances and lipid disorders were evaluated. Compared with nonsmokers, tobacco smokers showed a higher concentration of plasma triglycerides (177.67 ± 106.9 vs. 129.18 ± 65.61) and lower levels of iron and magnesium (96.68 ± 43.58 vs. 123.83 ± 52.36 and 1.85 ± 0.22 vs. 1.96 ± 0.21, respectively). Conclusions: In summary, this study showed that tobacco smoking, but not alcohol consumption, is related to bruxism intensity and lipid and electrolyte disturbances in individuals with sleep disorders.

Human circadian rhythm studies: Practical guidelines for inclusion/exclusion criteria and protocol

As interest in circadian rhythms and their effects continues to grow, there is an increasing need to perform circadian studies in humans. Although the constant routine is the gold standard for these studies, there are advantages to performing more naturalistic studies. Here, a review of protocols for such studies is provided along with sample inclusion and exclusion criteria. Sleep routines, drug use, shift work, and menstrual cycle are addressed as screening considerations. Regarding protocol, best practices for measuring melatonin, including light settings, posture, exercise, and dietary habits are described. The inclusion/exclusion recommendations and protocol guidelines are intended to reduce confounding variables in studies that do not involve the constant routine. Given practical limitations, a range of recommendations is provided from stringent to lenient. The scientific rationale behind these recommendations is discussed. However, where the science is equivocal, recommendations are based on empirical decisions made in previous studies. While not all of the recommendations listed may be practical in all research settings and with limited potential participants, the goal is to allow investigators to make well informed decisions about their screening procedures and protocol techniques and to improve rigor and reproducibility, in line with the objectives of the National Institutes of Health.

Self-Reported Sleep during the COVID Lockdown in a Sample of UK University Students and Staff

The link between disturbed sleep and the extended lockdown period resulting from COVID-19 is well established. Data from an online survey of 2341 of university students (n = 1972, 84.2%) and staff were reported. Overall (n = 1710, 73.1%) were female and the mean age for the sample was 29.26 (SD = 12.86). 1799 (76.8%) provided self-reported data from the Nottingham Health Profile (NHP) Sleep Subscale that allowed sleep to be compared prior to the lockdown period and during the lockdown period. Sociodemographic data which included, gender, age, whether an individual was a student or member of the university staff, ethnicity, caring responsibilities, and highest educational level were collected. Other data included, the NHP Sleep Sub-scale, change in alcohol consumption during the lockdown period, routine behaviours during the lockdown period, self-efficacy and health and wellbeing. There was a significant deterioration in NHP Sleep scores (p < 0.001) and all areas of sleep that were assessed significantly deteriorated during the lockdown period. These included indicators of sleep quality, sleep latency, sleep duration, sleep disturbance and increased use of sleep medication. Following a multinomial logit regression with change of NHP sleep scores entered as the dependent variable there were several significant predictors. Women had greater sleep dysfunction than men. Increased alcohol consumption, lower educational status and a deterioration in health and well-being scores were associated with greater sleep dysfunction. Not having a designated area to work in and not putting on clothes and make-up were both associated with greater sleep dysfunction during the lockdown period. These findings confirm the importance of taking steps to maintain sleep hygiene during extended lockdown periods.

Obstruktive Schlafapnoe und arterielle Hypertonie

Hintergrund

In Deutschland leiden rund 19 Mio. Patienten an einer diagnostizierten arteriellen Hypertonie (aHT). Die Schnittmenge zwischen Menschen mit aHT und obstruktiver Schlafapnoe (OSA) ist groß. Aufwachreaktionen und Hypoxämie im Rahmen einer OSA können zu einem gesteigerten Sympathikotonus und endothelialer Dysfunktion und somit zu aHT führen.

Fragestellung

Der vorliegende Übersichtsartikel soll die Zusammenhänge zwischen OSA und aHT sowie Behandlungsmöglichkeiten darstellen.

Materialien und Methoden

Es erfolgte eine Literaturrecherche von Original- und Übersichtsartikeln, die bis 2021 in der PubMed-Datenbank veröffentlicht wurden.

Ergebnisse

Obstruktive Schlafapnoe kann sowohl die Entstehung als auch die Verschlechterung einer aHT verursachen. Betroffene profitieren von einer CPAP-Behandlung mit einer durchschnittlichen Senkung des systolischen Blutdrucks um −4,4 mm Hg sowie des diastolischen Blutdrucks um −2,9 mm Hg. Prädiktoren für eine Reduktion des Blutdrucks unter kontinuierlicher Positivdrucktherapie (CPAP) sind junges Alter, therapieresistente aHT, schwere OSA-bedingte Sauerstoffentsättigungen und ein „Non-Dipping-Blutdruckmuster“.

Schlussfolgerung

Die adäquate Behandlung einer aHT fordert häufig einen multimodalen Ansatz. Neben einer medikamentösen antihypertensiven Therapie und einer Modifikation des Lebensstils sollte auch die Diagnose und gegebenenfalls die Behandlung einer OSA berücksichtigt werden.

Evaluation of Plasma/Serum Adiponectin (an Anti-Inflammatory Factor) Levels in Adult Patients with Obstructive Sleep Apnea Syndrome: A Systematic Review and Meta-Analysis

Background and objective: A variety of diseases, including obesity, type ‖ diabetes, and cardiovascular diseases are associated with obstructive sleep apnea syndrome (OSAS), and decreased adiponectin levels have been shown to be associated with an increased risk of these diseases. However, the association of blood levels of adiponectin in OSAS patients is a challenging and unknown issue with conflicting results. Therefore, we performed a systematic review and a meta-analysis to evaluate plasma/serum adiponectin levels in adult patients with OSAS. Materials and methods: A comprehensive search in four databases (PubMed/Medline, Web of Science, Scopus, and Cochrane Library) was performed in literature dated older than 12 March 2022, to retrieve the relevant articles. Effect sizes were calculated to show the standardized mean difference (SMD) along with a 95% confidence interval (CI) of plasma/serum of adiponectin between the OSAS patients and controls. The software RevMan 5.3, NCSS 21.0.2, CMA 2.0, trial sequential analysis (TSA) 0.9.5.10 beta, and GetData Graph Digitizer 2.26 were used for data synthesis in the meta-analysis. Results: A total of 28 articles including 36 studies were entered into the meta-analysis. The results showed that pooled SMD was −0.71 (95% CI: −0.92, 0.50; p < 0.00001; I2 = 79%) for plasma/serum levels of adiponectin in OSAS cases compared to the controls. The subgroup analyses showed that the geographical region and the Apnea-Hypopnea-Index (AHI) could be confounding factors in the pooled analysis of plasma/serum adiponectin levels. The sensitivity analysis showed the stability of the results. The radial and L’Abbé plots confirmed evidence of heterogeneity. Trial sequential analysis showed sufficient cases in the meta-analysis. Conclusions: With sufficient cases and stable results, the main finding of the meta-analysis identified significantly reduced plasma/serum levels of adiponectin in OSAS cases compared with the controls. This result suggests a potential role of adiponectin in the pathogenesis of OSAS.

Factors Associated With Undiagnosed Obstructive Sleep Apnea in Overweight and Obese High-Tech Employees: A Multisite Cross-Sectional Study

Background: Being overweight or obese is regarded as crucial risk factors for obstructive sleep apnea (OSA). Objectives: This study aimed to determine the influencing factors of overweight and obese employees with OSA in high-tech workplaces. Methods: A cross-sectional study design was employed. A total of 491 overweight and obese participants were recruited from a large-scale electronics industry. The Chinese version of Pittsburgh Sleep Quality Index, the Epworth Sleep Scale, and a portable sleep monitoring device were used for data collection. Logistic regression analysis was conducted to identify the factors affecting overweight and obese employees with OSA. This study was conducted from August 2019 to July 2020. Results: 60.5% of the overweight and obese participants were found to have OSA, of which 58.9% had mild and 18.5% had severe OSA, respectively. The results showed that age, neck circumference, snoring, and habitual drinking were the crucial factors affecting OSA. Remarkably, age and snoring times showed a significant correlation in predicting OSA of different severities. Neck circumference was an independent risk factor for moderate and severe OSA. Conclusion: More than 60% of the overweight and obese high-tech workplace employees were found to have OSA. We found that the older the age, the larger the neck circumference, a higher number of snoring instances, and drinking were important risk factors for predicting OSA in overweight high-tech employees. The healthcare providers should actively educate OSA-related information for employees in the workplace, and promote high-risk OSA groups to adopt screening based on at-home sleep apparatus.

The Incidence of Cancer Is Increased in Hospitalized Adult Patients With Obstructive Sleep Apnea in China: A Retrospective Cohort Study

Background

The association between obstructive sleep apnea (OSA) and the incidence and mortality of cancer remain unclear, especially in Asian populations. Thus, this study was conducted to explore the relationship between OSA and the incidence and mortality of cancer in hospitalized patients.

Methods

This retrospective cohort study evaluated inpatients from Guangdong Provincial People’s Hospital for suspected OSA between January 2005 and December 2015. Cancer incidence, all-cause mortality, and cancer mortality and were determined using data from the hospital information system and Centers for Disease Control. Between-group comparisons were carried out by performing a chi-square test and analysis of variance. Kaplan–Meier analysis and the Cox proportional risk model were applied to investigate the association between OSA and cancer incidence and mortality.

Results

Of the 4,623 hospitalized patients included, 3,786 (81.9%) patients were diagnosed with OSA. After a median follow-up of 9.1 years (interquartile range, 9.79–11.44), the incidence of cancer was 6.6% (251/3,786), with lung cancer having the highest incidence at 1.6% (60/3,786). The mortality rate of OSA patients was higher than that of non-OSA patients (16.83% vs.12.78%, p=0.008), but the relationship between apnea-hypopnea index (AHI), oxygen saturation less than 90% (TSat90), and cancer mortality was not statistically significant (p>0.05).The mortality rate for all types of cancer was 2.8% (105/3,786), with lung cancer having the highest mortality rate at 0.8% (32/3,786). The cumulative incidence of cancer in the severe OSA group was 8.2%, which was higher than that in the normal, mild, and moderate OSA groups (P=0.010). Further, the Cox proportional risk regression model showed a progressive enhancement in the risk of cancer incidence as the AHI increased (adjusted hazard ratio [HR]: 1.009 [95% confidence interval (CI): 1.003–1.016], P=0.005). Based on subgroup analysis, the risk of cancer increased as the AHI increased in patients aged <65 years (adjusted HR: 1.019 [95% CI: 1.007–1.031], P=0.002). In addition, the cancer incidence was significantly higher in the severe OSA group than in the normal, mild, and moderate OSA groups (adjusted HR: 2.825 [95% CI: 1.358–5.878], P=0.019).

Conclusion

The incidence of cancer is higher in patients with OSA than in non-OSA patients and is significantly positively associated with the severity of OSA. Particularly, for OSA patients aged <65 years, lung cancer is the main cause of death in those with new-onset cancer. Mortality was higher in OSA patients than in non-OSA patients.

Alcohol Consumption: Medical Implications, the Liver and Beyond

Alcohol consumption represents a major factor of morbidity and mortality, with a wide range of adverse medical implications that practically affect every organ system. It is the fifth major cause of deaths in men and women and causes up to 139 million disability-adjusted life years. Solid evidence places the risk as undoubtedly correlated to the length of time and amount of alcohol consumption. While alcohol-related liver disease represents one of the most studied and well-known consequences of alcohol use, the term itself embodies a wide spectrum of progressive disease stages that are responsible for almost half of the liver-related mortality worldwide. We discuss the staged alcohol-related fatty liver, alcohol-related steatohepatitis and, finally, fibrosis and cirrhosis, which ultimately may end up in a hepatocellular carcinoma. Other comorbidities such as acute and chronic pancreatitis; central nervous system; cardiovascular, respiratory and endocrine system; renal disease; urological pathologies; type 2 diabetes mellitus and even infectious diseases are reviewed in their relation to alcohol consumption. This article reviews the impact of alcohol use on different systems and organs, summarizing available evidence regarding its medical implications. It examines current basic and clinical data regarding mechanisms to highlight factors and processes that may be targetable to improve patient outcomes. Although alcohol use is a part of many cultural and social practices, as healthcare providers we must identify populations at high risk of alcohol abuse, educate patients about the potential alcohol-related harm and provide appropriate treatment.

High quality and anti-inflammatory diets and a healthy lifestyle are associated with lower sleep apnea risk

STUDY OBJECTIVES

Most studies on diet and sleep apnea focus on calorie restriction. Here we investigate potential associations between dietary quality [healthy eating index (HEI), dietary inflammatory index (DII)] and overall healthy lifestyle with sleep apnea risk.

METHODS

National Health and Nutrition Examination Survey data (waves 2005-2008, and 2015-2018; N=14,210) were used to determine HEI, DII and their quintiles, with the fifth quintile indicating highest adherence to each dietary construct. A healthy lifestyle score was determined using diet, smoking, alcohol intake and physical activity level. STOP-BANG questionnaire was used to define sleep apnea risk. Generalized linear regression models with binomial family and logit link were used to investigate potential associations. The models were adjusted for socioeconomic status, lifestyle factors and chronic conditions.

RESULTS

Prevalence of high sleep apnea risk was 25.1%. Higher DII was positively associated with sleep apnea (odds ratio (OR)_{Q5 vs. Q1}=1.55; 95% CI: 1.24-1.94; p for trend <0.001) whereas higher HEI was associated with reduced sleep apnea risk (OR_{Q5 VS. Q1}=0.72: 0.59-0.88; p for trend=0.007). Higher healthy lifestyle score was also associated with decreased odds of sleep apnea (p for trend <0.001). There was a significant interaction between healthy lifestyle and sex with sleep apnea risk (p for interaction=0.049) whereby females with higher healthy lifestyle scores had lower risk of sleep apnea versus males.

CONCLUSIONS

Higher quality and anti-inflammatory diets and a healthier overall lifestyle are associated with lower sleep apnea risk. These findings underline the importance of strategies to improve overall diet quality and promote healthy behavior, not just calorie restriction, to reduce sleep apnea risk.

Outpatient treatment following alcohol screening at health checkups and change in drinking patterns among excessive drinkers with lifestyle-related diseases

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General outpatient care following alcohol screening at health checkups was evaluated.

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Database of claims data and health checkups was used for propensity score matching.

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Outpatient care was associated with reduced drinking frequency in risky drinkers.

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Outpatient care was not associated with improved drinking behavior in heavy drinkers.

Screening and brief interventions have been implemented in primary care settings to reduce excessive drinking. However, the effectiveness of screening and brief interventions within a health checkup setting is unclear. We assessed the effectiveness of general treatment for lifestyle-related diseases following screening for alcohol consumption at health checkups, using data on medical claims and health checkups. Participants were people with excessive drinking who met the threshold of recommendation to receive treatment for lifestyle-related diseases. We analyzed risky drinkers (drinking every day, 40–60 g/day for male and 20–60 g/day for female) and heavy drinkers (drinking every day, >60 g/day) separately. We performed one-to-one propensity score matching between people who received general outpatient treatment for lifestyle-related diseases and those who did not. Outcomes were drinking patterns (frequency and amount) and liver function at the next year's health checkup. Middle-aged males accounted for about 94% of the 23,347 participants. Eleven percent of the participants received treatment after the health checkup. After propensity score matching, among 1990 pairs of risky drinkers, those with treatment were significantly more likely to reduce their frequency of drinking (11.7% vs. 8.7%, p = 0.002) and showed lower transaminase values than those without treatment. In 575 pairs of heavy drinkers, there was no significant change in drinking patterns or liver function. Treatment in primary care after screening at health checkups was associated with the change in drinking behavior and improvement in liver condition among risky drinkers. More intensive intervention may be needed to reduce drinking in heavy drinkers.

Obstructive sleep apnea in patients with head and neck cancer: a systematic review

STUDY OBJECTIVES

Head and neck cancers (HNCs) may modify the upper airway anatomy and thereby increase the risk for obstructive sleep apnea (OSA). If untreated, OSA is associated with adverse outcomes. Identification of risk factors for OSA in patients with HNC is essential to promote proper evaluation, treatment, and improvement of sleep-related outcomes. In this review, we assessed associations between tumor stage, cancer treatment, and OSA in the population with HNC.

METHODS

A systematic search of PubMed, EMBASE (Embase.com), Cochrane Library (Cochranelibrary.com), Scopus, and Web of Science was conducted to identify articles related to OSA in patients with HNC. A total of 215 articles were identified, of which 14 were included in the qualitative synthesis. These studies included 387 participants.

RESULTS

The most common cancer type, tumor location, and cancer therapy were squamous cell carcinoma, oropharynx, and surgery, respectively. Three of six articles reported an association between surgical treatment and OSA. Conversely, associations between tumor stage, radiotherapy, and OSA were found in only a minority of studies (15%). The prevalence of OSA was between 57% and 76% pre-cancer therapy and 12% and 96% afterward.

CONCLUSIONS

This review suggests a potential association between HNC surgery and OSA. An association between tumor stage, radiotherapy to the head and neck, and OSA is inconclusive. Further research is needed to examine the relationship between HNC and OSA.

Obstructive Sleep Apnea and Cognitive Decline: A Review of Potential Vulnerability and Protective Factors

Around 40% of dementia risk is attributable to modifiable risk factors such as physical inactivity, hypertension, diabetes and obesity. Recently, sleep disorders, including obstructive sleep apnea (OSA), have also been considered among these factors. However, despite several epidemiological studies investigating the link between OSA and cognitive decline, there is still no consensus on whether OSA increases the risk of dementia or not. Part of the heterogeneity observed in previous studies might be related to some individual characteristics that modulate the association between OSA and cognitive decline. In this narrative review, we present these individual characteristics, namely, age, sex, menopause, obesity, diabetes mellitus, hypertension, cardiovascular diseases, smoking, excessive alcohol consumption, depression, air pollution, Apolipoprotein E ε4 allele, physical activity, and cognitive reserve. To date, large cohort studies of OSA and cognitive decline tended to statistically control for the effects of these variables, but whether they interact with OSA to predict cognitive decline remains to be elucidated. Being able to better predict who is at risk of cognitive decline when they have OSA would improve clinical management and treatment decisions, particularly when patients present relatively mild OSA.

The Impact of Obstructive Sleep Apnea on the Sleep of Critically Ill Patients

Obstructive sleep apnea is becoming increasingly prevalent in society and thus critical care practitioners need to be prepared to care for these patients in the intensive care unit. Preparation begins with equipping the critical care nurse with the knowledge necessary to provide interventions which can enhance patient outcomes and mitigate complications.

Cultivating Lifestyle Transformations in Obstructive Sleep Apnea

Today, our well-being and awareness have become markedly determined by our way of living through our everyday activities. Needless to say, daily practices specifically have a significant impact on the quality of sleep. Obstructive sleep apnea (OSA) is an exhausting sleep disorder regulating an individual's routine life. Although several therapeutic modalities are available for curing OSA, behavioral therapies are also utilized for a positive outcome. Besides, several studies are performed to prove the efficacy of lifestyle strategies to resolute OSA in adults. Reducing weight, quitting alcohol and smoking, eating a nutritional diet, and exercising are the modifications to benefit people. This review aims to expand our knowledge of the association between alterations to comportment and better treatment outcomes for sleep apnea.

Social Engagement and Sleep Quality among Older Adults in Rural China: Is There a Sex Difference?

OBJECTIVES

Sleep quality plays a crucial role in maintaining the health of older people and has become a major public health concern throughout the world. Social engagement, as a core component of "Active Ageing", is one of the key determinants of health outcomes of older adults. This study estimated the relationship between social engagement and sleep quality among older adults living in rural China, and to determine whether there is a sex difference in these associations.

DESIGN

A cross-sectional design. Multilevel, multiple linear regression models were used to examine the independent associations between each type of social engagement and sleep quality. All standard errors were clustered at the community level.

SETTING AND PARTICIPANTS

Data were from 3243 adults age 60 years or older from rural areas in China.

METHODS

Sleep quality was measured by the Pittsburgh Sleep Quality Index. Social engagement was measured by 3 types of social groups' activity in this study, including participation in hobby groups, community-related organization, and sports groups.

RESULTS

Participating in hobby groups, community-related organization, and sports groups with high frequency are all associated with better sleep quality. In addition, the positive relation between participating in community-related organization and sleep quality is stronger for older male than female adults, and the positive association between participating in hobby groups/sports groups is stronger for older female than male adults.

CONCLUSIONS AND IMPLICATIONS

Older adults with high-frequency of social engagement may have better sleep quality. This study offers new insight for the sleep quality from the perspective of social engagement among older people, implies that encouraging targeted social engagement in older people with different sex may be effective in promoting sleep quality in rural China.

Ultrasound assessment of upper airway dilator muscle contraction during transcutaneous electrical stimulation in patients with obstructive sleep apnoea

Background

Electrical current can be used to stimulate upper airway dilator muscles to treat obstructive sleep apnoea (OSA). Ultrasound devices are widely available and may be used to detect contraction of the upper airway dilator muscles assessing the functionality of electrical stimulation (ES) used for this treatment.

Methods

In a physiological sub-study of a randomised controlled trial, patients with OSA underwent ultrasound examination to assess contraction of the upper airway dilator muscles in response to transcutaneous ES. Ultrasound scans were scored according to the picture quality (poor = '0', acceptable = '1' and good = '2'). Tongue base thickness was assessed in mid-sagittal and coronal planes with (D2, A2) and without ES (D1, A1), while awake and seated. The primary outcome was to determine the increase in tongue thickness during ES in both views (D2 - D1 = ΔD), as well as any increase in the cross-sectional area (CSA) in the coronal view (A2 - A1 = ΔA). Data were presented as mean and standard deviation (SD).

Results

Fourteen patients [eight male, age 57.5 (9.8) years, body mass index (BMI) 29.5 (2.8) kg/m²] with OSA [Apnea-Hypopnea Index (AHI) 19.5 (10.6) × hour^-1] were studied. Quality of the ultrasound scans was acceptable or good with 1.5 (0.5) points. In the mid-sagittal plane, ΔD was +0.17 (0.07) cm in midline and +0.21 (0.09) cm in the widest diameter, a percentual change of 12.2% (4%) and 12.8% (5.2%) (P<0.001, respectively). In the coronal plane, ΔD was +0.17 (0.04) cm, an increase of 12.3% (4.6%) (P<0.001, respectively), ΔA in the CSA increased by +18.9% (3.0%) with stimulation (P<0.001). There was a negative correlation between age and ΔA (r= -0.6, P=0.03), but no significant associations were found with gender, BMI, neck circumference, Epworth Sleepiness Scale (ESS), AHI, skin and subcutaneous tissue in the submental area.

Conclusions

Ultrasound can visualise upper airway dilator muscle contraction during transcutaneous ES in awake patients with OSA. Contraction is best detected in the CSA of the tongue base in the coronal plane.

The Accuracy of Repeated Sleep Studies in OSA: A Longitudinal Observational Study With 14 Nights of Oxygen Saturation Monitoring

BACKGROUND

Strong evidence exists for clinically relevant night-to-night variability of respiratory events in patients with suspected OSA.

RESEARCH QUESTION

How many sleep study nights are required to diagnose OSA accurately?

STUDY DESIGN AND METHODS

Patients with suspected OSA underwent up to 14 nights of pulse oximetry (PO) at home and one night of in-hospital respiratory polygraphy (RP). The accuracy of each of the 13 sleep study nights was analyzed using the mean oxygen desaturation index 3% (ODI_3%) of all 14 nights as a reference. Multiple regression analyses assessed possible predictors for night-to-night variability.

RESULTS

One hundred three patients underwent in-hospital RP. Using only the results of the RP, 19.7% were misdiagnosed using an ODI_3% cutoff of 15/h. One hundred eight patients underwent properly performed PO studies at home with a coefficient of variation (CV) of 31.5% (SD, 14.7%) across all nights. The first PO night demonstrated a sensitivity of 71.4% (95% CI, 55.4%-84.3%) and a specificity of 89.4% (95% CI, 79.4%-95.6%) to diagnose moderate OSA. Using only the first PO night, the negative predictive value was 83.1%. Adding a second recording night increased sensitivity up to 88.1% (95% CI, 74.4%-96.0%) with a slightly lower specificity of 85.9% (95% CI, 74.9%-93.4%). The ODI_3% of the in-hospital RP showed an independent negative association to the log-transformed CV (exponentiated coefficient, 0.989; 95% CI, 0.984-0.995).

INTERPRETATION

One single night of in-hospital RP may miss relevant OSA. Multiple study nights, for example, using ambulatory oxygen saturation monitoring, increase accuracy for diagnosing moderate OSA.

TRIAL REGISTRY

ClinicalTrials.gov; No.: NCT03819361; URL: www.clinicaltrials.gov.

Night-to-night variability of respiratory events in obstructive sleep apnoea: a systematic review and meta-analysis

Background

It is current practice to use a single diagnostic sleep study in the diagnostic workup of obstructive sleep apnoea (OSA). However, a relevant night-to-night variability (NtNV) of respiratory events has been reported.

Methods

We evaluated the NtNV of respiratory events in adults with suspected or already diagnosed OSA who underwent more than one diagnostic sleep study. Data sources were PubMed, Cochrane and Embase up to 23 January 2019. Random-effects models were used for evidence synthesis. For moderator analysis, mixed-effects regression analysis was performed. The study was registered with PROSPERO (CRD42019135277).

Results

Of 2143 identified papers, 24 studies, comprising 3250 participants, were included. The mean Apnoea-Hypopnoea Index (AHI) difference between the first and second night was −1.70/hour (95% CI −3.61 to 0.02). REM time differences (first to second night) were significantly positive associated with differences in mean AHI (β coefficient 0.262 (95% CI 0.096 to 0.428). On average, 41% (95% CI 27% to 57%) of all participants showed changes of respiratory events >10/hour from night to night. Furthermore, 49% (95% CI 32% to 65%) of participants changed OSA severity class (severity thresholds at 5/hour, 15/hour and 30/hour) at least once in sequential sleep studies. Depending on the diagnostic threshold (5/hour, 10/hour or 15/hour), on average 12% (95% CI 9% to 15%), 12% (95% CI 8% to 19%) and 10% (95% CI 8% to 13%) of patients would have been missed during the first night due to single night testing.

Conclusion

While there was no significant difference between mean AHI in two sequential study nights on a group level, there was a remarkable intraindividual NtNV of respiratory events, leading to misdiagnosis and misclassification of patients with suspected OSA.

Sleep and COVID-19: considerations about immunity, pathophysiology, and treatment

The fear and uncertainty caused by the coronavirus disease 2019 (COVID-19) pandemic, threats to survival are one of the main problems of everyday life; however, mental health care must also be considered a priority. During social isolation also called self-quarantine, the restricted mobility and social contact, concern about financial resources and availability of supplies, fear of infection, questions about the duration of self-quarantine, cause anxiety, depression, stress, insomnia and reduced the quality and quantity of sleep, that may present a greater risk to the health of the general population. Sleep disorders are increasingly becoming a major health issue in modern society, and are influenced by retinal stimulation by electronic devices, as well extended and/or night shift-work, which may aggravate the systemic and lung inflammation during viral infections. Sleep disorders can induce pro-inflammatory states and be harmful during the COVID-19 pandemic. The possible interactions between many drugs used to treat COVID-19, and those used to treat sleep disorders are unknown, mostly due to the lack of a standard protocol to treat these patients. Insufficient sleep or irregular sleep-wake cycles may impair health, immune system, induce pro-inflammation state, and may lead to increased vulnerability to viral infections, involving inflammatory and oxidative/antioxidant imbalance. In this sense, obstructive sleep apnea has been associated with recognized COVID-19 risk comorbidities and considered a risk factor for COVID-19. During the COVID-19 pandemic, health care cannot stop, and telemedicine has presented itself as an alternative method of delivering services. When a face-to-face visit is mandatory, or in locations with minimal community transmission where sleep centers have resumed activities, it is important that the sleep center facilities are properly prepared to receive the patients during the COVID-19 pandemic, and follow all relevant safety rules. In this work we gathered a group of researchers, specialists in aspects related to chronobiology, sleep, sleep disorders, and the immune system. Thus, we conducted a narrative review in order to address the relationship between COVID-19 and sleep, as well as its immunological aspects and strategies that may be applied in order to mitigate the harmful effects on health that affects everyone during the pandemic.

Validity of the STOP-Bang Questionnaire in Identifying OSA in a Dental Patient Cohort

Background and objectives: Obstructive Sleep Apnea represents a widespread problem in the population, but it is often not diagnosed and not considered a true pathology. Different diagnostic tools are available for the diagnosis of sleep apnea. This study aims to demonstrate the ability of the STOP-Bang (Snoring, Tiredness, Observed apnea, high blood Pressure, Body mass index, Age, Neck circumference, and Gender) questionnaire in identifying subjects with Obstructive Sleep Apnea (OSA) Syndrome, highlighting the role of dentists as epidemiological sentinels. Materials and methods: the STOP-Bang questionnaire was administered to a cohort of 1000 patients, assessing three private dental clinics in Italy. Excessive daytime sleepiness was measured using Epworth Sleepiness Scale (ESS) and defined as ≥ 10. Subjects were considered at risk of OSA if they had three or more positive items at STOP-Bang and were invited to undergo further examination with a type 3 polygraph. Presence of OSA was measured with the apnea-hypopnea index (AHI) and defined as AHI ≥ 5. Results: 482/1000 subjects (48.2%) had three or more positive items in the STOP-Bang questionnaire and were considered at risk for Obstructive Sleep Apnea Syndrome (OSAS). Excessive daytime sleepiness (EDS ≥ 10) was more frequent among subjects at risk for OSAS (73/482, 15.1%) vs. those not at risk for OSAS (30/518, 5.8%) (p < 0.0001). Moreover, 153/482 subjects at risk for OSAS (31.7%) accepted further examination with a type 3 polygraph. Presence of OSAS (AHI ≥ 5) was suggested in 121/153 subjects (79.1%, 95% CI 71.6% to 85.1%), with 76/121 subjects (62.8%) needing treatment (AHI ≥ 15). Conclusion: the high prevalence of OSAS highlights the role of dentists as “epidemiological sentinels”. The STOP-Bang questionnaire is a simple and efficacious instrument for screening sleep apnea patients.

Impact of Alcohol Consumption on Snoring and Sleep Apnea: A Systematic Review and Meta-analysis

Objective

To systematically review the international literature for studies evaluating the effect of alcohol consumption on the occurrence and severity of snoring and obstructive sleep apnea and to use the available data to perform a meta-analysis.

Data Sources

MEDLINE, Embase, The Cochrane Library, CINAHL/EBASCO, and Scopus.

Review Methods

The protocol was registered in PROSPERO in March 2018. Following PRISMA guidelines, 2 independent researchers conducted a search from their inception through July 2018. Polysomnography (PSG) data were collected for sleep stages, apnea-hypopnea index (AHI), respiratory disturbance index, and/or lowest oxygen saturation (LSAT). Data concerning the frequency and severity of snoring intensity and sleep architecture were also collected. Only studies with PSG data were evaluated, with exclusion of studies with home sleep testing data. A multivariate regression and pooled analysis with forest plot was performed.

Results

A total of 1266 manuscripts were screened, and 13 manuscripts with 279 patients met inclusion criteria. Pooled analysis of AHI for control versus alcohol consumption revealed a mean difference (MD) of 3.98 events per hour (95% CI, 3.27 to 4.68; P < .001). Pooled analysis of LSAT for control versus alcohol consumption revealed an MD of −2.72% (95% CI, −3.69 to −1.76; Z score, 5.53; P < .00001).

Conclusion

Alcohol consumption is associated with worsening severity of snoring, altered sleep architecture, AHI, as well as lowest oxygen saturation among patients susceptible to snoring and obstructive sleep apnea.

Environmental Factors as Modulators of the Relationship between Obstructive Sleep Apnea and Lesions in the Circulatory System

Obstructive sleep apnea (OSA) is a growing social problem, particularly in well-developed countries. It has been demonstrated that obstructive sleep apnea is a significant risk factor for cardiovascular diseases, including arterial hypertension, ischemic heart disease, heart failure, rhythm/conduction disturbances, as well as cerebral stroke. The pathophysiology of these diseases is complex and multifactorial. We present the current state of research on behavioral and environmental factors that influence the relationship between OSA and cardiovascular changes. We discuss the relationship between obesity, alcohol, sedatives, environmental tobacco smoke, allergic diseases and environmental pollution on the one hand and OSA on the other. In this context, the environment should be considered as an important modulator of the relationship between OSA and cardiovascular diseases.

Exploring the Intersection Between Immigration and Gender in the Context of Troubled Sleep: Some Evidence from Canada

This study explored the linkage between immigration status and troubled sleep among recent immigrants, established immigrants and native-born in Canada. In particular, it examined whether the role of immigration status on troubled sleep differs between females and males. Using the 2012 Canadian Community Health Survey-Mental Health, logistic regression models were fitted to examine the relationship between troubled sleep and immigration status among a weighted sample of 12,932,829 women and 12,424,195 men. Findings indicate that female recent (OR 0.42, p < 0.01) and established immigrants (OR 0.74, p < 0.05) report fewer troubled sleep than their native-born counterparts. However, only male established immigrants report fewer troubled sleep (OR 0.42, p < 0.05), as male recent immigrants did not significantly differ from their native-born counterparts (OR 0.70, p > 0.05). Moreover, male recent immigrants were more likely to report troubled sleep than their female counterparts (OR 1.30, p < 0.05). Based on these findings, we discussed the potential gendered mechanisms in which immigrants' sleep is informed by social, cultural, and economic factors. We also provided several useful implications for policymakers.