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Mann DL, Staykov E, Georgeson T, Azarbarzin A, Kainulainen S, Redline S, Sands SA, Terrill PI. Flow Limitation Is Associated with Excessive Daytime Sleepiness in Individuals without Moderate or Severe Obstructive Sleep Apnea. Ann Am Thorac Soc 2024; 21:1186-1193. [PMID: 38530665 PMCID: PMC11298983 DOI: 10.1513/annalsats.202308-710oc] [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: 08/17/2023] [Accepted: 03/20/2024] [Indexed: 03/28/2024] Open
Abstract
Rationale: Moderate-severe obstructive sleep apnea (OSA) (apnea-hypopnea index [AHI], >15 events/h) disturbs sleep through frequent bouts of apnea and is associated with daytime sleepiness. However, many individuals without moderate-severe OSA (i.e., AHI <15 events/h) also report sleepiness. Objectives: To test the hypothesis that sleepiness in the AHI <15 events/h group is a consequence of substantial flow limitation in the absence of overt reductions in airflow (i.e., apnea/hypopnea). Methods: A total of 1,886 participants from the MESA sleep cohort were analyzed for frequency of flow limitation from polysomnogram-recorded nasal airflow signal. Excessive daytime sleepiness (EDS) was defined by an Epworth Sleepiness Scale score ⩾11. Covariate-adjusted logistic regression assessed the association between EDS (binary dependent variable) and frequency of flow limitation (continuous) in individuals with an AHI <15 events/h. Results: A total of 772 individuals with an AHI <15 events/h were included in the primary analysis. Flow limitation was associated with EDS (odds ratio, 2.04; 95% confidence interval, 1.17-3.54; per 2-standard deviation increase in flow limitation frequency) after adjusting for age, sex, body mass index, race/ethnicity, and sleep duration. This effect size did not appreciably change after also adjusting for AHI. Conclusions: In individuals with an AHI <15 events/h, increasing flow limitation frequency by 2 standard deviations is associated with a twofold increase in the risk of EDS. Future studies should investigate addressing flow limitation in low-AHI individuals as a potential mechanism for ameliorating sleepiness.
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Affiliation(s)
- Dwayne L. Mann
- School of Electrical Engineering and Computer Science
- Institute for Social Science Research, and
| | - Eric Staykov
- School of Electrical Engineering and Computer Science
| | - Thomas Georgeson
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Ali Azarbarzin
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham & Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Samu Kainulainen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland; and
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham & Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Scott A. Sands
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham & Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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Pamidi S, Ayappa I. Automating detection of inspiratory flow limitation: the next frontier in assessing sleep disordered breathing in pregnancy and risk for adverse pregnancy outcomes? Eur Respir J 2024; 64:2400768. [PMID: 39025517 DOI: 10.1183/13993003.00768-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 06/03/2024] [Indexed: 07/20/2024]
Affiliation(s)
- Sushmita Pamidi
- The Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Indu Ayappa
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Azarbarzin A, Labarca G, Kwon Y, Wellman A. Physiological Consequences of Upper Airway Obstruction in Sleep Apnea. Chest 2024:S0012-3692(24)00708-6. [PMID: 38885898 DOI: 10.1016/j.chest.2024.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 05/22/2024] [Accepted: 05/27/2024] [Indexed: 06/20/2024] Open
Abstract
OSA is diagnosed and managed by a metric called the apnea-hypopnea index (AHI). The AHI quantifies the number of respiratory events (apnea or hypopnea), disregarding important information on the characteristics and physiological consequences of respiratory events, including degrees of ventilatory deficit and associated hypoxemia, cardiac autonomic response, and cortical activity. The oversimplification of the disorder by the AHI is considered one of the reasons for divergent findings on the associations of OSA and cardiovascular disease (CVD) in observational and randomized controlled trial studies. Prospective observational cohort studies have demonstrated strong associations of OSA with several cardiovascular diseases, and randomized controlled trials of CPAP intervention have not been able to detect a benefit of CPAP to reduce the risk of CVD. Over the last several years, novel methodologies have been proposed to better quantify the magnitude of OSA-related breathing disturbance and its physiological consequences. As a result, stronger associations with cardiovascular and neurocognitive outcomes have been observed. In this review, we focus on the methods that capture polysomnographic heterogeneity of OSA.
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Affiliation(s)
- Ali Azarbarzin
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
| | - Gonzalo Labarca
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Respiratory Diseases, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Younghoon Kwon
- Department of Medicine, University of Washington, Seattle, WA
| | - Andrew Wellman
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
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Rachmawati EZK, Tamin S, Fardizza F, Yunizaf R, Putranto FM, Rizki NA, Wardani RS. Types of Epiglottic Collapse in Breathing Sleep Disorder and Their Impact in Clinical Practice. Int Arch Otorhinolaryngol 2024; 28:e255-e262. [PMID: 38618588 PMCID: PMC11008943 DOI: 10.1055/s-0043-1776719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 06/29/2023] [Indexed: 04/16/2024] Open
Abstract
Introduction Obstructive sleep apnea (OSA) is a severe form of sleep-disordered breathing (SDB) that is strongly correlated with comorbidities, in which epiglottic collapse (EC) and other contributing factors are involved. Objectives To evaluate the occurrence of EC in OSA patients through drug-induced sleep endoscopy (DISE) and to determine the factors contributing to EC. Methods A retrospective study of 37 adult patients using medical history. Patients were assessed for laryngopharyngeal reflux (LPR) and lingual tonsil hypertrophy (LTH) using reflux symptom index and reflux finding score (RFS); for OSA using polysomnography, and for airway collapse through DISE. An independent t -test was performed to evaluate risk factors, including the involvement of three other airway structures. Results Most EC patients exhibited trap door epiglottic collapse (TDEC) (56.8%) or pushed epiglottic collapse (PEC) (29.7%). Lingual tonsil hypertrophy, RFS, and respiratory effort-related arousal (RERA) were associated with epiglottic subtypes. Laryngopharyngeal reflux patients confirmed by RFS (t(25) = -1.32, p = 0.197) tended to suffer PEC; LTH was significantly associated (X2(1) = 2.5, p = 0.012) with PEC (odds ratio [OR] value = 44) in grades II and III LTH patients; 11 of 16 TDEC patients had grade I LTH. Pushed epiglottic collapse was more prevalent among multilevel airway obstruction patients. A single additional collapse site was found only in TDEC patients. Conclusion Laryngopharyngeal reflux causes repetitive acid stress toward lingual tonsils causing LTH, resulting in PEC with grade II or III LTH. Trap door epiglottic collapse requires one additional structural collapse, while at least two additional collapse sites were necessary to develop PEC. Respiratory effort-related arousal values may indicate EC.
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Affiliation(s)
- Elvie Zulka Kautzia Rachmawati
- Department of Otorhinolaryngology-Head and Neck Surgery, Fakultas Kedokteran Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Susyana Tamin
- Department of Otorhinolaryngology-Head and Neck Surgery, Fakultas Kedokteran Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Fauziah Fardizza
- Department of Otorhinolaryngology-Head and Neck Surgery, Fakultas Kedokteran Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Rahmanofa Yunizaf
- Department of Otorhinolaryngology-Head and Neck Surgery, Fakultas Kedokteran Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Fikri Mirza Putranto
- Department of Otorhinolaryngology-Head and Neck Surgery, Fakultas Kedokteran Universitas Indonesia, Universitas Indonesia Hospital, Depok, Indonesia
| | - Niken Ageng Rizki
- Department of Otorhinolaryngology-Head and Neck Surgery, Fakultas Kedokteran Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Retno S. Wardani
- Department of Otorhinolaryngology-Head and Neck Surgery, Fakultas Kedokteran Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
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Staykov E, Mann DL, Duce B, Kainulainen S, Leppänen T, Töyräs J, Azarbarzin A, Georgeson T, Sands SA, Terrill PI. Increased Flow Limitation During Sleep Is Associated With Increased Psychomotor Vigilance Task Lapses in Individuals With Suspected OSA. Chest 2024; 165:990-1003. [PMID: 38048938 DOI: 10.1016/j.chest.2023.11.031] [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: 04/18/2023] [Revised: 09/03/2023] [Accepted: 11/16/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Impaired daytime vigilance is an important consequence of OSA, but several studies have reported no association between objective measurements of vigilance and the apnea-hypopnea index (AHI). Notably, the AHI does not quantify the degree of flow limitation, that is, the extent to which ventilation fails to meet intended ventilation (ventilatory drive). RESEARCH QUESTION Is flow limitation during sleep associated with daytime vigilance in OSA? STUDY DESIGN AND METHODS Nine hundred ninety-eight participants with suspected OSA completed a 10-min psychomotor vigilance task (PVT) before same-night in-laboratory polysomnography. Flow limitation frequency (percent of flow-limited breaths) during sleep was quantified using airflow shapes (eg, fluttering and scooping) from nasal pressure airflow. Multivariable regression assessed the association between flow limitation frequency and the number of lapses (response times > 500 ms, primary outcome), adjusting for age, sex, BMI, total sleep time, depression, and smoking status. RESULTS Increased flow limitation frequency was associated with decreased vigilance: a 1-SD (35.3%) increase was associated with 2.1 additional PVT lapses (95% CI, 0.7-3.7; P = .003). This magnitude was similar to that for age, where a 1-SD increase (13.5 years) was associated with 1.9 additional lapses. Results were similar after adjusting for AHI, hypoxemia severity, and arousal severity. The AHI was not associated with PVT lapses (P = .20). In secondary exploratory analysis, flow limitation frequency was associated with mean response speed (P = .012), median response time (P = .029), fastest 10% response time (P = .041), slowest 10% response time (P = .018), and slowest 10% response speed (P = .005). INTERPRETATION Increased flow limitation during sleep was associated with decreased daytime vigilance in individuals with suspected OSA, independent of the AHI. Flow limitation may complement standard clinical metrics in identifying individuals whose vigilance impairment most likely is explained by OSA.
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Affiliation(s)
- Eric Staykov
- School of Electrical Engineering and Computer Science, The University of Queensland, Brisbane, QLD, Australia.
| | - Dwayne L Mann
- School of Electrical Engineering and Computer Science, The University of Queensland, Brisbane, QLD, Australia; Institute for Social Science Research, The University of Queensland, Brisbane, QLD, Australia
| | - Brett Duce
- Department of Respiratory & Sleep Medicine, Princess Alexandra Hospital, Brisbane, QLD, Australia; Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Samu Kainulainen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland; Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Timo Leppänen
- School of Electrical Engineering and Computer Science, The University of Queensland, Brisbane, QLD, Australia; Department of Technical Physics, University of Eastern Finland, Kuopio, Finland; Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Juha Töyräs
- School of Electrical Engineering and Computer Science, The University of Queensland, Brisbane, QLD, Australia; Department of Technical Physics, University of Eastern Finland, Kuopio, Finland; Science Service Center, Kuopio University Hospital, Kuopio, Finland
| | - Ali Azarbarzin
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, MA
| | - Thomas Georgeson
- School of Electrical Engineering and Computer Science, The University of Queensland, Brisbane, QLD, Australia; Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Scott A Sands
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, MA
| | - Philip I Terrill
- School of Electrical Engineering and Computer Science, The University of Queensland, Brisbane, QLD, Australia
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Li D, Ruan Y, Zheng F, Su Y, Lin Q. Fast Sleep Stage Classification Using Cascaded Support Vector Machines with Single-Channel EEG Signals. SENSORS (BASEL, SWITZERLAND) 2022; 22:9914. [PMID: 36560286 PMCID: PMC9784858 DOI: 10.3390/s22249914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/10/2022] [Accepted: 12/13/2022] [Indexed: 06/01/2023]
Abstract
Long-term sleep stage monitoring is very important for the diagnosis and treatment of insomnia. With the development of wearable electroencephalogram (EEG) devices, we developed a fast and accurate sleep stage classification method in this study with single-channel EEG signals for practical applications. The original sleep recordings were collected from the Sleep-EDF database. The wavelet threshold denoising (WTD) method and wavelet packet transformation (WPT) method were applied as signal preprocessing to extract six kinds of characteristic waves. With a comprehensive feature system including time, frequency, and nonlinear dynamics, we obtained the sleep stage classification results with different Support Vector Machine (SVM) models. We proposed a novel classification method based on cascaded SVM models with various features extracted from denoised EEG signals. To enhance the accuracy and generalization performance of this method, nonlinear dynamics features were taken into consideration. With nonlinear dynamics features included, the average classification accuracy was up to 88.11% using this method. In addition, with cascaded SVM models, the classification accuracy of the non-rapid eye movement sleep stage 1 (N1) was enhanced from 41.5% to 55.65% compared with the single SVM model, and the overall classification time for each epoch was less than 1.7 s. Moreover, we demonstrated that it was possible to apply this method for long-term sleep stage monitor applications.
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Affiliation(s)
- Dezhao Li
- Zhejiang Provincial Key Laboratory of Quantum Precision Measurement, Collaborative Innovation Center for Information Technology in Biological and Medical Physics, College of Science, Zhejiang University of Technology, Hangzhou 310023, China
| | - Yangtao Ruan
- Zhejiang Provincial Key Laboratory of Quantum Precision Measurement, Collaborative Innovation Center for Information Technology in Biological and Medical Physics, College of Science, Zhejiang University of Technology, Hangzhou 310023, China
| | - Fufu Zheng
- Zhejiang Provincial Key Laboratory of Quantum Precision Measurement, Collaborative Innovation Center for Information Technology in Biological and Medical Physics, College of Science, Zhejiang University of Technology, Hangzhou 310023, China
| | - Yan Su
- School of Art, Zhejiang International Studies University, Hangzhou 310023, China
| | - Qiang Lin
- Zhejiang Provincial Key Laboratory of Quantum Precision Measurement, Collaborative Innovation Center for Information Technology in Biological and Medical Physics, College of Science, Zhejiang University of Technology, Hangzhou 310023, China
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Persistence and prevalence of sleep-disordered breathing after delivery: A scoping review of longitudinal and cross-sectional studies. Sleep Med Rev 2022; 65:101674. [DOI: 10.1016/j.smrv.2022.101674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 07/04/2022] [Accepted: 07/19/2022] [Indexed: 11/21/2022]
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Phan K, Pamidi S, Gomez YH, Gorgui J, El-Messidi A, Gagnon R, Kimoff RJ, Abenhaim HA, Daskalopoulou SS. Sleep-disordered breathing in high-risk pregnancies is associated with elevated arterial stiffness and increased risk for preeclampsia. Am J Obstet Gynecol 2022; 226:833.e1-833.e20. [PMID: 34863697 DOI: 10.1016/j.ajog.2021.11.1366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 11/25/2021] [Accepted: 11/29/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Impaired vascular function is a central feature of pathologic processes preceding the onset of preeclampsia. Arterial stiffness, a composite indicator of vascular health and an important vascular biomarker, has been found to be increased throughout pregnancy in those who develop preeclampsia and at the time of preeclampsia diagnosis. Although sleep-disordered breathing in pregnancy has been associated with increased risk for preeclampsia, it is unknown if sleep-disordered breathing is associated with elevated arterial stiffness in pregnancy. OBJECTIVE This prospective observational cohort study aimed to evaluate arterial stiffness in pregnant women, with and without sleep-disordered breathing and assess the interaction between arterial stiffness, sleep-disordered breathing, and preeclampsia risk. STUDY DESIGN Women with high-risk singleton pregnancies were enrolled at 10 to 13 weeks' gestation and completed the Epworth Sleepiness Score, Pittsburgh Sleep Quality Index, and Restless Legs Syndrome questionnaires at each trimester. Sleep-disordered breathing was defined as loud snoring or witnessed apneas (≥3 times per week). Central arterial stiffness (carotid-femoral pulse wave velocity, the gold standard measure of arterial stiffness), peripheral arterial stiffness (carotid-radial pulse wave velocity), wave reflection (augmentation index, time to wave reflection), and hemodynamics (central blood pressures, pulse pressure amplification) were assessed noninvasively using applanation tonometry at recruitment and every 4 weeks from recruitment until delivery. RESULTS High-risk pregnant women (n=181) were included in the study. Women with sleep-disordered breathing (n=41; 23%) had increased carotid-femoral pulse wave velocity throughout gestation independent of blood pressure and body mass index (P=.042). Differences observed in other vascular measures were not maintained after adjustment for confounders. Excessive daytime sleepiness, defined by Epworth Sleepiness Score >10, was associated with increased carotid-femoral pulse wave velocity only in women with sleep-disordered breathing (Pinteraction=.001). Midgestation (first or second trimester) sleep-disordered breathing was associated with an odds ratio of 3.4 (0.9-12.9) for preeclampsia, which increased to 5.7 (1.1-26.0) in women with sleep-disordered breathing and hypersomnolence, whereas late (third-trimester) sleep-disordered breathing was associated with an odds ratio of 8.2 (1.5-39.5) for preeclampsia. CONCLUSION High-risk pregnant women with midgestational sleep-disordered breathing had greater arterial stiffness throughout gestation than those without. Sleep-disordered breathing at any time during pregnancy was also associated with increased preeclampsia risk, and this effect was amplified by hypersomnolence.
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Konstanty-Kurkiewicz V, Dzięciołowska-Baran E, Szczurowski J, Gawlikowska-Sroka A. Sleep-Disordered Breathing in Pregnancy. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1375:101-109. [PMID: 34970727 DOI: 10.1007/5584_2021_691] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Sleep-disordered breathing (SDB) is a spectrum of abnormal respiratory events including habitual snoring and increased upper airway resistance and obstructive episodes. The uncertainties concerning the incidence and recognition of SDB during pregnancy and the importance of the issue for fetal and maternal health prompted us to screen pregnant women for SDB. The study included 312 women in the third trimester of pregnancy aged 17-46 of whom 51 were preselected, based on the results of SDB questionnaires, for a nighttime home screening using a portable ApneaLink Air device. We found that single or multiple episodes of apnea were present in 35 (69%) women. The mean apnea/hypopnea index (AHI) was 1.8 ± 1.8 episodes/h of sleep, which did not exceed the prevalence in the general young-adult female population. However, we noticed a substantial number of inspiratory airflow limitation (IFL) episodes most often accompanied by snoring and more frequent in pregnant women with a greater weight gain. IFLs, although not fulfilling the quantifiable criteria of hypopnea, raise the possibility of hardly recognizable oxygenation and cardiovascular disturbances in pregnancy, reflected in an increased risk index for SDB. We conclude that pregnancy encompasses the risk of revealing or intensifying pre-existing SDB which can jeopardize maternal and fetal health. The risk particularly applies to overweight women. We submit that women in late pregnancy should be carefully screened for possible SDB.
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Affiliation(s)
| | - Edyta Dzięciołowska-Baran
- Department of Anatomy, Pomeranian Medical University, Szczecin, Poland.,Department of Otolaryngology, Provincial Hospital, Szczecin, Poland
| | - Jacek Szczurowski
- Department of Anthropology, Institute of Environmental Biology, University of Environmental and Life Sciences, Wrocław, Poland
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10
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Mann DL, Georgeson T, Landry SA, Edwards BA, Azarbarzin A, Vena D, Hess LB, Wellman A, Redline S, Sands SA, Terrill PI. Frequency of flow limitation using airflow shape. Sleep 2021; 44:6317693. [PMID: 34240221 DOI: 10.1093/sleep/zsab170] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 06/27/2021] [Indexed: 12/26/2022] Open
Abstract
STUDY OBJECTIVES The presence of flow limitation during sleep is associated with adverse health consequences independent of obstructive sleep apnea (OSA) severity (apnea-hypopnea index, AHI), but remains extremely challenging to quantify. Here we present a unique library and an accompanying automated method that we apply to investigate flow limitation during sleep. METHODS A library of 117,871 breaths (N=40 participants) were visually classified (certain flow limitation, possible flow limitation, normal) using airflow shape and physiological signals (ventilatory drive per intra-esophageal diaphragm EMG). An ordinal regression model was developed to quantify flow limitation certainty using flow-shape features (e.g. flattening, scooping); breath-by-breath agreement (Cohen's ƙ) and overnight flow limitation frequency (R 2, %breaths in certain or possible categories during sleep) were compared against visual scoring. Subsequent application examined flow limitation frequency during arousals and stable breathing, and associations with ventilatory drive. RESULTS The model (23 features) assessed flow limitation with good agreement (breath-by-breath ƙ=0.572, p<0.001) and minimal error (overnight flow limitation frequency R 2=0.86, error=7.2%). Flow limitation frequency was largely independent of AHI (R 2=0.16) and varied widely within individuals with OSA (74[32-95]%breaths, mean[range], AHI>15/hr, N=22). Flow limitation was unexpectedly frequent but variable during arousals (40[5-85]%breaths) and stable breathing (58[12-91]%breaths), and was associated with elevated ventilatory drive (R 2=0.26-0.29; R 2<0.01 AHI v. drive). CONCLUSIONS Our method enables quantification of flow limitation frequency, a key aspect of obstructive sleep-disordered breathing that is independent of the AHI and often unavailable. Flow limitation frequency varies widely between individuals, is prevalent during arousals and stable breathing, and reveals elevated ventilatory drive.
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Affiliation(s)
- Dwayne L Mann
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia.,Institute for Social Science Research, The University of Queensland, Brisbane, Australia.,Department of Physiology, School of Biomedical Sciences and Biomedical Discovery Institute, Monash University, Melbourne, VIC, Australia
| | - Thomas Georgeson
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Shane A Landry
- Department of Physiology, School of Biomedical Sciences and Biomedical Discovery Institute, Monash University, Melbourne, VIC, Australia.,School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
| | - Bradley A Edwards
- Department of Physiology, School of Biomedical Sciences and Biomedical Discovery Institute, Monash University, Melbourne, VIC, Australia.,School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
| | - Ali Azarbarzin
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham & Women's Hospital & Harvard Medical School, Boston, MA, USA
| | - Daniel Vena
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham & Women's Hospital & Harvard Medical School, Boston, MA, USA
| | - Lauren B Hess
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham & Women's Hospital & Harvard Medical School, Boston, MA, USA
| | - Andrew Wellman
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham & Women's Hospital & Harvard Medical School, Boston, MA, USA
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham & Women's Hospital & Harvard Medical School, Boston, MA, USA
| | - Scott A Sands
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham & Women's Hospital & Harvard Medical School, Boston, MA, USA
| | - Philip I Terrill
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
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11
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Redhead K, Walsh J, Galbally M, Newnham JP, Watson SJ, Eastwood P. Obstructive sleep apnea is associated with depressive symptoms in pregnancy. Sleep 2021; 43:5648018. [PMID: 31782959 DOI: 10.1093/sleep/zsz270] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 08/23/2019] [Indexed: 12/13/2022] Open
Abstract
STUDY OBJECTIVES In pregnancy, the prevalence of both obstructive sleep apnea (OSA) and depression increases. Research reveals an association in the general population with up to 45% of patients diagnosed with OSA having depressive symptoms. Therefore, this study aimed to investigate the relationship between OSA and depression in pregnant women. METHODS One hundred and eighty-nine women ≥26 weeks pregnant were recruited from a tertiary perinatal hospital. This cross-sectional study measured OSA (Apnea Hypopnea Index, AHI, using an ApneaLink device) and symptoms of depression (Edinburgh Postnatal Depression Scale, EPDS). Data were collected from medical records including participant age, ethnicity, parity, BMI, smoking status, history of depression, and use of antidepressants. RESULTS Of the consenting women, data from 124 were suitable for analysis. Twenty women (16.1%) had OSA (AHI ≥ 5 events/h) and 11 (8.8%) had depressive symptoms (EPDS > 12). Women with OSA were more likely to have depressive symptoms after adjusting for covariates, odds ratio = 8.36, 95% CI [1.57, 44.46]. OSA was also related to higher EPDS scores and these were greater in women with a history of depression. CONCLUSIONS During late pregnancy women with OSA had eight times the odds of having depressive symptoms. Furthermore, an interaction was found between OSA and history of depression. Specifically, in women with no history of depression, OSA increases depressive symptoms. In women with a history of depression, OSA has an even stronger effect on depressive symptomology. This suggests screening for OSA in pregnancy may identify women prone to future depressive episodes and allow for targeted interventions.
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Affiliation(s)
- Karen Redhead
- School of Medicine, University of Notre Dame, Fremantle, Western Australia, Australia
| | - Jennifer Walsh
- Centre for Sleep Science, School of Human Sciences, University of Western Australia, Crawley, Western Australia, Australia
| | - Megan Galbally
- School of Medicine, University of Notre Dame, Fremantle, Western Australia, Australia.,Psychology Discipline, Murdoch University, Murdoch, Western Australia, Australia
| | - John P Newnham
- Centre for Sleep Science, School of Human Sciences, University of Western Australia, Crawley, Western Australia, Australia.,Division of Obstetrics and Gynaecology, School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Stuart J Watson
- School of Medicine, University of Notre Dame, Fremantle, Western Australia, Australia.,Psychology Discipline, Murdoch University, Murdoch, Western Australia, Australia
| | - Peter Eastwood
- Centre for Sleep Science, School of Human Sciences, University of Western Australia, Crawley, Western Australia, Australia
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Catathrenia resolved with the lowest CPAP pressure settings. Pulmonology 2020; 26:107-110. [DOI: 10.1016/j.pulmoe.2019.07.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 07/17/2019] [Accepted: 07/23/2019] [Indexed: 11/22/2022] Open
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Camassa A, Franciosini A, Sands SA, Zhi YX, Yadollahi A, Bianchi AM, Wellman A, Redline S, Azarbarzin A, Mariani S. Validating an Algorithm for Automatic Scoring of Inspiratory Flow Limitation Within a Range of Recording Settings. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2019; 2018:4788-4791. [PMID: 30441417 DOI: 10.1109/embc.2018.8513127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Inspiratory Flow Limitation (IFL) is a phenomenon associated with narrowing of the upper airway, preventing an increase in inspiratory airflow despite an elevation in intrathoracic pressure. It has been shown that quantification of IFL might complement information provided by standard indices such as the apnea-hypopnea index (AHI) in characterizing sleep disordered breathing and identifying subclinical disease. Defining guidelines for visual scoring of IFL has been of increasing interest, and automated methods are desirable to avoid inter-scorer variability and allow analysis of large datasets. In addition, as recording instrumentation and practices may vary across hospitals and laboratories, it is useful to assess the influence of the recording parameters on the accuracy of the automated classification. We employed nasal pressure signals recorded as part of polysomnography (PSG) studies in 7 patients. Two experts independently classified approximately 2000 breaths per subject as IFL or non-IFL, and we used the consensus scoring as the gold standard. For each breath, we derived features indicative of the shape and frequency content of the signals and used them to train and validate a Support Vector Machine (SVM) to distinguish IFL from non-IFL breaths. We also assessed the effect of signal filtering (down-sampling and baseline-removal) on classification performance. The performance of the classifier was excellent (accuracy ~93%) for the raw signals (collected at 125 Hz with no filtering), and decreased for increasing high-pass cut-off frequencies (fc = [0.05, 0.1, 0.15, 0.2] Hz) down to 84% for fc= 0.2 Hz and for decreasing sampling rate (fs = [20, 50, 75, 100] Hz) down to ~85% for fs=20 Hz. Loss of performance was minimized when the classifier was re-trained using data with matched filtering characteristics (accuracy > 89%). We can conclude that the SVM feature-based algorithm provides a reliable and efficient tool for breath-by-breath classification.
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Kim JS, Azarbarzin A, Wang R, Djonlagic IE, Punjabi NM, Zee PC, Koo BB, Soliman EZ, Younes M, Redline S. Association of novel measures of sleep disturbances with blood pressure: the Multi-Ethnic Study of Atherosclerosis. Thorax 2019; 75:57-63. [PMID: 31439722 DOI: 10.1136/thoraxjnl-2019-213533] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 08/02/2019] [Accepted: 08/02/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Mechanisms underlying blood pressure (BP) changes in obstructive sleep apnoea (OSA) are incompletely understood. We assessed the associations between BP and selected polysomnography (PSG) traits: sleep depth, airflow limitation measurements and OSA-specific hypoxic burden. METHODS This cross-sectional analysis included 2055 participants from the Multi-Ethnic Study of Atherosclerosis who underwent PSG and BP measurements in 2010-2013. Sleep depth was assessed using the 'OR product', a continuous measure of arousability. Airflow limitation was assessed by duty cycle (Ti/Tt) and % of breaths with flow limitation, and hypoxia by 'hypoxic burden'. Primary outcomes were medication-adjusted systolic BP (SBP) and diastolic BP (DBP). We used generalised linear models adjusted for age, sex, race/ethnicity, smoking, education, body mass index, alcohol use, periodic limb movements and alternative physiological disturbances. RESULTS The sample had a mean age of 68.4 years and apnoea-hypopnoea index of 14.8 events/hour. Sleep depth was not significantly associated with BP. Every 1 SD increment in log-transformed non-rapid eye movement duty cycle was associated with 0.9% decrease in SBP (95% CI: 0.1% to 1.6%), even after adjusting for sleep depth and hypoxic burden. Every 1 SD increment in log-transformed hypoxic burden was associated with a 1.1% increase in SBP (95% CI: 0.1% to 2.1%) and 1.9% increase in DBP (95% CI: 1.0% to 2.8%) among those not using hypertension medications. CONCLUSIONS Higher duty cycle was associated with lower SBP overall and hypoxic burden with higher SBP and DBP among non-BP medication users. These findings suggest changes in both respiratory effort and oxygenation during sleep influence BP.
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Affiliation(s)
- John S Kim
- Department of Medicine, Columbia University Medical Center, New York City, New York, USA
| | - Ali Azarbarzin
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Rui Wang
- Department of Biostatistics, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts, United States.,Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts, United States
| | - Ina E Djonlagic
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Naresh M Punjabi
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, United States
| | - Phyllis C Zee
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Brian B Koo
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Elsayed Z Soliman
- Department of Medicine, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Magdy Younes
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Susan Redline
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
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Guilleminault C, Huang YS, Chin WC, Okorie C. The nocturnal-polysomnogram and “non-hypoxic sleep-disordered-breathing” in children. Sleep Med 2019; 60:31-44. [DOI: 10.1016/j.sleep.2018.11.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 11/03/2018] [Accepted: 11/07/2018] [Indexed: 11/17/2022]
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Krakow B, McIver ND, Ulibarri VA, Krakow J, Schrader RM. Prospective Randomized Controlled Trial on the Efficacy of Continuous Positive Airway Pressure and Adaptive Servo-Ventilation in the Treatment of Chronic Complex Insomnia. EClinicalMedicine 2019; 13:57-73. [PMID: 31517263 PMCID: PMC6734001 DOI: 10.1016/j.eclinm.2019.06.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 05/28/2019] [Accepted: 06/19/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Complex insomnia, the comorbidity of chronic insomnia and obstructive sleep apnea (OSA), is a common sleep disorder, but the OSA component, whether presenting overtly or covertly, often goes unsuspected and undiagnosed due to a low index of suspicion. Among complex insomniacs, preliminary evidence demonstrates standard CPAP decreases insomnia severity. However, CPAP causes expiratory pressure intolerance or iatrogenic central apneas that may diminish its use. An advanced PAP mode-adaptive servo-ventilation (ASV)-may alleviate CPAP side-effects and yield superior outcomes. METHODS In a single-site protocol investigating covert complex insomnia (ClinicalTrials.gov identifier: NCT02365064), a low index of suspicion for this comorbidity was confirmed by exclusion of 455 of 660 eligible patients who presented during the study period with overt OSA signs and symptoms. Ultimately, stringent inclusion/exclusion criteria to test efficacy yielded 40 adult, covert complex insomnia patients [average Insomnia Severity Index (ISI) moderate-severe 19.30 (95% CI 18.42-20.17)] who reported no definitive OSA symptoms or risks and who failed behavioral or drug therapy for an average of one decade. All 40 were diagnosed with OSA and randomized (using block randomization) to a single-blind, prospective protocol, comparing CPAP (n = 21) and ASV (n = 19). Three successive PAP titrations fine-tuned pressure settings, facilitated greater PAP use, and collected objective sleep and breathing data. Patients received 14 weeks of treatment including intensive biweekly coaching and follow-up to foster regular PAP use in order to accurately measure efficaciousness. Primary outcomes measured insomnia severity and sleep quality. Secondary outcomes measured daytime impact: OSA-induced impairment, fatigue severity, insomnia impairment, and quality of life. Performance on these seven variables was assessed using repeated measures ANCOVA to account for the multiple biweekly time points. FINDINGS At intake, OSA diagnosis and OSA as a cause for insomnia were denied by all 40 patients, yet PAP significantly decreased insomnia severity scores (p = 0.021 in the primary ANCOVA analysis). To quantify effect sizes, mean intake vs endpoint analysis was conducted with ASV yielding nearly twice the effects of CPAP [- 13.2 (10.7-15.7), Hedges' g = 2.50 vs - 9.3 (6.3-12.3), g = 1.39], and between mode effect size was in the medium-large range 0.65. Clinically, ASV led to remission (ISI < 8) in 68% of cases compared to 24% on CPAP [Fisher's exact p = 0.010]. Two sleep quality measures in the ANCOVA analysis again demonstrated superior significant effects for ASV compared to CPAP (both p < 0.03), and pre- and post-analysis demonstrated substantial effects for both scales [ASV (g = 1.42; g = 1.81) over CPAP (g = 1.04; g = 0.75)] with medium size effects between modes (0.54, 0.51). Measures of impairment, residual objective sleep breathing events, and normalized breathing periods consistently demonstrated larger beneficial effects for ASV over CPAP. INTERPRETATION PAP therapy was highly efficacious in decreasing insomnia severity in chronic insomnia patients with previously undiagnosed co-morbid OSA. ASV proved superior to CPAP in this first efficacy trial to compare advanced to traditional PAP modes in complex insomnia. Future research must determine the following: pathophysiological mechanisms to explain how OSA causes chronic insomnia; general population prevalence of this comorbidity; and, cost-effectiveness of ASV therapy in complex insomnia. Last, efforts to raise awareness of complex insomnia are urgently needed as patients and providers appear to disregard both overt and covert signs and symptoms of OSA in the assessment of chronic insomnia.
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Affiliation(s)
- Barry Krakow
- Sleep & Human Health Institute, 6739 Academy Rd NE, Ste 380, Albuquerque, NM 87109, USA
- Maimonides Sleep Arts & Sciences, Ltd., 6739 Academy Rd NE, Ste 380, Albuquerque, NM 87109, USA
| | - Natalia D. McIver
- Sleep & Human Health Institute, 6739 Academy Rd NE, Ste 380, Albuquerque, NM 87109, USA
- Maimonides Sleep Arts & Sciences, Ltd., 6739 Academy Rd NE, Ste 380, Albuquerque, NM 87109, USA
| | - Victor A. Ulibarri
- Sleep & Human Health Institute, 6739 Academy Rd NE, Ste 380, Albuquerque, NM 87109, USA
- Maimonides Sleep Arts & Sciences, Ltd., 6739 Academy Rd NE, Ste 380, Albuquerque, NM 87109, USA
| | - Jessica Krakow
- Sleep & Human Health Institute, 6739 Academy Rd NE, Ste 380, Albuquerque, NM 87109, USA
- Maimonides Sleep Arts & Sciences, Ltd., 6739 Academy Rd NE, Ste 380, Albuquerque, NM 87109, USA
| | - Ronald M. Schrader
- RMS Biostatistics Services, 13129 Bluemist Ln NE, Albuquerque, NM 87111, USA
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Guilleminault C, Sullivan SS, Huang YS. Sleep-Disordered Breathing, Orofacial Growth, and Prevention of Obstructive Sleep Apnea. Sleep Med Clin 2019; 14:13-20. [PMID: 30709527 DOI: 10.1016/j.jsmc.2018.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Abnormal breathing during sleep is related to intrinsic and extrinsic factors that are present early in life. Investigation of fetal development and early-in-life orofacial growth allows recognition of risk factors that lead to change in upper airway patency, which leads to abnormal upper airway resistance, abnormal inspiratory efforts, and further increase in resistance and progressive narrowing of the collapsible upper airway. Such evolution can be recognized by appropriate clinical evaluation, specific polysomnographic patterns, and orofacial imaging. Recognition of the problems should lead to appropriate treatments and prevention of obstructive sleep apnea and its comorbidities.
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Affiliation(s)
- Christian Guilleminault
- Division of Sleep Medicine, Stanford University, 450 Broadway Pavillion C 2nd Floor, Redwood City, CA 94063, USA.
| | - Shannon S Sullivan
- Division of Sleep Medicine, Stanford University, 450 Broadway Pavillion C 2nd Floor, Redwood City, CA 94063, USA
| | - Yu-Shu Huang
- Division of Child-Psychiatry and Pediatric-Sleep laboratory, Department of Psychiatry, Chang Gung Memorial Hospital and Medical College, No. 5, Fuxing Street, Guishan, Taoyuan 333, Linkou, Taiwan
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Johnson KG, Johnson DC, Thomas RJ, Feldmann E, Lindenauer PK, Visintainer P, Kryger MH. Flow limitation/obstruction with recovery breath (FLOW) event for improved scoring of mild obstructive sleep apnea without electroencephalography. Sleep Med 2018; 67:249-255. [PMID: 30583916 DOI: 10.1016/j.sleep.2018.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 11/06/2018] [Accepted: 11/21/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Apnea/hypopnea index (AHI), especially without arousal criteria, does not adequately risk stratify patients with mild obstructive sleep apnea (OSA). We describe and test scoring reliability of an event, Flow Limitation/Obstruction With recovery breath (FLOW), representing obstructive airflow disruptions using only pressure transducer and snore signals available without electroencephalography. METHODS The following process was used (i) Development of FLOW event definition, (ii) Training period and definition refinement, and (iii) Reliability testing on 10 100-epoch polysomnography (PSG) samples and two 100-sample tests. Twenty full-night in-laboratory baseline PSGs in OSA patients with AHI with ≥4% desaturations <15 were rescored for FLOW events, traditional hypopneas with desaturations, respiratory-related arousal (RRA) events (hypopneas with arousals and respiratory-effort related arousals) and non-respiratory arousals (NRA). RESULTS Scoring of FLOW events in 100-epoch samples had good reliability with intraclass correlation (ICC) of 0.91. The overall kappa for presence of events on two sets of 100 sample events was 0.84 and 0.87 demonstrating good agreement. Moreover, 80% of RRA and 8% of NRA were concurrent with FLOW events. Furthermore, 56% of FLOW events were independent of RRA events. FLOW stratifies patients in traditional AHI categories with 50%/8% of AHI with ≥3% desaturations (AHI3) <5 and 12%/63% of AHI3 >5 in lowest/highest tertiles of AHI3 plus FLOW index. CONCLUSIONS Scoring of FLOW after training is reliable. FLOW scores a high proportion of RRA and many currently unrepresented obstructive airflow disruptions. FLOW allows for stratification within the current normal-mild OSA category, which may better identify patients who will benefit from treatment.
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Affiliation(s)
- Karin Gardner Johnson
- Department of Neurology, Baystate Medical Center, University of Massachusetts Medical School-Baystate, 759 Chestnut St, Springfield, MA, 01199, USA; Institute for Healthcare Delivery and Population Science and Department of Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA, USA.
| | - Douglas Clark Johnson
- Department of Medicine, Baystate Medical Center, University of Massachusetts Medical School-Baystate, 759 Chestnut St, Springfield, MA, 01199, USA
| | - Robert Joseph Thomas
- Division of Pulmonary, Critical Care & Sleep, Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA.
| | - Edward Feldmann
- Department of Neurology, Baystate Medical Center, University of Massachusetts Medical School-Baystate, 759 Chestnut St, Springfield, MA, 01199, USA
| | - Peter K Lindenauer
- Institute for Healthcare Delivery and Population Science and Department of Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA, USA; Department of Medicine, Baystate Medical Center, University of Massachusetts Medical School-Baystate, 759 Chestnut St, Springfield, MA, 01199, USA; Department of Quantitative Health Sciences University of Massachusetts Medical School, Worcester, MA, USA
| | - Paul Visintainer
- Institute for Healthcare Delivery and Population Science and Department of Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA, USA
| | - Meir H Kryger
- Division of Pulmonary, Critical Care and Sleep Medicine, Yale New Haven Medical Center, Yale School of Medicine, 20 York Street New Haven, CT, 06510, USA.
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Zhi YX, Vena D, Popovic MR, Bradley TD, Yadollahi A. Detecting inspiratory flow limitation with temporal features of nasal airflow. Sleep Med 2018; 48:70-78. [DOI: 10.1016/j.sleep.2018.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 03/01/2018] [Accepted: 04/17/2018] [Indexed: 12/25/2022]
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Himanen SL, Martikkala L, Sulkamo S, Rutanen A, Huupponen E, Tenhunen M, Saunamäki T. Prolonged partial obstruction during sleep is a NREM phenomenon. Respir Physiol Neurobiol 2018; 255:43-49. [PMID: 29803760 DOI: 10.1016/j.resp.2018.05.009] [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] [Received: 04/03/2018] [Revised: 05/21/2018] [Accepted: 05/24/2018] [Indexed: 10/16/2022]
Abstract
OBJECTIVE Prolonged partial obstruction (PPO) is a common finding in sleep studies. Although not verified, it seems to emerge in deep sleep. We study the effect of PPO on sleep architecture or sleep electroencephalography (EEG) frequency. METHODS Fifteen OSA patients, 15 PPO + OSA patients and 15 healthy subjects underwent a polysomnography. PPO was detected from Emfit mattress signal. Visual sleep parameters and median NREM sleep frequency of the EEG channels were evaluated. RESULTS The amount of deep sleep (N3) did not differ between the PPO + OSA and control groups (medians 11.8% and 13.8%). PPO + OSA-patients' N3 consisted mostly of PPO. PPO + OSA patients had lighter sleep than healthy controls in three brain areas (Fp2-A1, C4-A1, O1-A2, p-values < 0.05). CONCLUSION PPO evolved in NREM sleep and especially in N3 indicating that upper airway obstruction does not always ameliorate in deep sleep but changes the type. Even if PPO + OSA-patients had N3, their NREM sleep was lighter in three EEG locations. This might reflect impaired recovery function of sleep.
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Affiliation(s)
- Sari-Leena Himanen
- Department of Clinical Neurophysiology, Medical Imaging Centre and Hospital Pharmacy, Pirkanmaa Hospital District, Tampere, Finland; Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.
| | - Lauri Martikkala
- Department of Clinical Neurophysiology, Medical Imaging Centre and Hospital Pharmacy, Pirkanmaa Hospital District, Tampere, Finland
| | - Saramia Sulkamo
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Antti Rutanen
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Eero Huupponen
- Department of Clinical Neurophysiology, Medical Imaging Centre and Hospital Pharmacy, Pirkanmaa Hospital District, Tampere, Finland
| | - Mirja Tenhunen
- Department of Clinical Neurophysiology, Medical Imaging Centre and Hospital Pharmacy, Pirkanmaa Hospital District, Tampere, Finland; Department of Medical Physics, Tampere University Hospital, Medical Imaging Centre, Pirkanmaa Hospital District, Tampere, Finland
| | - Tiia Saunamäki
- Tampere University Hospital, Department of Neurology and Rehabilitation, Tampere, Finland
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El-Naggar MES. Pulse transit time in patients with sleep-disordered breathing. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2018. [DOI: 10.4103/ejb.ejb_49_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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22
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Guilleminault C, Huang YS. From oral facial dysfunction to dysmorphism and the onset of pediatric OSA. Sleep Med Rev 2017; 40:203-214. [PMID: 29103943 DOI: 10.1016/j.smrv.2017.06.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 03/21/2017] [Accepted: 06/26/2017] [Indexed: 01/01/2023]
Abstract
The upper airway is a collapsible tube, and its collapsibility increases during sleep. Extrinsic factors such as atypical craniofacial features may increase the risks of airway collapse. We review early development of oral-facial structures and the anatomical variants that may be present at birth and can impact nasal breathing. After birth, there is a continuous interaction between orofacial functions and growth of anatomic features. We review the dysfunctions identified to date that may impact orofacial development leading to sleep-disordered-breathing through changes in the orofacial growth. The identification of risk-factors, ultimately leading to full-blown obstructive sleep apnea, may allow early recognition of these factors and the development of treatments to eliminate early problems or at least decrease their impact.
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Affiliation(s)
- Christian Guilleminault
- Stanford University Sleep Medicine Division, CA, USA; Pediatric Sleep Laboratory Division of Child Psychiatry Chang Gung Memorial Hospital and Medical College, Linkou, Taiwan.
| | - Yu-Shu Huang
- Stanford University Sleep Medicine Division, CA, USA; Pediatric Sleep Laboratory Division of Child Psychiatry Chang Gung Memorial Hospital and Medical College, Linkou, Taiwan
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Weighted Polynomial Approximation for Automated Detection of Inspiratory Flow Limitation. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2017. [PMID: 28634497 PMCID: PMC5467386 DOI: 10.1155/2017/2750701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Inspiratory flow limitation (IFL) is a critical symptom of sleep breathing disorders. A characteristic flattened flow-time curve indicates the presence of highest resistance flow limitation. This study involved investigating a real-time algorithm for detecting IFL during sleep. Three categories of inspiratory flow shape were collected from previous studies for use as a development set. Of these, 16 cases were labeled as non-IFL and 78 as IFL which were further categorized into minor level (20 cases) and severe level (58 cases) of obstruction. In this study, algorithms using polynomial functions were proposed for extracting the features of IFL. Methods using first- to third-order polynomial approximations were applied to calculate the fitting curve to obtain the mean absolute error. The proposed algorithm is described by the weighted third-order (w.3rd-order) polynomial function. For validation, a total of 1,093 inspiratory breaths were acquired as a test set. The accuracy levels of the classifications produced by the presented feature detection methods were analyzed, and the performance levels were compared using a misclassification cobweb. According to the results, the algorithm using the w.3rd-order polynomial approximation achieved an accuracy of 94.14% for IFL classification. We concluded that this algorithm achieved effective automatic IFL detection during sleep.
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Guilleminault C, Huang YS. Pediatric obstructive sleep apnea: A short review of clinical aspects. ACTA ACUST UNITED AC 2017. [DOI: 10.4103/prcm.prcm_7_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Anttalainen U, Tenhunen M, Rimpilä V, Polo O, Rauhala E, Himanen SL, Saaresranta T. Prolonged partial upper airway obstruction during sleep - an underdiagnosed phenotype of sleep-disordered breathing. Eur Clin Respir J 2016; 3:31806. [PMID: 27608271 PMCID: PMC5015642 DOI: 10.3402/ecrj.v3.31806] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 08/10/2016] [Indexed: 12/31/2022] Open
Abstract
Obstructive sleep apnea syndrome (OSAS) is a well-recognized disorder conventionally diagnosed with an elevated apnea-hypopnea index. Prolonged partial upper airway obstruction is a common phenotype of sleep-disordered breathing (SDB), which however is still largely underreported. The major reasons for this are that cyclic breathing pattern coupled with arousals and arterial oxyhemoglobin saturation are easy to detect and considered more important than prolonged episodes of increased respiratory effort with increased levels of carbon dioxide in the absence of cycling breathing pattern and repetitive arousals. There is also a growing body of evidence that prolonged partial obstruction is a clinically significant form of SDB, which is associated with symptoms and co-morbidities which may partially differ from those associated with OSAS. Partial upper airway obstruction is most prevalent in women, and it is treatable with the nasal continuous positive pressure device with good adherence to therapy. This review describes the characteristics of prolonged partial upper airway obstruction during sleep in terms of diagnostics, pathophysiology, clinical presentation, and comorbidity to improve recognition of this phenotype and its timely and appropriate treatment.
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Affiliation(s)
- Ulla Anttalainen
- Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, Turku, Finland
- Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland
- Sleep Research Centre, Department of Physiology, University of Turku, Turku, Finland;
| | - Mirja Tenhunen
- Department of Clinical Neurophysiology, Medical Imaging Centre and Hospital Pharmacy, Pirkanmaa Hospital District, Tampere University Hospital, Tampere, Finland
- Department of Medical Physics, Medical Imaging Centre and Hospital Pharmacy, Pirkanmaa Hospital District, Tampere University Hospital, Tampere, Finland
| | - Ville Rimpilä
- School of Medicine, University of Tampere, Tampere, Finland
| | - Olli Polo
- Unesta Research Center, Tampere, Finland
- Department of Pulmonary Diseases, Tampere University Hospital, Tampere, Finland
| | - Esa Rauhala
- Department of Clinical Neurophysiology, Satakunta Hospital District, Pori, Finland
| | - Sari-Leena Himanen
- Department of Clinical Neurophysiology, Medical Imaging Centre and Hospital Pharmacy, Pirkanmaa Hospital District, Tampere University Hospital, Tampere, Finland
- School of Medicine, University of Tampere, Tampere, Finland
| | - Tarja Saaresranta
- Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, Turku, Finland
- Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland
- Sleep Research Centre, Department of Physiology, University of Turku, Turku, Finland
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Guilleminault C, Huseni S, Lo L. A frequent phenotype for paediatric sleep apnoea: short lingual frenulum. ERJ Open Res 2016; 2:00043-2016. [PMID: 27730205 PMCID: PMC5034598 DOI: 10.1183/23120541.00043-2016] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Accepted: 05/27/2016] [Indexed: 12/04/2022] Open
Abstract
A short lingual frenulum has been associated with difficulties in sucking, swallowing and speech. The oral dysfunction induced by a short lingual frenulum can lead to oral-facial dysmorphosis, which decreases the size of upper airway support. Such progressive change increases the risk of upper airway collapsibility during sleep. Clinical investigation of the oral cavity was conducted as a part of a clinical evaluation of children suspected of having sleep disordered breathing (SDB) based on complaints, symptoms and signs. Systematic polysomnographic evaluation followed the clinical examination. A retrospective analysis of 150 successively seen children suspected of having SDB was performed, in addition to a comparison of the findings between children with and without short lingual frenula. Among the children, two groups of obstructive sleep apnoea syndrome (OSAS) were found: 1) absence of adenotonsils enlargement and short frenula (n=63); and 2) normal frenula and enlarged adenotonsils (n=87). Children in the first group had significantly more abnormal oral anatomy findings, and a positive family of short frenulum and SDB was documented in at least one direct family member in 60 cases. A short lingual frenulum left untreated at birth is associated with OSAS at later age, and a systematic screening for the syndrome should be conducted when this anatomical abnormality is recognised. A short lingual frenulum left untreated at birth is associated with obstructive sleep apnoea syndrome at a later agehttp://ow.ly/6kMQ30163nG
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Affiliation(s)
| | | | - Lauren Lo
- Stanford University Sleep Medicine Division, Redwood City, CA, USA
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