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Meyer EJ, Wittert GA. Approach the Patient With Obstructive Sleep Apnea and Obesity. J Clin Endocrinol Metab 2024; 109:e1267-e1279. [PMID: 37758218 PMCID: PMC10876414 DOI: 10.1210/clinem/dgad572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/31/2023] [Accepted: 09/25/2023] [Indexed: 10/03/2023]
Abstract
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.
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Affiliation(s)
- Emily Jane Meyer
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, SA 5000, Australia
- Endocrine and Diabetes Services, The Queen Elizabeth Hospital, Woodville South, SA 5011, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, SA 5000, Australia
| | - Gary Allen Wittert
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, SA 5000, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, SA 5000, Australia
- Freemasons Centre for Male Health and Wellbeing, South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia
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Bouloukaki I, Schiza S, Tsiligianni I. Obstructive sleep apnea as an additive or even synergistic risk factor for cardiovascular disease in patients with type 2 Diabetes: A call for action in primary care? Diabetes Res Clin Pract 2021; 178:108940. [PMID: 34242716 DOI: 10.1016/j.diabres.2021.108940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/06/2021] [Accepted: 07/02/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Izolde Bouloukaki
- Sleep Disorders Center, Department of Thoracic Medicine, University of Crete, Heraklion, Greece.
| | - Sophia Schiza
- Sleep Disorders Center, Department of Thoracic Medicine, University of Crete, Heraklion, Greece
| | - Ioanna Tsiligianni
- Department of Social Medicine, Faculty of Medicine, University of Crete, Greece
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van Veldhuisen SL, Kuppens K, de Raaff CAL, Wiezer MJ, de Castro SMM, van Veen RN, Swank DJ, Demirkiran A, Boerma EJG, Greve JWM, van Dielen FMH, Frederix GWJ, Hazebroek EJ. Protocol of a multicentre, prospective cohort study that evaluates cost-effectiveness of two perioperative care strategies for potential obstructive sleep apnoea in morbidly obese patients undergoing bariatric surgery. BMJ Open 2020; 10:e038830. [PMID: 33033026 PMCID: PMC7542938 DOI: 10.1136/bmjopen-2020-038830] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Despite the high prevalence of obstructive sleep apnoea (OSA) in obese patients undergoing bariatric surgery, OSA is undiagnosed in the majority of patients and thus untreated. While untreated OSA is associated with an increased risk of preoperative and postoperative complications, no evidence-based guidelines on perioperative care for these patients are available. The aim of the POPCORN study (Post-Operative Pulse oximetry without OSA sCreening vs perioperative continuous positive airway pressure (CPAP) treatment following OSA scReeNing by polygraphy (PG)) is to evaluate which perioperative strategy is the most cost-effective for obese patients undergoing bariatric surgery without a history of OSA. METHODS AND ANALYSIS In this multicentre observational cohort study, data from 1380 patients who will undergo bariatric surgery will be collected. Patients will receive either postoperative care with pulse oximetry monitoring and supplemental oxygen during the first postoperative night, or care that includes preoperative PG and CPAP treatment in case of moderate or severe OSA. Local protocols for perioperative care in each participating hospital will determine into which cohort a patient is placed. The primary outcome is cost-effectiveness, which will be calculated by comparing all healthcare costs with the quality-adjusted life-years (QALYs, calculated using EQ-5D questionnaires). Secondary outcomes are mortality, complications within 30 days after surgery, readmissions, reoperations, length of stay, weight loss, generic quality of life (QOL), OSA-specific QOL, OSA symptoms and CPAP adherence. Patients will receive questionnaires before surgery and 1, 3, 6 and 12 months after surgery to report QALYs and other patient-reported outcomes. ETHICS AND DISSEMINATION Approval from the Medical Research Ethics Committees United was granted in accordance with the Dutch law for Medical Research Involving Human Subjects Act (WMO) (reference number W17.050). Results will be submitted for publication in peer-reviewed journals and presented at (inter)national conferences. TRIAL REGISTRATION NUMBER NTR6991.
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Affiliation(s)
| | - Kim Kuppens
- Department of Pulmonary Medicine, St. Antonius Ziekenhuis, Nieuwegein, The Netherlands
| | | | - Marinus J Wiezer
- Department of Surgery, St. Antonius Ziekenhuis, Nieuwegein, The Netherlands
| | | | - Ruben N van Veen
- Department of Surgery, OLVG, location West, Amsterdam, The Netherlands
| | - Dingeman J Swank
- Department of Surgery, Dutch Obesity Clinic (Nederlandse Obesitas Kliniek), The Hague, The Netherlands
| | - Ahmet Demirkiran
- Department of Surgery, Rode Kruis Ziekenhuis, Beverwijk, The Netherlands
| | - Evert-Jan G Boerma
- Department of Surgery, Zuyderland Medisch Centrum, Heerlen, The Netherlands
| | - Jan-Willem M Greve
- Department of Surgery, Zuyderland Medisch Centrum, Heerlen, The Netherlands
- Department of Surger / Nutrim, Maastricht University, Maastricht, The Netherlands
| | | | - Geert W J Frederix
- Department of Public Health, Julius Center Research Program Methodology, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands
| | - Eric J Hazebroek
- Department of Surgery / Vitalys Clinic, Rijnstate Ziekenhuis, Arnhem, The Netherlands
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, Gelderland, The Netherlands
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Janssen HC, Venekamp LN, Peeters GA, Pijpers A, Pevernagie DA. Management of insomnia in sleep disordered breathing. Eur Respir Rev 2019; 28:28/153/190080. [DOI: 10.1183/16000617.0080-2019] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 09/05/2019] [Indexed: 01/10/2023] Open
Abstract
Both obstructive sleep apnoea (OSA) and chronic insomnia disorder are highly prevalent in the general population. Whilst both disorders may occur together by mere coincidence, it appears that they share clinical features and that they may aggravate each other as a result of reciprocally adverse pathogenetic mechanisms. Comorbidity between chronic insomnia disorder and OSA is a clinically relevant condition that may confront practitioners with serious diagnostic and therapeutic challenges. Current data, while still scarce, advocate an integrated and multidisciplinary approach that seems superior over the isolated treatment of each sleep disorder alone.
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Abma IL, Rovers MM, IJff M, Hol B, Nägele M, Westert GP, van der Wees PJ. Does the Patient-Reported Apnea Questionnaire (PRAQ) increase patient-centredness in the daily practice of sleep centres? a mixed-methods study. BMJ Open 2019; 9:e025963. [PMID: 31203238 PMCID: PMC6585829 DOI: 10.1136/bmjopen-2018-025963] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The objective of this exploratory study was to see how the Patient-Reported Apnea Questionnaire (PRAQ) may impact the daily clinical practice of sleep centres, and why it may or may not work as expected. The hypotheses were tested that this patient-reported outcome measure makes patients more aware of which of their health complaints may be related to obstructive sleep apnoea (OSA), and that it improves patient-centredness of care by shifting the focus of care away from (only) medical problems towards the individual burden of disease and quality of life. DESIGN Mixed methods. The quantitative study (surveys, patient records) was a before-and-after study. SETTING Three sleep centres in The Netherlands (secondary care). PARTICIPANTS 27 patients and 14 healthcare professionals were interviewed. 487 patients completed surveys pre-implementation, and 377 patients completed surveys post-implementation of the PRAQ. For the health records, 125 patients were included in the pre-implementation group, and 124 other patients in the post-implementation group. INTERVENTIONS The PRAQ was used in clinical practice for six successive months. OUTCOME MEASURES Scores on individual survey items, number of patients receiving non-medical treatment, adjustment of treatment at first follow-up, compliance with treatment. RESULTS Patients were generally positive about the usefulness of the PRAQ before and during the consultation, as they felt more informed. Healthcare providers did not consider the PRAQ very useful, and they reported minor impact on their consultations. The surveys and health record study did not show an impact of the PRAQ on clinical practice. CONCLUSIONS Implementing the PRAQ may be beneficial to patients, but this study does not show much impact with regard to patient-centredness of care. New Dutch guidelines for OSA care may lead to a greater emphasis on quality of life and value of care for patients, making its integration in clinical care potentially more useful.
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Affiliation(s)
- Inger L Abma
- IQ Healthcare, Radboudumc, Nijmegen, The Netherlands
| | - Maroeska M Rovers
- Health Evidence and Operating Rooms, Radboudumc, Nijmegen, The Netherlands
| | | | - Bernard Hol
- Sleep Centre, Albert Schweitzer Ziekenhuis, Dordrecht, The Netherlands
| | - Masha Nägele
- IQ Healthcare, Radboudumc, Nijmegen, The Netherlands
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Abstract
Obstructive sleep apnea (OSA) is a main cause of excessive daytime sleepiness and increases the risk for driving accidents, which can be normalized by treatment with continuous positive airway pressure ventilation. Since it is estimated that OSA is not diagnosed in about 80% of cases, recognition of patients at risk for driving accidents is a problem from both medical and societal points of view. Strategies to screen and identify subjects at high risk for driving accidents are under study in order to improve safety on the road, especially for commercial drivers, who show a high prevalence of OSA.
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Affiliation(s)
- Maria Bonsignore
- DiBiMIS, University of Palermo, Palermo, Italy.,CNR Institute of Biomedicine and Molecular Immunology (IBIM), Palermo , Italy
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Abstract
Obstructive sleep apnoea (OSA) is very common in patients with Type 2 diabetes (T2D), which is not surprising considering that obesity is a common risk factor for both conditions. In general population studies, OSA has been shown to be associated with several comorbidities including increased risk of road traffic accidents, T2D, hypertension and lack of nocturnal dipping of blood pressure, hyperlipidaemia, increased inflammation, increased risk of cardiovascular disease and mortality, increased risk of atrial fibrillation, worse quality of life, and erectile dysfunction. However, the impact of OSA on diabetes-related vascular and metabolic outcomes remains unclear. Furthermore, the impact of continuous positive airway pressure (CPAP) treatment in patients with T2D is also unclear. This unclarity regarding the impact of OSA and CPAP in patients with T2D has possibly contributed to the lack of screening for OSA in patients with T2D in the UK despite the high prevalence of OSA in patients with T2D. In this commentary, I provide an overview about OSA with a particular focus on its role and impact in patients with T2D.
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Affiliation(s)
- Abd A Tahrani
- 1 Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- 2 Department of Diabetes & Endocrinology, Birmingham Heartlands Hospital, Birmingham, UK
- 3 Centre of Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
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