Publication trends in obstructive sleep apnea: Evidence of need for more evidence

A bibliometric analysis of obstructive sleep apnea and anesthesia

To conduct a bibliographic analysis of obstructive sleep apnea (OSA) which has reached epidemic proportions and is a frequent, unknown, and important cause of perioperative morbidity and mortality, by examining the internationally most cited articles. For OSA, the most cited articles in the field of anesthesiology and reanimation, appropriate access terms were compiled and combined, and related publications were searched using the Thompson Reuters Web of Science Citation Indexing search engine. A total of 79 journal publications were found on OSA and anesthesia, with an average of 14.86 citations per article. The most cited publication was the "Society for Ambulatory Anesthesia Consensus Statement on Preoperative Selection of Adult Patients with Obstructive Sleep Apnea Scheduled for Ambulatory Surgery" published in the journal Anesthesia and Analgesia and was conducted by Joshi et al. It was found that 38 of the 79 studies reached as a result of the search were articles, and the average number of citations was 21.13. The Hirsch index of these articles, which were cited 803 times in total, was 15. A total of 31 articles (81.57%) were cited at least once, while the remaining 7 articles (18.43%) were not cited at all. The majority of the articles obtained are from the research fields of anesthesiology (n = 20; 52.63%), followed by otorhinolaryngology (n = 5; 13.15%), pediatrics (n = 5; 13.15%), respiratory system (n = 5; 13.15%), internal medicine (n = 4; 10.52%), and the rest were in various fields. Publications on "Obstructive Sleep Apnea" and "Anesthesia" have increased rapidly in the last decade. Anesthesia management and airway safety, patient management, including pain control in the postoperative period, and noninvasive mechanical ventilation treatment methods, such as continuous positive airway pressure, are hot topics.

Prevalence of obstructive sleep apnea among patients with rheumatoid arthritis and its association with age and body mass index: A systematic review and meta-analysis

AIM

The study aims to recognize the prevalence and possible risk factors of obstructive sleep apnea among individuals with rheumatoid arthritis (RA).

METHODS

We searched PubMed, Scopus, EMBASE, and Google scholar for potential studies published before the October 30, 2020. The study characteristics, obstructive sleep apnea (OSA) events, and various types of rheumatic diseases were extracted, and the meta-analysis method was used to pool the estimates.

RESULTS

We identified eight studies with 37 285 patients for this meta-analysis. The overall pooled prevalence of OSA was 29.8% (95% confidence interval [CI] 15.2-46.7; I²  = 99.6%) in the patients with RA. Age was higher in RA patients with OSA but this was not significant. Body mass index (BMI) was significantly associated with OSA in the RA population (standardized mean difference 1.08; P = 0.044). Assessment based on the Berlin Questionnaire^© for Sleep Apnea resulted in a more precise estimate of OSA prevalence with reduced heterogeneity (prevalence 45.3%; 95% CI 37.4-53.3; I²  = 58.8%).

CONCLUSION

Prevalence of OSA among the RA cohort was 29.8% with significant heterogeneity. However, the prevalence was 45.3% when studies were restricted to the OSA diagnosis based on the Berlin questionnaire with very low heterogeneity. Higher BMI is the principal risk factor of OSA development in RA. Hence, controlling BMI could be a preventive strategy for OSA among RA patients.

Publication of meta-analyses in sleep medicine: a scoping review

STUDY OBJECTIVES

Sleep research has grown substantially in recent decades, producing a large amount of data and an increasing number of meta-analyses. This study sought to establish the volume of meta-analyses in this area and assess how this level of material has developed over time.

METHODS

A bibliographic search of the Web of Science database was conducted (1945-2019). The total number of articles and the total number of meta-analyses were extracted for both sleep medicine and a combination of 6 other medical specialties (cardiology, neurology, psychiatry, pulmonology, otorhinolaryngology, and pediatrics).

RESULTS

A total of 262,384 articles and 1,152 meta-analyses related to sleep medicine were identified. Considering the whole period under analysis, meta-analyses represented 0.44% of the total number of sleep medicine-related articles. Throughout this period, the proportion of meta-analyses published has been increasing in both sleep medicine and the other fields, but it is greater in the other fields. In 2019, meta-analyses in sleep medicine represented 1.10% of the publication output in this area but represented 1.62% of the other areas. However, sleep medicine's growth rate has been consistently higher than in the other fields. The United States, China, and the United Kingdom have been the top meta-analysis producers.

CONCLUSIONS

Meta-analyses in sleep medicine are underused. As a recent medical field, sleep medicine has more potential to grow and is likely to grow faster than other fields. Researchers should be encouraged to perform and publish meta-analyses on sleep medicine, as long as the analyses are reasonable and feasible from methodological, statistical. and practical perspectives.

Worldwide production on sleep apnea from 2009-2018. Analysis of the ability to secure funding and international collaboration networks

BACKGROUND

Obstructive sleep apnea (OSA) is an emerging health problem, but information on scientific production in this subject area is scarce. We aim to evaluate the scientific production on OSA from 2009 to 2018 to illustrate its worldwide distribution, topic areas, and ability to secure funding, as well as to describe international collaboration networks in this field.

METHODS

Articles published between 2009 and 2018 were extracted from the Science Citation Index Expanded via Web of Science (WoS) using the search term "obstructive sleep apn*". Publication year, number and country of authors, journal, subject category, key words, funding source and number of citations received were recorded. We also conducted network analyses for key words and international collaboration.

RESULTS

12,666 articles on OSA were located, which had increased from 895 documents in 2009 to 1592 in 2018. The progressive growth in scientific production on OSA had outpaced the growth rate of total WoS production since 2012.50% of the articles declared some type of funding, with a citation index higher than manuscripts that were not funded. The manuscripts were distributed in journals from 135 subject categories of the WoS, and keyword distribution showed a dispersed pattern with a high number of nodes. The international collaboration rate was 18.2%, and the country network showed the United States as the hegemonic node.

CONCLUSION

World production on OSA has grown at a higher rate than global production and shows notable thematic dispersion as well as a high ability to secure funding, which increases its impact.

Prevalence of Pulmonary Hypertension in Pediatric Patients With Obstructive Sleep Apnea and a Cardiology Evaluation: A Retrospective Analysis

STUDY OBJECTIVES

Pulmonary hypertension (PH) has been reported as a serious complication of obstructive sleep apnea (OSA) in children; however, estimated prevalence rates vary widely (zero to 85%). The purpose of this study is to determine the prevalence of PH in children with OSA and identify factors that may predict an increased PH risk in children with OSA.

METHODS

A retrospective review of all pediatric beneficiaries (88,058) in the San Antonio Military Health System with a diagnosis of OSA and a clinical evaluation by a pediatric cardiologist. OSA severity and nadir oxygen saturation were recorded from overnight polysomnography. Reason for referral, comorbid disorders, echocardiogram results, and cardiac diagnoses were obtained from cardiology records.

RESULTS

OSA was identified in 2,020 pediatric patients (2.3%). A pediatric cardiology consultation was reported for 296 patients with OSA. After excluding 95 patients for incorrect OSA diagnoses, incomplete data, or OSA treatment before cardiology evaluation, 163 patients were included in the final analysis. A diagnosis of PH was found in 3 patients with OSA (1.8%). Two of these patients had obesity, and all three had comorbid cardiac disorders.

CONCLUSIONS

Prevalence of PH in pediatric patients with OSA is low and none of the patients with PH had severe OSA. Current guidelines recommend PH screening in patients with severe OSA, yet OSA severity may not accurately predict risk. Factors evaluated in this study did not demonstrate an increased PH risk; additional research is necessary to improve screening in pediatric patients with OSA.

CITATION

Burns AT, Hansen SL, Turner ZS, Aden JK, Black AB, Hsu DP. Prevalence of pulmonary hypertension in pediatric patients with obstructive sleep apnea and a cardiology evaluation: a retrospective analysis. J Clin Sleep Med. 2019;15(8):1081-1087.

Clinical Trials in Obstructive Sleep Apnea: Recognizing Trends and Future Opportunities

OBJECTIVES/HYPOTHESIS

Examine US and international clinical trials in obstructive sleep apnea (OSA) to characterize researchers involved, interventions being studied, and opportunities for future investigation.

STUDY DESIGN

Retrospective database review.

METHODS

The information from ClinicalTrials.gov was used to assess OSA clinical trials between 1999 and 2017. Information was gathered on principle investigator (PI) demographics, interventions studied, study funding source, and regional distribution of research institutions.

RESULTS

There were 813 clinical trials studied. The majority of trials examined continuous positive airway pressure interventions (43.7%), with pharmacotherapies being the second most commonly investigated treatment (19.2%). Surgical interventions made up 10.7% (n = 87) of clinical trials for OSA. Most studies were based internationally (59.9%). PIs were predominantly male (72.0%); 72.7% had an MD and 28.6% had a PhD. There were no significant differences in funding source (National Institutes of Health vs. industry, P = .14) or institutional geography (international vs. US, P = .73) between surgical and nonsurgical studies. Surgical trials were significantly more likely to have a male PI and involve pediatric patients compared to nonsurgical trials (P < .001). Otolaryngologists represented 9.2% of all PIs and had similar rates of NIH funding compared to other medical specialists (P = .22).

CONCLUSIONS

This study provides a broad overview of past, current, and future treatment paradigms for OSA. Sleep surgery, specifically otolaryngology, is a small voice in the overall landscape of clinical trials for OSA. This information can help guide future research efforts and direct our specialty when setting priorities regarding research funding while encouraging a broad and interdisciplinary pursuit.

LEVEL OF EVIDENCE

NA Laryngoscope, 129:1940-1944, 2019.