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van Veldhuisen SL, Keusters WR, Kuppens K, de Raaff CAL, van Veen RN, Wiezer MJ, Swank DJ, Demirkiran A, Boerma EJG, Greve JWM, van Dielen FMH, de Castro SMM, Frederix GWJ, Hazebroek EJ. Cost-effectiveness and safety of continuous pulse oximetry for management of undiagnosed obstructive sleep apnea in bariatric surgery: a nationwide cohort study. Surg Obes Relat Dis 2024:S1550-7289(24)00676-2. [PMID: 39127531 DOI: 10.1016/j.soard.2024.06.009] [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: 09/09/2023] [Revised: 06/11/2024] [Accepted: 06/22/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND Undetected obstructive sleep apnea (OSA) is highly prevalent in patients undergoing bariatric surgery and increases perioperative risks. Screening for OSA using preoperative polygraphy (PG) with subsequent continuous positive airway pressure (CPAP) is costly and time-consuming. Postoperative continuous pulse oximetry (CPOX) is less invasive, and is hypothesized to be a safe and cost-effective alternative. OBJECTIVES This nationwide multicenter prospective observational cohort study compared CPOX monitoring with OSA-screening using PG. SETTING High-volume bariatric centers. METHODS Patients were either postoperatively monitored using CPOX without preoperative OSA-screening, or underwent preoperative PG and CPAP treatment when OSA was diagnosed. Cohort placement was based on local hospital protocols. Cost-effectiveness was analyzed using quality adjusted life years (QALYs) and healthcare costs. Surgical outcomes were also analyzed. Propensity score matching was used in sensitivity analyses. RESULTS A total of 1390 patients were included. QALYs were similar between groups at baseline and 1-year postoperatively. Postoperative complications, intensive care unit (ICU)-admissions and admissions, particularly OSA-related, did not differ between groups. Mean costs per patient/year in the CPOX group was €3094 versus €3680 in the PG group; mean difference €-586 (95% CI €-933-€-242). Following propensity score matching, 1090 of 1390 included patients remained, and similar findings for cost-effectiveness, complications, and ICU admissions were observed. CONCLUSION CPOX monitoring without preoperative OSA-screening was not associated with higher complication or readmission rates compared to PG. CPOX resulted in lower costs from a healthcare perspective and can therefore be considered a cost-effective alternative to routine OSA-screening in patients undergoing bariatric surgery.
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Affiliation(s)
| | - Willem R Keusters
- Department of Public Health, Julius Center Research Program Methodology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Kim Kuppens
- Department of Pulmonary Medicine, St. Antonius Hospital, Utrecht, The Netherlands
| | | | | | - Marinus J Wiezer
- Department of Surgery, St. Antonius Hospital, Utrecht, The Netherlands
| | | | - Ahmet Demirkiran
- Department of Surgery, Rode Kruis Hospital, Beverwijk, The Netherlands
| | | | - Jan-Willem M Greve
- Department of Surgery, Zuyderland Hospital, Heerlen, The Netherlands; Department of Surgery, Nutrim, Maastricht University, Maastricht, The Netherlands
| | | | | | - Geert W J Frederix
- Department of Public Health, Julius Center Research Program Methodology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Eric J Hazebroek
- Department of Surgery/Vitalys Clinic, Rijnstate Hospital, Arnhem, The Netherlands; Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands.
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Zhou R, Suo C, Jiang Y, Yuan L, Zhang T, Chen X, Zhang G. Association of Sleep Pattern and Genetic Susceptibility with Obstructive Sleep Apnea: A Prospective Analysis of the UK Biobank. Nat Sci Sleep 2024; 16:503-515. [PMID: 38803507 PMCID: PMC11129746 DOI: 10.2147/nss.s443721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 05/11/2024] [Indexed: 05/29/2024] Open
Abstract
Purpose The prevalence of obstructive sleep apnea (OSA) is high worldwide. This study aimed to quantify the relationship between the incidence of OSA and sleep patterns and genetic susceptibility. Methods A total of 355,133 white British participants enrolled in the UK Biobank between 2006 and 2010 with follow-up data until September 2021 were recruited. We evaluated sleep patterns using a customized sleep scoring method based on the low-risk sleep phenotype, defined as follows: morning chronotype, 7-8 hours of sleep per day, never/rarely experience insomnia, no snoring, no frequent daytime sleepiness, never/rarely nap, and easily getting up early. The polygenic risk score was calculated to assess genetic susceptibility to OSA. Cox proportional hazard models were used to evaluate the associations between OSA and sleep patterns and genetic susceptibility. Results During a mean follow-up of 12.57 years, 4618 participants were diagnosed with OSA (age: 56.83 ± 7.69 years, women: 31.3%). Compared with those with a poor sleep pattern, participants with a normal (HR: 0.42, 95% CI: 0.38-0.46), ideal (HR: 0.21, 95% CI: 0.19-0.24), or optimal (HR: 0.15, 95% CI: 0.12-0.18) sleep pattern were significantly more likely to have OSA. The genetic susceptibility of 173,239 participants was calculated, and the results showed that poor (HR: 3.67, 95% CI: 2.95-4.57) and normal (HR: 1.89, 95% CI: 1.66-2.16) sleep patterns with high genetic susceptibility can increase the risk for OSA. Conclusion This large-scale prospective study provides evidence suggesting that sleep patterns across seven low-risk sleep phenotypes may protect against OSA in individuals with varying degrees of genetic susceptibility.
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Affiliation(s)
- Rong Zhou
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, 200433, People’s Republic of China
- Shanghai Southgene Technology Co., Ltd., Shanghai, 201203, People’s Republic of China
| | - Chen Suo
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, 200433, People’s Republic of China
- Taizhou Institute of Health Sciences, Fudan University, Taizhou, 225300, People’s Republic of China
| | - Yong Jiang
- China National Clinical Research Center for Neurological Diseases, Beijing, 100070, People’s Republic of China
| | - Liyun Yuan
- Bio-Med Big Data Center, CAS Key Laboratory of Computational Biology, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Science, Shanghai, 200031, People’s Republic of China
| | - Tiejun Zhang
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, 200433, People’s Republic of China
- Taizhou Institute of Health Sciences, Fudan University, Taizhou, 225300, People’s Republic of China
| | - Xingdong Chen
- Taizhou Institute of Health Sciences, Fudan University, Taizhou, 225300, People’s Republic of China
- State Key Laboratory of Genetic Engineering, Human Phenome Institute, School of Life Sciences, Fudan University, Shanghai, 200433, People’s Republic of China
| | - Guoqing Zhang
- Bio-Med Big Data Center, CAS Key Laboratory of Computational Biology, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Science, Shanghai, 200031, People’s Republic of China
- Shanghai Sixth People’s Hospital, Shanghai, 200233, People’s Republic of China
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Bailly S, Mendelson M, Baillieul S, Tamisier R, Pépin JL. The Future of Telemedicine for Obstructive Sleep Apnea Treatment: A Narrative Review. J Clin Med 2024; 13:2700. [PMID: 38731229 PMCID: PMC11084346 DOI: 10.3390/jcm13092700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 04/24/2024] [Accepted: 04/30/2024] [Indexed: 05/13/2024] Open
Abstract
Obstructive sleep apnea is a common type of sleep-disordered breathing associated with multiple comorbidities. Nearly a billion people are estimated to have obstructive sleep apnea, which carries a substantial economic burden, but under-diagnosis is still a problem. Continuous positive airway pressure (CPAP) is the first-line treatment for OSAS. Telemedicine-based interventions (TM) have been evaluated to improve access to diagnosis, increase CPAP adherence, and contribute to easing the follow-up process, allowing healthcare facilities to provide patient-centered care. This narrative review summarizes the evidence available regarding the potential future of telemedicine in the management pathway of OSA. The potential of home sleep studies to improve OSA diagnosis and the importance of remote monitoring for tracking treatment adherence and failure and to contribute to developing patient engagement tools will be presented. Further studies are needed to explore the impact of shifting from teleconsultations to collaborative care models where patients are placed at the center of their care.
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Affiliation(s)
- Sébastien Bailly
- HP2 Laboratory, Inserm U1300, Grenoble Alps University, 38000 Grenoble, France; (S.B.); (M.M.); (S.B.); (R.T.)
| | - Monique Mendelson
- HP2 Laboratory, Inserm U1300, Grenoble Alps University, 38000 Grenoble, France; (S.B.); (M.M.); (S.B.); (R.T.)
| | - Sébastien Baillieul
- HP2 Laboratory, Inserm U1300, Grenoble Alps University, 38000 Grenoble, France; (S.B.); (M.M.); (S.B.); (R.T.)
| | - Renaud Tamisier
- HP2 Laboratory, Inserm U1300, Grenoble Alps University, 38000 Grenoble, France; (S.B.); (M.M.); (S.B.); (R.T.)
| | - Jean-Louis Pépin
- HP2 Laboratory, Inserm U1300, Grenoble Alps University, 38000 Grenoble, France; (S.B.); (M.M.); (S.B.); (R.T.)
- Laboratoire EFCR, CHU de Grenoble, CS10217, 38043 Grenoble, France
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4
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Ni YN, Lei F, Tang X, Liang Z, Thomas RJ. The association between the effective apnea-hypopnea index and blood pressure reduction efficacy following CPAP/oxygen treatment. Sleep Med 2024; 117:46-52. [PMID: 38507976 DOI: 10.1016/j.sleep.2024.02.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/28/2024] [Accepted: 02/29/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND The effect of sleep apnea treatment on reducing cardiovascular disease risk remains inconclusive. This study aims to assess if the effective apnea hypopnea index (eAHI), a measure of residual sleep apnea burden post-treatment, is a factor in determining blood pressure (BP) response to continuous positive airway pressure therapy. The eAHI integrates time on therapy, residual apnea, and % of sleep time untreated. METHODS A secondary analysis of the Heart Biomarker Evaluation in Apnea Treatment (HeartBEAT) study, a randomized, controlled, parallel group assessment of continuous positive airway pressure (CPAP), oxygen and sleep hygiene. The Delta-AHI (▲AHI) was defined as the difference between baseline AHI and effective AHI at 12 weeks. Logistic and linear regression models estimated the predictors for nocturnal systolic BP change following sleep apnea therapy. RESULTS One hundred and sixty-nine subjects with a mean age of 62.82 ± 6.99 years were included in the final analysis. Fifty subjects had ▲AHI ≤8/hour of sleep and 119 subjects were higher. After adjustment, baseline mean nighttime systolic blood pressure (OR 1.036, 95% CI 1.015-1.058, p: 0.001) and ▲AHI ≥8/hour (OR 2.406, 95% CI 1.116-5.185, p:0.025) were independent predictors for mean nighttime systolic blood pressure change >3 mm Hg. The higher effective AHI was negatively related with BNP (β: -2.564, SE: 1.167, p: 0.029) and positively related with troponin change (β: 0.703, SE: 0.256, p: 0.007). CONCLUSION The ▲AHI was an independent predictor of the blood pressure response to sleep apnea treatment. REGISTER NUMBER NCT01086800.
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Affiliation(s)
- Yue-Nan Ni
- Department of Respiratory, Critical Care and Sleep Medicine, West China School of Medicine and West China Hospital, Sichuan University, 610041, China.
| | - Fei Lei
- Sleep Medicine Center, West China School of Medicine and West China Hospital, Sichuan University, 610041, China.
| | - Xiangdong Tang
- Sleep Medicine Center, West China School of Medicine and West China Hospital, Sichuan University, 610041, China.
| | - Zongan Liang
- Department of Respiratory, Critical Care and Sleep Medicine, West China School of Medicine and West China Hospital, Sichuan University, 610041, China.
| | - Robert Joseph Thomas
- Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
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Qin H, Fietze I, Mazzotti DR, Steenbergen N, Kraemer JF, Glos M, Wessel N, Song L, Penzel T, Zhang X. Obstructive sleep apnea heterogeneity and autonomic function: a role for heart rate variability in therapy selection and efficacy monitoring. J Sleep Res 2024; 33:e14020. [PMID: 37709966 DOI: 10.1111/jsr.14020] [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: 02/07/2023] [Revised: 07/23/2023] [Accepted: 08/03/2023] [Indexed: 09/16/2023]
Abstract
Obstructive sleep apnea is a highly prevalent sleep-related breathing disorder, resulting in a disturbed breathing pattern, changes in blood gases, abnormal autonomic regulation, metabolic fluctuation, poor neurocognitive performance, and increased cardiovascular risk. With broad inter-individual differences recognised in risk factors, clinical symptoms, gene expression, physiological characteristics, and health outcomes, various obstructive sleep apnea subtypes have been identified. Therapeutic efficacy and its impact on outcomes, particularly for cardiovascular consequences, may also vary depending on these features in obstructive sleep apnea. A number of interventions such as positive airway pressure therapies, oral appliance, surgical treatment, and pharmaceutical options are available in clinical practice. Selecting an effective obstructive sleep apnea treatment and therapy is a challenging medical decision due to obstructive sleep apnea heterogeneity and numerous treatment modalities. Thus, an objective marker for clinical evaluation is warranted to estimate the treatment response in patients with obstructive sleep apnea. Currently, while the Apnea-Hypopnea Index is used for severity assessment of obstructive sleep apnea and still considered a major guide to diagnosis and managements of obstructive sleep apnea, the Apnea-Hypopnea Index is not a robust marker of symptoms, function, or outcome improvement. Abnormal cardiac autonomic modulation can provide additional insight to better understand obstructive sleep apnea phenotyping. Heart rate variability is a reliable neurocardiac tool to assess altered autonomic function and can also provide cardiovascular information in obstructive sleep apnea. Beyond the Apnea-Hypopnea Index, this review aims to discuss the role of heart rate variability as an indicator and predictor of therapeutic efficacy to different modalities in order to optimise tailored treatment for obstructive sleep apnea.
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Affiliation(s)
- Hua Qin
- Department of Otolaryngology, Head and Neck Surgery, State Key Laboratory of Respiratory Disease, The Key Laboratory of Advanced Interdisciplinary Studies Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Interdisciplinary Center of Sleep Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ingo Fietze
- Interdisciplinary Center of Sleep Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
- The Fourth People's Hospital of Guangyuan, Guangyuan, China
| | - Diego R Mazzotti
- Division of Medical Informatics, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
- Division of Pulmonary Critical Care and Sleep Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | | | - Jan F Kraemer
- Department of Physics, Humboldt-Universität zu Berlin, Berlin, Germany
- Information Processing and Analytics Group, School of Library and Information Science, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Martin Glos
- Interdisciplinary Center of Sleep Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Niels Wessel
- Department of Physics, Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Medicine, Medical School Berlin, Berlin, Germany
| | - Lijun Song
- Department of Otolaryngology, Head and Neck Surgery, State Key Laboratory of Respiratory Disease, The Key Laboratory of Advanced Interdisciplinary Studies Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Thomas Penzel
- Interdisciplinary Center of Sleep Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Xiaowen Zhang
- Department of Otolaryngology, Head and Neck Surgery, State Key Laboratory of Respiratory Disease, The Key Laboratory of Advanced Interdisciplinary Studies Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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Uataya M, Banhiran W, Chotinaiwattarakul W, Keskool P, Rungmanee S, Pimolsri C. Association between hypoxic burden and common cardiometabolic diseases in patients with severe obstructive sleep apnea. Sleep Breath 2023; 27:2423-2428. [PMID: 37392326 DOI: 10.1007/s11325-023-02860-x] [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: 02/03/2023] [Revised: 04/19/2023] [Accepted: 05/23/2023] [Indexed: 07/03/2023]
Abstract
PURPOSE To determine the possible associations between total sleep time spent with arterial oxygen saturation < 90% (T90) and comorbid cardiometabolic diseases (CMDs) in patients with severe obstructive sleep apnea (OSA). METHODS A retrospective review of the chart was conducted in patients with severe OSA diagnosed by in-lab polysomnography (PSG) between January 2018 and December 2019 at Siriraj Hospital. The patients were divided into two groups: hypoxic (T90 ≥ 10%) and nonhypoxic (T90 < 10%). The association between common CMDs including hypertension (HT), type 2 diabetes mellitus (T2DM), and impaired fasting glucose (IFG) was investigated and compared between the two groups. RESULTS Data were collected from 450 patients with severe OSA, 289 males/161 females with a mean age of 53.5 ± 14.2 years and an apnea-hypopnea index (AHI) of 49.6 events/h. Among these, 114 patients (25.3%) were defined as the hypoxic group (T90 ≥ 10%). When compared between the hypoxic and nonhypoxic groups, the patients in the hypoxic group were significantly younger and more obese, and had a higher proportion of male patients. The majority of patients (80%) had at least one CMD; however, the most common comorbidities significantly associated with hypoxic OSA (T90 ≥ 10%) were HT and IFG. CONCLUSION Hypoxic burden is significantly associated with an increased prevalence of HT and IFG in patients with severe OSA. T90 may be potentially useful for predicting CMDs in these patients. However, prospective studies are still required.
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Affiliation(s)
- Maythad Uataya
- Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Wish Banhiran
- Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand.
| | - Wattanachai Chotinaiwattarakul
- Division of Neurology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Phawin Keskool
- Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Sarin Rungmanee
- Siriraj Sleep Center, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Chawanont Pimolsri
- Siriraj Sleep Center, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand
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7
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Jorquera J, Dreyse J, Salas C, Letelier F, Weissglas B, Del-Río J, Henríquez-Beltrán M, Labarca G, Jorquera-Díaz J. Clinical Application of the Multicomponent Grading System for Sleep Apnea Classification and Incident Cardiovascular Mortality. Sleep Sci 2023; 16:e446-e453. [PMID: 38197019 PMCID: PMC10773515 DOI: 10.1055/s-0043-1776770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 02/14/2023] [Indexed: 01/11/2024] Open
Abstract
Objective To evaluate the clinical utility of the Baveno classification in predicting incident cardiovascular mortality after five years of follow-up in a clinic-based cohort of patients with obstructive sleep apnea (OSA). Materials and Methods We evaluated the reproducibility of the Baveno classification using data from the Santiago Obstructive Sleep Apnea (SantOSA) study. The groups were labeled Baveno A (minor symptoms and comorbidities), B (severe symptoms and minor comorbidities), C (minor symptoms and severe comorbidities), and D (severe symptoms and comorbidities). Within-group comparisons were performed using analysis of variance (ANOVA) and post hoc tests. The associations between groups and incident cardiovascular mortality were determined through the Mantel-Cox and Cox proportional hazard ratios (HRs) adjusted by covariables. Results A total of 1,300 OSA patients were included (Baveno A: 27.7%; B: 28%; C: 16.8%; and D: 27.5%). The follow-up was of 5.4 years. Compared to Baveno A, the fully-adjusted risk of cardiovascular mortality with Baveno B presented an HR of 1.38 (95% confidence interval [95%CI]: 0.14-13.5; p = 0.78); with Baveno C, it was of 1.71 (95%CI: 0.18-16.2; p = 0.63); and, with Baveno D, of 1.04 (95%CI: 0.12-9.2; p = 0.98). We found no interactions involving Baveno group, sex and OSA severity. Discussion Among OSA patients, the Baveno classification can describe different subgroups. However, its utility in identifying incident cardiovascular mortality is unclear. Long-term follow-up studies and the inclusion of demographic variables in the classification could improve its ability to detect a high-risk phenotype associated with cardiovascular mortality. Conclusion The Baveno classification serves as a valuable method for categorizing varying groups of patients afflicted with OSA. Nevertheless, its precision in identifying occurrence of cardiovascular mortality is still unclear.
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Affiliation(s)
- Jorge Jorquera
- Center for Respiratory Diseases, Las Condes Clinic, Faculty of Medicine, Finis Terrae University, Santiago, Chile
| | - Jorge Dreyse
- Center for Respiratory Diseases, Las Condes Clinic, Faculty of Medicine, Finis Terrae University, Santiago, Chile
| | - Constanza Salas
- Center for Respiratory Diseases, Las Condes Clinic, Faculty of Medicine, Finis Terrae University, Santiago, Chile
| | - Francisca Letelier
- Center for Respiratory Diseases, Las Condes Clinic, Faculty of Medicine, Finis Terrae University, Santiago, Chile
| | - Bunio Weissglas
- Department of Clinical Biochemistry and Immunology, Facultad de Farmacia, Universidad de Concepción, Bío-Bío, Chile
| | - Javiera Del-Río
- Department of Clinical Biochemistry and Immunology, Facultad de Farmacia, Universidad de Concepción, Bío-Bío, Chile
| | - Mario Henríquez-Beltrán
- Núcleo de Investigación en Ciencias de la Salud, Universidad Adventista de Chile, Chillán, Chile
- Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomas, Chile
- Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, Biomedical Research Institute of Lleida (IRBLleida), Lleida, Spain
| | - Gonzalo Labarca
- Department of Clinical Biochemistry and Immunology, Facultad de Farmacia, Universidad de Concepción, Bío-Bío, Chile
- Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomas, Chile
| | - Jorge Jorquera-Díaz
- Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, Biomedical Research Institute of Lleida (IRBLleida), Lleida, Spain
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8
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O'Halloran KD. Divorce proceedings: Uncoupling of genioglossus EMG activity and regional tongue movement in humans with and without sleep apnoea. J Physiol 2023; 601:5587-5588. [PMID: 38051694 DOI: 10.1113/jp285841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 11/22/2023] [Indexed: 12/07/2023] Open
Affiliation(s)
- Ken D O'Halloran
- Department of Physiology, School of Medicine, College of Medicine & Health, University College Cork, Cork, Ireland
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Sadeghniiat-Haghighi K, Akbarpour S, Behkar A, Moradzadeh R, Alemohammad ZB, Forouzan N, Mouseli A, Amirifard H, Najafi A. A nationwide study on the prevalence and contributing factors of obstructive sleep apnea in Iran. Sci Rep 2023; 13:17649. [PMID: 37848453 PMCID: PMC10582253 DOI: 10.1038/s41598-023-44229-w] [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: 03/05/2023] [Accepted: 10/05/2023] [Indexed: 10/19/2023] Open
Abstract
Reliable obstructive sleep apnea (OSA) prevalence information in Iran is lacking due to inconsistent local study results. To estimate OSA prevalence and identify clinical phenotypes, we conducted a nationally representative study using multi-stage random cluster sampling. We recruited 3198 individuals and extrapolated the results to the entire Iranian population using complex sample survey analyses. We identified 3 clinical phenotypes as "sleepy," "insomnia," and "restless legs syndrome (RLS)." The prevalence of OSA was 28.7% (95%CI: 26.8-30.6). The prevalence of "sleepy," "insomnia," and "RLS" phenotypes were 82.3%, 77.8%, and 36.5% in women, and 64.8%, 67.5%, and 17.9% in men, respectively. "Sleepy" and "insomnia" phenotypes overlapped the most. Age (OR: 1.9), male sex (OR: 3.8), BMI (OR: 1.13), neck circumference (OR: 1.3), RLS (OR: 2.0), and insomnia (OR: 2.3) were significant OSA predictors (p-values: 0.001). In men, "sleepy" phenotype was associated with youth and unmarried status but not in women. The "insomnia" phenotype was associated with shorter sleep duration in women; cardiovascular diseases (CVD), urban residency, and shorter sleep duration in men. "RLS" phenotype was associated with shorter sleep duration and CVD in women and older age, lower educational level, CVD, and hypertension in men. The findings point to the need for funding of OSA screening in Iran, for a different assessment of men and women, and for future sleep research to consider overlapping phenotypes.
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Affiliation(s)
- Khosro Sadeghniiat-Haghighi
- Sleep Breathing Disorders Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Occupational Sleep Research Center, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Samaneh Akbarpour
- Sleep Breathing Disorders Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Occupational Sleep Research Center, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Atefeh Behkar
- Occupational Sleep Research Center, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Rahmatollah Moradzadeh
- Department of Epidemiology, School of Health, Arak University of Medical Sciences, Arak, Iran
| | - Zahra Banafsheh Alemohammad
- Sleep Breathing Disorders Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Occupational Sleep Research Center, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Nazanin Forouzan
- Occupational Sleep Research Center, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Mouseli
- Department of Health Services Management, Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Hamed Amirifard
- Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Arezu Najafi
- Occupational Sleep Research Center, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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10
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Labarca G, Vena D, Hu WH, Esmaeili N, Gell L, Yang HC, Wang TY, Messineo L, Taranto-Montemurro L, Sofer T, Barr RG, Stone KL, White DP, Wellman A, Sands S, Redline S, Azarbarzin A. Sleep Apnea Physiological Burdens and Cardiovascular Morbidity and Mortality. Am J Respir Crit Care Med 2023; 208:802-813. [PMID: 37418748 PMCID: PMC10563185 DOI: 10.1164/rccm.202209-1808oc] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 07/07/2023] [Indexed: 07/09/2023] Open
Abstract
Rationale: Obstructive sleep apnea is characterized by frequent reductions in ventilation, leading to oxygen desaturations and/or arousals. Objectives: In this study, association of hypoxic burden with incident cardiovascular disease (CVD) was examined and compared with that of "ventilatory burden" and "arousal burden." Finally, we assessed the extent to which the ventilatory burden, visceral obesity, and lung function explain variations in hypoxic burden. Methods: Hypoxic, ventilatory, and arousal burdens were measured from baseline polysomnograms in the Multi-Ethnic Study of Atherosclerosis (MESA) and the Osteoporotic Fractures in Men (MrOS) studies. Ventilatory burden was defined as event-specific area under ventilation signal (mean normalized, area under the mean), and arousal burden was defined as the normalized cumulative duration of all arousals. The adjusted hazard ratios for incident CVD and mortality were calculated. Exploratory analyses quantified contributions to hypoxic burden of ventilatory burden, baseline oxygen saturation as measured by pulse oximetry, visceral obesity, and spirometry parameters. Measurements and Main Results: Hypoxic and ventilatory burdens were significantly associated with incident CVD (adjusted hazard ratio [95% confidence interval] per 1 SD increase in hypoxic burden: MESA, 1.45 [1.14, 1.84]; MrOS, 1.13 [1.02, 1.26]; ventilatory burden: MESA, 1.38 [1.11, 1.72]; MrOS, 1.12 [1.01, 1.25]), whereas arousal burden was not. Similar associations with mortality were also observed. Finally, 78% of variation in hypoxic burden was explained by ventilatory burden, whereas other factors explained only <2% of variation. Conclusions: Hypoxic and ventilatory burden predicted CVD morbidity and mortality in two population-based studies. Hypoxic burden is minimally affected by measures of adiposity and captures the risk attributable to ventilatory burden of obstructive sleep apnea rather than a tendency to desaturate.
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Affiliation(s)
- Gonzalo Labarca
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Daniel Vena
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Wen-Hsin Hu
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Neda Esmaeili
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Laura Gell
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Hyung Chae Yang
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, South Korea
| | - Tsai-Yu Wang
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ludovico Messineo
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Luigi Taranto-Montemurro
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Tamar Sofer
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Robert G. Barr
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York; and
| | - Katie L. Stone
- Research Institute, California Pacific Medical Center, San Francisco, California
| | - David P. White
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Andrew Wellman
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Scott Sands
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ali Azarbarzin
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
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Martínez-García MÁ, Oscullo G, Gomez-Olivas JD, Gozal D. Measuring severity in OSA: the arguments for collaboratively developing a multidimensional score. J Clin Sleep Med 2023; 19:1705-1707. [PMID: 37421330 PMCID: PMC10545991 DOI: 10.5664/jcsm.10722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 06/29/2023] [Accepted: 06/29/2023] [Indexed: 07/10/2023]
Affiliation(s)
- Miguel Ángel Martínez-García
- Servicio de Neumología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- CIBERES de Enfermedades Respiratorias, ISCIII, Madrid, Spain
| | - Grace Oscullo
- Servicio de Neumología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | - David Gozal
- Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia
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12
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Pei G, Ou Q, Lao M, Wang L, Xu Y, Tan J, Zheng G. APAP Treatment Acceptance Rate and Cost-Effectiveness of Telemedicine in Patients with Obstructive Sleep Apnea: A Randomized Controlled Trial. Nat Sci Sleep 2023; 15:607-622. [PMID: 37560381 PMCID: PMC10408676 DOI: 10.2147/nss.s416221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 07/27/2023] [Indexed: 08/11/2023] Open
Abstract
PURPOSE This study evaluated the treatment acceptance rate and cost-effectiveness of the telemedicine model in clinical practice for adult patients with obstructive sleep apnea (OSA). PATIENTS AND METHODS Patients admitted to the sleep center for snoring were randomly divided into telemedicine and control groups. Patients diagnosed with moderate-to-severe OSA using the Home Sleep Apnea Test (HSAT) were voluntarily treated with auto-adjusted positive airway pressure (APAP) therapy. The acceptance rate of the APAP treatment, cost of patient visits, time cost, and labor cost of doctors in the two groups were observed. RESULTS A total of 57 subjects were included, with an average age of 40.12±11.73 years, including 47 males (82.5%); 26 patients were in the telemedicine group, and 31 were in the control group. Follow-up results showed that the acceptance rate of APAP treatment was 57.7% and 54.8% in the telemedicine and control groups, respectively, with no significant difference between the two groups (p=0.829). The cost-benefit analysis showed that the telemedicine group reduced the cost of patients' medical treatment [-457.84(-551.19,1466.87)] but increased the extra intervention frequency and time outside the doctor's office. Further analysis showed that male subjects of older age, higher education level, distant residence, no fatty liver, poor sleep quality, severe insomnia, and higher OSA severity were more likely to receive telemedicine diagnosis and treatment. CONCLUSION The APAP treatment acceptance rate and compliance of OSA patients in the telemedicine group were similar to those in the control group, and the cost of patients' medical treatment was reduced. However, telemedicine increases the frequency and duration of additional out-of-hospital interventions.
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Affiliation(s)
- Guo Pei
- Department of Sleep Center, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, People’s Republic of China
- School of Medicine, South China University of Technology, Guangzhou, 510006, People’s Republic of China
| | - Qiong Ou
- Department of Sleep Center, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, People’s Republic of China
- School of Medicine, South China University of Technology, Guangzhou, 510006, People’s Republic of China
| | - Miaochan Lao
- Department of Sleep Center, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, People’s Republic of China
| | - Longlong Wang
- Department of Sleep Center, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, People’s Republic of China
| | - Yanxia Xu
- Department of Sleep Center, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, People’s Republic of China
| | - Jiaoying Tan
- Department of Sleep Center, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, People’s Republic of China
| | - Gaihong Zheng
- Department of Sleep Center, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, People’s Republic of China
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13
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Osuna ED, Zamora AC, Buitrago AF, Salazar JF, Rosales SA, Galeano C, Guzman-Prado Y, Ferreira-Atuesta C. Is it Mandatory to do a 24 hour ABPM in all Patients with Moderate to Severe Obstructive Sleep Apnoea? Sleep Sci 2023; 16:197-205. [PMID: 37425971 PMCID: PMC10325839 DOI: 10.1055/s-0043-1770797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023] Open
Abstract
Background Obstructive sleep apnoea (OSA) has been described as a risk factor for arterial hypertension (HT). One of the proposed mechanisms linking these conditions is non dipping (ND) pattern in nocturnal blood pressure, however evidence is variable and based on specific populations with underlying conditions. Data for OSA and ND in subjects residing at high altitude are currently unavailable. Objective Identify the prevalence and association of moderate to severe OSA with HT and ND pattern in hypertensive and non-hypertensive otherwise healthy middle-aged individuals in residing at high altitude (Bogotá:2640 mt) Methods Adult individuals with diagnosis of moderate to severe OSA underwent 24 hour- ambulatory blood pressure monitoring (ABPM) between 2015 and 2017. Univariable and multivariable logistic regression analysis were performed to identify predictors of HT and ND pattern. Results Ninety-three (93) individuals (male 62.4% and median age 55) were included in the final analysis. Overall, 30.1% showed a ND pattern in ABPM and 14.9% had diurnal and nocturnal hypertension. Severe OSA (higher apnea-hiponea index [AHI]) was associated with HT (p = 0.006), but not with ND patterns (p = 0.54) in multivariable regression. Smoking status and lowest oxygen saturation during respiratory events where independently associated with ND pattern (p = 0.04), whereas age (p = 0.001) was associated with HT. Conclusions In our sample, one in three individuals with moderate to severe OSA have non dipping patterns suggesting lack of straight association between OSA and ND. Older individuals who have higher AHI are more likely to have HT, and those who smoke have a higher risk of ND. These findings add aditional information to the multiple mechanisms involved in the relationship between OSA and ND pattern, and questions the routine use of 24-hour ABPM, particullary in our region, with limited resources and healthcare acces. However, further work with more robust methodology is needed to draw conclusions.
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Affiliation(s)
- Edgar D. Osuna
- Department of Neurology, Fundación Santafé de Bogotá, Bogotá, Colombia
- School of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Adrián C. Zamora
- Department of Neurology, Fundación Santafé de Bogotá, Bogotá, Colombia
| | | | | | | | - Camila Galeano
- Faculty of Medicine, Universidad de los Andes, Bogotá, Colombia
| | | | - Carolina Ferreira-Atuesta
- Faculty of Medicine, Universidad de los Andes, Bogotá, Colombia
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
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14
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Šmon J, Kočar E, Pintar T, Dolenc-Grošelj L, Rozman D. Is obstructive sleep apnea a circadian rhythm disorder? J Sleep Res 2023:e13875. [PMID: 36922163 DOI: 10.1111/jsr.13875] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 02/06/2023] [Accepted: 02/28/2023] [Indexed: 03/17/2023]
Abstract
Obstructive sleep apnea is the most common sleep-related breathing disorder worldwide and remains underdiagnosed. Its multiple associated comorbidities contribute to a decreased quality of life and work performance as well as an increased risk of death. Standard treatment seems to have limited effects on cardiovascular and metabolic aspects of the disease, emphasising the need for early diagnosis and additional therapeutic approaches. Recent evidence suggests that the dysregulation of circadian rhythms, processes with endogenous rhythmicity that are adjusted to the environment through various cues, is involved in the pathogenesis of comorbidities. In patients with obstructive sleep apnea, altered circadian gene expression patterns have been demonstrated. Obstructive respiratory events may promote circadian dysregulation through the effects of sleep disturbance and intermittent hypoxia, with subsequent inflammation and disruption of neural and hormonal homeostasis. In this review, current knowledge on obstructive sleep apnea, circadian rhythm regulation, and circadian rhythm sleep disorders is summarised. Studies that connect obstructive sleep apnea to circadian rhythm abnormalities are critically evaluated. Furthermore, pathogenetic mechanisms that may underlie this association, most notably hypoxia signalling, are presented. A bidirectional relationship between obstructive sleep apnea and circadian rhythm dysregulation is proposed. Approaching obstructive sleep apnea as a circadian rhythm disorder may prove beneficial for the development of new, personalised diagnostic, therapeutic and prognostic tools. However, further studies are needed before the clinical approach to obstructive sleep apnea includes targeting the circadian system.
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Affiliation(s)
- Julija Šmon
- Institute of Clinical Neurophysiology, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Centre for Functional Genomics and Bio-Chips, Institute of Biochemistry and Molecular Genetics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Eva Kočar
- Centre for Functional Genomics and Bio-Chips, Institute of Biochemistry and Molecular Genetics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Tadeja Pintar
- Department of Abdominal Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Leja Dolenc-Grošelj
- Institute of Clinical Neurophysiology, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Department of Neurology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Damjana Rozman
- Centre for Functional Genomics and Bio-Chips, Institute of Biochemistry and Molecular Genetics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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15
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Proteomic profiling for prediction of recurrent cardiovascular event in patients with acute coronary syndrome and obstructive sleep apnea: A post-hoc analysis from the ISAACC study. Biomed Pharmacother 2023; 158:114125. [PMID: 36549084 DOI: 10.1016/j.biopha.2022.114125] [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: 09/21/2022] [Revised: 11/28/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is associated with a recurrent cardiovascular event (CVE) risk in patients with a first acute coronary syndrome (ACS). However, the pathological pathways by which OSA promotes this deleterious role are unknown. We aim to explore the proteomic profile associated with OSA that promote the recurrent CVE risk in severe OSA patients with ACS without previous cardiovascular diseases. METHODS This post-hoc analysis from the ISAACC study (NCT01335087) included 86 patients admitted for ACS. Patients underwent respiratory polygraphy for the first 24-72 h to OSA diagnosis. We analyzed of 276 cardiovascular and inflammatory related proteins in baseline fasting plasma samples using proximity expression assay technology (Olink®, Sweden). Protein levels were compared between severe OSA patients with/without recurrent CVEs during follow-up. Random forest was conducted to select relevant proteins and generate a predictive model of recurrent CVE. RESULTS We included 86 patients (median age: 61 years, median BMI: 29.4 kg/m2 and 86 % males) admitted for ACS with severe OSA (56 without recurrent CVE/30 with recurrent CVE). The plasma levels of 38 proteins were differentially expressed between groups. Additionally, 12 proteins had a significant association with respiratory polygraphy parameters. Three proteins discriminate with an AUC of 0.81 (95 % CI of 0.71-0.9) between severe OSA patients with and without recurrent CVE. These proteins were implicated in cell proliferation, communication and apoptosis, and regulation/response to the inflammatory and immune systems. CONCLUSION In ACS patients with severe OSA, a proteomic profile was associated with recurrent CVEs. This proteomic profile was correlated with specific OSA parameters from respiratory polygraphy. Proteomic profiling may provide an new direction for patient risk stratification and clinical management.
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16
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Syndrome d’apnées du sommeil 1999–2022 : des essais randomisés aux études de cohorte. BULLETIN DE L'ACADÉMIE NATIONALE DE MÉDECINE 2023. [DOI: 10.1016/j.banm.2022.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
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17
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Sánchez-de-la-Torre M, Cano-Pumarega I. The Development of New Interventional Clinical Trials on Obstructive Sleep Apnoea: Targeting the Outcome, Endotype and Trial Design. Arch Bronconeumol 2022; 59:203-204. [PMID: 36639346 DOI: 10.1016/j.arbres.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 12/13/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Manuel Sánchez-de-la-Torre
- Group of Precision Medicine in Chronic Diseases, Respiratory Department, University Hospital Arnau de Vilanova and Santa María, Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Lleida, IRBLleida, Lleida, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.
| | - Irene Cano-Pumarega
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain; Sleep Unit, Pneumology Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
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18
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Abdelwahab R, Campbell E, Pride R, Demer A, Vidal NY. Sustained periorbital edema following Mohs micrographic surgery in the setting of continuous positive airway pressure. JAAD Case Rep 2022; 30:117-119. [DOI: 10.1016/j.jdcr.2022.08.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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19
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Gao Y, Guo Y, Dong J, Liu Y, Hu W, Lu M, Shen Y, Liu Y, Wei Y, Wang Z, Zhan X. Differences in the prevalence of cardiovascular and metabolic diseases coinciding with clinical subtypes of obstructive sleep apnea. Clin Cardiol 2022; 46:92-99. [PMID: 36403266 PMCID: PMC9849430 DOI: 10.1002/clc.23941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 10/13/2022] [Accepted: 10/17/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND It is unclear about the cardiovascular and metabolic diseases (CMD) among Chinese patients with different clinical subtypes of obstructive sleep apnea (OSA). HYPOTHESIS The prevalence of CMD varies among OSA patients of different clinical subtypes. METHODS A total of 1483 Chinese patients with OSA were assessed to evaluate the existence of clinical subtypes of OSA using latent class analysis. We compared the differences in demographic characteristics and prevalence of CMD using ANOVA and χ2 tests. Associations between clinical subtypes and disease prevalence were assessed using adjusted logistic regression. RESULTS We identified prevalent CMD in Chinese patients with the four subtypes of OSA: excessively sleepy (ES), moderately sleepy with disturbed sleep (ModSwDS), moderately sleepy (ModS), and minimally symptomatic (MinS). The ES subtype had a higher body mass index, average Epworth Sleepiness Scale score, Apnea-hypopnea index, and oxyhemoglobin saturation below 90% compared with the other subtypes (p < .05). The MinS subtype had the lowest mean ESS score (p < .05). We found a significant difference in the prevalence of CMD among the four subtypes, with the highest proportion of cases of CMD in the ES subtype. In adjusted models, significant associations with CMD were also found. ES, ModSwDS, ModS, and MinS subtypes are very high-risk, high-risk, medium-risk, and low-risk in prevalent CMD. CONCLUSIONS This study identified four clinical subtypes of OSA in Chinese patients. Each clinical subtype corresponds with a different level of prevalence of CMD; this finding is helpful for the more precise treatment of patients with different clinical manifestations.
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Affiliation(s)
- Yang Gao
- Department of Otolaryngology‐Head and Neck Surgery, Xuanwu HospitalCapital Medical UniversityBeijingChina,Department of Otolaryngology‐Head and Neck Surgery, Beijing Anzhen HospitalCapital Medical UniversityBeijingChina
| | - Yaxin Guo
- Beijing Institute of Heart Lung and Blood Vessel DiseasesBeijingChina
| | - Jiajia Dong
- Department of Otolaryngology‐Head and Neck Surgery, Beijing Anzhen HospitalCapital Medical UniversityBeijingChina
| | - Yifan Liu
- Department of Otolaryngology‐Head and Neck Surgery, Beijing Anzhen HospitalCapital Medical UniversityBeijingChina,Department of Otorhinolaryngology‐Head and Neck SurgeryCapital Institute of PediatricsBeijingChina
| | - Wen Hu
- Department of Otolaryngology‐Head and Neck Surgery, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Mi Lu
- Department of Otolaryngology‐Head and Neck Surgery, Beijing Anzhen HospitalCapital Medical UniversityBeijingChina
| | - Yueran Shen
- Beijing Institute of Heart Lung and Blood Vessel DiseasesBeijingChina
| | - Yi Liu
- Department of Otolaryngology‐Head and Neck Surgery, Beijing Anzhen HospitalCapital Medical UniversityBeijingChina
| | - Yongxiang Wei
- Department of Otolaryngology‐Head and Neck Surgery, Beijing Anzhen HospitalCapital Medical UniversityBeijingChina,Department of Otorhinolaryngology‐Head and Neck SurgeryCapital Institute of PediatricsBeijingChina
| | - Zhenlin Wang
- Department of Otolaryngology‐Head and Neck Surgery, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Xiaojun Zhan
- Department of Otolaryngology‐Head and Neck Surgery, Beijing Anzhen HospitalCapital Medical UniversityBeijingChina,Department of Otorhinolaryngology‐Head and Neck SurgeryCapital Institute of PediatricsBeijingChina
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20
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Sundbom F, Janson C, Ljunggren M, Lindberg E. Asthma and asthma-related comorbidity: effects on nocturnal oxygen saturation. J Clin Sleep Med 2022; 18:2635-2641. [PMID: 35924855 PMCID: PMC9622994 DOI: 10.5664/jcsm.10178] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/27/2022] [Accepted: 06/29/2022] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Nocturnal symptoms are very common in asthma, which is associated with worse sleep quality. The nocturnal oxygen saturation may be decreased in asthma; however, whether this association is dependent on nocturnal asthma symptoms, lung function, coexisting obstructive sleep apnea (OSA), or other asthma-related comorbidities is unknown. The objective of this study was to examine the effects of asthma, OSA, lung function, airway symptoms, and asthma-related comorbidities on the nocturnal oxygen saturation in a cross-sectional community-based population study. METHODS In total, 395 women and 392 men underwent overnight polysomnography, performed spirometry, and completed questionnaires on airway symptoms and asthma-related comorbidities. RESULTS Participants with asthma (n = 88) had a lower nocturnal oxygen saturation than those without asthma (93.8% vs 94.3%, P = .01) also after adjusting for comorbidity, age, body mass index, and smoking status (coefficient -0.38; CI -0.67, -0.10; P < .01). The nocturnal oxygen saturation was lower among participants with wheezing, nocturnal chest tightness, fixed airflow limitation, gastroesophageal reflux, obesity, and OSA than in those without these conditions. The associations between lower oxygen saturation and wheezing, forced expiratory volume in 1 second, gastroesophageal reflux, and apnea-hypopnea index were significant also after adjusting for age, sex, body mass index, and smoking status. Participants with both wheezing and OSA had a significantly lower nocturnal oxygen saturation (92.5 ± 0.5%) than participants with wheezing only (94.3 ± 0.3%) and OSA only (93.6 ± 0.2% %) (P < .01). CONCLUSIONS Participants with asthma displayed a lower mean oxygen saturation during sleep, which could not be explained only by coexisting OSA or obesity. Also, asthma symptoms and lung function were associated with lower nocturnal oxygen saturation. The lower oxygen saturation seen in asthma is hence multifactorial in origin and is a result of the combination of symptoms, lung function, and comorbidity. CITATION Sundbom F, Janson C, Ljunggren M, Lindberg E. Asthma and asthma-related comorbidity: effects on nocturnal oxygen saturation. J Clin Sleep Med. 2022;18(11):2635-2641.
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Affiliation(s)
- Fredrik Sundbom
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Christer Janson
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Mirjam Ljunggren
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Eva Lindberg
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
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Streckenbach B, Osswald M, Malesevic S, Zenobi R, Kohler M. Validating Discriminative Signatures for Obstructive Sleep Apnea in Exhaled Breath. Cells 2022; 11:cells11192982. [PMID: 36230943 PMCID: PMC9563926 DOI: 10.3390/cells11192982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/19/2022] [Accepted: 09/22/2022] [Indexed: 11/16/2022] Open
Abstract
Rapid and reliable tools for the diagnosis and monitoring of obstructive sleep apnea (OSA) are currently lacking. Prior studies using a chemical analysis of exhaled breath have suggested the existence of an OSA-specific metabolic signature. Here, we validated this diagnostic approach and the proposed marker compounds, as well as their potential to reliably diagnose OSA. In this cross-sectional observational study, exhaled breath was analyzed using secondary electrospray ionization high-resolution mass spectrometry. The study cohort included untreated OSA patients, OSA patients treated with continuous positive airway pressure and healthy subjects. The robustness of previously reported OSA markers was validated based on detectability, significant differences between groups (Mann–Whitney U test) and classification performance. The breath analysis of 118 participants resulted in 42 previously reported markers that could be confirmed in this independent validation cohort. Nine markers were significantly increased in untreated OSA compared to treated OSA, with a subset of them being consistent with a previous validation study. An OSA prediction based on the confirmed OSA signature performed with an AUC of 0.80 (accuracy 77%, sensitivity 73% and specificity 80%). As several breath markers were clearly found to be repeatable and robust in this independent validation study, these results underscore the clinical potential of breath analysis for OSA diagnostics and monitoring.
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Affiliation(s)
- Bettina Streckenbach
- ETH Zurich, Department of Chemistry and Applied Biosciences, 8093 Zurich, Switzerland
| | - Martin Osswald
- Department of Pulmonology, University Hospital Zürich, 8091 Zurich, Switzerland
| | - Stefan Malesevic
- Department of Pulmonology, University Hospital Zürich, 8091 Zurich, Switzerland
| | - Renato Zenobi
- ETH Zurich, Department of Chemistry and Applied Biosciences, 8093 Zurich, Switzerland
| | - Malcolm Kohler
- Department of Pulmonology, University Hospital Zürich, 8091 Zurich, Switzerland
- Correspondence:
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Baillieul S, Shah NM, Dharmasena R, Schiza S, Testelmans D, Pataka A. CPAP for secondary cardiovascular prevention in obstructive sleep apnoea patients: not only one moon, but many stars. Breathe (Sheff) 2022; 18:220148. [PMID: 36865657 PMCID: PMC9973521 DOI: 10.1183/20734735.0148-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 09/14/2022] [Indexed: 11/16/2022] Open
Abstract
While continuous positive airway pressure (CPAP) therapy has a strong evidence base for the treatment of obstructive sleep apnoea (OSA), its impact on cardiovascular comorbidity remains unclear. This journal club reviews three recent randomised controlled trials aimed to evaluate the impact of CPAP therapy in secondary prevention of cerebrovascular and coronary heart disease (SAVE trial), comorbid coronary heart disease (RICCADSA trial) and in patients admitted with acute coronary syndrome (ISAACC trial). All three trials included patients with moderate-to-severe OSA and excluded patients with severe daytime sleepiness. When CPAP was compared with usual care, they all reported no difference in a similar primary composite end-point including death from cardiovascular disease, cardiac events, and strokes. These trials faced the same methodological challenges, including a low primary end-point incidence, the exclusion of sleepy patients, and a low CPAP adherence. Therefore, caution must be taken when broadening their results to the wider OSA population. Although randomised controlled trials provide a high level of evidence, they may not be sufficient to capture the diversity of OSA. Large-scale, real-world data may be able to provide a more rounded and generalisable picture of the effects of routine clinical use of CPAP on cardiovascular morbimortality.
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Affiliation(s)
- Sébastien Baillieul
- Grenoble Alpes University, HP2 Laboratory, INSERM U1300 and Grenoble Alpes University Hospital, Grenoble, France,Corresponding author: Sébastien Baillieul ()
| | - Neeraj M. Shah
- Lane Fox Respiratory Research Centre, Guy's and St. Thomas’ NHS Foundation Trust, London, UK
| | | | - Sophia Schiza
- Sleep Disorders Centre, Dept of Respiratory Medicine, Medical School, University of Crete, Heraklion, Greece
| | - Dries Testelmans
- KU Leuven – University of Leuven, University Hospitals Leuven, Department of Respiratory diseases, Leuven, Belgium
| | - Athanasia Pataka
- Aristotle University Thessaloniki and Respiratory Failure Unit, Aristotle University Thessaloniki, G. Papanikolaou Hospital Exohi, Thessaloniki, Greece
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23
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Allen AH, Jen R, Mazzotti DR, Keenan BT, Goodfellow SD, Taylor CM, Daniele P, Peres B, Liu Y, Mehrtash M, Ayas NT. Symptom subtypes and risk of incident cardiovascular and cerebrovascular disease in a clinic-based obstructive sleep apnea cohort. J Clin Sleep Med 2022; 18:2093-2102. [PMID: 35459444 PMCID: PMC9435337 DOI: 10.5664/jcsm.9986] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 03/14/2022] [Accepted: 03/14/2022] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Patients with obstructive sleep apnea (OSA) are at increased risk of cardiovascular and cerebrovascular disease, but predicting those at greatest risk is challenging. Using latent class analysis, patients with OSA can be placed into discrete symptom subtypes. The aim of this study was to determine whether symptom subtypes are associated with future cerebrovascular disease in patients with OSA in a clinic-based cohort. METHODS Patients with suspected OSA referred for a polysomnogram at an academic sleep center completed a comprehensive symptom survey. Patients with OSA (apnea-hypopnea index ≥ 5 events/h) were then placed into symptom subtypes based on responses to survey questions using latent class analysis. Cardiovascular events (stroke, myocardial infarction, unstable angina, bypass grafting, percutaneous coronary intervention, cardiac resynchronization therapy, defibrillation) occurring within 8 years of polysomnogram were identified by linkage to provincial health databases. RESULTS 1,607 patients were studied, of whom 1,292 had OSA. One hundred forty first events occurred within 8 years of polysomnogram. Patients in the excessively sleepy with disturbed sleep subtype had a significantly increased rate of events compared to the minimally symptomatic subtype (hazard ratio = 2.25, 95% confidence interval: 1.02-4.94; P = .04). Two symptoms (restless legs and dozing off or sleeping while talking to someone) were significantly associated with future risk of cerebrovascular disease (hazard ratio = 1.68, 1.12-2.49 and 4.23, 1.61-11.16, respectively). CONCLUSIONS Patients with OSA in the clinic who are in the excessively sleepy with disturbed sleep subtype are significantly more likely to have a future cardiovascular event. This underscores the importance of understanding clinical heterogeneity and incorporating symptom subtype definitions into routine clinical care. CITATION Allen AJH, Jen R, Mazzotti DR, et al. Symptom subtypes and risk of incident cardiovascular and cerebrovascular disease in a clinic-based obstructive sleep apnea cohort. J Clin Sleep Med. 2022;18(9):2093-2102.
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Affiliation(s)
- A.J. Hirsch Allen
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rachel Jen
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Diego R. Mazzotti
- Division of Medical Informatics, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Brendan T. Keenan
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | | | - Carolyn M. Taylor
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Patrick Daniele
- School of Population and Public, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bernardo Peres
- Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Yu Liu
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Pharmacology, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Morvarid Mehrtash
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Najib T. Ayas
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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24
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Labarca G, Sanchez-de-la Torre M, Jorquera J. Editorial: Systemic involvement in obstructive sleep apnea: Personalized medicine to improve health outcomes. Front Med (Lausanne) 2022; 9:999977. [PMID: 36052334 PMCID: PMC9425094 DOI: 10.3389/fmed.2022.999977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 08/01/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Gonzalo Labarca
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
- *Correspondence: Gonzalo Labarca
| | - Manuel Sanchez-de-la Torre
- Precision Medicine in Chronic Diseases, Hospital Universitari Arnau de Vilanova-Santa Maria, IRB Lleida, Faculty of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Department of Medicine, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Jorge Jorquera
- Grupo de Estudio Trastornos Respiratorios del Sueño (GETRS), Centro de Enfermedades Respiratorias, Clinica Las Condes, Santiago, Chile
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25
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Reiter J, Ramagopal M, Gileles-Hillel A, Forno E. Sleep disorders in children with asthma. Pediatr Pulmonol 2022; 57:1851-1859. [PMID: 33647191 PMCID: PMC8408281 DOI: 10.1002/ppul.25264] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 01/03/2021] [Accepted: 01/07/2021] [Indexed: 11/07/2022]
Abstract
Asthma and sleep disorders are both common in childhood, and often co-exist in the same child. Moreover, studies have shown that in many children the rate of one is influenced by the other. Sleep disorders can be classified into six different groups-insomnia, hypersomnia, parasomnia, movement disorders, circadian disorders, and sleep-related breathing disorders. Children with asthma often present with complaints of insomnia with poor sleep quality, difficulty falling asleep and sleep disruptions. These complains are often associated with asthma control. They may also complain of daytime sleepiness and have higher rates of parasomnias, such as night terrors and nocturnal enuresis when compared with their healthy peers. Whether movement and circadian disorders are also more prevalent in children with asthma is less clear. Finally, there is a complex bidirectional interaction between sleep-related breathing disorders and asthma: poor sleep and sleep disorders may worsen asthma, and asthma, particularly when it is poorly controlled, may impair sleep. In the current review we examine the association of each of the sleep disorders with asthma and review the common pathophysiological pathways. We hope to convince the reader that appropriate management of asthma must include inquiries into the patient's sleep, and vice versa.
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Affiliation(s)
- Joel Reiter
- Pediatric Pulmonary and Sleep Unit, Department of Pediatrics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Maya Ramagopal
- Division of Pulmonary Medicine and Cystic Fibrosis Center, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New-Jersey, USA
| | - Alex Gileles-Hillel
- Pediatric Pulmonary and Sleep Unit, Department of Pediatrics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Erick Forno
- Division of Pulmonary Medicine, Department of Pediatrics, Children’s Hospital of Pittsburgh and University of Pittsburgh, PA
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26
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Sutherland K, Sadr N, Bin YS, Cook K, Dissanayake HU, Cistulli PA, de Chazal P. Comparative associations of oximetry patterns in Obstructive Sleep Apnea with incident cardiovascular disease. Sleep 2022; 45:6650848. [PMID: 35896039 PMCID: PMC9742894 DOI: 10.1093/sleep/zsac179] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 06/27/2022] [Indexed: 12/15/2022] Open
Abstract
STUDY OBJECTIVES Intermittent hypoxia is a key mechanism linking Obstructive Sleep Apnea (OSA) to cardiovascular disease (CVD). Oximetry analysis could enhance understanding of which OSA phenotypes are associated with CVD risk. The aim of this study was to compare associations of different oximetry patterns with incident CVD in men and women with OSA. METHODS Sleep Heart Health Study data were used for analysis. n = 2878 Participants (51.8% female; mean age 63.5 ± 10.5 years) with OSA (Apnea Hypopnea Index [AHI] ≥ 5 events/h) and no pre-existing CVD at baseline or within the first 2 years of follow-up were included. Four oximetry analysis approaches were applied: desaturation characteristics, time series analysis, power spectral density, and non-linear analysis. Thirty-one resulting oximetry patterns were compared to incident CVD using proportional hazards regression models adjusted for age, race, smoking, BMI, and sex. RESULTS There were no associations between OSA oximetry patterns and incident CVD in the total sample or in men. In women, there were some associations between incident CVD and time series analysis (e.g. SpO2 distribution standard deviation, HR 0.81, 95% CI 0.68-0.96, p = 0.014) and power spectral density oximetry patterns (e.g. Full frequency band mean HR 0.75; 95% CI 0.59-0.95; p = 0.015). CONCLUSIONS Comprehensive comparison of baseline oximetry patterns in OSA found none were related to development of CVD. There were no standout individual oximetry patterns that appear to be candidates for CVD risk phenotyping in OSA, but some showed marginal relationships with CVD risk in women. Further work is required to understand whether OSA phenotypes can be used to predict susceptibility to cardiovascular disease.
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Affiliation(s)
- Kate Sutherland
- Sleep Research Group, Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia,Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Nadi Sadr
- Sleep Research Group, Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia,Department of Biomedical Informatics, Emory University, Atlanta, Georgia, USA
| | - Yu Sun Bin
- Sleep Research Group, Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia,Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Kristina Cook
- Sleep Research Group, Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia,Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Hasthi U Dissanayake
- Sleep Research Group, Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia,Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Peter A Cistulli
- Sleep Research Group, Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia,Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia,Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Philip de Chazal
- Corresponding author. Philip de Chazal, Sleep Research Group, Level 3, D17 Charles Perkins Centre, University of Sydney Camperdown, New South Wales 2006, Australia.
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Martínez-García MÁ, Sierra-Párraga JM, Garcia-Ortega A A. Obstructive sleep apnea in women: WE can do more and better. Sleep Med Rev 2022; 64:101645. [DOI: 10.1016/j.smrv.2022.101645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 04/28/2022] [Accepted: 04/28/2022] [Indexed: 11/28/2022]
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Martínez-García MÁ, Lévy P. Some forgotten issues in sleep apnoea. Eur Respir J 2022; 59:59/4/2101627. [PMID: 35483717 DOI: 10.1183/13993003.01627-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 06/11/2021] [Indexed: 11/05/2022]
Affiliation(s)
- Miguel Ángel Martínez-García
- Respiratory Dept, Polytechnic and University Hospital la Fe, Valencia, Spain.,CIBER of respiratory diseases. CIBERES, Madrid, Spain
| | - Patrick Lévy
- HP2 Laboratory and Physiology Dept, Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, Grenoble, France
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29
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Mouth Closing to Improve the Efficacy of Mandibular Advancement Devices in Sleep Apnea. Ann Am Thorac Soc 2022; 19:1185-1192. [PMID: 35254967 DOI: 10.1513/annalsats.202109-1050oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE Mouth breathing increases upper airway collapsibility, leading to decreased efficacy of obstructive sleep apnea (OSA) treatments. We hypothesized that the use of mandibular advancement devices (MAD) increases mouth breathing and, thus, using an adhesive mouthpiece (AMT), to prevent mouth breathing, in combination with MAD can improve the treatment efficacy. OBJECTIVES To evaluate the efficacy of MAD + AMT in comparison to MAD alone. METHODS A prospective crossover pilot study was designed to test this hypothesis. Briefly, adult participants with an apnea-hypopnea index (AHI) between 10-50 events/h at the screening visit were randomized to no treatment (baseline), MAD treatment, AMT treatment, and MAD+AMT treatment. As a primary analysis, absolute AHI was compared between MAD and MAD + AMT arms. Secondary analyses included quantifying the percent change in AHI, percentage of complete (AHI < 5 events/h) and incomplete (AHI 5 - 10 events/h) responders, and the efficacy of AMT alone in comparison with other treatment arms. RESULTS A total 21 of participants were included. (Baseline AHI= 24.3±9.9 event/h) The median AHI (Interquartile [IQR]) in the MAD and MAD+AMT arms were 10.5 [5.4-19.6] events/h and 5.6 [2.2-11.7] events/h (p-value= 0.02), respectively. A total of 76% of individuals achieved an AHI < 10 events/h in the MAD + AMT arm vs. 43% in the MAD arm (p-value<0.01). Finally, the observed effect was similar in moderate to severe OSA (AHI ≥15 events/h) in terms of absolute reduction and treatment responders, and AMT alone did not significantly reduce the AHI compared to baseline. CONCLUSION Combination of an adhesive mouthpiece and MAD is a more effective therapy than MAD alone. These findings may help improve clinical decision-making in sleep apnea.
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30
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Martinez-Garcia M. Multidimensional approach to obstructive sleep apnea. Pulmonology 2022; 28:158-160. [DOI: 10.1016/j.pulmoe.2022.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 01/16/2022] [Indexed: 10/19/2022] Open
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31
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Riha RL. Defining obstructive sleep apnoea syndrome: a failure of semantic rules. Breathe (Sheff) 2022; 17:210082. [PMID: 35035552 PMCID: PMC8753646 DOI: 10.1183/20734735.0082-2021] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 07/27/2021] [Indexed: 12/14/2022] Open
Abstract
Obstructive sleep apnoea syndrome (OSAS) is one of the most ubiquitous medical conditions in industrialised society. Since the recognition that symptoms of excessive daytime somnolence, problems with concentration, mood and cognitive impairment, as well as cardiometabolic abnormalities can arise as a consequence of obstructed breathing during sleep, it has been subject to variation in its definition. Over the past five decades, attempts have been made to standardise the definitions and scoring criteria used for apnoeas and hypopnoea, which are the hallmarks of obstructive sleep apnoea (OSA). However, applying these definitions in clinical and research practice has resulted in over- and under-estimation of the severity and prevalence of OSAS. Furthermore, the definitions may eventually become redundant in the context of rapid technological advances in breathing measurement and other signal acquisition. Increased efforts towards precision medicine have led to a focus on the pathophysiology of obstructed breathing during sleep. However, the same degree of effort has not been focused on how and why the latter does or does not result in diurnal symptoms, integral to the definition of OSAS. This review focuses on OSAS in adults and discusses some of the difficulties with current definitions and the possible reasons behind them. The definition of obstructive sleep apnoea syndrome appears to be in constant flux dependent on the definitions attributed to its diagnostic componentshttps://bit.ly/3zXrWKg
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Affiliation(s)
- Renata L Riha
- Dept of Sleep Medicine, Royal Infirmary Edinburgh, Edinburgh, UK.,Sleep Research Unit, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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32
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Pini L, Magri R, Perger E, Levi G, Zambelli L, Giordani J, Ciarfaglia M, Tantucci C. Phenotyping OSAH patients during wakefulness. Sleep Breath 2022; 26:1801-1807. [PMID: 35023036 DOI: 10.1007/s11325-021-02551-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/30/2021] [Accepted: 12/02/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Although currently there are simplified methods to measure the pathophysiological traits that stimulate the occurrence and maintenance of obstructive sleep apnea-hypopnea (OSAH), they remain difficult to implement in routine practice. This pilot study aimed to find a simpler daytime approach to obtain a meaningful, similar pathophysiological phenotypic profile in patients with OSAH. METHODS After obtaining diagnostic polygraphy from a group of consecutive patients with OSAH, we performed the dial-down CPAP technique during nocturnal polysomnography and used it as reference method. This allowed assessment of upper airway collapsibility, loop gain (LG), arousal threshold (AT), and upper airway muscle gain (UAG). We compared these results with a daytime protocol based on negative expiratory pressure (NEP) technique for evaluating upper airway collapsibility and UAG, on maximal voluntary apnea for LG, and on clinical predictors for AT. RESULTS Of 15 patients studied, 13 patients with OSAH accurately completed the two procedures. There were strong (all r2 > 0.75) and significant (all p < 0.001) correlations for each phenotypic trait between the measurements obtained through the reference method and those achieved during wakefulness. CONCLUSION It is possible to phenotype patients with OSAH from a pathophysiological point of view while they are awake. Using this approach, cutoff values corresponding to those usually adopted using the reference method can be identified to detect abnormal traits, achieving profiles similar to those obtained through the dial-down CPAP technique.
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Affiliation(s)
- L Pini
- Respiratory Medicine Unit, ASST-Spedali Civili di Brescia, Brescia, Italy. .,Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
| | - R Magri
- Respiratory Medicine Unit, ASST-Spedali Civili di Brescia, Brescia, Italy
| | - E Perger
- Istituto Auxologico Italiano, IRCCS, Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - G Levi
- Respiratory Medicine Unit, ASST-Spedali Civili di Brescia, Brescia, Italy
| | - L Zambelli
- Respiratory Medicine Unit, ASST-Spedali Civili di Brescia, Brescia, Italy
| | - J Giordani
- Respiratory Medicine Unit, ASST-Spedali Civili di Brescia, Brescia, Italy
| | - M Ciarfaglia
- Respiratory Medicine Unit, ASST-Spedali Civili di Brescia, Brescia, Italy
| | - C Tantucci
- Respiratory Medicine Unit, ASST-Spedali Civili di Brescia, Brescia, Italy.,Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
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Baillieul S, Tamisier R, Eckert DJ, Pépin JL. Current knowledge and perspectives for pharmacological treatment in OSA. Arch Bronconeumol 2022; 58:681-684. [DOI: 10.1016/j.arbres.2021.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 12/20/2021] [Indexed: 11/29/2022]
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Martínez-García MÁ, Labarca G. Obstructive sleep apnea in women: scientific evidence is urgently needed. J Clin Sleep Med 2022; 18:1-2. [PMID: 34648424 PMCID: PMC8807894 DOI: 10.5664/jcsm.9684] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Miguel Ángel Martínez-García
- Servicio de Neumología, Hospital Universitario y Politécnico la Fe de Valencia, Valencia, Spain;,CIBEres de Enfermedades Respiratorias, ISCIII, Madrid, Spain;,Address correspondence to: Miguel Ángel Martínez-García, MD, Pneumology Department, Hospital Universitario y Politécnico La Fe, Avenida Fernando Abril Martorell, s/n 46012-Valencia, Spain; Tel: (+34) 609865934;
| | - Gonzalo Labarca
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
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35
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Mediano O, González Mangado N, Montserrat JM, Alonso-Álvarez ML, Almendros I, Alonso-Fernández A, Barbé F, Borsini E, Caballero-Eraso C, Cano-Pumarega I, de Carlos Villafranca F, Carmona-Bernal C, Carrillo Alduenda JL, Chiner E, Cordero Guevara JA, de Manuel L, Durán-Cantolla J, Farré R, Franceschini C, Gaig C, Garcia Ramos P, García-Río F, Garmendia O, Gómez García T, González Pondal S, Hoyo Rodrigo MB, Lecube A, Antonio Madrid J, Maniegas Lozano L, Martínez Carrasco JL, Masa JF, Masdeu Margalef MJ, Mayos Pérez M, Mirabet Lis E, Monasterio C, Navarro Soriano N, Olea de la Fuente E, Plaza G, Puertas Cuesta FJ, Rabec C, Resano P, Rigau D, Roncero A, Ruiz C, Salord N, Saltijeral A, Sampol Rubio G, Sánchez Quiroga MÁ, Sans Capdevila Ó, Teixeira C, Tinahones Madueño F, Maria Togeiro S, Troncoso Acevedo MF, Vargas Ramírez LK, Winck J, Zabala Urionaguena N, Egea C. [Translated article] International consensus document on obstructive sleep apnea. Arch Bronconeumol 2022. [DOI: 10.1016/j.arbres.2021.03.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Osteopathic Manipulation of the Sphenopalatine Ganglia Versus Sham Manipulation, in Obstructive Sleep Apnoea Syndrom: A Randomised Controlled Trial. J Clin Med 2021; 11:jcm11010099. [PMID: 35011840 PMCID: PMC8745154 DOI: 10.3390/jcm11010099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/06/2021] [Accepted: 12/21/2021] [Indexed: 11/16/2022] Open
Abstract
(1) Background: osteopathic manipulation of the sphenopalatine ganglia (SPG) blocks the action of postganglionic sensory fibres. This neuromodulation can reduce nasal obstruction and enhance upper airway stability. We investigated the manipulation of the SPG in 31 patients with obstructive sleep apnoea syndrome (OSAS); (2) Methods: Randomised, controlled, double-blind, crossover study. Participants received active (AM), then sham manipulation (SM), or vice versa. The primary endpoint was apnoea-hypopnoea index (AHI). Secondary endpoints were variation of nasal obstruction evaluated by peak nasal inspiratory flow (PNIF) and upper airways stability evaluated by awake critical closing pressure [awake Pcrit]), at 30 min and 24 h. Schirmer’s test and pain were assessed immediately post-manipulation. Tactile/gustatory/olfactory/auditory/nociceptive/visual sensations were recorded. Adverse events were collected throughout. (3) Results: SPG manipulation did not reduce AHI (p = 0.670). PNIF increased post-AM but not post-SM at 30 min (AM-SM: 18 [10; 38] L/min, p = 0.0001) and 24 h (23 [10; 30] L/min, p = 0.001). There was no significant difference on awake Pcrit (AM-SM) at 30 min or 24 h). Sensations were more commonly reported post-AM (100% of patients) than post-SM (37%). Few adverse events and no serious adverse events were reported. (4) Conclusions: SPG manipulation is not supported as a treatment for OSAS but reduced nasal obstruction. This effect remains to be confirmed in a larger sample before using this approach to reduce nasal congestion in CPAP-treated patients or in mild OSAS.
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Martínez-García MÁ, Labarca G. Sleep apnea phenotypes: do not forget the external validation. Sleep 2021; 44:6357666. [PMID: 34432066 DOI: 10.1093/sleep/zsab213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Miguel Ángel Martínez-García
- Servicio de Neumología, Hospital Universitario y Politécnico La Fe, Valencia, Spain.,CIBEres de enfermedades respiratorias, ISCIII, Madrid, Spain
| | - Gonzalo Labarca
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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Pépin JL, Eastwood P, Eckert DJ. Novel avenues to approach non-CPAP therapy and implement comprehensive OSA care. Eur Respir J 2021; 59:13993003.01788-2021. [PMID: 34824053 DOI: 10.1183/13993003.01788-2021] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 09/16/2021] [Indexed: 11/05/2022]
Abstract
Recent advances in obstructive sleep apnoea (OSA) pathophysiology and translational research have opened new lines of investigation for OSA treatment and management. Key goals of such investigations are to provide efficacious, alternative treatment and management pathways that are better tailored to individual risk profiles to move beyond the traditional, continuous positive airway pressure (CPAP)-focused, "one size fits all", trial and error approach which is too frequently inadequate for many patients. Identification of different clinical manifestations of OSA (clinical phenotypes) and underlying pathophysiological phenotypes (endotypes), that contribute to OSA have provided novel insights into underlying mechanisms and have underpinned these efforts. Indeed, this new knowledge has provided the framework for precision medicine for OSA to improve treatment success rates with existing non-CPAP therapies such as mandibular advancement devices and upper airway surgery, and newly developed therapies such as hypoglossal nerve stimulation and emerging therapies such as pharmacotherapies and combination therapy. These concepts have also provided insight into potential physiological barriers to CPAP adherence for certain patients. This review summarises the recent advances in OSA pathogenesis, non-CPAP treatment, clinical management approaches and highlights knowledge gaps for future research. OSA endotyping and clinical phenotyping, risk stratification and personalised treatment allocation approaches are rapidly evolving and will further benefit from the support of recent advances in e-health and artificial intelligence.
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Affiliation(s)
- Jean-Louis Pépin
- HP2 Laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France .,EFCR Laboratory, Grenoble Alpes University Hospital, Grenoble, France
| | - Peter Eastwood
- Flinders Health and Medical Research Institute and Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Danny J Eckert
- Flinders Health and Medical Research Institute and Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
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Schiza S, Lévy P, Martinez-Garcia MA, Pepin JL, Simonds A, Randerath W. The search for realistic evidence on the outcomes of obstructive sleep apnoea. Eur Respir J 2021; 58:58/4/2101963. [PMID: 34620678 DOI: 10.1183/13993003.01963-2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 07/30/2021] [Indexed: 01/21/2023]
Affiliation(s)
- Sophia Schiza
- Sleep Disorders Center, Dept of Respiratory Medicine, Medical School, University of Crete, Heraklion, Greece
| | - Patrick Lévy
- Univ. Grenoble Alpes, Inserm, HP2 Laboratory, Grenoble, France.,Grenoble University Hospital, Sleep Laboratory, EFCR, Grenoble, France
| | - Miguel Angel Martinez-Garcia
- Pneumology Dept, University and Politechnic La Fe Hospital, Valencia, Spain.,CIBERES de enfermedades respiratorias, ISCIII, Madrid, Spain
| | - Jean-Louis Pepin
- Univ. Grenoble Alpes, Inserm, HP2 Laboratory, Grenoble, France.,Grenoble University Hospital, Sleep Laboratory, EFCR, Grenoble, France
| | - Anita Simonds
- Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Winfried Randerath
- Bethanien Hospital, Clinic of Pneumology and Allergology, Center for Sleep Medicine and Respiratory Care, Institute of Pneumology at the University of Cologne, Solingen, Germany
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Fenotipos clínicos en el síndrome de apnea obstructiva del sueño. REVISTA MÉDICA CLÍNICA LAS CONDES 2021. [DOI: 10.1016/j.rmclc.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Roche F, Mouhli L, Pichot V, Celle S. Obstructive sleep apnea/hypopnea syndrome phenotypes after night sleep recordings: how to get to precision medicine in 2021. Sleep 2021; 44:6304415. [PMID: 34143218 DOI: 10.1093/sleep/zsab154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Frédéric Roche
- Department of Clinical Physiology, VISAS Center, University Hospital, Saint-Etienne, France.,Inserm SAINBIOSE U1059, DVH, Jean Monnet University, Saint Etienne, France
| | - Lytissia Mouhli
- Department of Clinical Physiology, VISAS Center, University Hospital, Saint-Etienne, France
| | - Vincent Pichot
- Department of Clinical Physiology, VISAS Center, University Hospital, Saint-Etienne, France.,Inserm SAINBIOSE U1059, DVH, Jean Monnet University, Saint Etienne, France
| | - Sébastien Celle
- Department of Clinical Physiology, VISAS Center, University Hospital, Saint-Etienne, France.,Inserm SAINBIOSE U1059, DVH, Jean Monnet University, Saint Etienne, France
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Longitudinal Analysis of Causes of Mortality in Continuous Positive Airway Pressure-treated Patients at the Population Level. Ann Am Thorac Soc 2021; 18:1390-1396. [PMID: 33606959 DOI: 10.1513/annalsats.202007-888oc] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Rationale: Randomized controlled trials do not support a role for continuous positive airway pressure (CPAP) in preventing major cardiovascular events or mortality in patients with obstructive sleep apnea (OSA). However, these trials' setting does not apply to most CPAP-treated patients. Objectives: We aimed to assess the effect of CPAP on mortality in real-world patients. Methods: We performed a population-based longitudinal observational study including all patients with OSA prescribed CPAP during 2011 in Catalonia, Spain, and non-OSA control subjects matched (1:2) by sex, 5-year age group, and region who were followed from 2011 to 2016. Results: A total of 9,317 CPAP-treated patients with OSA and 18,370 control subjects without OSA were included (median age, 67 [57-72] years; 74% male). During a median follow-up of 5.5 years, 2,301 deaths were recorded. After adjustment by a composite of diagnosed comorbidities and previous use of healthcare resources, CPAP-treated patients showed a lower risk of death than control subjects (hazard ratio [HR], 0.67; 95% confidence interval [CI], 0.61-0.74), with the association not being statistically significant in women. Cancer-related deaths were the main drivers of this association (men: HR, 0.44; 95% CI, 0.36-0.54; women: HR, 0.44; 95% CI, 0.28-0.68). No significant associations were found for cardiovascular-related deaths. CPAP-treated women had an increased risk of respiratory-related death (HR, 2.41; 95% CI, 1.37-4.23). Conclusions: CPAP-treated patients had a lower mortality rate than control subjects. This relationship was driven by cancer-related, but not cardiovascular-related, deaths. Results suggest a role for sex when prescribing CPAP, especially considering respiratory-related deaths, and foster a debate on the relationship between OSA and cardiovascular outcomes.
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Circulating levels of cell adhesion molecules and risk of cardiovascular events in obstructive sleep apnea. PLoS One 2021; 16:e0255306. [PMID: 34329349 PMCID: PMC8323915 DOI: 10.1371/journal.pone.0255306] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 07/13/2021] [Indexed: 11/25/2022] Open
Abstract
Background Obstructive sleep apnea (OSA) patients are at increased risk of cardiovascular disease (CVD). Cell adhesion molecules (CAM) are increased in OSA and CAM are also implicated in the development of CVD. Research question Do CAM (ICAM-1, VCAM-1 and E-selectin) have prognostic value in identifying risk of cardiovascular events in OSA? Study design and methods Patients with suspected OSA referred for a polysomnogram provided a fasting blood sample. Plasma levels of ICAM-1, VCAM-1 and E-selectin were determined by multiplex Luminex Assay (Milliporesigma ON, Canada). Cardiovascular events were determined by deterministic linkage to provincial health databases. Results 418 patients were included in the analysis. Mostly male (68.2%), mean age of 50.7 yrs, median AHI 16.5 events/hour, and mean BMI of 31.7 kg/m2. 36 cardiovascular events occurred in 8-yrs of follow up. Higher levels of ICAM-1 were associated with developing CVD (HR = 3.65 95% CI 1.40–9.53, 2nd and 3rd tertiles vs. 1st tertile), including in patients with OSA (HR = 3.1 95% CI 1.16–8.25). E-selectin was significantly associated with cardiovascular events in patients with moderate to severe OSA (HR = 3.31 95% CI 0.94–11.72, 2nd and 3rd tertiles vs. 1st tertile) but not in patients without moderate to severe OSA (HR = 0.67 95% CI 0.19–2.38), p-value for interaction = 0.07. Interpretation In a suspected OSA cohort, patients with higher levels of ICAM-1 (>816 ng/ml) were significantly more likely to experience a cardiovascular event within 8 years after PSG. In moderate to severe OSA patients, a higher E-selectin (>36.4 ng/ml) was significantly associated with cardiovascular events.
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Labarca G, Dreyse J, Salas C, Letelier F, Jorquera J. A Validation Study of Four Different Cluster Analyses of OSA and the Incidence of Cardiovascular Mortality in a Hispanic Population. Chest 2021; 160:2266-2274. [PMID: 34217682 DOI: 10.1016/j.chest.2021.06.047] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 06/11/2021] [Accepted: 06/17/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Previous studies reported a strong association between sleepiness-related symptoms and comorbidities with poor cardiovascular outcomes among patients with moderate to severe OSA (msOSA). However, the validation of these associations in the Hispanic population from South America and the ability to predict incident cardiovascular disease remain unclear. RESEARCH QUESTION In Hispanic patients with msOSA, are four different cluster analyses reproducible and able to predict incident cardiovascular mortality? STUDY DESIGN AND METHODS Using the SantOSA cohort, we reproduced four cluster analyses (Sleep Heart Health Study [SHHS], Icelandic Sleep Apnea Cohort [ISAC], Sleep Apnea Cardiovascular Endpoints [SAVE], and The Institute de Recherche en Sante Respiratoire des Pays de la Loire [IRSR] cohorts) following a cluster analysis similar to each training dataset. The incidence of cardiovascular mortality was constructed using a Kaplan-Meier (log-rank) model, and Cox proportional hazards models were adjusted by confounders. RESULTS Among 780 patients with msOSA in our cohort, two previous cluster analyses (SHHS and ISAC) were reproducible. The SAVE and IRSR cluster analyses were not reproducible in our sample. We identified the following subtypes for SHHS: "minimally symptomatic," "disturbed sleep," "moderate sleepiness," and "severe sleepiness." For ISAC, three different subtypes ("minimally symptomatic," "disturbed sleep," and "excessive sleepiness") were similar to the original dataset. Compared with "minimally symptomatic," we found a significant association between "excessive sleepiness" and cardiovascular mortality after 5 years of follow-up in SantOSA, hazard ratio (HR), 5.47; 95%CI, 1.74-8.29; P < .01; and HR, 3.23; 95%CI, 1.21-8.63; P = .02, using the SHHS and ISAC cluster analyses, respectively. INTERPRETATION Among patients with msOSA, a symptom-based approach can validate different OSA patient subtypes, and those with excessive sleepiness have an increased risk of incident cardiovascular mortality in the Hispanic population from South America.
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Affiliation(s)
- Gonzalo Labarca
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
| | - Jorge Dreyse
- Centro de Enfermedades Respiratorias y Grupo de Estudio Trastornos Respiratorios del Sueño (GETRS), Clínica Las Condes, Santiago, Chile
| | - Constanza Salas
- Centro de Enfermedades Respiratorias y Grupo de Estudio Trastornos Respiratorios del Sueño (GETRS), Clínica Las Condes, Santiago, Chile
| | - Francisca Letelier
- Centro de Enfermedades Respiratorias y Grupo de Estudio Trastornos Respiratorios del Sueño (GETRS), Clínica Las Condes, Santiago, Chile
| | - Jorge Jorquera
- Centro de Enfermedades Respiratorias y Grupo de Estudio Trastornos Respiratorios del Sueño (GETRS), Clínica Las Condes, Santiago, Chile
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Pevernagie D. Future Treatment of Sleep Disorders: Syndromic Approach Versus Management of Treatable Traits? Sleep Med Clin 2021; 16:465-473. [PMID: 34325823 DOI: 10.1016/j.jsmc.2021.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Sleep disorders are categorized in line with traditional taxonomy. This conventional approach allows adequate management of many patients. Failure of treatment, however, may be due to nonspecificity of symptoms, coincidental association between symptoms and pathophysiological endotype, as well as co-occurrence of different pathologic mechanisms affecting sleep. Complex phenotypes often do not respond well to standard therapeutic interventions. In these cases, the clinical workup should aim at identifying treatable traits that will likely improve under targeted therapy. The challenge for sleep medicine is to further develop this innovative approach that is driven by the principles of systems medicine.
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Affiliation(s)
- Dirk Pevernagie
- Department of Respiratory Medicine, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Gent, Belgium; Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10, 9000 Gent, Belgium.
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Cheng H, Li D. Investigation into the association between obstructive sleep apnea and incidence of all-type cancers: a systematic review and meta-analysis. Sleep Med 2021; 88:274-281. [PMID: 34219029 DOI: 10.1016/j.sleep.2021.05.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 03/13/2021] [Accepted: 05/24/2021] [Indexed: 11/16/2022]
Abstract
Obstructive sleep apnea (OSA) is one of the most common sleep-related breathing disorders and is featured by complete or partial obstruction of the upper airway using sleep. Conflicting reports regarding the association between obstructive sleep apnea (OSA) and cancer incidence are existing in different studies. The aim of this study is to determine whether OSA is independently associated with incidence of all-type cancers by using the meta-analysis. Medline, Embase, PubMed, Ovid, the Cochrane Library database, Web of Science, and Google Scholar were searched by two independent reviewers until 31 January 2021. Studies that evaluated OSA and the cancer incidence were included. Pooled risk ratios (RR) and corresponding 95% confidence intervals (CI) were calculated. Twelve studies, involved 184,915 participants, were pooled in this meta-analysis. Fixed-effects model analysis showed that patients with OSA had an increased risk of cancer incidence (RR: 1.52, 95% CI: 1.39-1.66, P < 0.001). The subgroup analysis showed that the pooled RRs of cancer incidence were 1.14 (95% CI: 1.04-1.25, P = 0.006) for mild OSA, 1.36 (95% CI: 1.32-1.92; P < 0.001) for moderate OSA and 1.59 (95% CI: 1.45-1.74; P < 0.001) for severe OSA, respectively. Patients with moderate and severe OSA were identified to have an increased risk of cancer incidence when compared to patients with mild OSA. In addition, patients with severe OSA also showed an increased risk of incident cancer (RR: 1.18, 95% CI: 1.08-1.28, P < 0.001) when compared to patients with moderate OSA. In conclusion, from most updated literatures, our meta-analysis results indicated that OSA was independently associated with incidence of all-type cancers when stratified the severity of OSA. However, further detailed analysis and clinical studies are warranted to decipher the association between OSA and cancer prevalence.
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Affiliation(s)
- Hanrong Cheng
- Institute of Respiratory Diseases, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, Guangdong, 518020, China.
| | - Dongcai Li
- Longgang ENT Hospital, Institute of ENT and Shenzhen Key Laboratory of ENT, Shenzhen, Guangdong, 518172, China.
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Cortese R. Epigenetics of Sleep Disorders: An Emerging Field in Diagnosis and Therapeutics. Diagnostics (Basel) 2021; 11:diagnostics11050851. [PMID: 34068472 PMCID: PMC8150507 DOI: 10.3390/diagnostics11050851] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 05/07/2021] [Indexed: 12/16/2022] Open
Affiliation(s)
- Rene Cortese
- Department of Child Health, Child Health Research Institute, School of Medicine, University of Missouri, Columbia, MO 65211, USA
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Abstract
PURPOSE OF REVIEW The purpose of this review is to describe the variability of obstructive sleep apnea (OSA), both from a standpoint of underlying mechanisms and in terms of clinical manifestations. RECENT FINDINGS Recent data suggest that not all patients with sleep apnea get their disease for the same reason. As such, no one variable is effective at defining which patients do or do not have sleep apnea. Identifying the mechanism(s) underlying OSA for an individual is helpful as it can help to determine whether personalized therapy could be developed based on an individual's characteristics. In addition, these underlying mechanisms may be helpful in predicting response to therapy and prognosticating regarding future complications. SUMMARY OSA is a heterogeneous disease with highly varying underlying mechanisms. OSA has variable clinical manifestations with definable subsets having risk of particular complications. Future studies will be helpful to identify mechanisms underlying OSA using clinically accessible tools and then using these data to focus individualized treatment approaches.
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Combined orthodontic and orthognathic treatment with 3D-printing technique offers a precise outcome: A case report of two years followup. Int J Surg Case Rep 2021; 84:105934. [PMID: 34175680 PMCID: PMC8253947 DOI: 10.1016/j.ijscr.2021.105934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/22/2021] [Accepted: 04/24/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction and importance Precision Medicine and evidence-based clinical treatment approach are proposed worldwide in medical science nowadays. Orthodontic first approach (OFA) and Computer-aided surgical simulation (CASS) combined 3D-printing technique offered more chances for the doctors to obey the principle of Precision Medicine in the orthodontic and orthognathic approach. Case presentation We reported a 20-year-old patient, with skeletal Class III relationship and asymmetric mandible, was treated by OFA. And with the CASS combined 3D-Printing Technique, the presurgery simulation and 3D-printed surgery guiding splint and stable splint offered the Combined Orthodontic and Orthognathic Treatment (COOT) a powerful and accurate guiding. The results exhibited that the patient had a perfect maxilla and mandible relationship and significant improvement in profile. Clinical discussion There is still a debate between “surgery first” (SF) and conventional OFA. In this study, we analyzed the trend of different approaches in the COOT, which was a team work and required mainly the collaboration of orthodontist and Orthognathic surgeon. This study showed the precision of the CASS could offer for the OFA to evoke people immersing in saving time in COOT. Conclusion All of these indicated that CASS was a powerful and precise method for COOT, which could offer the patient an esthetic and stable result. OFA and CASS combined 3D-Printing Technique Obey the Principle of Precision Medicine in Combined Orthodontic and Orthognathic Treatment (COOT). Our protocol was presurgical orthodontic decompensation,CASS combined 3D-printing technique, orthognathic surgery, and postsurgical orthodontic adjustment. With the CASS combined 3D-Printing Technique, the CASS, 3D-printed surgery guiding splint and stable splint offered COOT an accurate guide.
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Sutherland K, Almeida FR, Kim T, Brown EC, Knapman F, Ngiam J, Yang J, Bilston LE, Cistulli PA. Treatment usage patterns of oral appliances for obstructive sleep apnea over the first 60 days: a cluster analysis. J Clin Sleep Med 2021; 17:1785-1792. [PMID: 33847557 DOI: 10.5664/jcsm.9288] [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] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Oral appliance (OA) therapy usage can be objectively measured through temperature-sensing data chips embedded in the appliance. Initial reports of group data for short-term treatment usage suggest good nightly hours of usage. However, individual variability in treatment usage patterns has not been assessed. We aimed to identify OA treatment usage subtypes in the first 60 days and the earliest predictors of these usage patterns. METHODS OSA patients were recruited for a study of OA therapy with an embedded compliance chip (DentiTrac, Braebon, Canada). Fifty-eight participants with 60 days of downloadable treatment usage data (5-minute readings) were analyzed. A hierarchical cluster analysis was used to group participants with similar usage patterns. A random forest classification model was used to identify the minimum number of days to predict usage subtype. RESULTS Three user groups were identified and named "consistent users" (48.3%), "inconsistent users" (32.8%) and "non-users" (19.0%). The first twenty days provided optimal data to predict which treatment usage group a patient would belong to at 60-days (90% accuracy). The strongest predictors of user group were downloaded usage data; average wear time and number of days missed. CONCLUSIONS Granular analysis of OA usage data suggests the existence of treatment user subtypes (consistent, inconsistent and non-users). Our data suggest that 60-day usage patterns can be identified in the first twenty days of treatment using downloaded treatment usage data. Understanding initial treatment usage patterns provide an opportunity for early intervention to improve long-term usage and outcomes.
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Affiliation(s)
- Kate Sutherland
- Sleep Research Group, Charles Perkins Centre & Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia.,Department of Respiratory & Sleep Medicine, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Fernanda R Almeida
- Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, British Columbia, Canada
| | - Taiyun Kim
- Charles Perkins Centre & School of Mathematics and Statistics, University of Sydney, NSW, Australia
| | - Elizabeth C Brown
- Neuroscience Research Australia, Randwick, NSW, Australia.,Prince of Wales Hospital, Sydney, NSW, Australia
| | - Fiona Knapman
- Neuroscience Research Australia, Randwick, NSW, Australia.,University of New South Wales, Sydney NSW, Australia
| | - Joachim Ngiam
- Department of Respiratory & Sleep Medicine, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Jean Yang
- Charles Perkins Centre & School of Mathematics and Statistics, University of Sydney, NSW, Australia
| | - Lynne E Bilston
- Neuroscience Research Australia, Randwick, NSW, Australia.,University of New South Wales, Sydney NSW, Australia
| | - Peter A Cistulli
- Sleep Research Group, Charles Perkins Centre & Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia.,Department of Respiratory & Sleep Medicine, Royal North Shore Hospital, St Leonards, NSW, Australia
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