1
|
Parise BK, Santos RB, Mesas AE, Silva WA, Giatti S, Aielo AN, Cunha LF, Souza SP, Bortolotto LA, Griep RH, Lotufo PA, Bensenor IM, Drager LF. Sleep irregularity and the association with hypertension and blood pressure levels: the ELSA-Brasil study. J Hypertens 2023; 41:670-677. [PMID: 36779344 DOI: 10.1097/hjh.0000000000003392] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
OBJECTIVE To evaluate the associations of sleep irregularity with hypertension (HTN) and blood pressure (BP) levels. METHODS Adult participants from the ELSA-Brasil performed a clinical evaluation including objective sleep duration (actigraphy), insomnia, and a sleep study for defining obstructive sleep apnoea (OSA). To quantify sleep irregularity, we used two parameters obtained through actigraphy: 7-day standard deviation (SD) of sleep duration and 7-day SD of sleep-onset timing. A multivariate analysis was used to determine the independent associations of sleep irregularity with HTN and SBP/DBP values. RESULTS We studied 1720 participants (age 49 ± 8 years; 43.4% men) and 27% fulfilled the HTN diagnosis. After adjustments for age, gender, race, BMI, excessive alcohol consumption, physical activity intensity, urinary sodium excretion, insomnia, objective sleep duration and OSA (apnoea-hypopnoea index ≥15 events/h), we found that the continuous analysis of 7-day SD of sleep duration was modestly associated with prevalent HTN. However, 7-day SD of sleep duration more than 90 min was independently associated with SBP [ β : 1.55; 95% confidence interval (CI) 0.23-2.88] and DBP ( β : 1.07; 95% CI 0.12-2.01). Stratification analysis excluding participants with OSA revealed that a 7-day SD of sleep duration greater than 90 min was associated with a 48% higher chance of having HTN (OR: 1.48; 95% CI: 1.05-2.07). No significant associations were observed for the SD of sleep-onset timing. CONCLUSION Objective measurement of sleep irregularity, evaluated by SD of sleep duration for 1 week, was associated with HTN and higher BP levels, especially in participants without OSA.
Collapse
Affiliation(s)
- Barbara K Parise
- Center of Clinical and Epidemiologic Research
- Unidade de Hipertensao, Disciplina de Nefrologia
| | - Ronaldo B Santos
- Center of Clinical and Epidemiologic Research
- Unidade de Hipertensao, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Arthur E Mesas
- Universidad de Castilla-La Mancha, Spain
- Universidade Estandualde Londrina, Postgraduate Program in Public Health, Londrina, Paraná
| | - Wagner A Silva
- Center of Clinical and Epidemiologic Research
- Unidade de Hipertensao, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Soraya Giatti
- Center of Clinical and Epidemiologic Research
- Unidade de Hipertensao, Disciplina de Nefrologia
| | - Aline N Aielo
- Center of Clinical and Epidemiologic Research
- Unidade de Hipertensao, Disciplina de Nefrologia
| | - Lorenna F Cunha
- Center of Clinical and Epidemiologic Research
- Unidade de Hipertensao, Disciplina de Nefrologia
| | - Silvana P Souza
- Center of Clinical and Epidemiologic Research
- Unidade de Hipertensao, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Luiz A Bortolotto
- Unidade de Hipertensao, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Rosane H Griep
- Laboratory of Health and Environment Education, Fundação Oswaldo Cruz, Brazil
| | | | | | - Luciano F Drager
- Center of Clinical and Epidemiologic Research
- Unidade de Hipertensao, Disciplina de Nefrologia
- Unidade de Hipertensao, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| |
Collapse
|
2
|
Portable evaluation of obstructive sleep apnea in adults: A systematic review. Sleep Med Rev 2023; 68:101743. [PMID: 36657366 DOI: 10.1016/j.smrv.2022.101743] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 12/10/2022] [Accepted: 12/23/2022] [Indexed: 01/07/2023]
Abstract
Obstructive sleep apnea (OSA) is a significant healthcare burden affecting approximately one billion people worldwide. The prevalence of OSA is rising with the ongoing obesity epidemic, a key risk factor for its development. While in-laboratory polysomnography (PSG) is the gold standard for diagnosing OSA, it has significant drawbacks that prevent widespread use. Portable devices with different levels of monitoring are available to allow remote assessment for OSA. To better inform clinical practice and research, this comprehensive systematic review evaluated diagnostic performances, study cost and patients' experience of different levels of portable sleep studies (type 2, 3, and 4), as well as wearable devices and non-contact systems, in adults. Despite varying study designs and devices used, portable diagnostic tests are found to be sufficient for initial screening of patients at risk of OSA. Future studies are needed to evaluate cost effectiveness with the incorporation of portable diagnostic tests into the diagnostic pathway for OSA, as well as their application in patients with chronic respiratory diseases and other comorbidities that may affect test performance.
Collapse
|
3
|
Riha RL, Celmina M, Cooper B, Hamutcu-Ersu R, Kaditis A, Morley A, Pataka A, Penzel T, Roberti L, Ruehland W, Testelmans D, van Eyck A, Grundström G, Verbraecken J, Randerath W. ERS technical standards for using type III devices (limited channel studies) in the diagnosis of sleep disordered breathing in adults and children. Eur Respir J 2023; 61:13993003.00422-2022. [PMID: 36609518 DOI: 10.1183/13993003.00422-2022] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 07/27/2022] [Indexed: 02/01/2023]
Abstract
For more than three decades, type III devices have been used in the diagnosis of sleep disordered breathing in supervised as well as unsupervised settings. They have satisfactory positive and negative predictive values for detecting obstructive and central sleep apnoea in populations with moderately high pre-test probability of symptoms associated with these events. However, standardisation of commercially available type III devices has never been undertaken and the technical specifications can vary widely. None have been subjected to the same rigorous processes as most other diagnostic modalities in the medical field. Although type III devices do not include acquisition of electroencephalographic signals overnight, the minimum number of physical sensors required to allow for respiratory event scoring using standards outlined by the American Academy of Sleep Medicine remains debatable. This technical standard summarises data on type III studies published since 2007 from multiple perspectives in both adult and paediatric sleep practice. Most importantly, it aims to provide a framework for considering current type III device limitations in the diagnosis of sleep disordered breathing while raising research- and practice-related questions aimed at improving our use of these devices in the present and future.
Collapse
Affiliation(s)
- Renata L Riha
- Department of Sleep Medicine, The Royal Infirmary Edinburgh, Edinburgh, UK
| | - Marta Celmina
- Epilepsy and Sleep Medicine Centre, Children's Clinical University Hospital, Riga, Latvia
| | - Brendan Cooper
- Lung Function and Sleep, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, UK
| | | | - Athanasios Kaditis
- Division of Paediatric Pulmonology and Sleep Disorders Laboratory, First Department of Pediatrics, National and Kapodistrian University of Athens School of Medicine and Agia Sofia Children's Hospital, Athens, Greece
| | | | - Athanasia Pataka
- Respiratory Failure Unit, G. Papanikolaou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Thomas Penzel
- Department of Cardiology and Angiology, Interdisciplinary Center of Sleep Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Warren Ruehland
- Institute for Breathing and Sleep, Austin Health, Melbourne, Australia
| | - Dries Testelmans
- Department of Pneumology, University Hospitals Leuven, Leuven, Belgium
| | - Annelies van Eyck
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp (Edegem), Belgium
- Department of Pediatrics, Antwerp University Hospital, Antwerp (Edegem), Belgium
| | | | - Johan Verbraecken
- Antwerp University Hospital and University of Antwerp, Edegem (Antwerp), Belgium
| | - 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
| |
Collapse
|
4
|
Fitzgerald L, Lopez Ruiz L, Zhu J, Lach J, Quinn D. Towards breath sensors that are self-powered by design. ROYAL SOCIETY OPEN SCIENCE 2022; 9:220895. [PMID: 36147941 PMCID: PMC9490333 DOI: 10.1098/rsos.220895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 08/26/2022] [Indexed: 06/16/2023]
Abstract
Piezoelectric materials are widely used to generate electric charge from mechanical deformation or vice versa. These strategies are increasingly common in implantable medical devices, where sensing must be done on small scales. In the case of a flow rate sensor, a sensor's energy harvesting rate could be mapped to that flow rate, making it 'self-powered by design (SPD)'. Prior fluids-based SPD work has focused on turbulence-driven resonance and has been largely empirical. Here, we explore the possibility of sub-resonant SPD flow sensing in a human airway. We present a physical model of piezoelectric sensing/harvesting in the airway, which we validated with a benchtop experiment. Our work offers a model-based roadmap for implantable SPD sensing solutions. We also use the model to theorize a new form of SPD sensing that can detect broadband flow information.
Collapse
Affiliation(s)
- Lucy Fitzgerald
- Mechanical and Aerospace Engineering, University of Virginia, Charlottesville, VA, USA
| | - Luis Lopez Ruiz
- Electrical and Computer Engineering, University of Virginia, Charlottesville, VA, USA
| | - Joe Zhu
- Mechanical and Aerospace Engineering, University of Virginia, Charlottesville, VA, USA
| | - John Lach
- Electrical and Computer Engineering, George Washington University, Washington, DC, USA
| | - Daniel Quinn
- Mechanical and Aerospace Engineering, University of Virginia, Charlottesville, VA, USA
- Electrical and Computer Engineering, University of Virginia, Charlottesville, VA, USA
| |
Collapse
|
5
|
Emami E, Lavigne G, Feine JS, Karp I, Rompré PH, Almeida FR, Huynh NT. Effects of nocturnal wearing of dentures on the quality of sleep and oral-health-related quality in edentate elders with untreated sleep apnea: a randomized cross-over trial. Sleep 2021; 44:zsab101. [PMID: 33955479 PMCID: PMC8503827 DOI: 10.1093/sleep/zsab101] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 04/07/2021] [Indexed: 11/28/2022] Open
Abstract
STUDY OBJECTIVES This study aims to assess whether the nocturnal wear of dentures has an effect on the quality of sleep and oral-health-related quality of life of the edentulous elderly with untreated sleep apnea. METHODS A single-blind randomized cross-over design with two sequences and two periods was used. Participants (n = 77) were randomly assigned either to sequence 1 (nocturnal wear followed by nocturnal nonwear of the denture for 30-30 days) or sequence 2 (nocturnal nonwear followed by nocturnal wear of denture for 30-30 days). The primary sleep outcome was the quality of sleep, assessed through sleep fragmentation measured as Apnea-Hypopnea Index (AHI) and respiratory arousal from portable polysomnography. Secondary outcomes were daytime sleepiness, sleep quality (Pittsburgh Sleep Quality Index, PSQI) and oral-health-related quality of life measured by validated questionnaires. RESULTS The mean paired difference in AHI scores for the period of wearing versus not wearing dentures at night was small 1.0 event per hour (p = 0.50; 95% confidence interval (CI) = -2.0 to 4.1). The mean respiratory arousal index was higher when wearing dentures at night than when not wearing dentures at night, with a mean paired difference of 2.3 events per hour (p = 0.05; 95% CI = 0.0 to 4.6). No difference in sleepiness and PSQI were noted. Wearing dentures at night resulted in a statistically significantly higher mean score of psychological discomfort when compared to not wearing dentures at night. CONCLUSIONS The results provide some support to usual practice guidelines to remove dentures at night in edentulous elders suffering from sleep apnea. CLINICAL TRIAL REGISTRATION NCT01868295.
Collapse
Affiliation(s)
- Elham Emami
- Faculty of Dentistry, McGill University, Montréal, Québec, Canada
| | - Gilles Lavigne
- Faculty of Dentistry, Université de Montréal, Montréal, Québec, Canada
| | - Jocelyne S Feine
- Faculty of Dentistry, McGill University, Montréal, Québec, Canada
| | - Igor Karp
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario,Canada
| | - Pierre H Rompré
- Faculty of Dentistry, Université de Montréal, Montréal, Québec, Canada
| | - Fernanda R Almeida
- Faculty of Dentistry, University of British Colombia, Vancouver, British Columbia, Canada
| | - Nelly T Huynh
- Faculty of Dentistry, Université de Montréal, Montréal, Québec, Canada
| |
Collapse
|
6
|
Acute stroke and TIA patients have specific polygraphic features of obstructive sleep apnea. Sleep Breath 2020; 24:1495-1505. [PMID: 31938989 PMCID: PMC7679322 DOI: 10.1007/s11325-019-02010-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 12/19/2019] [Accepted: 12/23/2019] [Indexed: 11/24/2022]
Abstract
Purpose Obstructive sleep apnea (OSA) is associated with increased risk for stroke, which is known to further impair respiratory functions. However, it is unknown whether the type and severity of respiratory events are linked to stroke or transient ischemic attack (TIA). Thus, we investigate whether the characteristics of individual respiratory events differ between patients experiencing TIA or acute ischemic stroke and matched patients with clinically suspected sleep-disordered breathing. Methods Polygraphic data of 77 in-patients with acute ischemic stroke (n = 49) or TIA (n = 28) were compared to age, gender, and BMI-matched patients with suspected sleep-disordered breathing and no cerebrovascular disease. Along with conventional diagnostic parameters (e.g., apnea-hypopnea index), durations and severities of individual apneas, hypopneas and desaturations were compared between the groups separately for ischemic stroke and TIA patients. Results Stroke and TIA patients had significantly shorter apneas and hypopneas (p < 0.001) compared to matched reference patients. Furthermore, stroke patients had more central apnea events (p = 0.007) and a trend for higher apnea/hypopnea number ratios (p = 0.091). The prevalence of OSA (apnea-hypopnea index ≥ 5) was 90% in acute stroke patients and 79% in transient ischemic attack patients. Conclusion Stroke patients had different characteristics of respiratory events, i.e., their polygraphic phenotype of OSA differs compared to matched reference patients. The observed differences in polygraphic features might indicate that stroke and TIA patients suffer from OSA phenotype recently associated with increased cardiovascular mortality. Therefore, optimal diagnostics and treatment require routine OSA screening in patients with acute cerebrovascular disease, even without previous suspicion of OSA. Electronic supplementary material The online version of this article (10.1007/s11325-019-02010-2) contains supplementary material, which is available to authorized users.
Collapse
|
7
|
Santos RB, Silva WA, Parise BK, Giatti S, Aielo AN, Souza SP, Santos IS, Lotufo PA, Bensenor IM, Drager LF. Accuracy of global and/or regional anthropometric measurements of adiposity in screening sleep apnea: the ELSA-Brasil cohort. Sleep Med 2019; 63:115-121. [PMID: 31622952 DOI: 10.1016/j.sleep.2019.04.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 04/05/2019] [Accepted: 04/24/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Adiposity is a well-established risk factor for obstructive sleep apnea (OSA) but the existence of a preferable anthropometric measurement is not established or whether the combination of measurements may improve the accuracy to detect OSA. This study aimed to compare the accuracies of body mass index (BMI), several surrogate markers of body fat (in isolation or combined) and validated questionnaires for screening OSA. METHODS A total of 2059 participants from the ELSA-Brasil study given anthropometric measurements using standard procedures and a home sleep study. OSA was defined by an apnea-hypopnea index ≥15 events/hour. RESULTS The frequency of OSA was 32.3%. Compared with the non-OSA group, all anthropometric measurements were higher in the OSA group. Age and gender-adjusted BMI afforded the highest accuracy to detect OSA [AUC = 0.760 (0.739-0.781)], followed by waist [AUC = 0.753 (0.732-0.775)] and neck [AUC = 0.733 (0.711-0.755)] circumferences, waist-to-hip ratio [AUC = 0.722 (0.699-0.745)] and body shape index [AUC = 0.680 (0.656-0.704)]. The combination of two or more anthropometric measurements did not improve the accuracy of BMI in predicting OSA. The adjusted BMI had similar predictive performance to the NoSAS score [AUC = 0.748 (0.727-0.770)] but a better accuracy than the Berlin Questionnaire [AUC = 0.676 (0.653-0.699)]. CONCLUSIONS Despite one's intuition, surrogate markers of regional adiposity are not better than BMI in screening OSA. Combining measurements of global and/or regional adiposity did not have additional value in detecting OSA. The merely fair accuracy range of BMI and sleep questionnaires underscore the need for additional tools to improve OSA underdiagnosis.
Collapse
Affiliation(s)
- Ronaldo B Santos
- Center of Clinical and Epidemiologic Research (CPCE), University of Sao Paulo, Sao Paulo, Brazil; Hypertension Unit, Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil
| | - Wagner A Silva
- Center of Clinical and Epidemiologic Research (CPCE), University of Sao Paulo, Sao Paulo, Brazil; Hypertension Unit, Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil
| | - Barbara K Parise
- Center of Clinical and Epidemiologic Research (CPCE), University of Sao Paulo, Sao Paulo, Brazil; Hypertension Unit, Renal Division, University of Sao Paulo, Sao Paulo, Brazil
| | - Soraya Giatti
- Hypertension Unit, Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil; Hypertension Unit, Renal Division, University of Sao Paulo, Sao Paulo, Brazil
| | - Aline N Aielo
- Center of Clinical and Epidemiologic Research (CPCE), University of Sao Paulo, Sao Paulo, Brazil
| | - Silvana P Souza
- Center of Clinical and Epidemiologic Research (CPCE), University of Sao Paulo, Sao Paulo, Brazil; Hypertension Unit, Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil
| | - Itamar S Santos
- Center of Clinical and Epidemiologic Research (CPCE), University of Sao Paulo, Sao Paulo, Brazil
| | - Paulo A Lotufo
- Center of Clinical and Epidemiologic Research (CPCE), University of Sao Paulo, Sao Paulo, Brazil
| | - Isabela M Bensenor
- Center of Clinical and Epidemiologic Research (CPCE), University of Sao Paulo, Sao Paulo, Brazil
| | - Luciano F Drager
- Center of Clinical and Epidemiologic Research (CPCE), University of Sao Paulo, Sao Paulo, Brazil; Hypertension Unit, Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil; Hypertension Unit, Renal Division, University of Sao Paulo, Sao Paulo, Brazil.
| |
Collapse
|
8
|
OSA, Short Sleep Duration, and Their Interactions With Sleepiness and Cardiometabolic Risk Factors in Adults. Chest 2019; 155:1190-1198. [DOI: 10.1016/j.chest.2018.12.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 10/26/2018] [Accepted: 12/03/2018] [Indexed: 02/06/2023] Open
|
9
|
Aielo AN, Santos RB, Silva WA, Parise BK, Souza SP, Cunha LF, Giatti S, Lotufo PA, Bensenor IM, Drager LF. Pragmatic Validation of Home Portable Sleep Monitor for diagnosing Obstructive Sleep Apnea in a non-referred population: The ELSA-Brasil study. ACTA ACUST UNITED AC 2019; 12:65-71. [PMID: 31879537 PMCID: PMC6922554 DOI: 10.5935/1984-0063.20190072] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Objective Polygraphy (PG) is an attractive alternative for diagnosing obstructive sleep apnea (OSA) in patients with high pre-test probability. However, several patients may not present typical symptoms. In this scenario, it is unclear the performance of PG for diagnosing OSA in non-referred populations to sleep laboratories. Methods Data from participants of the ELSA-Brasil cohort were used for this analysis. We performed an overnight home PG (Embletta GoldTM) synchronized with a wrist actigraphy (Actiwatch model 2TM). The validation strategy comprised three scorings from each participant: 1) Original scoring (PG): Routine scoring using data from the exclamation button mark to define “analysis start” and “analysis stop”; 2) Scoring using actigraphy data (PG+actigraphy): total sleep time defined by the actigraphy data; 3) Scoring using diaries (PG+diary): “analysis start” and “analysis stop” based on the diaries. Bland-Altman plots were generated to assess the agreements (Kappa) between each scoring strategy. Results A total of 300 participants were included in the final analysis (45% males, mean age: 48±8 years). The frequency of OSA using the PG score was 27.3%. Despite small differences in the OSA severity index, we obtained a high concordance of AHI comparing the PG vs. PG+actigraphy (Kappa: 0.95) as well as PG+diary vs. PG+actigraphy (Kappa: 0.96). No significant changes in the OSA classification (mild, moderate and severe) were observed in the 3 protocols. Conclusion Using a pragmatic approach to address OSA at home, our results suggest that PG is a useful tool for OSA diagnosis even in subjects not referred to sleep studies.
Collapse
Affiliation(s)
- Aline N Aielo
- University of Sao Paulo, Center of Clinical and Epidemiologic Research (CPCE) - São Paulo - São Paulo - Brazil.,University of Sao Paulo, Hypertension Unit, Renal Division - São Paulo - São Paulo - Brazil
| | - Ronaldo B Santos
- University of Sao Paulo, Center of Clinical and Epidemiologic Research (CPCE) - São Paulo - São Paulo - Brazil.,University of Sao Paulo, Hypertension Unit, Heart Institute (InCor) - São Paulo - São Paulo - Brazil
| | - Wagner A Silva
- University of Sao Paulo, Center of Clinical and Epidemiologic Research (CPCE) - São Paulo - São Paulo - Brazil.,University of Sao Paulo, Hypertension Unit, Heart Institute (InCor) - São Paulo - São Paulo - Brazil
| | - Barbara K Parise
- University of Sao Paulo, Center of Clinical and Epidemiologic Research (CPCE) - São Paulo - São Paulo - Brazil.,University of Sao Paulo, Hypertension Unit, Renal Division - São Paulo - São Paulo - Brazil
| | - Silvana P Souza
- University of Sao Paulo, Center of Clinical and Epidemiologic Research (CPCE) - São Paulo - São Paulo - Brazil.,University of Sao Paulo, Hypertension Unit, Heart Institute (InCor) - São Paulo - São Paulo - Brazil
| | - Lorenna F Cunha
- University of Sao Paulo, Center of Clinical and Epidemiologic Research (CPCE) - São Paulo - São Paulo - Brazil
| | - Soraya Giatti
- University of Sao Paulo, Center of Clinical and Epidemiologic Research (CPCE) - São Paulo - São Paulo - Brazil.,University of Sao Paulo, Hypertension Unit, Renal Division - São Paulo - São Paulo - Brazil
| | - Paulo A Lotufo
- University of Sao Paulo, Center of Clinical and Epidemiologic Research (CPCE) - São Paulo - São Paulo - Brazil
| | - Isabela M Bensenor
- University of Sao Paulo, Center of Clinical and Epidemiologic Research (CPCE) - São Paulo - São Paulo - Brazil
| | - Luciano F Drager
- University of Sao Paulo, Center of Clinical and Epidemiologic Research (CPCE) - São Paulo - São Paulo - Brazil.,University of Sao Paulo, Hypertension Unit, Renal Division - São Paulo - São Paulo - Brazil.,University of Sao Paulo, Hypertension Unit, Heart Institute (InCor) - São Paulo - São Paulo - Brazil
| |
Collapse
|
10
|
Anitua E, Duran-Cantolla J, Almeida GZ, Alkhraisat MH. Predicting the night-to-night variability in the severity of obstructive sleep apnea: the case of the standard error of measurement. ACTA ACUST UNITED AC 2019; 12:72-78. [PMID: 31879538 PMCID: PMC6922552 DOI: 10.5935/1984-0063.20190063] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Study objectives Night-to-night variability in the apnea-hypopnea index (AHI) may affect the accuracy of the diagnosis of obstructive sleep apnea (OSA) and treatment selection. This study was conducted to assess the utility of the standard error of measurement (SEM) in predicting the night-to-night variability in the OSA. Methods Ninety nine patients underwent a 3-consecutive nights of sleep monitoring with a validated home portable monitoring devise (BTI-APNiA, BTI Biotechnology Institute, Vitoria, Spain). The night-to-night variability in apnea- and hypopnea-related measures and blood desaturation were assessed. The agreement between the three nights was also assessed. The SEM and the AHI of the first night were used to calculate a range for the severity of the OSA. This range was then challenged to predict the most frequent OSA severity, the OSA severity in nights 2 and 3, and the OSA severity in the three nights. Results Ninety nine patients (mean age: 56±14 years) participated in the study. The mean body mass index was 25.4±4.0 Kg/m2 and the mean score of Epworth questionnaire was 8±5. The AHI of the first, second and third nights were 13.96±13.46, 13.76±12.76 and 13.52±12.91 events/h, respectively. The night-to-night variability in the AHI and the sleep time in supine position over the three nights were not statistically significant. However, the differences in the severity of the OSA was statistically significant (range of agreement in the diagnosis: 41.7%-83.3%). The standard error of measurement (SEM) considering the AHI was 4.64 events/h.. The SEM was efficient in predicting the most frequent OSA severity (among the three nights) in more than 96% of the cases. Conclusions The night-to-night variability in the AHI might affect the diagnosis of OSA. The use of standard error of measurement and the AHI of one single night would be of interest to predict the night-to-night variability in the severity of OSA.
Collapse
Affiliation(s)
- Eduardo Anitua
- University Institute for Regenerative Medicine and Oral Implantology - UIRMI (UPV/EHU-Fundación Eduardo Anitua), Sleep - Vitoria - Álava - Spain.,Clínica Eduardo Anitua, Sleep - Vitoria - Álava - Spain.,BTI Biotechnology Institute, Research and development - Vitoria - Álava - Spain
| | - Joaquin Duran-Cantolla
- University Institute for Regenerative Medicine and Oral Implantology - UIRMI (UPV/EHU-Fundación Eduardo Anitua), Sleep - Vitoria - Álava - Spain.,Clínica Eduardo Anitua, Sleep - Vitoria - Álava - Spain.,Bioaraba Research Institute, OSI Araba University Hospital - Vitoria - Álava - Spain.,Interdisciplinary Sleep Unit, OSI Araba University Hospital - Vitoria - Álava - Spain.,Basque Country University, Medicine Department - Vitoria - Álava - Spain.,Ciber de Enfermedades Respiratorias, (CIBERES) - Madrid - Madrid - Spain
| | | | - Mohammad Hamdan Alkhraisat
- University Institute for Regenerative Medicine and Oral Implantology - UIRMI (UPV/EHU-Fundación Eduardo Anitua), Sleep - Vitoria - Álava - Spain.,BTI Biotechnology Institute, Research and development - Vitoria - Álava - Spain
| |
Collapse
|
11
|
Genta-Pereira DC, Furlan SF, Omote DQ, Giorgi DM, Bortolotto LA, Lorenzi-Filho G, Drager LF. Nondipping Blood Pressure Patterns Predict Obstructive Sleep Apnea in Patients Undergoing Ambulatory Blood Pressure Monitoring. Hypertension 2018; 72:979-985. [DOI: 10.1161/hypertensionaha.118.11525] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A nondipping blood pressure (BP) pattern is common in patients with obstructive sleep apnea (OSA). However, it is unclear how useful a nondipping BP pattern is in screening for OSA. In this cross-sectional study, we recruited consecutive patients with clinical indications for performing ambulatory BP monitoring evaluating the following dipping patterns: (1) normal: ≥10% but <20%; (2) extreme: ≥20%; (3) reduced: ≥0% but <10%; and (4) reverse (riser): <0%. Sleep questionnaires and sleep studies were performed within 7 days after ambulatory BP monitoring. OSA was defined as an apnea-hypopnea index ≥15 events/h. We evaluated 153 patients (OSA frequency, 50.3%). Patients with OSA had higher BPs during sleep, were taking more antihypertensive drugs, and more frequently used hypertensive drugs during the night than patients without OSA. Considering systolic BP, the frequency of OSA in patients with reverse dippers (73.5%) was higher than normal (37.3%), extreme (46.2%), and reduced dippers (49.1%;
P
=0.012). For diastolic BP, OSA was more common in reduced (66.7%) and reverse dippers (69.6%) as compared to normal (41.4%) or extreme dippers (33.3%;
P
=0.007). In the regression analysis, reverse systolic dipper was independently associated with OSA (odds ratio, 3.92; 95% CI, 1.31–11.78). Both reduced and reverse diastolic dippers increased the likelihood of OSA for 2.7-fold and 3.5-fold, respectively. Snoring and positive sleep questionnaire findings were associated with a modest increase in the accuracy of reverse dipping pattern for predicting OSA. In conclusion, reverse systolic, as well as reduced and reverse diastolic dippers are independently associated with OSA.
Collapse
Affiliation(s)
- Daniel Castanho Genta-Pereira
- From the Program in Cardiology, Faculty of Medicine, University of São Paulo, Brazil (D.C.G.-P., S.F.F.)
- Hypertension Unit, Heart Institute (InCor) (D.C.G.-P., S.F.F., D.Q.O., D.M.A.G., L.A.B., L.F.D.), University of São Paulo Medical School, Brazil
| | - Sofia F. Furlan
- From the Program in Cardiology, Faculty of Medicine, University of São Paulo, Brazil (D.C.G.-P., S.F.F.)
- Hypertension Unit, Heart Institute (InCor) (D.C.G.-P., S.F.F., D.Q.O., D.M.A.G., L.A.B., L.F.D.), University of São Paulo Medical School, Brazil
| | - Daniel Q. Omote
- Hypertension Unit, Heart Institute (InCor) (D.C.G.-P., S.F.F., D.Q.O., D.M.A.G., L.A.B., L.F.D.), University of São Paulo Medical School, Brazil
| | - Dante M.A. Giorgi
- Hypertension Unit, Heart Institute (InCor) (D.C.G.-P., S.F.F., D.Q.O., D.M.A.G., L.A.B., L.F.D.), University of São Paulo Medical School, Brazil
| | - Luiz A. Bortolotto
- Hypertension Unit, Heart Institute (InCor) (D.C.G.-P., S.F.F., D.Q.O., D.M.A.G., L.A.B., L.F.D.), University of São Paulo Medical School, Brazil
| | - Geraldo Lorenzi-Filho
- Sleep Laboratory, Pulmonary Division (G.L.-F.), University of São Paulo Medical School, Brazil
| | - Luciano F. Drager
- Hypertension Unit, Heart Institute (InCor) (D.C.G.-P., S.F.F., D.Q.O., D.M.A.G., L.A.B., L.F.D.), University of São Paulo Medical School, Brazil
- Hypertension Unit, Renal Division (L.F.D.), University of São Paulo Medical School, Brazil
| |
Collapse
|
12
|
Sharma RA, Varga AW, Bubu OM, Pirraglia E, Kam K, Parekh A, Wohlleber M, Miller MD, Andrade A, Lewis C, Tweardy S, Buj M, Yau PL, Sadda R, Mosconi L, Li Y, Butler T, Glodzik L, Fieremans E, Babb JS, Blennow K, Zetterberg H, Lu SE, Badia SG, Romero S, Rosenzweig I, Gosselin N, Jean-Louis G, Rapoport DM, de Leon MJ, Ayappa I, Osorio RS. Obstructive Sleep Apnea Severity Affects Amyloid Burden in Cognitively Normal Elderly. A Longitudinal Study. Am J Respir Crit Care Med 2018; 197:933-943. [PMID: 29125327 PMCID: PMC6020410 DOI: 10.1164/rccm.201704-0704oc] [Citation(s) in RCA: 164] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 11/09/2017] [Indexed: 12/13/2022] Open
Abstract
RATIONALE Recent evidence suggests that obstructive sleep apnea (OSA) may be a risk factor for developing mild cognitive impairment and Alzheimer's disease. However, how sleep apnea affects longitudinal risk for Alzheimer's disease is less well understood. OBJECTIVES To test the hypothesis that there is an association between severity of OSA and longitudinal increase in amyloid burden in cognitively normal elderly. METHODS Data were derived from a 2-year prospective longitudinal study that sampled community-dwelling healthy cognitively normal elderly. Subjects were healthy volunteers between the ages of 55 and 90, were nondepressed, and had a consensus clinical diagnosis of cognitively normal. Cerebrospinal fluid amyloid β was measured using ELISA. Subjects received Pittsburgh compound B positron emission tomography scans following standardized procedures. Monitoring of OSA was completed using a home sleep recording device. MEASUREMENTS AND MAIN RESULTS We found that severity of OSA indices (AHIall [F1,88 = 4.26; P < 0.05] and AHI4% [F1,87 = 4.36; P < 0.05]) were associated with annual rate of change of cerebrospinal fluid amyloid β42 using linear regression after adjusting for age, sex, body mass index, and apolipoprotein E4 status. AHIall and AHI4% were not associated with increases in ADPiB-mask (Alzheimer's disease vulnerable regions of interest Pittsburg compound B positron emission tomography mask) most likely because of the small sample size, although there was a trend for AHIall (F1,28 = 2.96, P = 0.09; and F1,28 = 2.32, not significant, respectively). CONCLUSIONS In a sample of cognitively normal elderly, OSA was associated with markers of increased amyloid burden over the 2-year follow-up. Sleep fragmentation and/or intermittent hypoxia from OSA are likely candidate mechanisms. If confirmed, clinical interventions for OSA may be useful in preventing amyloid build-up in cognitively normal elderly.
Collapse
Affiliation(s)
- Ram A. Sharma
- Center for Brain Health, Department of Psychiatry, and
| | - Andrew W. Varga
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Omonigho M. Bubu
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, Florida
| | | | - Korey Kam
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ankit Parekh
- College of Engineering, The University of Iowa, Iowa City, Iowa
| | | | | | | | - Clifton Lewis
- Center for Brain Health, Department of Psychiatry, and
| | | | - Maja Buj
- Center for Brain Health, Department of Psychiatry, and
| | - Po L. Yau
- Center for Brain Health, Department of Psychiatry, and
| | - Reem Sadda
- Harlem Hospital–Columbia University Medical Center, New York, New York
| | - Lisa Mosconi
- Center for Brain Health, Department of Psychiatry, and
| | - Yi Li
- Center for Brain Health, Department of Psychiatry, and
| | - Tracy Butler
- Center for Brain Health, Department of Psychiatry, and
| | - Lidia Glodzik
- Center for Brain Health, Department of Psychiatry, and
| | - Els Fieremans
- Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York
| | - James S. Babb
- Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York
| | - Kaj Blennow
- Institute of Neuroscience and Psychiatry, Department of Psychiatry and Neurochemistry, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Henrik Zetterberg
- Institute of Neuroscience and Psychiatry, Department of Psychiatry and Neurochemistry, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Molecular Neuroscience, UCL Institute of Neurology, Queen Square, London, United Kingdom
| | - Shou E. Lu
- Department of Biostatistics, Rutgers School of Public Health, Piscataway, New Jersey
| | - Sandra G. Badia
- Sleep Unit, Respiratory Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Institute for Biomedical Research Sant Pau, CIBERSAM, Barcelona, Spain
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain
| | - Sergio Romero
- Biomedical Engineering Research Centre, Department of Automatic Control, Universitat Politècnica de Catalunya, Barcelona, Spain
- CIBER de Bioingeniería, Biomateriales y Nanomedicina, Barcelona, Spain
| | - Ivana Rosenzweig
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- Sleep Disorders Centre, Guy’s and St. Thomas’ Hospital, GSTT NHS Trust, London, United Kingdom
| | - Nadia Gosselin
- Center for Advanced Research in Sleep Medicine, Hospital du Sacre-Coeur de Montreal, Montreal, Quebec, Canada; and
- Department of Psychology, Universite de Montreal, Montreal, Quebec, Canada
| | - Girardin Jean-Louis
- Center for Healthful Behavior Change, Division of Health and Behavior, Department of Population Health, New York University Langone Medical Center, New York, New York
| | - David M. Rapoport
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Indu Ayappa
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | | |
Collapse
|
13
|
Anitua E, Durán-Cantolla J, Almeida GZ, Alkhraisat MH. Minimizing the mandibular advancement in an oral appliance for the treatment of obstructive sleep apnea. Sleep Med 2017; 34:226-231. [DOI: 10.1016/j.sleep.2016.12.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 12/23/2016] [Accepted: 12/27/2016] [Indexed: 11/30/2022]
|
14
|
Koo CY, de la Torre AS, Loo G, Torre MSDL, Zhang J, Duran-Cantolla J, Li R, Mayos M, Sethi R, Abad J, Furlan SF, Coloma R, Hein T, Ho HH, Jim MH, Ong TH, Tai BC, Turino C, Drager LF, Lee CH, Barbe F. Effects of Ethnicity on the Prevalence of Obstructive Sleep Apnoea in Patients with Acute Coronary Syndrome: A Pooled Analysis of the ISAACC Trial and Sleep and Stent Study. Heart Lung Circ 2016; 26:486-494. [PMID: 27939743 DOI: 10.1016/j.hlc.2016.09.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 09/02/2016] [Accepted: 09/12/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Obstructive sleep apnoea (OSA) is an emerging risk factor for acute coronary syndrome (ACS). We sought to determine the effects of ethnicity on the prevalence of OSA in patients presenting with ACS who participated in an overnight sleep study. METHODS A pooled analysis using patient-level data from the ISAACC Trial and Sleep and Stent Study was performed. Using the same portable diagnostic device, OSA was defined as an apnoea-hypopnoea index of ≥15 events per hour. RESULTS A total of 1961 patients were analysed, including Spanish (53.6%, n=1050), Chinese (25.5%, n=500), Indian (12.0%, n=235), Malay (6.1%, n=119), Brazilian (1.7%, n=34) and Burmese (1.2%, n=23) populations. Significant differences in body mass index (BMI) were found among the various ethnic groups, averaging from 25.3kg/m2 for Indians and 25.4kg/m2 for Chinese to 28.6kg/m2 for Spaniards. The prevalence of OSA was highest in the Spanish (63.1%), followed by the Chinese (50.2%), Malay (47.9%), Burmese (43.5%), Brazilian (41.2%), and Indian (36.1%) patients. The estimated odds ratio of BMI on OSA was highest in the Chinese population (1.17; 95% confidence interval: 1.10-1.24), but was not significant in the Spanish, Burmese or Brazilian populations. The area under the curve (AUC) for the Asian patients (ranging from 0.6365 to 0.6692) was higher than that for the Spanish patients (0.5161). CONCLUSION There was significant ethnic variation in the prevalence of OSA in patients with ACS. The magnitude of the effect of BMI on OSA was greater in the Chinese population than in the Spanish patients.
Collapse
Affiliation(s)
- Chieh-Yang Koo
- Department of Cardiology, National University Heart Centre, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore.
| | - Alicia Sánchez de la Torre
- Respiratory Department, Hospital Universitari Arnau de Vilanova and Santa Maria, IRB Lleida, Lleida, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Germaine Loo
- Department of Cardiology, National University Heart Centre, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore
| | - Manuel Sánchez-de-la Torre
- Respiratory Department, Hospital Universitari Arnau de Vilanova and Santa Maria, IRB Lleida, Lleida, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Junjie Zhang
- Department of Cardiology, Nanjing First Hospital, Nanjing, China
| | - Joaquin Duran-Cantolla
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain; Bio-Araba Research Institute, Araba University Hospital, Department of Medicine of Basque Country University, Vitoria-Gasteiz, Spain
| | - Ruogu Li
- Department of Cardiology, Shanghai Chest Hospital, Shanghai, China
| | - Mercé Mayos
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain; Sleep Unit, Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Rishi Sethi
- Department of Cardiology, King George's Medical University, Lucknow, India
| | - Jorge Abad
- Respiratory Department, Hospital Universitari Germans Trias I Pujol, Badalona, Barcelona, Catalonia, Spain
| | - Sofia F Furlan
- Hypertension Unit-Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Ramón Coloma
- Respiratory Department, Hospital General Universitario de Albacete, Spain
| | - Thet Hein
- No (1) 1000 bedded Defence Services General Hospital, Mingaladon, Yangon, Myanmar
| | - Hee-Hwa Ho
- Department of Cardiology, Tan Tock Seng Hospital, Singapore
| | - Man-Hong Jim
- Cardiac Medical Unit, The Grantham Hospital, Hong Kong
| | - Thun-How Ong
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
| | - Bee-Choo Tai
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Cecilia Turino
- Respiratory Department, Hospital Universitari Arnau de Vilanova and Santa Maria, IRB Lleida, Lleida, Spain
| | - Luciano F Drager
- Hypertension Unit-Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Chi-Hang Lee
- Department of Cardiology, National University Heart Centre, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore
| | - Ferran Barbe
- Respiratory Department, Hospital Universitari Arnau de Vilanova and Santa Maria, IRB Lleida, Lleida, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.
| |
Collapse
|
15
|
Durán-Cantolla J, Zamora Almeida G, Vegas Diaz de Guereñu O, Saracho Rotaeche L, Hamdan Alkhraisat M, Durán Carro J, Egea Santaolalla C, Anitua E. Validation of a new domiciliary diagnosis device for automatic diagnosis of patients with clinical suspicion of OSA. Respirology 2016; 22:378-385. [DOI: 10.1111/resp.12894] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 06/01/2016] [Accepted: 06/25/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Joaquín Durán-Cantolla
- Bioaraba Research Institute; OSI Araba University Hospital; Vitoria Spain
- Interdisciplinary Sleep Unit; OSI Araba University Hospital; Vitoria Spain
- Medicine Department; Basque Country University; Vitoria Spain
- Ciber de Enfermedades Respiratorias (CIBERES); Madrid Spain
| | - Gabriela Zamora Almeida
- Bioaraba Research Institute; OSI Araba University Hospital; Vitoria Spain
- Interdisciplinary Sleep Unit; OSI Araba University Hospital; Vitoria Spain
| | | | | | | | - Joaquín Durán Carro
- Bioaraba Research Institute; OSI Araba University Hospital; Vitoria Spain
- Interdisciplinary Sleep Unit; OSI Araba University Hospital; Vitoria Spain
| | - Carlos Egea Santaolalla
- Bioaraba Research Institute; OSI Araba University Hospital; Vitoria Spain
- Interdisciplinary Sleep Unit; OSI Araba University Hospital; Vitoria Spain
| | | | | |
Collapse
|
16
|
Osorio RS, Ducca EL, Wohlleber ME, Tanzi EB, Gumb T, Twumasi A, Tweardy S, Lewis C, Fischer E, Koushyk V, Cuartero-Toledo M, Sheikh MO, Pirraglia E, Zetterberg H, Blennow K, Lu SE, Mosconi L, Glodzik L, Schuetz S, Varga AW, Ayappa I, Rapoport DM, de Leon MJ. Orexin-A is Associated with Increases in Cerebrospinal Fluid Phosphorylated-Tau in Cognitively Normal Elderly Subjects. Sleep 2016; 39:1253-60. [PMID: 26951396 DOI: 10.5665/sleep.5846] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 02/07/2016] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES To evaluate the role of orexin-A with respect to cerebrospinal fluid (CSF) Alzheimer disease (AD) biomarkers, and explore its relationship to cognition and sleep characteristics in a group of cognitively normal elderly individuals. METHODS Subjects were recruited from multiple community sources for National Institutes of Health supported studies on normal aging, sleep and CSF biomarkers. Sixty-three participants underwent home monitoring for sleep-disordered breathing, clinical, sleep and cognitive evaluations, as well as a lumbar puncture to obtain CSF. Individuals with medical history or with magnetic resonance imaging evidence of disorders that may affect brain structure or function were excluded. Correlation and linear regression analyses were used to assess the relationship between orexin-A and CSF AD-biomarkers controlling for potential sociodemographic and sleep confounders. RESULTS Levels of orexin-A, amyloid beta 42 (Aβ42), phosphorylated-tau (P-Tau), total-tau (T-Tau), Apolipoprotein E4 status, age, years of education, reported total sleep time, number of awakenings, apnea-hypopnea indices (AHI), excessive daytime sleepiness, and a cognitive battery were analyzed. Subjects were 69.59 ± 8.55 years of age, 57.1% were female, and 30.2% were apolipoprotein E4+. Orexin-A was positively correlated with Aβ42, P-Tau, and T-Tau. The associations between orexin-A and the AD-biomarkers were driven mainly by the relationship between orexin-A and P-Tau and were not influenced by other clinical or sleep characteristics that were available. CONCLUSIONS Orexin-A is associated with increased P-Tau in normal elderly individuals. Increases in orexin-A and P-Tau might be a consequence of the reduction in the proportion of the deeper, more restorative slow wave sleep and rapid eye movement sleep reported with aging. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov registration number NCT01962779.
Collapse
Affiliation(s)
| | - Emma L Ducca
- Division of Pulmonary, Critical Care, and Sleep Medicine, NYU School of Medicine, New York, NY
| | | | - Emily B Tanzi
- Center for Brain Health, NYU School of Medicine, New York, NY
| | - Tyler Gumb
- Center for Brain Health, NYU School of Medicine, New York, NY
| | - Akosua Twumasi
- Center for Brain Health, NYU School of Medicine, New York, NY
| | - Samuel Tweardy
- Center for Brain Health, NYU School of Medicine, New York, NY
| | - Clifton Lewis
- Center for Brain Health, NYU School of Medicine, New York, NY
| | - Esther Fischer
- Department of Neuroscience, JFK Medical Center, Edison, NJ
| | | | | | | | | | - Henrik Zetterberg
- Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,UCL Institute of Neurology, Queen Square, London, UK
| | - Kaj Blennow
- Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | - Shou-En Lu
- Department of Biostatistics, Rutgers School of Public Health, Piscataway, NJ
| | - Lisa Mosconi
- Center for Brain Health, NYU School of Medicine, New York, NY
| | - Lidia Glodzik
- Center for Brain Health, NYU School of Medicine, New York, NY
| | - Sonja Schuetz
- Division of Pulmonary, Critical Care, and Sleep Medicine, NYU School of Medicine, New York, NY
| | - Andrew W Varga
- Division of Pulmonary, Critical Care, and Sleep Medicine, NYU School of Medicine, New York, NY
| | - Indu Ayappa
- Division of Pulmonary, Critical Care, and Sleep Medicine, NYU School of Medicine, New York, NY
| | - David M Rapoport
- Division of Pulmonary, Critical Care, and Sleep Medicine, NYU School of Medicine, New York, NY
| | - Mony J de Leon
- Center for Brain Health, NYU School of Medicine, New York, NY
| |
Collapse
|
17
|
Chan PF, Tai BC, Loo G, Koo CY, Ong TH, Yeo TC, Lee CH. Optimal Body Mass Index Cut-offs for Identification of Patients with Coronary Artery Disease at High Risk of Obstructive Sleep Apnoea. Heart Lung Circ 2016; 25:847-54. [PMID: 27067667 DOI: 10.1016/j.hlc.2016.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 02/10/2016] [Accepted: 02/12/2016] [Indexed: 01/20/2023]
Abstract
BACKGROUND We sought to evaluate the relationship between Body Mass Index (BMI) and obstructive sleep apnoea (OSA) in Chinese patients hospitalised with coronary artery disease, and to determine the optimal BMI cut-off for prediction of OSA. METHODS Consecutive Chinese patients who were hospitalised with symptomatic coronary artery disease were recruited to undergo an in-hospital sleep study. RESULTS A total of 587 patients were recruited. Using cut-off for Asians, 81.2% of the cohort was overweight (BMI ≥23kg/m(2)) and 31.6% was obese (≥27kg/m(2)). A total of 59.5% was diagnosed with OSA, defined as apnoea-hypopnoea index ≥15. Body mass index, hypertension and smoking were predictors of OSA. Multiple logistic regression analysis showed that BMI remains an independent predictor of OSA (odds ratio: 1.11 [95% confidence interval: 1.06 to 1.17], p<0.001) after adjusting for smoking and hypertension. Further analysis using BMI and Apnoea-Hypopnoea Index (AHI) as continuous variables showed significant correlation between BMI and AHI (Pearson's r =0.25, P<0.001). In adjusted models, optimal BMI cut-offs to screen for OSA were 27.3kg/m(2), 23.0-23.9kg/m(2), and 20kg/m(2) for patients with neither, either, or both predictors (smoking and hypertension) respectively. The area under the curve for the adjusted and unadjusted models were similar (0.6013 vs 0.6262, p=0.118). CONCLUSIONS Body mass index represents a convenient and readily available tool for bedside identification of patients at high risk of OSA. Body mass index cut-offs to predict risks of OSA in Chinese patients with symptomatic coronary artery disease are defined in this study.
Collapse
Affiliation(s)
- Po-Fun Chan
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Bee-Choo Tai
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Germaine Loo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Chieh-Yang Koo
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Thun-How Ong
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
| | - Tiong-Cheng Yeo
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Chi-Hang Lee
- Department of Cardiology, National University Heart Centre Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| |
Collapse
|
18
|
Zhang JJ, Gao XF, Ge Z, Jiang XM, Xiao PX, Tian NL, Kan J, Lee CH, Chen SL. Obstructive sleep apnea affects the clinical outcomes of patients undergoing percutaneous coronary intervention. Patient Prefer Adherence 2016; 10:871-8. [PMID: 27284240 PMCID: PMC4881919 DOI: 10.2147/ppa.s104100] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND There is a paucity of evidence regarding the association between obstructive sleep apnea (OSA) and patients undergoing percutaneous coronary intervention (PCI) for coronary artery disease. We sought to investigate whether OSA affects the clinical outcomes of patients undergoing PCI. PATIENTS AND METHODS All enrolled individuals treated with PCI were evaluated for OSA by polysomnography. The primary end point was defined as major adverse cardiac events (MACEs) at 2 years, including cardiac death, myocardial infarction (MI), and/or target vessel revascularization. RESULTS A total of 340 consecutive patients undergoing PCI were assigned to the OSA (n=152, apnea-hypopnea index ≥15) and non-OSA (n=188, apnea-hypopnea index <15) groups. The incidence of OSA in patients with coronary artery disease undergoing PCI was 44.7%. Patients in the OSA group had more three-vessel disease (34.9%), increased number of total implanted stents (3.3±2.0), and longer total stent length (83.8±53.1 mm) when compared to the non-OSA group (23.4%, P=0.020; 2.8±1.9, P=0.007; 68.7±48.4, P=0.010). After a median follow-up of 2 years, the incidence of MACEs was significantly higher in patients with OSA (25.0% vs 16.0%, P=0.038), mainly driven by the increased periprocedural MI (19.2% vs 11.2%, P=0.038) in the OSA group. By Cox regression multivariable analysis, the independent predictor of MACEs was OSA (hazard ratio: 1.962, 95% confidence interval: 1.036-3.717, P=0.039). CONCLUSION There was a high prevalence of moderate-to-severe OSA in patients undergoing PCI, and OSA was associated with significantly increased MACE rate, mainly due to the increase in periprocedural MI rate.
Collapse
Affiliation(s)
- Jun-jie Zhang
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, People’s Republic of China
- Department of Cardiology, Nanjing Heart Center, Nanjing, People’s Republic of China
| | - Xiao-fei Gao
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, People’s Republic of China
| | - Zhen Ge
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, People’s Republic of China
- Department of Cardiology, Nanjing Heart Center, Nanjing, People’s Republic of China
| | - Xiao-Min Jiang
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, People’s Republic of China
| | - Ping-xi Xiao
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, People’s Republic of China
- Department of Cardiology, Nanjing Heart Center, Nanjing, People’s Republic of China
| | - Nai-liang Tian
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, People’s Republic of China
- Department of Cardiology, Nanjing Heart Center, Nanjing, People’s Republic of China
| | - Jing Kan
- Department of Cardiology, Nanjing Heart Center, Nanjing, People’s Republic of China
| | - Chi-Hang Lee
- Department of Cardiology, National University Heart Center, Singapore
| | - Shao-Liang Chen
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, People’s Republic of China
- Department of Cardiology, Nanjing Heart Center, Nanjing, People’s Republic of China
- Correspondence: Shao-Liang Chen, Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, 210006 Nanjing, People’s Republic of China, Tel/fax +86 25 5220 8048, Email
| |
Collapse
|
19
|
Use of oximetry as a screening tool for obstructive sleep apnea: a case study in Taiwan. J Med Syst 2015; 39:29. [PMID: 25677955 DOI: 10.1007/s10916-015-0195-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 01/13/2015] [Indexed: 12/15/2022]
Abstract
Obstructive sleep apnea (OSA) is a relatively common disease in the general population. Patients with OSA have a high risk of various comorbid medical diseases. Polysomnography (PSG) is the current gold standard for diagnosing OSA but is time consuming and expensive. This study aims to identify a sensitive screening parameter that can be used by clinicians to determine the time of referral for PSG examination in Taiwan. Eighty-seven patients, including 67 males and 20 females, were included in this study. We divided the patients into two groups: training data (n = 58) and testing group (n = 29). Pearson χ(2) test was used to perform bivariate analysis, and a decision tree was used to build a model. The decision model selected the frequency of desaturation > 4% per hour (DI4) as the indicator of OSA influence. The testing data accuracy of the C4.5 decision tree was 82.80%. External data were also used to validate the model reliability. The accuracy of the external data was 95.96%. Approximately one-third of patients with DI4 between 11 and 33 suffered from OSA. This population requires further diagnosis. Oximetry is an important and widely available screening method in Taiwan. This study proposes the need for PSG referral if DI4 is between 11 and 33.
Collapse
|
20
|
Chernyshev OY, McCarty DE, Moul DE, Liendo C, Caldito GC, Munjampalli SK, Kelley RE, Chesson AL. A pilot study: portable out-of-center sleep testing as an early sleep apnea screening tool in acute ischemic stroke. Nat Sci Sleep 2015; 7:127-38. [PMID: 26527904 PMCID: PMC4621189 DOI: 10.2147/nss.s85780] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Prompt diagnosis of obstructive sleep apnea (OSA) after acute ischemic stroke (AIS) is critical for optimal clinical outcomes, but in-laboratory conventional polysomnograms (PSG) are not routinely practical. Though portable out-of-center type III cardiopulmonary sleep studies (out-of-center cardiopulmonary sleep testing [OCST]) are widely available, these studies have not been validated in patients who have recently suffered from AIS. We hypothesized that OCST in patients with AIS would yield similar results when compared to conventional PSG. METHODS Patients with AIS had simultaneous type III OCST and PSG studies performed within 72 hours from symptom onset. The accuracy of OCST was compared to PSG using: chi-square tests, receiver operatory characteristic curves, Bland-Altman plot, paired Student's t-test/Wilcoxon signed-rank test, and calculation of sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). RESULTS Twenty-one out of 23 subjects with AIS (age 61±9.4 years; 52% male; 58% African-American) successfully completed both studies (9% technical failure). Nearly all (95%) had Mallampati IV posterior oropharynx; the mean neck circumference was 16.8±1.6 in. and the mean body mass index (BMI) was 30±7 kg/m(2). The apnea hypopnea index (AHI) provided by OCST was similar to that provided by PSG (19.8±18.0 vs 22.0±22.7, respectively; P=0.49). On identifying subjects by OCST with an AHI ≥5 on PSG, OCST had the following parameters: sensitivity 100%, specificity 85.7%, PPV 93%, and NPV 100%. On identifying subjects with an AHI ≥15 on PSG, OCST parameters were as follows: sensitivity 100%, specificity 83.3%, PPV 81.8%, and NPV 100%. Bland-Altman plotting showed an overall diagnostic agreement between OCST and PSG modalities for an AHI cutoff >5, despite fine-grained differences in estimated AHIs. CONCLUSION Compared with PSG, OCST provides similar diagnostic information when run simultaneously in AIS patients. OCST is a reliable screening tool for early diagnosis of OSA in AIS patients.
Collapse
Affiliation(s)
- Oleg Y Chernyshev
- Division of Sleep Medicine, Department of Neurology, Louisiana State University Health Sciences Center at Shreveport, LA, USA
| | - David E McCarty
- Division of Sleep Medicine, Department of Neurology, Louisiana State University Health Sciences Center at Shreveport, LA, USA
| | - Douglas E Moul
- Sleep Disorders Center, Cleveland Clinic, Cleveland, OH, USA
| | - Cesar Liendo
- Division of Sleep Medicine, Department of Neurology, Louisiana State University Health Sciences Center at Shreveport, LA, USA
| | - Gloria C Caldito
- Division of Sleep Medicine, Department of Neurology, Louisiana State University Health Sciences Center at Shreveport, LA, USA
| | - Sai K Munjampalli
- Division of Sleep Medicine, Department of Neurology, Louisiana State University Health Sciences Center at Shreveport, LA, USA
| | - Roger E Kelley
- Department of Neurology, Tulane University, New Orleans, LA, USA
| | - Andrew L Chesson
- Division of Sleep Medicine, Department of Neurology, Louisiana State University Health Sciences Center at Shreveport, LA, USA
| |
Collapse
|
21
|
Emami E, Nguyen PTH, Almeida FR, Feine JS, Karp I, Lavigne G, Huynh N. The effect of nocturnal wear of complete dentures on sleep and oral health related quality of life: study protocol for a randomized controlled trial. Trials 2014; 15:358. [PMID: 25218696 PMCID: PMC4177759 DOI: 10.1186/1745-6215-15-358] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 09/09/2014] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Edentulism and sleep disturbance are chronic conditions that are common in older people and have serious adverse consequences for their functioning and quality of life. Edentulism can disturb sleep through the alteration of the craniofacial structure and surrounding soft tissue. However, the effect of prosthetic rehabilitation of edentulism on sleep quality is still not well understood. The objectives of this study are to test whether nocturnal denture wear affects sleep quality, daytime sleepiness, and the oral health related quality of life of edentate older people with moderate to severe sleep apnea, and to identify modifiers of effect of nocturnal denture wear. METHODS/DESIGN We will carry out a single-blind randomized cross-over trial. Seventy edentate older people with moderate to severe obstructive sleep apnea will be enrolled. The study participants will be assigned to wear and not wear their dentures on alternate periods of 30 days. The outcome measures will be sleep quality (assessed by portable polysomnography), daytime sleepiness (assessed by the Epworth Sleepiness Scale), and oral health related quality of life (assessed by validated questionnaire). A number of characteristics (sociodemographic, oropharyngeal morphology, oral and prosthesis characteristics, and perceived general health quality of life) will be assessed by means of clinical examination, 3D imaging of the craniofacial structure, and validated questionnaires at baseline. Linear mixed effects regression models for repeated measures will be fitted to test the study hypotheses. The main analyses will be based on the intention-to-treat principle. To assess the robustness of the findings to potential incomplete adherence, sensitivity analyses will be conducted while applying the per-protocol principle. DISCUSSION This practice-relevant evidence could represent a preventive approach to improve sleep characteristics of the older population and improve their well-being and quality of life. TRIAL REGISTRATION ClinicalTrials.gov NCT01868295.
Collapse
Affiliation(s)
- Elham Emami
- />Faculty of Dentistry, Université de Montréal, 2900 Edouard-Montpetit, Montreal, QC H3T 1J4 Canada
- />Faculty of Dentistry, McGill University, 3550 University Street, Montreal, QC H3A 2A7 Canada
| | - Phan The Huy Nguyen
- />Faculty of Dentistry, Université de Montréal, 2900 Edouard-Montpetit, Montreal, QC H3T 1J4 Canada
| | - Fernanda R Almeida
- />Faculty of Dentistry, University of British Colombia, #103 - 2786W 16th Ave, Vancouver, BC V6K 4M1 Canada
| | - Jocelyne S Feine
- />Faculty of Dentistry, McGill University, 3550 University Street, Montreal, QC H3A 2A7 Canada
| | - Igor Karp
- />Faculty of Dentistry, Université de Montréal, 2900 Edouard-Montpetit, Montreal, QC H3T 1J4 Canada
- />Schulich School of Medicine and Dentistry, University of Western Ontario, 1151 Richmond Street, London, ON N6A 5C1 Canada
| | - Gilles Lavigne
- />Faculty of Dentistry, Université de Montréal, 2900 Edouard-Montpetit, Montreal, QC H3T 1J4 Canada
| | - Nelly Huynh
- />Faculty of Dentistry, Université de Montréal, 2900 Edouard-Montpetit, Montreal, QC H3T 1J4 Canada
| |
Collapse
|
22
|
Loo G, Koo C, Zhang J, Li R, Sethi R, Ong T, Tai B, Lee C. Impact of obstructive sleep apnea on cardiovascular outcomes in patients treated with percutaneous coronary intervention: rationale and design of the sleep and stent study. Clin Cardiol 2014; 37:261-9. [PMID: 24945037 PMCID: PMC6649491 DOI: 10.1002/clc.22261] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Revised: 01/15/2014] [Indexed: 12/21/2022] Open
Abstract
Elucidating the effects of obstructive sleep apnea (OSA) on cardiovascular outcomes is crucial in risk assessments and therapeutic recommendations for affected individuals. The Sleep and Stent Study is a multicenter observational study investigating the relationships between OSA and cardiovascular outcomes in patients treated with percutaneous coronary intervention (PCI). Eight centers in 5 countries (Singapore, China and Hong Kong, India, Myanmar, and Brazil) are participating in the study, and the recruitment target is 1600 patients. Adult patients age 18 to 80 years who have undergone successful PCI are eligible. Recruited patients will undergo an overnight sleep study using a level-3 portable diagnostic device before hospital discharge. The sleep tracings will be analyzed by a certified sleep technologist and audited by a sleep physician, both of whom will be blinded to other study data. The patients will be divided into 2 groups based on apnea-hypopnea index (AHI): OSA (AHI ≥15) and non-OSA (AHI <15) groups. The primary study endpoint of cardiovascular death, myocardial infarction, stroke, and unplanned revascularization will be compared between the OSA and non-OSA groups at a median follow-up of 2 years. Secondary endpoints include all-cause mortality, target-vessel revascularization, stent thrombosis, and hospitalization for heart failure. As of December 31, 2013, a total of 1358 patients have been recruited. Based on the complete preliminary results of the first 785 recruited patients, the prevalence of OSA was 48.3%. We expect the follow-up for primary endpoint to be completed in late 2015; study results will be presented in 2016.
Collapse
Affiliation(s)
- Germaine Loo
- Department of Cardiology, National University Heart Centre, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Chieh‐Yang Koo
- Department of Cardiology, National University Heart Centre, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Junjie Zhang
- Department of Cardiology, Nanjing First Hospital, Nanjing, China
| | - Ruogu Li
- Department of Cardiology, Shanghai Chest Hospital, Shanghai, China
| | - Rithi Sethi
- Department of Cardiology, King George's Medical University, Lucknow, India
| | - Thun‐How Ong
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
| | - Bee‐Choo Tai
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore
| | - Chi‐Hang Lee
- Department of Cardiology, National University Heart Centre, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| |
Collapse
|
23
|
El Shayeb M, Topfer LA, Stafinski T, Pawluk L, Menon D. Diagnostic accuracy of level 3 portable sleep tests versus level 1 polysomnography for sleep-disordered breathing: a systematic review and meta-analysis. CMAJ 2014; 186:E25-51. [PMID: 24218531 PMCID: PMC3883848 DOI: 10.1503/cmaj.130952] [Citation(s) in RCA: 138] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Greater awareness of sleep-disordered breathing and rising obesity rates have fueled demand for sleep studies. Sleep testing using level 3 portable devices may expedite diagnosis and reduce the costs associated with level 1 in-laboratory polysomnography. We sought to assess the diagnostic accuracy of level 3 testing compared with level 1 testing and to identify the appropriate patient population for each test. METHODS We conducted a systematic review and meta-analysis of comparative studies of level 3 versus level 1 sleep tests in adults with suspected sleep-disordered breathing. We searched 3 research databases and grey literature sources for studies that reported on diagnostic accuracy parameters or disease management after diagnosis. Two reviewers screened the search results, selected potentially relevant studies and extracted data. We used a bivariate mixed-effects binary regression model to estimate summary diagnostic accuracy parameters. RESULTS We included 59 studies involving a total of 5026 evaluable patients (mostly patients suspected of having obstructive sleep apnea). Of these, 19 studies were included in the meta-analysis. The estimated area under the receiver operating characteristics curve was high, ranging between 0.85 and 0.99 across different levels of disease severity. Summary sensitivity ranged between 0.79 and 0.97, and summary specificity ranged between 0.60 and 0.93 across different apnea-hypopnea cut-offs. We saw no significant difference in the clinical management parameters between patients who underwent either test to receive their diagnosis. INTERPRETATION Level 3 portable devices showed good diagnostic performance compared with level 1 sleep tests in adult patients with a high pretest probability of moderate to severe obstructive sleep apnea and no unstable comorbidities. For patients suspected of having other types of sleep-disordered breathing or sleep disorders not related to breathing, level 1 testing remains the reference standard.
Collapse
Affiliation(s)
- Mohamed El Shayeb
- Health Technology and Policy Unit, School of Public Health (El Shayeb, Topfer, Stafinski, Menon); Sleep Medicine Program (Pawluk), Department of Psychiatry, University of Alberta, Edmonton, Alta
| | - Leigh-Ann Topfer
- Health Technology and Policy Unit, School of Public Health (El Shayeb, Topfer, Stafinski, Menon); Sleep Medicine Program (Pawluk), Department of Psychiatry, University of Alberta, Edmonton, Alta
| | - Tania Stafinski
- Health Technology and Policy Unit, School of Public Health (El Shayeb, Topfer, Stafinski, Menon); Sleep Medicine Program (Pawluk), Department of Psychiatry, University of Alberta, Edmonton, Alta
| | - Lawrence Pawluk
- Health Technology and Policy Unit, School of Public Health (El Shayeb, Topfer, Stafinski, Menon); Sleep Medicine Program (Pawluk), Department of Psychiatry, University of Alberta, Edmonton, Alta
| | - Devidas Menon
- Health Technology and Policy Unit, School of Public Health (El Shayeb, Topfer, Stafinski, Menon); Sleep Medicine Program (Pawluk), Department of Psychiatry, University of Alberta, Edmonton, Alta
| |
Collapse
|
24
|
Low TT, Hong WZ, Tai BC, Hein T, Khoo SM, Tan AY, Chan MY, Richards M, Lee CH. The influence of timing of polysomnography on diagnosis of obstructive sleep apnea in patients presenting with acute myocardial infarction and stable coronary artery disease. Sleep Med 2013; 14:985-90. [DOI: 10.1016/j.sleep.2013.03.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2012] [Revised: 02/18/2013] [Accepted: 03/19/2013] [Indexed: 01/24/2023]
|
25
|
Relationship between CHA65DS2 score and obstructive sleep apnea (CHA65DS2 and OSA). Int J Cardiol 2013; 168:5037-9. [DOI: 10.1016/j.ijcard.2013.07.221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 07/20/2013] [Indexed: 01/24/2023]
|
26
|
Seetho IW, Wilding JPH. Screening for obstructive sleep apnoea in obesity and diabetes--potential for future approaches. Eur J Clin Invest 2013; 43:640-55. [PMID: 23586795 DOI: 10.1111/eci.12083] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 03/07/2013] [Indexed: 12/17/2022]
Abstract
BACKGROUND It is recognised that sleep-disordered breathing (SDB), in particular, obstructive sleep apnoea (OSA) is associated with obesity and diabetes. The complications of OSA include dysregulation of metabolic and cardiovascular homeostasis. With the growing population of diabetes and obesity globally, it is becoming apparent that identifying and screening patients who are at risk is becoming increasingly crucial. Many patients may remain unaware of the potential diagnosis and continue to be undiagnosed. The high prevalence of OSA poses a demanding challenge to healthcare providers in order to provide sufficient resources and facilities for patient diagnosis and treatment. DESIGN In this article, we review the evidence in favour of screening populations deemed to be at increased risk of OSA, with particular reference to patients with obesity and diabetes. We consider the recent advances in potential screening methods that may allow new prognostic and predictive tools to be developed. A detailed search of Medline and Web of Science electronic databases for relevant articles in English was performed. RESULTS Apart from the use of screening tools such as questionnaires and clinical decision models, there is increasing evidence to suggest that there are differences in biological parameters in patients with OSA. Although further studies are required, there may be potential for such biomarkers to contribute to and augment the screening process. However, the significance of such biological tools remains to be elucidated. CONCLUSIONS A fundamental role for improved screening in patients with conditions such as obesity and diabetes can enable early interventions that may improve health outcomes relating to the adverse consequences of OSA. The future will see further research being carried out in the development of potential screening methods with emphasis on the selection of patients at risk of sleep disorders, thereby allowing more detailed physiological studies to be carried out where needed.
Collapse
Affiliation(s)
- Ian W Seetho
- Department of Obesity & Endocrinology, University of Liverpool, Clinical Sciences Centre, University Hospital Aintree, Liverpool, UK.
| | | |
Collapse
|
27
|
Chang KM, Liu SH. Wireless portable electrocardiogram and a tri-axis accelerometer implementation and application on sleep activity monitoring. Telemed J E Health 2011; 17:177-84. [PMID: 21413872 DOI: 10.1089/tmj.2010.0078] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Night-to-night variability of sleep activity requires more home-based portable sleep monitoring instead of clinical polysomnography examination in the laboratory. In this article, a wireless sleep activity monitoring system is described. The system is light and small for the user. Sleep postures, such as supine or left/right side, were observed by a signal from a tri-axis accelerometer. An overnight electrocardiogram was also recorded with a single lead. Using an MSP430 as microcontroller, both physiological signals were transmitted by a Bluetooth chip. A Labview-based interface demonstrated the recorded signal and sleep posture. Three nights of sleep recordings were used to examine night-to-night variability. The proposed system can record overnight heart rate. Results show that sleep posture and posture change can be precisely detected via tri-axis accelerometer information. There is no significant difference within subject data sets, but there are statistically significant differences among subjects, both for heart rate and for sleep posture distribution. The wireless transmission range is also sufficient for home-based users.
Collapse
Affiliation(s)
- Kang-Ming Chang
- Department of Photonics and Communication Engineering, Asia University, Taichung, Taiwan.
| | | |
Collapse
|
28
|
Lettieri CF, Lettieri CJ, Carter K. Does home sleep testing impair continuous positive airway pressure adherence in patients with obstructive sleep apnea? Chest 2011; 139:849-854. [PMID: 21292757 DOI: 10.1378/chest.10-1060] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND The increasing recognition of obstructive sleep apnea (OSA) and demand for polysomnography has created a need for home sleep testing (HST) using unattended diagnostic and titration studies. Although these studies increase access to care and reduce cost, the limited interaction with sleep laboratories may negatively affect positive airway pressure (PAP) adherence. We sought to determine the difference in PAP use between HST and traditional in-laboratory studies. METHODS This observational cohort study included 210 patients with OSA classified into three equal groups. Following preestablished guidelines, group 1 underwent unattended, type III home diagnostic and unattended home auto-adjustable PAP (APAP) titrations; group 2 underwent in-laboratory, type I diagnostic and continuous PAP titration studies; group 3 underwent type I diagnostic and APAP titration studies. Group 1 was primarily managed and educated in a primary care clinic, whereas groups 2 and 3 received extensive education in an academic sleep medicine center. Objective measures of PAP use during the first 4 to 6 weeks of therapy were compared between groups. RESULTS Type of study and location of care did not affect PAP adherence. PAP was used for 70%, 73%, and 72% of nights in groups 1, 2, and 3, respectively (P = .94). Mean hours of nightly use (4.4 ± 2.0 h, 4.7 ± 1.5 h, and 4.6 ± 1.5 h; P = .98) was also similar. Regular use was observed in 54%, 51%, and 50% of subjects (P = .84). Discontinuation rates were similar between groups. CONCLUSIONS PAP usage did not differ between those undergoing HST vs in-laboratory studies. HST offers a more accessible and cost-effective alternative without compromising therapeutic adherence.
Collapse
Affiliation(s)
- Christine F Lettieri
- Department of Family Medicine, DeWitt Army Community Hospital, Fort Belvoir, VA; Department of Family Medicine, Uniformed Services University, Bethesda, MD.
| | - Christopher J Lettieri
- Department of Pulmonary, Critical Care, and Sleep Medicine, Walter Reed Army Medical Center, Washington DC; Department of Medicine, Uniformed Services University, Bethesda, MD
| | - Kevin Carter
- Department of Pulmonary, Critical Care, and Sleep Medicine, Walter Reed Army Medical Center, Washington DC
| |
Collapse
|
29
|
Chung F, Liao P, Sun Y, Amirshahi B, Fazel H, Shapiro CM, Elsaid H. Perioperative practical experiences in using a level 2 portable polysomnography. Sleep Breath 2010; 15:367-75. [PMID: 20232260 DOI: 10.1007/s11325-010-0340-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2009] [Accepted: 02/08/2010] [Indexed: 11/29/2022]
Abstract
PURPOSE The objective of the study is to test the hypothesis that a level 2 portable sleep device (Embletta X100) is a reliable alternative for standard PSG in surgical patients. METHODS After hospital ethics approvals, preoperative patients over 18 years old were recruited. The patients for validation underwent standard PSG and Embletta X100 simultaneously in a sleep laboratory before surgery. The other patients received sleep studies with Embletta X100 perioperatively. The correlation analysis and paired Student t test between variables from Embletta and from standard PSG were used to evaluate the accuracy of Embletta. The quality of PSG recordings with Embletta was summarized. RESULT Twenty-one patients completed sleep study on both systems; ten females and ten males, age was 54 ± 11 and BMI was 36 ± 9. There was a significant correlation between the majority of parameters from standard PSG and Embeltta X100 with manual scoring. The inter-rater agreement was substantial to perfect at different AHI cutoffs with a Kappa coefficient of 0.69 to 1. A significant correlation between standard PSG and Embletta X100 with automatic scoring was found only in AHI and a few other parameters. In 385 patients, 1,002 perioperative PSG recordings were carried out with Embletta. Of them, 889(88.7%) were technically good and 90(9%) technically acceptable. Only 23 (2.3%) PSG recordings failed. CONCLUSION Embletta X100, installed by a well-trained sleep technician, is a good alternative when standard PSG was not available or impractical. Manual scoring by a certified PSG technologist is the key for reliable results.
Collapse
Affiliation(s)
- Frances Chung
- Department of Anesthesia, University of Toronto, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.
| | | | | | | | | | | | | |
Collapse
|