2
|
Bucklin AA, Ganglberger W, Quadri SA, Tesh RA, Adra N, Da Silva Cardoso M, Leone MJ, Krishnamurthy PV, Hemmige A, Rajan S, Panneerselvam E, Paixao L, Higgins J, Ayub MA, Shao YP, Ye EM, Coughlin B, Sun H, Cash SS, Thompson BT, Akeju O, Kuller D, Thomas RJ, Westover MB. High prevalence of sleep-disordered breathing in the intensive care unit - a cross-sectional study. Sleep Breath 2023; 27:1013-1026. [PMID: 35971023 PMCID: PMC9931933 DOI: 10.1007/s11325-022-02698-9] [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: 02/11/2022] [Revised: 07/08/2022] [Accepted: 08/08/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE Sleep-disordered breathing may be induced by, exacerbate, or complicate recovery from critical illness. Disordered breathing during sleep, which itself is often fragmented, can go unrecognized in the intensive care unit (ICU). The objective of this study was to investigate the prevalence, severity, and risk factors of sleep-disordered breathing in ICU patients using a single respiratory belt and oxygen saturation signals. METHODS Patients in three ICUs at Massachusetts General Hospital wore a thoracic respiratory effort belt as part of a clinical trial for up to 7 days and nights. Using a previously developed machine learning algorithm, we processed respiratory and oximetry signals to measure the 3% apnea-hypopnea index (AHI) and estimate AH-specific hypoxic burden and periodic breathing. We trained models to predict AHI categories for 12-h segments from risk factors, including admission variables and bio-signals data, available at the start of these segments. RESULTS Of 129 patients, 68% had an AHI ≥ 5; 40% an AHI > 15, and 19% had an AHI > 30 while critically ill. Median [interquartile range] hypoxic burden was 2.8 [0.5, 9.8] at night and 4.2 [1.0, 13.7] %min/h during the day. Of patients with AHI ≥ 5, 26% had periodic breathing. Performance of predicting AHI-categories from risk factors was poor. CONCLUSIONS Sleep-disordered breathing and sleep apnea events while in the ICU are common and are associated with substantial burden of hypoxia and periodic breathing. Detection is feasible using limited bio-signals, such as respiratory effort and SpO2 signals, while risk factors were insufficient to predict AHI severity.
Collapse
Affiliation(s)
- Abigail A Bucklin
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
| | - Wolfgang Ganglberger
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
- Sleep & Health Zurich, University of Zurich, Zurich, Switzerland
- Henry and Allison McCance Center for Brain Health, MGH, Boston, MA, USA
| | - Syed A Quadri
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
| | - Ryan A Tesh
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
| | - Noor Adra
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
| | - Madalena Da Silva Cardoso
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
| | - Michael J Leone
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
| | - Parimala Velpula Krishnamurthy
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
| | - Aashritha Hemmige
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
| | - Subapriya Rajan
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
| | - Ezhil Panneerselvam
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
| | - Luis Paixao
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
| | - Jasmine Higgins
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
| | - Muhammad Abubakar Ayub
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
| | - Yu-Ping Shao
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
| | - Elissa M Ye
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
| | - Brian Coughlin
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA
| | - Haoqi Sun
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
- Henry and Allison McCance Center for Brain Health, MGH, Boston, MA, USA
| | - Sydney S Cash
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
| | | | - Oluwaseun Akeju
- Henry and Allison McCance Center for Brain Health, MGH, Boston, MA, USA
- Department of Anesthesia, Critical Care and Pain Medicine, MGH, Boston, MA, USA
| | | | - Robert J Thomas
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
- Department of Medicine, Division of Pulmonary, Critical Care & Sleep, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - M Brandon Westover
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA.
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA.
- Henry and Allison McCance Center for Brain Health, MGH, Boston, MA, USA.
| |
Collapse
|
3
|
Rossetto A, Midelet A, Baillieul S, Tamisier R, Borel JC, Prigent A, Bailly S, Pépin JL. Factors Associated With Residual Apnea-Hypopnea Index Variability During CPAP Treatment. Chest 2023; 163:1258-1265. [PMID: 36642368 DOI: 10.1016/j.chest.2022.12.048] [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: 11/21/2022] [Accepted: 12/12/2022] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND CPAP is the first-line therapy for OSA. A high or variable residual apnea-hypopnea index (rAHI) reflects treatment failure and potentially is triggered by exacerbation of cardiovascular comorbidities. Previous studies showed that high rAHI and large rAHI variability are associated with underlying comorbidities, OSA characteristics at diagnosis, and CPAP equipment, including mask type and settings. RESEARCH QUESTION What factors are associated with predefined groups with low to high rAHI variability? STUDY DESIGN AND METHODS This registry-based study included patients with a diagnosis of OSA who were receiving CPAP treatment with at least 90 days of CPAP remote monitoring. We applied the hidden Markov model to analyze the day-to-day trajectories of rAHI variability using telemonitoring data. An ordinal logistic regression analysis identified factors associated with a risk of having a higher and more variable rAHI with CPAP treatment. RESULTS The 1,126 included patients were middle-aged (median age, 66 years; interquartile range [IQR], 57-73 years), predominantly male (n = 791 [70.3%]), and obese (median BMI, 30.6 kg/m2 (IQR, 26.8-35.2 kg/m2). Three distinct groups of rAHI trajectories were identified using hidden Markov modeling: low rAHI variability (n = 393 [35%]), moderate rAHI variability group (n = 420 [37%]), and high rAHI variability group (n = 313 [28%]). In multivariate analysis, factors associated with high rAHI variability were age, OSA severity at diagnosis, heart failure, opioids and alcohol consumption, mental and behavioral disorders, transient ischemic attack and stroke, an oronasal mask, and level of leaks when using CPAP. INTERPRETATION Identifying phenotypic traits and factors associated with high rAHI variability will allow early intervention and the development of personalized follow-up pathways for CPAP treatment.
Collapse
Affiliation(s)
- Anaïs Rossetto
- HP2 Laboratory, Inserm U1300, Université Grenoble Alpes, Grenoble, France
| | - Alphanie Midelet
- HP2 Laboratory, Inserm U1300, Université Grenoble Alpes, Grenoble, France; Probayes, Montbonnot-Saint-Martin, France
| | - Sébastien Baillieul
- HP2 Laboratory, Inserm U1300, Université Grenoble Alpes, Grenoble, France; Service Universitaire de Pneumologie Physiologie, CHU Grenoble Alpes, Grenoble, France
| | - Renaud Tamisier
- HP2 Laboratory, Inserm U1300, Université Grenoble Alpes, Grenoble, France; Service Universitaire de Pneumologie Physiologie, CHU Grenoble Alpes, Grenoble, France
| | - Jean-Christian Borel
- HP2 Laboratory, Inserm U1300, Université Grenoble Alpes, Grenoble, France; AGIR à dom. HomeCare Charity, Meylan, France
| | - Arnaud Prigent
- HP2 Laboratory, Inserm U1300, Université Grenoble Alpes, Grenoble, France; Groupe Medical de Pneumologie, Polyclinique Saint-Laurent, Rennes, France
| | - Sébastien Bailly
- HP2 Laboratory, Inserm U1300, Université Grenoble Alpes, Grenoble, France; Service Universitaire de Pneumologie Physiologie, CHU Grenoble Alpes, Grenoble, France
| | - Jean-Louis Pépin
- HP2 Laboratory, Inserm U1300, Université Grenoble Alpes, Grenoble, France; Service Universitaire de Pneumologie Physiologie, CHU Grenoble Alpes, Grenoble, France.
| |
Collapse
|
4
|
Latif Z, Modest AM, Ahn A, Thomas R, Tieu H, Tung P. Effect of Widespread Sleep Apnea Screening on Progression of Atrial Fibrillation. Am J Cardiol 2022; 182:25-31. [PMID: 36075759 DOI: 10.1016/j.amjcard.2022.07.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 07/08/2022] [Accepted: 07/11/2022] [Indexed: 12/01/2022]
Abstract
Sleep apnea (SA) is recognized as a predictor of incident atrial fibrillation (AF) and AF recurrence after treatment. However, data on the prevalence of SA phenotypes in patients with AF and the effect of widespread SA screening on AF outcomes are scarce. We conducted a retrospective study of patients with AF referred for SA testing between March 2018 and April 2020. The screening was performed using home sleep testing or polysomnography. AF outcomes were examined by assessment of AF progression as defined by a change from paroxysmal AF to persistent AF, change in antiarrhythmic drug, having an ablation or cardioversion. Of 321 patients evaluated for AF, 251 patients (78%) completed SA testing. A total of 185 patients with complete follow-up data and SA testing were included in our analysis: 172 patients (93%) had SA; 90 of those (49%) had primarily obstructive sleep apnea, 77 patients (42%) had mixed apnea, and 5 patients (3%) had pure central apnea. Time from AF diagnosis to SA testing was associated with AF progression; after 2 years, the risk of AF progression increased (p <0.008). Continuous positive airway pressure treatment did not affect AF progression (p = 0.99). In conclusion, SA is highly prevalent in an unselected population of patients with AF, with mixed apnea being present in over 40% of the population. Early SA testing was associated with decreased rates of AF progression, likely because of earlier and potentially more aggressive pursuit of rhythm control.
Collapse
Affiliation(s)
- Zara Latif
- Department of Internal Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Anna M Modest
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Anjali Ahn
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Robert Thomas
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Hieu Tieu
- Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Patricia Tung
- Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
| |
Collapse
|
5
|
Schmickl CN, Orr JE, Kim P, Nokes B, Sands S, Manoharan S, McGinnis L, Parra G, DeYoung P, Owens RL, Malhotra A. Point-of-care prediction model of loop gain in patients with obstructive sleep apnea: development and validation. BMC Pulm Med 2022; 22:158. [PMID: 35468829 PMCID: PMC9036750 DOI: 10.1186/s12890-022-01950-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 04/13/2022] [Indexed: 11/10/2022] Open
Abstract
Background High loop gain (unstable ventilatory control) is an important—but difficult to measure—contributor to obstructive sleep apnea (OSA) pathogenesis, predicting OSA sequelae and/or treatment response. Our objective was to develop and validate a clinical prediction tool of loop gain. Methods A retrospective cohort of consecutive adults with OSA (apnea–hypopnea index, AHI > 5/hour) based on in-laboratory polysomnography 01/2017–12/2018 was randomly split into a training and test-set (3:1-ratio). Using a customized algorithm (“reference standard”) loop gain was quantified from raw polysomnography signals on a continuous scale and additionally dichotomized (high > 0.7). Candidate predictors included general patient characteristics and routine polysomnography data. The model was developed (training-set) using linear regression with backward selection (tenfold cross-validated mean square errors); the predicted loop gain of the final linear regression model was used to predict loop gain class. More complex, alternative models including lasso regression or random forests were considered but did not meet pre-specified superiority-criteria. Final model performance was validated on the test-set. Results The total cohort included 1055 patients (33% high loop gain). Based on the final model, higher AHI (beta = 0.0016; P < .001) and lower hypopnea-percentage (beta = −0.0019; P < .001) predicted higher loop gain values. The predicted loop gain showed moderate-to-high correlation with the reference loop gain (r = 0.48; 95% CI 0.38–0.57) and moderate discrimination of patients with high versus low loop gain (area under the curve = 0.73; 95% CI 0.67–0.80). Conclusion To our knowledge this is the first prediction model of loop gain based on readily-available clinical data, which may facilitate retrospective analyses of existing datasets, better patient selection for clinical trials and eventually clinical practice.
Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-01950-y.
Collapse
Affiliation(s)
- Christopher N Schmickl
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego (UCSD), San Diego, CA, 92037, USA.
| | - Jeremy E Orr
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego (UCSD), San Diego, CA, 92037, USA
| | - Paul Kim
- Division of Cardiology, University of California, San Diego (UCSD), San Diego, CA, 92037, USA
| | - Brandon Nokes
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego (UCSD), San Diego, CA, 92037, USA
| | - Scott Sands
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sreeganesh Manoharan
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego (UCSD), San Diego, CA, 92037, USA
| | - Lana McGinnis
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego (UCSD), San Diego, CA, 92037, USA
| | - Gabriela Parra
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego (UCSD), San Diego, CA, 92037, USA
| | - Pamela DeYoung
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego (UCSD), San Diego, CA, 92037, USA
| | - Robert L Owens
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego (UCSD), San Diego, CA, 92037, USA
| | - Atul Malhotra
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego (UCSD), San Diego, CA, 92037, USA
| |
Collapse
|