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Gothi D, Kumar R, Anand S, Patro M, Malhotra N, Vaidya S. A study on the prevalence of RLS in OSA and the consequences of co-occurrence. Lung India 2023; 40:321-326. [PMID: 37417084 PMCID: PMC10401975 DOI: 10.4103/lungindia.lungindia_28_23] [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: 01/20/2023] [Revised: 02/21/2023] [Accepted: 03/01/2023] [Indexed: 07/08/2023] Open
Abstract
Background Restless leg syndrome (RLS) is common among patients with obstructive sleep apnoea (OSA) but the prognostic importance of this is not studied. We have called OSA and RLS coexistence as ComOSAR. Materials and Methods A prospective observational study was done on patients referred for polysomnography (PSG) with the aims to evaluate 1) the prevalence of RLS in OSA and comparing it with RLS in non-OSA, 2) the prevalence of insomnia, psychiatric, metabolic and cognitive disorders in ComOSAR versus OSA alone, 3) chronic obstructive airway disease (COAD) in ComOSAR versus OSA alone. OSA, RLS and insomnia were diagnosed as per respective guidelines. They were evaluated for psychiatric disorders, metabolic disorders, cognitive disorders and COAD. Results Of 326 patients enrolled, 249 were OSA and 77 were non-OSA. 61/249 OSA patients, i.e. 24.4% had comorbid RLS, i.e. ComOSAR. RLS in non-OSA patients was similar (22/77, i.e. 28.5%); P = 0.41. ComOSAR had a significantly higher prevalence of insomnia (26% versus 10.1%; P = 0.016), psychiatric disorders (73.7% versus 48.4%; P = 0.00026) and cognitive deficits (72.1% versus 54.7%, P = 0.016) compared to OSA alone. Metabolic disorders like metabolic syndrome, diabetes mellitus, hypertension and coronary artery disease were also observed in a significantly higher number of patients with ComOSAR versus OSA alone (57% versus 34%; P = 0.0015). COAD was also seen in a significantly higher number of patients with ComOSAR compared to OSA alone (49% versus 19% respectively; P = 0.00001). Conclusion It is essential to look for RLS in patients with OSA as it leads to a significantly higher prevalence of insomnia, and cognitive, metabolic and psychiatric disorders. COAD is also more common in ComOSAR compared to OSA alone.
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Affiliation(s)
- Dipti Gothi
- Department of Pulmonary and Critical Care Medicine, ESI-PGIMSR, Basaidarapur, New Delhi, India
| | - Rahul Kumar
- Department of Pulmonary and Critical Care Medicine, ESI-PGIMSR, Basaidarapur, New Delhi, India
| | - Shweta Anand
- Department of Pulmonary and Critical Care Medicine, ESI-PGIMSR, Basaidarapur, New Delhi, India
| | - Mahismita Patro
- Department of Pulmonary and Critical Care Medicine, ESI-PGIMSR, Basaidarapur, New Delhi, India
| | - Nipun Malhotra
- Department of Pulmonary and Critical Care Medicine, ESI-PGIMSR, Basaidarapur, New Delhi, India
| | - Sameer Vaidya
- Department of Pulmonary and Critical Care Medicine, Shwas Superspecialtiy Respiratory Centre, Indore, Madhya Pradesh, India
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2
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Li Y, Wang J, Ji L, Cheng C, Su T, Wu S, Han F, Cox DJ, Wang E, Chen R. Cortical thinning in male obstructive sleep apnoea patients with excessive daytime sleepiness. Front Neurol 2023; 14:1019457. [PMID: 37034093 PMCID: PMC10076663 DOI: 10.3389/fneur.2023.1019457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 02/28/2023] [Indexed: 04/11/2023] Open
Abstract
Background and purpose Obstructive sleep apnoea is associated with excessive daytime sleepiness due to sleep fragmentation and hypoxemia, both of which can lead to abnormal brain morphology. However, the pattern of brain structural changes associated with excessive daytime sleepiness is still unclear. This study aims to investigate the effects of excessive daytime sleepiness on cortical thickness in patients with obstructive sleep apnoea. Materials and methods 61 male patients with newly diagnosed obstructive sleep apnoea were included in the present study. Polysomnography and structural MRI were performed for each participant. Subjective daytime sleepiness was assessed using the Epworth Sleepiness Scale score. Surface-based morphometric analysis was performed using Statistical Parametric Mapping 12 and Computational Anatomy 12 toolboxes to extract cortical thickness. Results Using the median Epworth Sleepiness Scale score, patients were divided into the non-sleepiness group and the sleepiness group. The cortical thickness was markedly thinner in the sleepiness group in the left temporal, frontal, and parietal lobe and bilateral pre- and postcentral gyri (pFWE < 0.05). There was a significant negative correlation between the cortical thickness and the Epworth Sleepiness Scale score. After adjusting for age, body mass index, and obstructive sleep apnoea severity, the Epworth Sleepiness Scale score remained an independent factor affecting the cortical thickness of the left middle temporal lobe, transverse temporal and temporal pole. Conclusion Subjective daytime sleepiness is associated with decreased cortical thickness, and the Epworth Sleepiness Scale score may be of utility as a clinical marker of brain injury in patients with obstructive sleep apnoea.
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Affiliation(s)
- Yezhou Li
- School of Biological Sciences, University of Manchester, Manchester, United Kingdom
| | - Jing Wang
- Department of Respiratory and Critical Care, The Second Affiliated Hospital of Soochow University, Suzhou, China
- Department of Sleep Centre, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Lirong Ji
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Chaohong Cheng
- Department of Respiratory and Critical Care, The Second Affiliated Hospital of Soochow University, Suzhou, China
- Department of Sleep Centre, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Tong Su
- Department of Respiratory and Critical Care, The Second Affiliated Hospital of Soochow University, Suzhou, China
- Department of Sleep Centre, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Shuqing Wu
- Department of Sleep Centre, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Fei Han
- Department of Sleep Centre, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Daniel J. Cox
- Division of Psychology, Communication, and Human Neuroscience, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Erlei Wang
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, China
- Erlei Wang,
| | - Rui Chen
- Department of Respiratory and Critical Care, The Second Affiliated Hospital of Soochow University, Suzhou, China
- Department of Sleep Centre, The Second Affiliated Hospital of Soochow University, Suzhou, China
- *Correspondence: Rui Chen,
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3
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Effect of CPAP vs. mandibular advancement device for excessive daytime sleepiness, fatigue, mood, sustained attention, and quality of life in patients with mild OSA. Sleep Breath 2022; 27:991-1003. [DOI: 10.1007/s11325-022-02694-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 05/31/2022] [Accepted: 08/04/2022] [Indexed: 11/25/2022]
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4
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Liu P, Chen Q, Yuan F, Zhang Q, Zhang X, Xue C, Wei Y, Wang Y, Wang H. Clinical Predictors of Mixed Apneas in Patients with Obstructive Sleep Apnea (OSA). Nat Sci Sleep 2022; 14:373-380. [PMID: 35280432 PMCID: PMC8906897 DOI: 10.2147/nss.s351946] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/18/2022] [Indexed: 01/01/2023] Open
Abstract
PURPOSE Mixed events in obstructive sleep apnea (OSA) patients (mixed-OSA) indicate respiratory regulation instability and are essential for OSA pathogenesis and prognosis. It also shows a decreased compliance with continuous positive airway pressure (CPAP). Using predictors to identify mixed-OSA has significant clinical guidance for OSA precise diagnosis and treatment. This study aimed to establish a simple and accessible method for rapid screening of mixed-OSA, thus promoting OSA precise diagnosis. PATIENTS AND METHODS A total of 907 patients with suspected OSA were screened, of which 513 OSA patients, including 344 with pure-OSA and 169 with mixed-OSA, were finally included in the study. The clinical characteristics and polysomnography (PSG) parameters of the two OSA groups were compared. Multivariate logistic regression analysis was used to investigate the factors affecting the morbidity of mixed-OSA. The receiver operating characteristic (ROC) curve was used to explore if some convenient PSG parameters can be used to predict mixed-OSA. RESULTS About 33% of OSA patients were identified as mixed-OSA. Multivariate logistic regression analysis showed that apnea hypopnea index (AHI) and lowest oxygen saturation (LSO2) were independently associated with mixed-OSA after adjusting for age, sex, body mass index (BMI), smoking, drinking, hypertension, and Epworth Sleepiness Score (ESS) (AHI: OR=1.046, 95% CI 1.032-1.060, P < 0.001; LSO2: OR=0.958, 95% CI 0.936-0.981, P < 0.001). ROC curve analysis showed that AHI > 47 or LSO2 < 77% indicated mixed-OSA. The sensitivity and specificity of AHI> 47 was 0.952 and 0.652, respectively, and 0.822 and 0.675 for LSO2 < 77%, respectively. CONCLUSION Our research found that AHI > 47 or LSO2 < 77% are independently associated with mixed-OSA and can be used to quickly identify the occurrence of mixed-OSA. Therefore, this study can help detect mixed-OSA and precise individual diagnosis of OSA patients.
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Affiliation(s)
- Pengfei Liu
- Department of Sleep Medicine, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Quanhui Chen
- Department of Sleep Medicine, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Fang Yuan
- Department of Physiology, Hebei Key Laboratory of Neurophysiology, Shijiazhuang, Hebei, People's Republic of China
| | - Qingru Zhang
- Department of Sleep Medicine, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Xiaoying Zhang
- Department of Sleep Medicine, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Chan Xue
- Department of Sleep Medicine, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Yuqing Wei
- Department of Sleep Medicine, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Yakun Wang
- Department of Sleep Medicine, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Hanqiao Wang
- Department of Sleep Medicine, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China.,Department of Physiology, Hebei Key Laboratory of Neurophysiology, Shijiazhuang, Hebei, People's Republic of China
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5
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Kim REY, Abbott RD, Kim S, Thomas RJ, Yun CH, Kim H, Johnson H, Shin C. Sleep Duration, Sleep Apnea, and Gray Matter Volume. J Geriatr Psychiatry Neurol 2022; 35:47-56. [PMID: 33511901 DOI: 10.1177/0891988720988918] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
This study aimed to evaluate the effect of sleep duration on brain structures in the presence versus absence of sleep apnea in middle-aged and older individuals. The study investigated a population-based sample of 2,560 individuals, aged 49-80 years. The presence of sleep apnea and self-reported sleep duration were examined in relation to gray matter volume (GMV) in total and lobar brain regions. We identified ranges of sleep duration associated with maximal GMV using quadratic regression and bootstrap sampling. A significant quadratic association between sleep duration and GMV was observed in total and lobar brain regions of men with sleep apnea. In the fully adjusted model, optimal sleep durations associated with peak GMV between brain regions ranged from 6.7 to 7.0 hours. Shorter and longer sleep durations were associated with lower GMV in total and 4 sub-regions of the brain in men with sleep apnea.
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Affiliation(s)
- Regina Eun Young Kim
- Institute of Human Genomic Study, Korea University College of Medicine, Ansan City, South Korea.,Department of Psychiatry, University of Iowa, Iowa City, IA, USA
| | - Robert Douglas Abbott
- Institute of Human Genomic Study, Korea University College of Medicine, Ansan City, South Korea
| | - Soriul Kim
- Institute of Human Genomic Study, Korea University College of Medicine, Ansan City, South Korea
| | - Robert Joseph Thomas
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam-si Gyeonggi-do, South Korea
| | - Chang-Ho Yun
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center and the Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, USA
| | - Hyun Kim
- Department of Clinical Psychology, Boston University, Boston, MA, USA
| | - Hans Johnson
- Department of Electrical and Computer Engineering, University of Iowa, Iowa City, IA, USA
| | - Chol Shin
- Institute of Human Genomic Study, Korea University College of Medicine, Ansan City, South Korea
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6
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Spektor E, Fietze I, Poluektov MG. Periodic Limb Movements Syndrome in Patients With Cerebral Small Vessel Disease: Protocol for a Prospective Observational Study. Front Neurol 2021; 12:700151. [PMID: 34646228 PMCID: PMC8503532 DOI: 10.3389/fneur.2021.700151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 08/17/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Cerebrovascular diseases are the leading cause of cognitive decline and dementia. Therefore, the investigation of the potential ways to slow down the disease progression is an important research field. Periodic limb movements in sleep (PLMS) are known to be associated with transient changes in heart rate and blood pressure. These changes might influence the course of cerebral small vessel disease (cSVD). Nevertheless, the clinical significance of PLMS, particularly its influence on cardiovascular diseases course, is still controversial and underinvestigated. Methods/design: Patients from 60 to 75 years old diagnosed with cSVD will undergo nocturnal polysomnography. Subjects with apnea/hypopnea index under 5 will be enrolled. Sleep quality and daytime functioning will be assessed at baseline with self-reported questionnaires. Brain MRI and cognitive assessment will be performed at baseline and in the 2-year follow-up. Progression of cSVD markers and cognitive dysfunction will be compared between patients with PLMS index (PLMI) equal to or more than 15 movements per hour of sleep and controls (PLMI <15/h). Discussion: The negative role of PLMS in cSVD progression and related cognitive decline is expected. We suppose that patients with PLMS tend to worsen in cognitive performance more rapidly than age-, gender-, and comorbidity-matched controls. We also expect them to have more rapid white matter hyperintensities and other cSVD marker progression. The limitations of the study protocol are the short follow-up period, the absence of a treatment group, and inability to make a conclusion about causality.
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Affiliation(s)
- Ekaterina Spektor
- Department of Sleep Medicine, Chair of Neurology and Neurosurgery, University Clinical Hospital No. 3, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Ingo Fietze
- Center of Sleep Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany.,The Fourth People's hospital of Guangyuan, Guangyuan City, China.,The Federal State Autonomous Educational Institution of Higher Education, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Mikhail G Poluektov
- Department of Sleep Medicine, Chair of Neurology and Neurosurgery, University Clinical Hospital No. 3, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
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7
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Pauletto P, Réus JC, Bolan M, Massignan C, Flores-Mir C, Maia I, Gozal D, Hallal ALC, Porporatti AL, Canto GDL. Association between obstructive sleep apnea and health-related quality of life in untreated adults: a systematic review. Sleep Breath 2021; 25:1773-1789. [PMID: 33709191 DOI: 10.1007/s11325-021-02323-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 02/07/2021] [Accepted: 02/12/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE The objective of this systematic review was to answer the question: "Is there association between obstructive sleep apnea (OSA) and health-related quality of life (HRQoL) in untreated adults?" METHODS We included observational studies that evaluated the health-related quality of life of patients with OSA vs control groups, through generic and disease-specific questionnaires. The searches were conducted in six databases: Embase, Lilacs, PsycINFO, PubMed, Scopus, and Web of Science. Additional search in the grey literature and hand search were performed, and also experts were consulted. Risk of bias was performed by using Joanna Briggs Institute Critical Appraisal Checklist for cross-sectional, cohort, and case-control studies. We analyzed the data using a narrative synthesis. The Grading of Recommendations Assessment, Development, and Evaluation evidence profile was used to verify the overall certainty of the assessed evidence. RESULTS Nineteen studies were included for qualitative analysis. Generic questionnaires showed worse HRQoL in the OSA group compared to the control group in at least one domain of the HRQoL questionnaires. The affected domains that showed statistical and clinically relevant differences were physical functioning, physical role, pain, general health, vitality, emotional role, and mental health. The certainty of evidence assessment was very low. CONCLUSION The available literature suggests that OSA in untreated adults is associated with worse HRQoL. However, this association seems to disappear when we consider only studies adjusted for related covariates. REGISTRATION CRD42018114746.
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Affiliation(s)
- Patrícia Pauletto
- Department of Dentistry, Brazilian Centre for Evidence-Based Research, Health Sciences Center, Federal University of Santa Catarina, Campus Universitário Caixa Postal 476 - Trindade, Florianópolis, Santa Catarina, 88040-900, Brazil.
| | - Jéssica Conti Réus
- Department of Dentistry, Brazilian Centre for Evidence-Based Research, Health Sciences Center, Federal University of Santa Catarina, Campus Universitário Caixa Postal 476 - Trindade, Florianópolis, Santa Catarina, 88040-900, Brazil
| | - Michele Bolan
- Department of Dentistry, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Carla Massignan
- Department of Dentistry, Brazilian Centre for Evidence-Based Research, Health Sciences Center, Federal University of Santa Catarina, Campus Universitário Caixa Postal 476 - Trindade, Florianópolis, Santa Catarina, 88040-900, Brazil.,Department of Dentistry, Federal University of Brasília, Brasilia, Distrito Federal, Brazil
| | | | - Israel Maia
- Baía Sul Research Institute, Florianópolis, Santa Catarina, Brazil
| | - David Gozal
- Department of Child Health, University of Missouri School of Medicine, Columbia, MO, 65201, USA
| | - Ana Luiza Curi Hallal
- Department of Dentistry, Brazilian Centre for Evidence-Based Research, Health Sciences Center, Federal University of Santa Catarina, Campus Universitário Caixa Postal 476 - Trindade, Florianópolis, Santa Catarina, 88040-900, Brazil
| | - André Luís Porporatti
- Department of Dentistry, Brazilian Centre for Evidence-Based Research, Health Sciences Center, Federal University of Santa Catarina, Campus Universitário Caixa Postal 476 - Trindade, Florianópolis, Santa Catarina, 88040-900, Brazil
| | - Graziela De Luca Canto
- Department of Dentistry, Brazilian Centre for Evidence-Based Research, Health Sciences Center, Federal University of Santa Catarina, Campus Universitário Caixa Postal 476 - Trindade, Florianópolis, Santa Catarina, 88040-900, Brazil
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8
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Sun Y, Li J, Zhang X, Jiao Q, Yang S, Ji L. Case Report: Parasomnia Overlap Disorder Induced by Obstructive Sleep Hypopnea Apnea Syndrome: A Case Report and Literature Review. Front Neurosci 2020; 14:578171. [PMID: 33362452 PMCID: PMC7758532 DOI: 10.3389/fnins.2020.578171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 11/10/2020] [Indexed: 01/17/2023] Open
Abstract
Obstructive sleep apnea hypopnea syndrome (OSAHS) and parasomnia overlap disorder (POD) are types of sleep disorders. When the symptoms of both conditions coexist, the POD symptoms are most likely caused by OSAHS. In these cases, the symptoms of POD will be relieved when OSAHS is effectively treated. We refer to these cases as symptomatic POD (related to OSAHS), which differs in pathophysiology, complications, and treatment from idiopathic POD. It is important to note that the treatment for idiopathic POD may aggravate the symptoms of OSAHS. In this case, we used video polysomnography (v-PSG) on a POD patient with suspected OSAHS to distinguish idiopathic POD from symptomatic POD, to inform the appropriate treatment course. The video results and clinical features lead us to diagnose symptomatic POD, and we treated the patient with auto-set continuous positive airway pressure to address their OSAHS. This course of treatment resolved all POD-related symptoms. Here, we discuss this case and review the relevant literature. This report highlights the importance of the use of v-PSG in the clinical diagnosis, differential diagnosis, and subsequent treatment of POD.
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Affiliation(s)
- Yun Sun
- Department of Sleep Medicine, Tianjin Anding Hospital, Tianjin, China
| | - Jie Li
- Institute of Mental Health, Tianjin Anding Hospital, Tianjin, China
| | - Xinjun Zhang
- Department of Sleep Medicine, Tianjin Anding Hospital, Tianjin, China
| | - Qingyan Jiao
- Department of Sleep Medicine, Tianjin Anding Hospital, Tianjin, China
| | - Shutong Yang
- Department of Sleep Medicine, Tianjin Anding Hospital, Tianjin, China
| | - Lijie Ji
- Department of Sleep Medicine, Tianjin Anding Hospital, Tianjin, China
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Bonsignore MR, Randerath W, Schiza S, Verbraecken J, Elliott MW, Riha R, Barbe F, Bouloukaki I, Castrogiovanni A, Deleanu O, Goncalves M, Leger D, Marrone O, Penzel T, Ryan S, Smyth D, Teran-Santos J, Turino C, McNicholas WT. European Respiratory Society statement on sleep apnoea, sleepiness and driving risk. Eur Respir J 2020; 57:13993003.01272-2020. [DOI: 10.1183/13993003.01272-2020] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 08/25/2020] [Indexed: 12/22/2022]
Abstract
Obstructive sleep apnoea (OSA) is highly prevalent and is a recognised risk factor for motor vehicle accidents (MVA). Effective treatment with continuous positive airway pressure has been associated with a normalisation of this increased accident risk. Thus, many jurisdictions have introduced regulations restricting the ability of OSA patients from driving until effectively treated. However, uncertainty prevails regarding the relative importance of OSA severity determined by the apnoea–hypopnoea frequency per hour and the degree of sleepiness in determining accident risk. Furthermore, the identification of subjects at risk of OSA and/or accident risk remains elusive. The introduction of official European regulations regarding fitness to drive prompted the European Respiratory Society to establish a task force to address the topic of sleep apnoea, sleepiness and driving with a view to providing an overview to clinicians involved in treating patients with the disorder. The present report evaluates the epidemiology of MVA in patients with OSA; the mechanisms involved in this association; the role of screening questionnaires, driving simulators and other techniques to evaluate sleepiness and/or impaired vigilance; the impact of treatment on MVA risk in affected drivers; and highlights the evidence gaps regarding the identification of OSA patients at risk of MVA.
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10
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Lin YC, Chen TY, Chien WC, Chung CH, Chang HA, Kao YC, Tsai CS, Lin CS, Tzeng NS. Stimulants associated with reduced risk of hospitalization for motor vehicle accident injury in patients with obstructive sleep apnea-a nationwide cohort study. BMC Pulm Med 2020; 20:28. [PMID: 32013932 PMCID: PMC6998364 DOI: 10.1186/s12890-019-1041-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 12/24/2019] [Indexed: 02/07/2023] Open
Abstract
Background The risk of injury directly related to hospitalization for motor vehicle accidents (MVAs) in the obstructive sleep apnea (OSA) patients has not been thoroughly understood. Our study aimed to examine the association between the OSA and the hospitalization for an MVA injury. Methods This retrospective cohort study used Taiwan’s National Health Insurance Research Database (NHIRD) between 2000 and 2015. The OSA patients aged ≥20 years by age, sex, and index-year matched by non-OSA controls were enrolled (1:3). We used the Cox proportional regression model to evaluate the association between the OSA and the hospitalization for an MVA injury. Results The incidence rate of hospitalization for an MVA injury was higher in the OSA cohort (N = 3025) when compared with the non-OSA controls (N = 9075), as 575.3 and 372.0 per 100,000 person-years, respectively (p < 0.001). The Kaplan-Meier analysis showed that the OSA cohort had a significantly higher incidence of hospitalization for the MVA injury (log-rank test, p < 0.001). After adjusting for the covariates, the risk of hospitalization for the MVA injury among the OSA was significantly higher (hazard ratio [HR] =2.18; 95% confidence interval [CI] = 1.79–2.64; p < 0.001). Stimulants usage was associated with a nearly 20% decrease in the risk of an overall hospitalization for an MVA injury in the OSA patients. Conclusions This study provides evidence that patients with OSA are at a two-fold higher risk of developing hospitalization for an MVA injury, and the usage of modafinil and methylphenidate was associated with a lower risk of an overall hospitalization for the MVA injury.
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Affiliation(s)
- Yi-Chang Lin
- Division of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Department of Biological Science and Technology, National Chiao Tung University, No.75, Po-Ai Street, Hsinchu, 30068, Taiwan
| | - Tien-Yu Chen
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu District, Taipei City, 11490, Taiwan.,Department of Psychiatry, Tri-Service General Hospital, Keelung Branch, National Defense Medical Center, Taipei, Taiwan
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,School of Public Health, National Defense Medical Center, Taipei, Taiwan.,Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,School of Public Health, National Defense Medical Center, Taipei, Taiwan.,Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan
| | - Hsin-An Chang
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu District, Taipei City, 11490, Taiwan.,Student Counseling Center, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Chen Kao
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu District, Taipei City, 11490, Taiwan.,Department of Psychiatry, Tri-Service General Hospital, Song-Shan Branch, National Defense Medical Center, Taipei, Taiwan
| | - Chien-Sung Tsai
- Division of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chih-Sheng Lin
- Department of Biological Science and Technology, National Chiao Tung University, No.75, Po-Ai Street, Hsinchu, 30068, Taiwan.
| | - Nian-Shen Tzeng
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu District, Taipei City, 11490, Taiwan. .,Student Counseling Center, National Defense Medical Center, Taipei, Taiwan.
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11
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Lusic Kalcina L, Pavlinac Dodig I, Pecotic R, Valic M, Dogas Z. Psychomotor Performance in Patients with Obstructive Sleep Apnea Syndrome. Nat Sci Sleep 2020; 12:183-195. [PMID: 32210650 PMCID: PMC7069561 DOI: 10.2147/nss.s234310] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 02/09/2020] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Determinants of obstructive sleep apnea (OSA) are hypoxemia and hypercapnia, as well as (micro) arousals from sleep, resulting in chronic sleep fragmentation, sleep deprivation, and excessive daytime sleepiness (EDS). All of the above-mentioned factors might contribute to psychomotor impairment seen in OSA patients. Additionally, this study aimed to assess the contribution of BMI, age, EDS assessed with Epworth sleepiness scale (ESS), and severity of OSA assessed with apnea-hypopnea index (AHI) to the reaction time on chronometric tests in OSA patients and controls. It is hypothesized that moderate and severe OSA have adverse effects on reaction time of perception to visual stimulus, of solving simple arithmetic operations, and of psychomotor limbs coordination assessed by chronometric psychodiagnostic test battery. PATIENTS AND METHODS This study was conducted on 206 male participants; 103 of them had moderate or severe OSA diagnosed by whole-night polysomnography/polygraphy. Control participants (N=103), matched to patients with OSA by age and BMI, had no reported OSA in their medical history, no increased risk for OSA, nor EDS. All participants were assessed with three chronometric psychodiagnostic tests, measuring the reaction time of perception to visual stimulus, of solving simple arithmetic operations, and of psychomotor limbs coordination. RESULTS Participants from the OSA group achieved impaired results compared to control participants in minimum single task solving time in speed of solving simple arithmetic operations (3±0.9 and 2.6±0.6, P<0.001), and in minimum solving time of a single task in complex psychomotor limbs coordination (0.69±0.2 and 0.61±0.1, P=0.007). Regression analysis revealed no significant contribution of daytime sleepiness to the results achieved in each of the tests. CONCLUSION It is concluded that severe OSA impaired speed of perception, convergent, and operative thinking. Moreover, it is suggested that EDS did not contribute to poor psychomotor outcome in patients with OSA in this study, when age was controlled for.
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Affiliation(s)
- Linda Lusic Kalcina
- Department of Neuroscience, Split Sleep Medicine Center, University of Split School of Medicine, Split, Croatia
| | - Ivana Pavlinac Dodig
- Department of Neuroscience, Split Sleep Medicine Center, University of Split School of Medicine, Split, Croatia
| | - Renata Pecotic
- Department of Neuroscience, Split Sleep Medicine Center, University of Split School of Medicine, Split, Croatia
| | - Maja Valic
- Department of Neuroscience, Split Sleep Medicine Center, University of Split School of Medicine, Split, Croatia
| | - Zoran Dogas
- Department of Neuroscience, Split Sleep Medicine Center, University of Split School of Medicine, Split, Croatia
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Compensatory Neural Recruitment for Error-Related Cerebral Activity in Patients with Moderate-To-Severe Obstructive Sleep Apnea. J Clin Med 2019; 8:jcm8071077. [PMID: 31336598 PMCID: PMC6678110 DOI: 10.3390/jcm8071077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 07/19/2019] [Indexed: 01/14/2023] Open
Abstract
(1) Background: Although it is known that obstructive sleep apnea (OSA) impairs action-monitoring function, there is only limited information regarding the associated cerebral substrate underlying this phenomenon. (2) Methods: The modified Flanker task, error-related event-related potentials (ERPs), namely, error-related negativity (ERN) and error positivity (Pe), and functional magnetic resonance imaging (fMRI) were used to evaluate neural activities and the functional connectivity underlying action-monitoring dysfunction in patients with different severities of OSA. (3) Results: A total of 14 control (Cont) subjects, 17 patients with moderate OSA (mOSA), and 10 patients with severe OSA (sOSA) were enrolled. A significant decline in posterror correction rate was observed in the modified Flanker task when patients with mOSA were compared with Cont subjects. Comparison between patients with mOSA and sOSA did not reveal any significant difference. In the analysis of ERPs, ERN and Pe exhibited declined amplitudes in patients with mOSA compared with Cont subjects, which were found to increase in patients with sOSA. Results of fMRI revealed a decreased correlation in multiple anterior cingulate cortex functional-connected areas in patients with mOSA compared with Cont subjects. However, these areas appeared to be reconnected in patients with sOSA. (4) Conclusions: The behavioral, neurophysiological, and functional image findings obtained in this study suggest that mOSA leads to action-monitoring dysfunction; however, compensatory neural recruitment might have contributed to the maintenance of the action-monitoring function in patients with sOSA.
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Sleep disturbance in women who undergo surgical menopause compared with women who experience natural menopause. Menopause 2019; 26:357-364. [DOI: 10.1097/gme.0000000000001257] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Tam W, Ng SS, To K, Ko FW, Hui DS. The interaction between hypertension and obstructive sleep apnea on subjective daytime sleepiness. J Clin Hypertens (Greenwich) 2019; 21:390-396. [DOI: 10.1111/jch.13485] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 11/01/2018] [Accepted: 11/01/2018] [Indexed: 01/14/2023]
Affiliation(s)
- Wilson Tam
- Alice Lee Centre for Nursing StudiesNational University of Singapore Singapore
| | - Susanna S. Ng
- Department of Medicine & Therapeutics The Chinese University of Hong Kong New Territories Hong Kong
| | - Kin‐Wang To
- Department of Medicine & Therapeutics The Chinese University of Hong Kong New Territories Hong Kong
| | - Fanny W. Ko
- Department of Medicine & Therapeutics The Chinese University of Hong Kong New Territories Hong Kong
| | - David S. Hui
- Department of Medicine & Therapeutics The Chinese University of Hong Kong New Territories Hong Kong
- SH Ho Sleep Apnoea Management Center The Chinese University of Hong Kong New Territories Hong Kong
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Beiske KK, Stavem K. Health status in subjects with suspected obstructive sleep apnea and comparison with a general population. Sci Rep 2018; 8:5579. [PMID: 29615753 PMCID: PMC5882801 DOI: 10.1038/s41598-018-23904-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 03/22/2018] [Indexed: 12/18/2022] Open
Abstract
The purpose of this study was to assess health status (HS) in patients with clinical suspicion of obstructive sleep apnea (OSA) in order to estimate the dose response relationship between HS and OSA severity, and to compare HS in this clinical cohort with a general population sample (N = 5000). Patients referred to an overnight sleep study due to suspected OSA, whom also responded to the SF-36 questionnaire, were included (N = 418). Of these, 194 showed normal findings, while 111, 60 and 53 demonstrated mild, moderate and severe OSA, respectively. Mean age was 47.5 (SD 11.9) and 69% were males. Only the mental health scale (p = 0.015) and mental component summary score (p = 0.023) were associated with OSA severity. This association, however, disappeared in multivariable analysis. All SF-36 scores in the sleep study group were lower than that of the general population sample, in both unadjusted and multivariable linear regression analysis. In this study, there was a lack of association between OSA severity and general HS. However, as a whole, patients in this clinical population referred to an overnight sleep study due to suspected OSA had impaired HS on all scales compared to a general population, with greatest differences in the vitality domain.
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Affiliation(s)
- Kornelia K Beiske
- Department of Neurology and Clinical Neurophysiology, Medical Division, Akershus University Hospital, Lørenskog, Norway.
| | - Knut Stavem
- Institute of Clinical Medicine, Campus Akershus University Hospital, University of Oslo, Oslo, Norway
- Department of Pulmonary Medicine, Akershus University Hospital, Lørenskog, Norway
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
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