Obstructive Sleep Apnea as an Independent Stroke Risk Factor: A Review of the Evidence, Stroke Prevention Guidelines, and Implications for Neuroscience Nursing Practice

Effectiveness of continuous positive airway pressure therapy on romantic relationships and intimacy among individuals with obstructive sleep apnea: A systematic review and a meta-analysis

Obstructive sleep apnea is a common yet often overlooked chronic sleep disorder with significant health implications globally. Bedpartners play a vital role in motivating individuals with obstructive sleep apnea to seek medical help, though their sleep quality may suffer, straining the couple's relationship. From September 2023 to January 2024, utilizing PubMed, Scopus, BioMed Central, Cochrane Library, ScienceDirect and www.clinicaltrials.gov databases, this systematic review meticulously examined data from 27 studies to investigate how continuous positive airway pressure therapy, recognized as the gold-standard for treating obstructive sleep apnea, may positively influence psychological dynamics within couples. Additionally, a meta-analysis was conducted on nine studies, to assess the effect of continuous positive airway pressure on erectile function, which is often compromised in patients with obstructive sleep apnea. The PRISMA checklist and specific quality assessments were followed to ensure methodological rigour and transparency. Findings reveal positive changes in conflict resolution for patients with obstructive sleep apnea post- continuous positive airway pressure adaptation (p < 0.05). Emotional functioning (p = 0.002) and social relationships (p < 0.001) also show improvements in bedpartners. While six subjective assessments indicate enhancements in sexual quality of life for patients with obstructive sleep apnea, challenges related to continuous positive airway pressure use as a barrier to intimacy are acknowledged. Focusing on male patients with obstructive sleep apnea, findings demonstrated a substantial improvement in erectile function post-continuous positive airway pressure utilization, with a Z-score of 4.84 (p < 0.00001). Female patients with obstructive sleep apnea using continuous positive airway pressure show no significant improvements in sexual functioning, while female bedpartners report positive changes. These insights emphasize the importance of holistic approaches in addressing the impact of obstructive sleep apnea on both individuals and their relationships.

Prevalence and Detection of Obstructive Sleep Apnea Early after Stroke

Background

Obstructive sleep apnea (OSA) negatively impacts post-stroke recovery. This study's purpose: examine the prevalence of undiagnosed OSA and describe a simple tool to identify those at-risk for OSA in the early phase of stroke recovery.

Methods

This was a cross-sectional descriptive study of people ∼15 days post-stroke. Adults with stroke diagnosis admitted to inpatient rehabilitation over a 3-year period were included if they were alert/arousable, able to consent/assent to participation, and excluded if they had a pre-existing OSA diagnosis, other neurologic health conditions, recent craniectomy, global aphasia, inability to ambulate 150 feet independently pre-stroke, pregnant, or inability to understand English. OSA was deemed present if oxygen desaturation index (ODI) of >=15 resulted from overnight oximetry measures. Prevalence of OSA was determined accordingly. Four participant characteristics comprised the "BASH" tool (body mass index >=35, age>=50, sex=male, hypertension=yes). A receiver operator characteristics (ROC) curve analysis was performed with BASH as test variable and OSA presence as state variable.

Results

Participants (n=123) were 50.4% male, averaged 64.12 years old (sd 14.08), and self-identified race as 75.6% White, 20.3% Black/African American, 2.4%>1 race, and 1.6% other; 22% had OSA. ROC analysis indicated BASH score >=3 predicts presence of OSA (sensitivity=0.778, specificity=0.656, area under the curve =0.746, p<0.001).

Conclusions

Prevalence of undiagnosed OSA in the early stroke recovery phase is high. With detection of OSA post-stroke, it may be possible to offset untreated OSA's deleterious impact on post-stroke recovery of function. The BASH tool is an effective OSA screener for this application.

A Soft Bioelectronic Patch for Simultaneous Respiratory and Cardiovascular Monitoring

Sleep is critical to maintaining physical and mental health. Measuring physiological parameters to quantify sleep quality without uncomfortable user experience remains highly desired but a challenge. Here, this work develops a soft bioelectronic patch to perform simultaneous respiration and cardiovascular monitoring during sleep in a wearable and non-invasive manner. The soft bioelectronic patch system is mainly composed of a pressure sensor, a flexible printed circuit for signal processing, and a soft thermoplastic urethane mold for assembling different functional modules. The soft bioelectronic patch holds a sensitivity of >0.12 V kPa-1 and a remarkable low-frequency response from 0.5 to 15 Hz. It is demonstrated to continuously monitor respiration and heartbeat during the whole night, which could be harnessed for sleep monitoring and obstructive sleep apnea-hypopnea syndrome diagnosis. The reported soft bioelectronic patch represents a simple and convenient platform technology for sleep study.

Clinical prediction models for the early diagnosis of obstructive sleep apnea in stroke patients: a systematic review

BACKGROUND

Obstructive sleep apnea (OSA) is a common sleep disorder characterized by repetitive cessation or reduction in airflow during sleep. Stroke patients have a higher risk of OSA, which can worsen their cognitive and functional disabilities, prolong their hospitalization, and increase their mortality rates.

METHODS

We conducted a comprehensive literature search in the databases of PubMed, CINAHL, Embase, PsycINFO, Cochrane Library, and CNKI, using a combination of keywords and MeSH words in both English and Chinese. Studies published up to March 1, 2022, which reported the development and/or validation of clinical prediction models for OSA diagnosis in stroke patients.

RESULTS

We identified 11 studies that met our inclusion criteria. Most of the studies used logistic regression models and machine learning approaches to predict the incidence of OSA in stroke patients. The most frequently selected predictors included body mass index, sex, neck circumference, snoring, and blood pressure. However, the predictive performance of these models ranged from poor to moderate, with the area under the receiver operating characteristic curve varying from 0.55 to 0.82. All the studies have a high overall risk of bias, mainly due to the small sample size and lack of external validation.

CONCLUSION

Although clinical prediction models have shown the potential for diagnosing OSA in stroke patients, their limited accuracy and high risk of bias restrict their implications. Future studies should focus on developing advanced algorithms that incorporate more predictors from larger and representative samples and externally validating their performance to enhance their clinical applicability and accuracy.

The firstly visited department affects the acceptance of CPAP in patients with obstructive sleep apnea: a cohort study

BACKGROUND

Continuous positive airway pressure (CPAP) therapy is the first-line treatment for obstructive sleep apnea (OSA). However, the low acceptance rate of CPAP remains a challenging clinical issue. This study aimed to determine the factors that influence the acceptance rate of CPAP.

METHODS

This retrospective cohort study was conducted at the sleep center of Shuang-Ho Hospital. Initially, 1186 OSA patients who received CPAP therapy between December 2013 and December 2017 were selected, and finally, 1016 patients were analyzed. All patients with OSA received CPAP therapy for at least 1 week, and their acceptance to treatment was subsequently recorded. Outcome measures included patients' demographic and clinical characteristics (sex, age, BMI, comorbidities, history of smoking, and the medical specialist who prescribed CPAP treatment), polysomnography (PSG) results, and OSA surgical records.

RESULTS

Patients with a lower CPAP acceptance rate were referred from otolaryngologists (acceptance rate of otolaryngology vs. others: 49.6% vs. 56.6%, p = .015), in addition to having a lower apnea-hypopnea index (AHI) (acceptance vs. non-acceptance: 55.83 vs. 40.79, p = .003), rapid eye movement AHI (REM-AHI) (acceptance vs. non-acceptance: 51.21 vs. 44.92, p = .014), and arousal index (acceptance vs. non-acceptance: 36.80 vs. 28.75, p = .011). The multiple logistic regression model showed that patients referred from otolaryngology had a lower CPAP acceptance rate (odds ratio 0.707, p = .0216) even after adjusting for age, sex, BMI, AHI, REM-AHI, arousal index, comorbidities, and smoking status.

CONCLUSIONS

Before their initial consultation, patients may already have their preferred treatment of choice, which is strongly linked to the type of medical specialists they visit, and consequently, affects their rate of acceptance to CPAP therapy. Therefore, physicians should provide personalized care to patients by exploring and abiding by their preferred treatment choices.

International Consensus Statement on Obstructive Sleep Apnea

BACKGROUND

Evaluation and interpretation of the literature on obstructive sleep apnea (OSA) allows for consolidation and determination of the key factors important for clinical management of the adult OSA patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International Consensus statement on Obstructive Sleep Apnea (ICS:OSA).

METHODS

Using previously defined methodology, focal topics in OSA were assigned as literature review (LR), evidence-based review (EBR), or evidence-based review with recommendations (EBR-R) formats. Each topic incorporated the available and relevant evidence which was summarized and graded on study quality. Each topic and section underwent iterative review and the ICS:OSA was created and reviewed by all authors for consensus.

RESULTS

The ICS:OSA addresses OSA syndrome definitions, pathophysiology, epidemiology, risk factors for disease, screening methods, diagnostic testing types, multiple treatment modalities, and effects of OSA treatment on multiple OSA-associated comorbidities. Specific focus on outcomes with positive airway pressure (PAP) and surgical treatments were evaluated.

CONCLUSION

This review of the literature consolidates the available knowledge and identifies the limitations of the current evidence on OSA. This effort aims to create a resource for OSA evidence-based practice and identify future research needs. Knowledge gaps and research opportunities include improving the metrics of OSA disease, determining the optimal OSA screening paradigms, developing strategies for PAP adherence and longitudinal care, enhancing selection of PAP alternatives and surgery, understanding health risk outcomes, and translating evidence into individualized approaches to therapy.

Impact of the 3% Oxygen Desaturation Index via Overnight Pulse Oximetry on Cardiovascular Events and Death in Patients Undergoing Hemodialysis: A Retrospective Cohort Study

It is unclear whether the severity of sleep-disordered breathing (SDB) affects the risk of cardiovascular events and mortality in patients undergoing hemodialysis (HD). We determined the severity of SDB with the 3% oxygen desaturation index (ODI) via overnight pulse oximetry. This study was a retrospective cohort, observational study of 134 patients on maintenance HD at a single center. They were divided into four groups according to SDB severity (normal, mild, moderate, and severe), and were followed. The baseline characteristics of all patients were as follows: the median age was 67 (interquartile range, 59-75) years, 64.2% were men, 37.3% were diabetic, and the median duration of HD was 69 (29-132) months. During follow-up, major adverse cardiovascular events (MACEs) occurred in 71 patients and deaths in 60 (including 32 cardiovascular deaths). Severe SDB was an independent risk factor for MACEs (hazard ratio [HR] = 4.66, 95% confidence interval [CI] = 1.87-11.61, p = 0.001) and all-cause death (HR = 5.74, 95% CI = 1.92-16.70, p = 0.001). Severe SDB had a statistically significant impact on the risk of MACEs and mortality in patients undergoing HD. The severity of the 3% ODI via overnight pulse oximetry may be a useful marker as a risk factor for cardiovascular outcomes and mortality in these patients.

A systematic review on the association of sleep-disordered breathing with cardiovascular pathology in adults

Sleep-disordered breathing (SDB) is characterized by repeated breathing pauses during sleep. The prevalence of SDB varies widely between studies. Some longitudinal studies have found an association of SDB with incident or recurrent cardiovascular events. We sought to systematically describe the current data on the correlation between SDB and cardiovascular pathology. Studies were included if they were original observational population-based studies in adults with clearly diagnosed SDB. The primary outcomes include all types of cardiovascular pathology. We carried out pooled analyses using a random effects model. Our systematic review was performed according to the PRISMA and MOOSE guidelines for systematic reviews and was registered with PROSPERO. In total, 2652 articles were detected in the databases, of which 76 articles were chosen for full-text review. Fourteen studies were focused on samples of an unselected population, and 8 studies were focused on a group of persons at risk for SDB. In 5 studies, the incidence of cardiovascular pathology in the population with SDB was examined. In total, 49 studies described SDB in patients with cardiovascular pathology. We found an association between SDB and prevalent /incident cardiovascular disease (pooled OR 1.76; 95% CI 1.38–2.26), and pooled HR (95% CI 1.78; 95% CI 1.34–2.45). Notably, in patients with existing SDB, the risk of new adverse cardiovascular events was high. However, the relationship between cardiovascular disease and SDB is likely to be bidirectional. Thus, more large-scale studies are needed to better understand this association and to decide whether screening for possible SDB in cardiovascular patients is reasonable and clinically significant.

A spatio-temporal learning-based model for sleep apnea detection using single-lead ECG signals

Sleep apnea (SA) is a common chronic sleep breathing disorder, which would cause stroke, cognitive decline, cardiovascular disease, or even death. The SA symptoms often manifest as frequent breathing interruptions during sleep and most individuals with sleeping disorders are not aware of the SA events. Using a portable device with single-lead ECG signal is an effective way to help an individual to monitor their sleep conditions at home. However, the SA detection performance of ECG-based methods is still difficult to meet the clinical practice requirement. In this study, we propose an end-to-end spatio-temporal learning-based SA detection method, which consists of multiple spatio-temporal blocks. Each block has the identical architecture with a convolutional neural network (CNN) layer, a max-pooling layer, and a bi-gated recurrent unit (BiGRU) layer. This architecture with repeated spatio-temporal blocks can well capture the morphological spatial feature information as well as the temporal feature information from ECG signals. The proposed SA detection model was evaluated on the publicly available datasets of PhysioNet Apnea-ECG dataset (Apnea-ECG) and University College Dublin Sleep Apnea Database (UCDDB). Extensive experimental results show that our proposed SA model on both Apnea-ECG and UCDDB datasets achieves state-of-the-art results, which are obviously superior to existing ECG-based SA detection methods. It means that our proposed method has the potential to be deployed into a healthcare system to provide a sleep monitoring service, which can screen out SA population with high risk and help to take timely interventions to prevent serious consequences.

Accurate Prediction of Stroke for Hypertensive Patients Based on Medical Big Data and Machine Learning Algorithms: Retrospective Study

Background

Stroke risk assessment is an important means of primary prevention, but the applicability of existing stroke risk assessment scales in the Chinese population has always been controversial. A prospective study is a common method of medical research, but it is time-consuming and labor-intensive. Medical big data has been demonstrated to promote disease risk factor discovery and prognosis, attracting broad research interest.

Objective

We aimed to establish a high-precision stroke risk prediction model for hypertensive patients based on historical electronic medical record data and machine learning algorithms.

Methods

Based on the Shenzhen Health Information Big Data Platform, a total of 57,671 patients were screened from 250,788 registered patients with hypertension, of whom 9421 had stroke onset during the 3-year follow-up. In addition to baseline characteristics and historical symptoms, we constructed some trend characteristics from multitemporal medical records. Stratified sampling according to gender ratio and age stratification was implemented to balance the positive and negative cases, and the final 19,953 samples were randomly divided into a training set and test set according to a ratio of 7:3. We used 4 machine learning algorithms for modeling, and the risk prediction performance was compared with the traditional risk scales. We also analyzed the nonlinear effect of continuous characteristics on stroke onset.

Results

The tree-based integration algorithm extreme gradient boosting achieved the optimal performance with an area under the receiver operating characteristic curve of 0.9220, surpassing the other 3 traditional machine learning algorithms. Compared with 2 traditional risk scales, the Framingham stroke risk profiles and the Chinese Multiprovincial Cohort Study, our proposed model achieved better performance on the independent validation set, and the area under the receiver operating characteristic value increased by 0.17. Further nonlinear effect analysis revealed the importance of multitemporal trend characteristics in stroke risk prediction, which will benefit the standardized management of hypertensive patients.

Conclusions

A high-precision 3-year stroke risk prediction model for hypertensive patients was established, and the model's performance was verified by comparing it with the traditional risk scales. Multitemporal trend characteristics played an important role in stroke onset, and thus the model could be deployed to electronic health record systems to assist in more pervasive, preemptive stroke risk screening, enabling higher efficiency of early disease prevention and intervention.

Obstructive Sleep Apnea and the Brain: a Focus on Gray and White Matter Structure

PURPOSE OF REVIEW

Obstructive sleep apnea is extremely prevalent in the elderly and may precipitate dementia. We review recent advances on gray and white matter structure in obstructive sleep apnea, the impact of treatment, and potential pathological and neurodegenerative processes underlying brain structural changes.

RECENT FINDINGS

Two opposite patterns are observed in neuroimaging studies of obstructive sleep apnea. One may indicate cellular damage (gray matter atrophy, higher white matter hyperintensity burden, lower white matter fractional anisotropy, higher water diffusivities), while the other (gray matter hypertrophy, restricted white matter diffusivities) may reflect transitory responses, such as intracellular edema, reactive gliosis or compensatory structural changes. Treating obstructive sleep apnea could partly reverse these structural changes. Structural alterations related to obstructive sleep apnea may follow a multi-determined biphasic pattern depending on numerous factors (e.g. severity, symptomatology, age) that could tip the scale toward neurodegeneration and need to be investigated by longitudinal studies.

Sesamol alleviates chronic intermittent hypoxia-induced cognitive deficits via inhibiting oxidative stress and inflammation in rats

Chronic intermittent hypoxia (CIH) is a major pathophysiological feature of obstructive sleep apnea (OSA), which can cause oxidative stress and inflammation which can further impair the nervous system. Cognitive impairment is a common complication of the nervous system in OSA. Sesamol, a natural extract from Sesamum plants, is believed to have strong antioxidant and anti-inflammation capacity, which has a powerful neuroprotective function. But whether sesamol can improve CIH-induced cognitive impairment is unclear. This study aimed to explore whether sesamol can improve CIH-induced cognitive impairment and its relative mechanism in the model rats with OSA. Rats were exposed to CIH for 8 h a day for 2, 4, 6, and 8 weeks separately and concurrently were treated with sesamol (20 mg/kg/day, intraperitoneal). The Morris water maze (MWM) test was used to evaluate their learning and memory function. The activity of the superoxide dismutase (SOD) and the level of malondialdehyde were measured to evaluate the oxidative stress in the hippocampus of the rats. The levels of tumour necrosis factor-alpha (TNF-α) and interleukin-1 beta (IL-1β) in the hippocampus were quantified to analyse neuroinflammation by ELISA. The MWM test showed that sesamol improved learning and memory impairment in CIH-exposed rats. We also found that the sesamol-treated CIH-exposed rats had significantly increased the activity of SOD, as well as reduced the level of malondialdehyde in the hippocampus. In addition, sesamol also reduced the levels of TNF-α and IL-1β in the hippocampus. These data show that sesamol is able to alleviate cognitive impairments in CIH-exposed rats, with its neuroprotective effects likely inhibiting oxidative stress and inflammation.

Association Between Obstructive Sleep Apnea-Hypopnea Syndrome and Outcomes in Patients With Myocardial Infarction in the Absence of Obstructive Coronary Artery Disease

Background and Aims: Myocardial infarction in the absence of obstructive coronary artery disease (MINOCA) occurs in 5-10% of all patients with acute myocardial infarction. Obstructive sleep apnea-hypopnea syndrome (OSAHS) is linked to increased cardiovascular morbidity and mortality, but the relationship of OSAHS and outcomes in patients with MINOCA remains unknown. We aimed to evaluate the association between OSAHS and clinical outcomes in patients with MINOCA. Methods: Between January 2015 and December 2016, we carried out a consecutive cohort study of 583 patients with MINOCA and followed them up for 3 years. An apnea-hypopnea index of ≥ 15 events per hour recorded by polysomnography was defined as the diagnostic criterion for OSAHS. The primary end point was all-cause mortality, and the second end point was major adverse cardiovascular or cerebrovascular events (MACCE), a composite of cardiac death, non-fatal myocardial infarction, heart failure, cardiovascular-related rehospitalization, and stroke. Results: All-cause mortality happened in 69 patients and MACCE occurred in 113 patients during the 3-year follow-up. Kaplan-Meier survival curves indicated the significant relationship of OSAHS with all-cause mortality (log-rank P = 0.012) and MACCE (log-rank P = 0.002). Multivariate Cox regression analysis indicated OSAHS as an independent predictor of all-cause mortality and MACCE [adjusted hazard ratio: 1.706; 95% confidence interval (CI): 1.286-2.423; P = 0.008; and adjusted hazard ratio: 1.733; 95% CI: 1.201-2.389; P < 0.001; respectively], independent of age, sex, cardiovascular risk factors and discharge medications. Conclusions: OSAHS is independently associated with increased risk of all-cause mortality and MACCE in patients with MINOCA. Intervention and treatment should be considered to alleviate OSAHS-associated risk.

Cerebrovascular reactivity in young and old patients with obstructive sleep apnea

OBJECTIVE

Impaired cerebrovascular reactivity (CVR) in patients with obstructive sleep apnea syndrome (OSAS) increases the risk of ischemic stroke. CVR also decreases with age in normal individuals. However, it is unclear whether OSAS affects CVR differently in young and old patients. The aim of this study was to compare CVR in old and young patients with OSAS via transcranial Doppler (TCD) measurements of changes in cerebral blood flow velocity in the middle cerebral artery (MCAmv) during breath holding and hyperventilation.

METHODS

A total of 20 old patients (≥65 y) and 40 young patients (<65 y) with similar distributions of sex and OSAS severity were recruited for this study. The breath-holding index (BHI) and the hyperventilation index (HVI) were calculated to measure CVR.

RESULTS

No differences were found in MCAmv at baseline, apnea or hyperventilation between the two groups with different OSAS severities. However, reduced BHI (P < 0.01) and HVI (P < 0.01) were found in the young group with increasing severity of OSAS. Notably, the decline in BHI and HVI associated with OSAS severity was steeper in young patients than in old patients (P < 0.01).

CONCLUSIONS

These findings suggest that CVR in young patients is more impacted by OSAS severity than that in old patients, suggesting the existence of age-related cerebrovascular susceptibility to OSAS.

Single-layered ultra-soft washable smart textiles for all-around ballistocardiograph, respiration, and posture monitoring during sleep

Good sleep is considered to be the cornerstone for maintaining both physical and mental health. However, nearly one billion people worldwide suffer from various sleep disorders. To date, polysomnography (PSG) is the most commonly used sleep-monitoring technology,however, it is complex, intrusive, expensive and uncomfortable. Unfortunately, present noninvasive monitoring technologies cannot simultaneously achieve high sensitivity, multi-parameter monitoring and comfort. Here, we present a single-layered, ultra-soft, smart textile for all-around physiological parameters monitoring and healthcare during sleep. With a high-pressure sensitivity of 10.79 mV/Pa, a wide working frequency bandwidth from 0 Hz to 40 Hz, good stability, and decent washability, the single-layered ultra-soft smart textile is simultaneously capable of real-time detection and tracking of dynamic changes in sleep posture, and subtle respiration and ballistocardiograph (BCG) monitoring. Using the set of patient generated health data, an obstructive sleep apnea-hypopnea syndrome (OSAHS) monitoring and intervention system was also developed to improve the sleep quality and prevent sudden death during sleep. This work is expected to pave a new and practical pathway for physiological monitoring during sleep.

Prevalence of Sleep Apnea in Patients with Carotid Artery Stenosis

Obstructive sleep apnea (OSA) is a common disease affecting about 13% of men and 6% of women, usually having severe cardiovascular sequalae. OSA is responsible for the systemic inflammatory response and oxidative stress and results in endothelial injury being a risk factor for atherosclerosis. The aim of this study was to estimate the prevalence of OSA among patients with severe carotid artery stenosis. Fifty-five patients (F/M-24/31, mean age 70 ± 7 years, body mass index 28.3 ± 6.3 kg/m²) were enrolled into the study. The patients were qualified for elective surgical treatment of carotid artery stenosis. Polysomnography was performed in all patients the night before surgery. Thirty-six patients underwent surgical endarterectomy and nineteen patients underwent carotid artery stenting. Sleep apnea was diagnosed in 44 (80%) of all patients. The mean apnea-hypopnea index (AHI) was 14.5 ± 12.9. The OSA severity distribution was as follows: 22 mild, 16 moderate, and 6 severe cases. We found that the percentage of carotid endarterectomies was the greatest in mild and moderate OSA. It was approximately twofold greater than that in non-OSA patients. Carotid artery stenting was performed in nearly half of the patients in each of these groups. We conclude that OSA is highly prevalent in patients with carotid artery stenosis scheduled for carotid surgery. Nonetheless, the exact pathogenetic mechanisms underlying mutual interaction between OSA and vascular wall damage remain elusive. OSA is not routinely diagnosed among patients with advanced atherosclerosis. The study results might be an argument for performing polysomnography in patients with carotid artery stenosis.

Sleep apnea assessment using declination duration-based global metrics from unobtrusive fiber optic sensors

OBJECTIVE

Sufficient sleep helps to restore the immune, nervous and cardiovascular systems, but is sometimes disturbed by sleep apnea (SA). The early diagnosis of sleep apnea is beneficial for the prevention of diseases. Polysomnography (PSG) recording provides comprehensive data for such assessment, but is not suitable for use at home due to discomfort during measurement and the difficulty of identification. This study proposes an unobtrusive measurement process by placing fiber optic sensors (FOSs) in a pillow (head-neck) or a bed mattress (thoracic-dorsal).

APPROACH

We test two approaches: drop degrees from the baseline to validate the capability of catching respiratory drops, and linear regression models based on a new global measure, the percentage of the total duration of respiratory declination (PTDRD), to estimate the hand-scored apnea/hypopnea index (AHI).

MAIN RESULTS

Based on data recorded from 63 adults, the drop degrees derived from respiratory signals exhibited statistical differences among central sleep apnea (CSA), obstructive sleep apnea (OSA) and normal breathing. The regression models based on the PTDRDs derived from head-neck FOS and thoracic-dorsal FOS also achieved good agreement with manually scored AHIs in Bland-Altman plots as well as oronasal airflow and thoracic wall movement.

SIGNIFICANCE

The aforementioned performance demonstrates the capability of the FOS measurement and the efficacy of the PTDRD metrics for SA assessment.

Effects of continuous positive airway pressure (CPAP) therapy on neurological and functional rehabilitation in Basal Ganglia Stroke patients with obstructive sleep apnea: A prospective multicenter study

Obstructive sleep apnea (OSA) adversely affects neurological recovery. This study aimed to determine the impact of continuous positive airway pressure (CPAP) and/or rehabilitation in basal ganglia stroke patients with OSA.A prospective controlled trial was conducted in 2015-2018. The subjects received routine rehabilitation training for up to 2 years and were assigned to the intervention and control groups treated with CPAP or without, respectively. Then, treatment effects on sleep parameters, motor function, stroke severity, daily life activities, cognitive function, and psychological states were assessed at different time points.At 6 months, the CPAP group showed significantly lower mean apnea-hypopnea index (AHI), percentage of time with SpO2 at <90% (TS90%), micro-arousal index, and percentages of time in non-rapid eye movement (non-REM) stages 1-2 and REM stage in total sleeping time compared with the control group, and significantly higher mean minimum of peripheral oxygen saturation (L-SaO2%) and percentage of time in stage 3 (P < .001) sleep. The CPAP group showed significant improvements in average the National Institutes of Health Stroke Scale (NIHSS), Fugl-Meyer assessment scale (FMA), Barthel index (BI), Minimental state examination (MMSE), Hamilton anxiety scale (HAMA) and Hamilton depression rating scale for depression (HRSD) scores at different times versus the control group, respectively (P < .05). However, no difference in body mass index (BMI) management was observed (P > .05). Repeated-measures ANOVA revealed significant interactions between the two groups for change in FMA, MMSE, BI, HAMA, and HRSD scores from admission to 24 months (P < .001), but no significant was found for BMI (P = .582).Basal ganglia stroke patients with OSA tend to have significantly greater sleeping, neurological and functional recovery after CPAP, and rehabilitation over 2 years.

Extended Risk Factors for Stroke Prevention

Stroke causes disability and high mortality, while it can be prevented by increasing public awareness of risk factors. The common known risk factors are hypertension, atrial fibrillation, heart failure, smoking, alcohol consumption, low physical activity, overweight and hypercholesterolemia. However, the deep understanding of risk factors is limited. Moreover, more risk factor emerges in recent years. To further increase the awareness of risk factors for stroke prevention, this review indicates the reasonable application of antihypertensive agents according to the age-dependent changes of hypertension, and some new risk factors including chronic kidney disease, obstructive sleep apnea, migraine with aura, working environment, genetic factors and air pollution. Therefore, internal risk factors (e.g. heredity, hypertension, hyperglycemia) and external risk factors (e.g. working environment, air pollution) are both important for stroke prevention. All of these are reviewed to provide more information for the pre-hospital prevention and management, and the future clinical studies.

Sleep hygiene in patients with chronic respiratory disease

PURPOSE

This study assessed the effectiveness of patient-directed interventions for improving sleep quality in patients with cystic fibrosis and pulmonary hypertension.

METHODS

A nonrandomized, prospective pilot study was used to monitor the effectiveness of patient-initiated sleep preferences in 15 hospitalized patients.

RESULTS

During their stay, 53.3% of patients reported better sleep associated with the intervention, supporting the need for and efficacy of patient-driven sleep interventions.

CONCLUSION

Patients unanimously recognized the need for sleep interventions and were open to seeking a good sleep hygiene regimen to improve their sleep quality while in the hospital.

Effects of obesity therapies on sleep disorders

Obesity is a significant risk factor for obstructive sleep apnea syndrome (OSAS), and has also been linked to reductions in sleep quality and quantity. Weight loss has been shown to be an effective treatment for improving OSAS; however, there is a high degree of variability in improvements of OSAS in response to weight loss. There are three modalities of obesity therapies: 1) lifestyle modification, which includes changes in dietary intake and physical activity, along with behavioral interventions; 2) pharmacologic agents; and 3) bariatric surgery. Individuals have a highly variable response to the various obesity interventions, and maintenance of weight loss can be especially challenging. These factors influence the effect of weight loss on sleep disorders. There is still a need for large, well-controlled studies examining short- and long-term efficacy of weight loss modalities and their impact on long-term treatment of OSAS and other sleep parameters, particularly in youth. Nonetheless, given our current knowledge, weight reduction should always be encouraged for people coping with obesity, OSAS, and/or sleep disruptions and resources identified to assist patients in choosing a weight loss approach that will benefit them the most.

Obstructive sleep apnea, COPD, the overlap syndrome, and mortality: results from the 2005-2008 National Health and Nutrition Examination Survey

Objective

The aim of this study was to investigate the role of obstructive sleep apnea (OSA) on all-cause mortality in patients with COPD.

Methods

Data for this cross-sectional study were obtained from the National Health and Nutrition Examination Survey (NHANES) data (year 2005–2008). Eligible subjects were ≥20 years who had no COPD or OSA (n=9,237), had only OSA (n=366), had only COPD (n=695), and had OSA/COPD overlap syndrome (n=90). Univariate and multivariate analyses were used to evaluate factors associated with overall mortality.

Results

Multivariate analysis found that the COPD and OSA/COPD overlap syndrome groups had significantly higher chance of all-cause mortality than the group of subjects who did not have OSA or COPD (adjusted hazard ratio [HR] =1.5 for the COPD group and 2.4 for the overlap syndrome group) (P≤0.007). Although not significant, having OSA/COPD overlap syndrome was associated with higher likelihood of death than COPD alone (HR =1.5; P=0.160). Other factors associated with higher overall mortality were aging, poorer family status, current smoker, serum vitamin D deficiency, cardiovascular disease, history of cancer, diabetes, and impaired renal function.

Conclusion

The present study found that COPD and OSA/COPD overlap syndrome were associated with higher all-cause mortality compared with patients without either disease and that OSA did not significantly increase mortality in patients with COPD.

Electrical stimulation for the treatment of obstructive sleep apnoea: a review of the evidence

INTRODUCTION

Obstructive sleep apnoea is an increasingly prevalent clinical condition with significant impact on individuals and public health. Continuous positive airway pressure therapy is the standard treatment, but adherence is limited and alternative treatments are needed. In this context, non-invasive and invasive methods for the electrical stimulation of upper airway dilator muscles have been demonstrated to be effective in selected patients. Areas covered: This review will cover investigations on the clinical effects, safety, and tolerability of non-invasive and invasive electrical stimulation of the upper airway for the management of obstructive sleep apnoea. Following a search of the relevant literature published on PubMed this review is focused mainly on data obtained from randomized clinical trials and clinical studies. Expert commentary: The available evidence provides a rationale to consider upper airway electrical stimulation as treatment for selected patients with obstructive sleep apnoea, who have poor adherence or experience difficulties with continuous positive airway pressure therapy. Non-invasive stimulation using transcutaneous electrodes and implantable hypoglossal nerve stimulator technologies may provide an alternative to continuous positive airway pressure for the treatment of obstructive sleep apnoea via restoration of neuromuscular tone and improved upper airway patency.

Obesity and common respiratory diseases in children

Obesity has become an important public health problem worldwide that disproportionally affects the underserved. Obesity has been associated with many diseases and unfortunately has not spared the respiratory system. Specifically, the prevalence of common respiratory problems, such as asthma and obstructive sleep apnoea, is higher in obese children. Further, the treatment outcomes of these frequent conditions is also worse in obese children compared to lean controls.

Should the diagnosis and management of OSA move into general practice?

Sleep apnoea is a common disease that for accurate management requires the participation of primary care medicine http://ow.ly/G6Mq301zcaM.