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Thomas RJ. REM sleep breathing: Insights beyond conventional respiratory metrics. J Sleep Res 2024:e14270. [PMID: 38960862 DOI: 10.1111/jsr.14270] [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: 05/23/2024] [Accepted: 05/29/2024] [Indexed: 07/05/2024]
Abstract
Breathing and sleep state are tightly linked. The traditional approach to evaluation of breathing in rapid eye movement sleep has been to focus on apneas and hypopneas, and associated hypoxia or hypercapnia. However, rapid eye movement sleep breathing offers novel insights into sleep physiology and pathology, secondary to complex interactions of rapid eye movement state and cardiorespiratory biology. In this review, morphological analysis of clinical polysomnogram data to assess respiratory patterns and associations across a range of health and disease is presented. There are several relatively unique insights that may be evident by assessment of breathing during rapid eye movement sleep. These include the original discovery of rapid eye movement sleep and scoring of neonatal sleep, control of breathing in rapid eye movement sleep, rapid eye movement sleep homeostasis, sleep apnea endotyping and pharmacotherapy, rapid eye movement sleep stability, non-electroencephalogram sleep staging, influences on cataplexy, mimics of rapid eye movement behaviour disorder, a reflection of autonomic health, and insights into cardiac arrhythmogenesis. In summary, there is rich clinically actionable information beyond sleep apnea encoded in the respiratory patterns of rapid eye movement sleep.
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Affiliation(s)
- Robert Joseph Thomas
- Department of Medicine, Division of Pulmonary Critical Care & Sleep Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts, USA
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2
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Fang R, Cheng Y, Li F, Xu Y, Li Y, Liu X, Guo S, Wang Y, Jiang J, Zhou D, Zhang B. The Chinese Clinical Sleep Database: An Innovative Database System Includes Large-Scale Clinical Data of Chinese Population. Nat Sci Sleep 2024; 16:305-313. [PMID: 38533251 PMCID: PMC10964089 DOI: 10.2147/nss.s450578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 03/12/2024] [Indexed: 03/28/2024] Open
Abstract
Purpose In this study, we established the Chinese Clinical Sleep Database (CCSD), aiming to provide a safe, scalable, and user-friendly database that includes high-quality clinical data from Chinese population to facilitate sleep research. Material and Methods We collect individual's demographic data, scales, anthropometric measurements, clinical diagnosis, and polysomnography (PSG) recordings from the routine medical process of sleep medicine centers using standardized procedures. The distributed cluster storage technology are utilized to store these data. The structured data are stored in a high-performance MySQL database, while the unstructured data are stored in an object storage service. And we have developed an online data platform to share and manage our data. Results The data collection has been conducted in three hospitals. In the preliminary stage of data collection (from October 18, 2022 to September 4, 2023), our database included a total of 1183 patients. Among them, 56.8% were male and their ages ranged from 3 to 88 years. These patients were diagnosed with various types of sleep disorders. Conclusion Since the CCSD's inception, it has demonstrated good stability, security, and scalability. As an public database, the CCSD also exhibits user-friendliness. The CCSD contains comprehensive clinical data, which can contribute to the advancement of the diagnosis and treatment strategies for sleep disorders, ultimately promoting sleep health.
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Affiliation(s)
- Ruichen Fang
- Department of Psychiatry, Sleep Medicine Center, Nanfang Hospital, Southern Medical University, Guangzhou, People’s Republic of China
- Key Laboratory of Mental Health of the Ministry of Education, Guangzhou, People’s Republic of China
| | - Yihong Cheng
- Department of Psychiatry, Sleep Medicine Center, Nanfang Hospital, Southern Medical University, Guangzhou, People’s Republic of China
- Key Laboratory of Mental Health of the Ministry of Education, Guangzhou, People’s Republic of China
| | - Fan Li
- School of Biomedical Engineering, Faculty of Medicine, Dalian University of Technology, Dalian, 116024, People’s Republic of China
| | - Yan Xu
- Department of Psychiatry, Sleep Medicine Center, Nanfang Hospital, Southern Medical University, Guangzhou, People’s Republic of China
- Key Laboratory of Mental Health of the Ministry of Education, Guangzhou, People’s Republic of China
| | - Yuanhui Li
- Adai Technology (Beijing) Co., Ltd, Beijing, People’s Republic of China
| | - Xiang Liu
- Adai Technology (Beijing) Co., Ltd, Beijing, People’s Republic of China
| | - Simin Guo
- Adai Technology (Beijing) Co., Ltd, Beijing, People’s Republic of China
| | - Yuling Wang
- Department of Psychiatry, Sleep Medicine Center, Nanfang Hospital, Southern Medical University, Guangzhou, People’s Republic of China
- Key Laboratory of Mental Health of the Ministry of Education, Guangzhou, People’s Republic of China
| | - Jinnong Jiang
- Department of Psychiatry, Sleep Medicine Center, Nanfang Hospital, Southern Medical University, Guangzhou, People’s Republic of China
- Key Laboratory of Mental Health of the Ministry of Education, Guangzhou, People’s Republic of China
| | - Dan Zhou
- Department of Psychiatry, Sleep Medicine Center, Nanfang Hospital, Southern Medical University, Guangzhou, People’s Republic of China
- Key Laboratory of Mental Health of the Ministry of Education, Guangzhou, People’s Republic of China
| | - Bin Zhang
- Department of Psychiatry, Sleep Medicine Center, Nanfang Hospital, Southern Medical University, Guangzhou, People’s Republic of China
- Key Laboratory of Mental Health of the Ministry of Education, Guangzhou, People’s Republic of China
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3
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Ercolano E, Bencivenga L, Palaia ME, Carbone G, Scognamiglio F, Rengo G, Femminella GD. Intricate relationship between obstructive sleep apnea and dementia in older adults. GeroScience 2024; 46:99-111. [PMID: 37814196 PMCID: PMC10828345 DOI: 10.1007/s11357-023-00958-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 09/21/2023] [Indexed: 10/11/2023] Open
Abstract
Numerous evidence reports direct correlation between cognitive impairment, Alzheimer's disease and sleep disorders, in particular obstructive sleep apnea. Both obstructive sleep apnea and Alzheimer's disease are highly prevalent conditions whose incidence increases with age. Several studies demonstrate how sleep-disordered breathing may lead to poor cognition, even though the underlying mechanisms of this association remain partially unclear. According to the most recent studies, obstructive sleep apnea may be considered a modifiable risk factor for cognitive dysfunction. In the present review, the authors aim to integrate recent research examining obstructive sleep apnea and Alzheimer's disease biomarkers, also focusing on the mechanisms that support this correlation, including but not limited to the role of hypoxia and cardiovascular risk. Moreover, the potential favourable effect of obstructive sleep apnea therapy on cognitive function is discussed, to evaluate the benefits deriving from appropriate treatment of sleep-disordered breathing on cognition.
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Affiliation(s)
- Erica Ercolano
- Department of Translational Medical Sciences, University of Naples "Federico II", Via Pansini, 5, Naples, Italy
| | - Leonardo Bencivenga
- Department of Translational Medical Sciences, University of Naples "Federico II", Via Pansini, 5, Naples, Italy
| | - Maria Emiliana Palaia
- Department of Translational Medical Sciences, University of Naples "Federico II", Via Pansini, 5, Naples, Italy
| | - Giovanni Carbone
- Department of Translational Medical Sciences, University of Naples "Federico II", Via Pansini, 5, Naples, Italy
| | - Francesco Scognamiglio
- Department of Translational Medical Sciences, University of Naples "Federico II", Via Pansini, 5, Naples, Italy
| | - Giuseppe Rengo
- Department of Translational Medical Sciences, University of Naples "Federico II", Via Pansini, 5, Naples, Italy
- Istituti Clinici Scientifici ICS Maugeri - S.P.A. - Istituti Di Ricovero E Cura a Carattere Scientifico (IRCCS) Istituto Scientifico Di Telese Terme, Telese, Italy
| | - Grazia Daniela Femminella
- Department of Translational Medical Sciences, University of Naples "Federico II", Via Pansini, 5, Naples, Italy.
- Department of Brain Sciences, Imperial College London, London, UK.
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Cheng WJ, Finnsson E, Ágústsson JS, Sands SA, Hang LW. Continuous positive airway pressure and adherence in patients with different endotypes of obstructive sleep apnea. J Sleep Res 2024; 33:e13999. [PMID: 37452710 PMCID: PMC10788376 DOI: 10.1111/jsr.13999] [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: 03/09/2023] [Revised: 05/26/2023] [Accepted: 06/27/2023] [Indexed: 07/18/2023]
Abstract
Determining the endotypes of obstructive sleep apnea (OSA) has potential implications for precision interventions. Here we assessed whether continuous positive airway pressure (CPAP) treatment outcomes differ across endotypic subgroups. We conducted a retrospective analysis of data obtained from 225 patients with moderate-to-severe OSA from a single sleep centre. Polysomnographic and CPAP titration study data were collected between May 2020 and January 2022. One-month CPAP treatment adherence was followed. Obstructive sleep apnea endotypes, namely arousal threshold, collapsibility, loop gain, and upper airway gain were estimated from polysomnography and dichotomised as high versus low. We examined associations between endotypic subgroups and (1) optimal CPAP titration pressure, (2) CPAP-related improvements in sleep architecture (proportions of slow-wave and rapid eye movement (REM) sleep), and (3) CPAP adherence. We observed that patients with high collapsibility required a higher CPAP pressure than those with low collapsibility (∆ = 0.4 cmH2 O, 95% confidence interval [CI] = 0.3-1.7). A larger increase in slow-wave sleep and in REM sleep proportions after CPAP treatment were observed in patients with a high arousal threshold, high collapsibility, high loop gain, or high upper airway gain than in those with low levels of endotypes. High loop gain and high collapsibility were independently associated with longer CPAP use hours per night (∆ = 0.6 h, 95% CI = 0.2-1.5 and ∆ = 0.3 h, 95% CI = 0.03-1.5, respectively). In conclusion, different endotypic subgroups of OSA exhibit a difference in outcomes of CPAP treatment. Knowledge of endotypes may help clinicians to understand which patients are expected to benefit most from CPAP therapy prior to its administration.
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Affiliation(s)
- Wan-Ju Cheng
- Department of Psychiatry, China Medical University Hospital, Taichung, Taiwan
- Department of Public Health, China Medical University, Taichung, Taiwan
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, 35 Keyan Road, Miaoli, Taiwan
| | | | | | - Scott A. Sands
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Liang-Wen Hang
- School of Nursing & Graduate Institute of Nursing, China Medical University, Taichung, Taiwan
- Sleep Medicine Center, Department of Pulmonary and Critical Care Medicine, China Medical University Hospital, Taichung, Taiwan
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Shirahata T, Uchida Y, Uchida T, Shinomiya S, Sato H, Yamazaki S, Yogi S, Masaki K, Akagami T, Soma M, Ohmura K, Miyashita T, Kanazawa M, Nagata M, Nakamura H. Improvement of sleep parameters by titration polysomnography could predict adherence to positive airway pressure therapy in obstructive sleep apnea. J Clin Sleep Med 2023; 19:1465-1473. [PMID: 37082821 PMCID: PMC10394356 DOI: 10.5664/jcsm.10606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 03/28/2023] [Accepted: 03/28/2023] [Indexed: 04/22/2023]
Abstract
STUDY OBJECTIVES Poor adherence to continuous positive airway pressure (CPAP) has been a critical issue in treating obstructive sleep apnea. Because long-term CPAP adherence may be established shortly after treatment begins, early intervention is essential. This study aimed to identify the potential factors affecting CPAP therapy adherence during diagnostic polysomnography and auto CPAP titration polysomnography. METHODS This retrospective observational study included 463 patients with obstructive sleep apnea who underwent consecutive diagnostic polysomnography and titration polysomnography. We recorded their demographic, anthropometric, and lifestyle factors and obtained self-reported comments regarding their sleep status following both polysomnography evaluations. CPAP adherence was evaluated following 3 months of treatment. RESULTS A total of 312 patients (67.4%) fulfilled the criteria for good adherence. Each patient's CPAP adherence was categorized as "poor" (< 4 hours/night or <70% of nights), "good" (≥ 4 hours/night and ≥ 70% of nights), or "excellent" (≥ 6 hours/night and ≥ 80% of nights). There were no significant differences in arterial oxyhemoglobin saturation measured by pulse oximetry and apnea-hypopnea index during diagnostic polysomnography among 3 groups. The polysomnographic evaluations indicated that patients with better adherence displayed more significant improvements in sleep parameters, including apnea-hypopnea index, sleep efficacy, sleep latency, and sleep architecture, which were correlated with an improvement in self-reported sleep quality. CONCLUSIONS Polysomnographic evaluations enabled CPAP adherence prediction and a comparison of self-reported sleep quality with and without CPAP; CPAP adherence led to improvements in polysomnographic parameters. Our findings suggest that titration polysomnography and self-reported sleep improvement with CPAP could be used for adherence prediction in clinical practice. CITATION Shirahata T, Uchida Y, Uchida T, et al. Improvement of sleep parameters by titration polysomnography could predict adherence to positive airway pressure therapy in obstructive sleep apnea. J Clin Sleep Med. 2023;19(8):1465-1473.
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Affiliation(s)
- Toru Shirahata
- Department of Respiratory Medicine, Saitama Medical University, Saitama, Japan
| | - Yoshitaka Uchida
- Department of Respiratory Medicine, Saitama Medical University, Saitama, Japan
| | - Takahiro Uchida
- Department of Respiratory Medicine, Saitama Medical University, Saitama, Japan
| | - Shun Shinomiya
- Department of Respiratory Medicine, Saitama Medical University, Saitama, Japan
| | - Hideaki Sato
- Department of Respiratory Medicine, Saitama Medical University, Saitama, Japan
| | - Susumu Yamazaki
- Department of Respiratory Medicine, Saitama Medical University, Saitama, Japan
| | - Sanehiro Yogi
- Department of Respiratory Medicine, Saitama Medical University, Saitama, Japan
| | - Kenji Masaki
- Department of Respiratory Medicine, Saitama Medical University, Saitama, Japan
| | - Tomoe Akagami
- Department of Respiratory Medicine, Saitama Medical University, Saitama, Japan
| | - Machika Soma
- Department of Respiratory Medicine, Saitama Medical University, Saitama, Japan
| | - Kazuyuki Ohmura
- Department of Respiratory Medicine, Saitama Medical University, Saitama, Japan
- School of Medical Technology, Faculty of Health and Medical Care, Saitama Medical University, Saitama, Japan
| | - Tatsuyuki Miyashita
- Department of Respiratory Medicine, Saitama Medical University, Saitama, Japan
| | - Minoru Kanazawa
- Department of Respiratory Medicine, Saitama Medical University, Saitama, Japan
| | - Makoto Nagata
- Department of Respiratory Medicine, Saitama Medical University, Saitama, Japan
| | - Hidetoshi Nakamura
- Department of Respiratory Medicine, Saitama Medical University, Saitama, Japan
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6
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Wilckens KA, Jeon B, Morris JL, Buysse DJ, Chasens ER. Effects of continuous positive airway pressure treatment on sleep architecture in adults with obstructive sleep apnea and type 2 diabetes. Front Hum Neurosci 2022; 16:924069. [PMID: 36177385 PMCID: PMC9513763 DOI: 10.3389/fnhum.2022.924069] [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: 04/20/2022] [Accepted: 08/09/2022] [Indexed: 11/24/2022] Open
Abstract
Obstructive sleep apnea (OSA) severely impacts sleep and has long-term health consequences. Treating sleep apnea with continuous positive airway pressure (CPAP) not only relieves obstructed breathing, but also improves sleep. CPAP improves sleep by reducing apnea-induced awakenings. CPAP may also improve sleep by enhancing features of sleep architecture assessed with electroencephalography (EEG) that maximize sleep depth and neuronal homeostasis, such as the slow oscillation and spindle EEG activity, and by reducing neurophysiological arousal during sleep (i.e., beta EEG activity). We examined cross-sectional differences in quantitative EEG characteristics of sleep, assessed with power spectral analysis, in 29 adults with type 2 diabetes treated with CPAP and 24 adults undergoing SHAM CPAP treatment (total n = 53). We then examined changes in spectral characteristics of sleep as the SHAM group crossed over to active CPAP treatment (n = 19). Polysomnography (PSG) from the CPAP titration night was used for the current analyses. Analyses focused on EEG frequencies associated with sleep maintenance and arousal. These included the slow oscillation (0.5–1 Hz), sigma activity (12–16 Hz, spindle activity), and beta activity (16–20 Hz) in F3, F4, C3, and C4 EEG channels. Whole night non-rapid eye movement (NREM) sleep and the first period of NREM spectral activity were examined. Age and sex were included as covariates. There were no group differences between CPAP and SHAM in spectral characteristics of sleep architecture. However, SHAM cross-over to active CPAP was associated with an increase in relative 12–16 Hz sigma activity across the whole night and a decrease in average beta activity across the whole night. Relative slow oscillation power within the first NREM period decreased with CPAP, particularly for frontal channels. Sigma and beta activity effects did not differ by channel. These findings suggest that CPAP may preferentially enhance spindle activity and mitigate neurophysiological arousal. These findings inform the neurophysiological mechanisms of improved sleep with CPAP and the utility of quantitative EEG measures of sleep as a treatment probe of improvements in neurological and physical health with CPAP.
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Affiliation(s)
- Kristine A Wilckens
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Bomin Jeon
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, United States
| | - Jonna L Morris
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, United States
| | - Daniel J Buysse
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Eileen R Chasens
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, United States
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7
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Berro LF, Overton JS, Rowlett JK. Methamphetamine-Induced Sleep Impairments and Subsequent Slow-Wave and Rapid Eye Movement Sleep Rebound in Male Rhesus Monkeys. Front Neurosci 2022; 16:866971. [PMID: 35464308 PMCID: PMC9021839 DOI: 10.3389/fnins.2022.866971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 03/03/2022] [Indexed: 11/18/2022] Open
Abstract
Use of amphetamine-type stimulants is associated with numerous adverse health outcomes, with disturbed sleep being one of the most prominent consequences of methamphetamine use. However, the extent to which methamphetamine alters sleep architecture, and whether methamphetamine-induced sleep impairment is associated with next-day sleep rebound effects, has received relatively little investigation. In the present study, we investigated the effects of acute morning methamphetamine administration on sleep parameters in adult male rhesus monkeys (N = 4) using a fully-implantable telemetry system. Monkeys were prepared with telemetry devices that continuously monitored electroencephalography (EEG), electromyography (EMG) and electrooculography (EOG) throughout the night. We investigated the effects of morning (10h00) administration of methamphetamine (0.01-0.3 mg/kg, i.m.) on sleep during the night of the injection. In addition, we investigated sleep during the subsequent night in order to assess the possible emergence of sleep rebound effects. Methamphetamine administration dose-dependently increased sleep latency and wake time after sleep onset (WASO). Methamphetamine also decreased total sleep time, which was reflected by a decrease in total time spent in N2, slow-wave (N3) and REM sleep stages, while increasing the percentage of total sleep time spent in sleep stage N1. Importantly, methamphetamine decreased time spent in N3 and REM sleep even at doses that did not significantly decrease total sleep time. Sleep rebound effects were observed on the second night after methamphetamine administration, with increased total sleep time reflected by a selective increase in time spent in sleep stages N3 and REM, as well as a decrease in REM sleep latency. Our findings show that methamphetamine administered 8 h prior to the inactive (dark) phase induces marked changes in sleep architecture in rhesus monkeys, even at doses that do not change sleep duration, and that sleep rebound effects are observed the following day for both N3 and REM sleep stages.
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Affiliation(s)
| | - John S. Overton
- Department of Psychiatry and Human Behavior, Center for Innovation and Discovery in Addictions, University of Mississippi Medical Center, Jackson, MS, United States
| | - James K. Rowlett
- Department of Psychiatry and Human Behavior, Center for Innovation and Discovery in Addictions, University of Mississippi Medical Center, Jackson, MS, United States
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Mullins AE, Parekh A, Kam K, Castillo B, Roberts ZJ, Fakhoury A, Valencia DI, Schoenholz R, Tolbert TM, Bronstein JZ, Mooney AM, Burschtin OE, Rapoport DM, Ayappa I, Varga AW. Selective Continuous Positive Airway Pressure Withdrawal With Supplemental Oxygen During Slow-Wave Sleep as a Method of Dissociating Sleep Fragmentation and Intermittent Hypoxemia-Related Sleep Disruption in Obstructive Sleep Apnea. Front Physiol 2021; 12:750516. [PMID: 34880775 PMCID: PMC8646104 DOI: 10.3389/fphys.2021.750516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 10/13/2021] [Indexed: 11/17/2022] Open
Abstract
Obstructive sleep apnea (OSA) is considered to impair memory processing and increase the expression of amyloid-β (Aβ) and risk for Alzheimer’s disease (AD). Given the evidence that slow-wave sleep (SWS) is important in both memory and Aβ metabolism, a better understanding of the mechanisms by which OSA impacts memory and risk for AD can stem from evaluating the role of disruption of SWS specifically and, when such disruption occurs through OSA, from evaluating the individual contributions of sleep fragmentation (SF) and intermittent hypoxemia (IH). In this study, we used continuous positive airway pressure (CPAP) withdrawal to recapitulate SWS-specific OSA during polysomnography (PSG), creating conditions of both SF and IH in SWS only. During separate PSGs, we created the conditions of SWS fragmentation but used oxygen to attenuate IH. We studied 24 patients (average age of 55 years, 29% female) with moderate-to-severe OSA [Apnea-Hypopnea Index (AHI); AHI4% > 20/h], who were treated and adherent to CPAP. Participants spent three separate nights in the laboratory under three conditions as follows: (1) consolidated sleep with CPAP held at therapeutic pressure (CPAP); (2) CPAP withdrawn exclusively in SWS (OSASWS) breathing room air; and (3) CPAP withdrawn exclusively in SWS with the addition of oxygen during pressure withdrawal (OSASWS + O2). Multiple measures of SF (e.g., arousal index) and IH (e.g., hypoxic burden), during SWS, were compared according to condition. Arousal index in SWS during CPAP withdrawal was significantly greater compared to CPAP but not significantly different with and without oxygen (CPAP = 1.1/h, OSASWS + O2 = 10.7/h, OSASWS = 10.6/h). However, hypoxic burden during SWS was significantly reduced with oxygen compared to without oxygen [OSASWS + O2 = 23 (%min)/h, OSASWS = 37 (%min)/h]. No significant OSA was observed in non-rapid eye movement (REM) stage 1 (NREM 1), non-REM stage 2 (NREM 2), or REM sleep (e.g., non-SWS) in any condition. The SWS-specific CPAP withdrawal induces OSA with SF and IH. The addition of oxygen during CPAP withdrawal results in SF with significantly less severe hypoxemia during the induced respiratory events in SWS. This model of SWS-specific CPAP withdrawal disrupts SWS with a physiologically relevant stimulus and facilitates the differentiation of SF and IH in OSA.
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Affiliation(s)
- Anna E Mullins
- Division of Pulmonary, Critical Care, and Sleep Medicine, Mount Sinai Integrative Sleep Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Ankit Parekh
- Division of Pulmonary, Critical Care, and Sleep Medicine, Mount Sinai Integrative Sleep Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Korey Kam
- Division of Pulmonary, Critical Care, and Sleep Medicine, Mount Sinai Integrative Sleep Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Bresne Castillo
- Division of Pulmonary, Critical Care, and Sleep Medicine, Mount Sinai Integrative Sleep Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Zachary J Roberts
- Division of Pulmonary, Critical Care, and Sleep Medicine, Mount Sinai Integrative Sleep Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Ahmad Fakhoury
- Division of Pulmonary, Critical Care, and Sleep Medicine, Mount Sinai Integrative Sleep Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Daphne I Valencia
- Division of Pulmonary, Critical Care, and Sleep Medicine, Mount Sinai Integrative Sleep Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Reagan Schoenholz
- Division of Pulmonary, Critical Care, and Sleep Medicine, Mount Sinai Integrative Sleep Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Thomas M Tolbert
- Division of Pulmonary, Critical Care, and Sleep Medicine, Mount Sinai Integrative Sleep Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Jason Z Bronstein
- Division of Pulmonary, Critical Care, and Sleep Medicine, Mount Sinai Integrative Sleep Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Anne M Mooney
- Division of Pulmonary, Critical Care, and Sleep Medicine, Mount Sinai Integrative Sleep Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Omar E Burschtin
- Division of Pulmonary, Critical Care, and Sleep Medicine, Mount Sinai Integrative Sleep Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - David M Rapoport
- Division of Pulmonary, Critical Care, and Sleep Medicine, Mount Sinai Integrative Sleep Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Indu Ayappa
- Division of Pulmonary, Critical Care, and Sleep Medicine, Mount Sinai Integrative Sleep Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Andrew W Varga
- Division of Pulmonary, Critical Care, and Sleep Medicine, Mount Sinai Integrative Sleep Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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9
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Jung YJ, Oh E. Is REM sleep behavior disorder a friend or foe of obstructive sleep apnea? Clinical and etiological implications for neurodegeneration. J Clin Sleep Med 2021; 17:1305-1312. [PMID: 33660615 DOI: 10.5664/jcsm.9144] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
NONE Rapid eye movement sleep behavior disorder (RBD) is a parasomnia characterized by loss of muscle atonia during rapid eye movement sleep, associated with complex motor enactment of dreams. Obstructive sleep apnea (OSA) is a relatively common sleep disorder characterized by repetitive episodes of upper airway obstruction while sleeping, which can result in hypoxemia and sleep fragmentation. Even though the nature of RBD and OSA is different, OSA may sometimes be accompanied by RBD symptoms. Accordingly, it is reasonable to distinguish these 2 sleep disorders in people with dream enactment behaviors. Although RBD and OSA share similar sleep phenomena, their association has yet to be elucidated. Herein we draw attention to various RBD-mimicking conditions, RBD combined with OSA, and the relationship between RBD and OSA. Furthermore, the clinical implications of OSA in neurodegeneration and the optimized management of RBD combined with OSA are also discussed in this review.
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Affiliation(s)
- Yu Jin Jung
- Department of Neurology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Eungseok Oh
- Department of Neurology, Chungnam National University Hospital, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
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Cordone S, Scarpelli S, Alfonsi V, De Gennaro L, Gorgoni M. Sleep-Based Interventions in Alzheimer's Disease: Promising Approaches from Prevention to Treatment along the Disease Trajectory. Pharmaceuticals (Basel) 2021; 14:ph14040383. [PMID: 33921870 PMCID: PMC8073746 DOI: 10.3390/ph14040383] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/10/2021] [Accepted: 04/16/2021] [Indexed: 02/07/2023] Open
Abstract
The multifactorial nature of Alzheimer’s disease (AD) has led scientific researchers to focus on the modifiable and treatable risk factors of AD. Sleep fits into this context, given the bidirectional relationship with AD confirmed by several studies over the last years. Sleep disorders appear at an early stage of AD and continue throughout the entire course of the pathology. Specifically, sleep abnormalities, such as more fragmented sleep, increase in time of awakenings, worsening of sleep quality and primary sleep disorders raise with the severity and progression of AD. Intervening on sleep, therefore, means acting both with prevention strategies in the pre-clinical phase and with treatments during the course of the disease. This review explores sleep disturbances in the different stages of AD, starting from the pre-clinical stage. Particular attention is given to the empirical evidence investigating obstructive sleep apnea (OSA) disorder and the mechanisms overlapping and sharing with AD. Next, we discuss sleep-based intervention strategies in the healthy elderly population, mild cognitive impairment (MCI) and AD patients. We mention interventions related to behavioral strategies, combination therapies, and bright light therapy, leaving extensive space for new and raising evidence on continuous positive air pressure (CPAP) treatment effectiveness. Finally, we clarify the role of NREM sleep across the AD trajectory and consider the most recent studies based on the promising results of NREM sleep enhancement, which use innovative experimental designs and techniques.
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Affiliation(s)
- Susanna Cordone
- UniCamillus, Saint Camillus International University of Health Sciences, 00131 Rome, Italy;
| | - Serena Scarpelli
- Department of Psychology, University of Rome “Sapienza”, 00185 Rome, Italy; (S.S.); (M.G.)
| | | | - Luigi De Gennaro
- Department of Psychology, University of Rome “Sapienza”, 00185 Rome, Italy; (S.S.); (M.G.)
- IRCCS Fondazione Santa Lucia, 00179 Rome, Italy;
- Correspondence:
| | - Maurizio Gorgoni
- Department of Psychology, University of Rome “Sapienza”, 00185 Rome, Italy; (S.S.); (M.G.)
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11
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Cheng JX, Ren J, Qiu J, Jiang Y, Zhao X, Sun S, Su C. Rapid eye movement sleep and slow wave sleep rebounded and related factors during positive airway pressure therapy. Sci Rep 2021; 11:7599. [PMID: 33828160 PMCID: PMC8027864 DOI: 10.1038/s41598-021-87149-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 03/15/2021] [Indexed: 02/06/2023] Open
Abstract
This study aimed to investigate the clinical characteristics and predictors of increased rapid eye movement (REM) sleep or slow wave sleep (SWS) in patients with obstructive sleep apnea (OSA) following positive airway pressure (PAP) therapy. The study retrospectively analyzed data from patients with OSA who underwent both diagnostic polysomnography (PSG) and pressure titration PSG at the Tangdu Hospital Sleep Medicine Center from 2011-2016. Paired diagnostic PSG and pressure titration studies from 501 patients were included. REM rebound was predicted by a higher oxygen desaturation index, lower REM proportion, higher arousal index, lower mean pulse oxygen saturation (SpO2), higher Epworth sleepiness score and younger age (adjusted R2 = 0.482). The SWS rebound was predicted by a longer total duration of apneas and hypopneas, lower N3 duration, lower SpO2 nadir, lower REM proportion in diagnostic PSG and younger age (adjusted R2 = 0.286). Patients without REM rebound or SWS rebound had a high probability of comorbidities with insomnia and mood complaints. Some parameters (subjective and objective insomnia, excessive daytime sleepiness, age and OSA severity) indicate changes in REM sleep and SWS between diagnostic and titration PSG tests. Treatment of insomnia and mood disorders in patients with OSA may helpful to improve the use PAP.
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Affiliation(s)
- Jin-Xiang Cheng
- Department of Neurology, Tangdu Hospital, Fourth Military Medical University, Xi'an, 710038, Shaanxi Province, China.
| | - Jiafeng Ren
- Department of Neurology, Tangdu Hospital, Fourth Military Medical University, Xi'an, 710038, Shaanxi Province, China
| | - Jian Qiu
- Department of Neurology, Tangdu Hospital, Fourth Military Medical University, Xi'an, 710038, Shaanxi Province, China
| | - Yingcong Jiang
- Department of Neurology, Tangdu Hospital, Fourth Military Medical University, Xi'an, 710038, Shaanxi Province, China
| | - Xianchao Zhao
- Department of Neurology, Tangdu Hospital, Fourth Military Medical University, Xi'an, 710038, Shaanxi Province, China
| | - Shuyu Sun
- Department of Neurology, Tangdu Hospital, Fourth Military Medical University, Xi'an, 710038, Shaanxi Province, China
| | - Changjun Su
- Department of Neurology, Tangdu Hospital, Fourth Military Medical University, Xi'an, 710038, Shaanxi Province, China.
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12
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Acute effects of noninvasive ventilation on sleep physiology in patients with moderate to severe stable chronic obstructive pulmonary disease: a pilot study. Sleep Med 2021; 80:118-125. [PMID: 33596525 DOI: 10.1016/j.sleep.2021.01.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 12/03/2020] [Accepted: 01/26/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE/BACKGROUND Changes in sleep architecture in patients with Chronic Obstructive Pulmonary Disease (COPD) can be explained by a combination of physiological changes in breathing during sleep, with impairment of respiratory mechanics and reduction of arterial oxygenation. This study aimed to evaluate the acute effects of noninvasive ventilation (NIV) - compared to spontaneous breathing - on sleep latency and stages, and on the occurrence of sleep-related respiratory events, nocturnal hypoxemia, and changes in heart rate (HR) in patients with moderate to severe stable COPD. PATIENTS/METHODS Patients completed two polysomnography (PSG) studies: one during spontaneous breathing and one while receiving NIV in bilevel mode and with backup respiratory rate (RR.) setting. Sleepware G3 software was used for the analysis of PSG and pressure, volume, and ventilator flow curves × time. RESULTS Participants were 10 female patients with a mean age of 68.1 ± 10.2 years. NIV during sleep decreased sleep onset latency (17 ± 18.8 min vs 46.8 ± 39.5 min; p = 0.02), increased REM sleep time (41.2 ± 24.7 min vs 19.7 ± 21.7 min; p = 0.03), and decreased the obstructive apnea index (OAI) (0 vs 8.7 ± 18.8; p = 0.01). Lower mean HR (66.6 ± 4.1 bpm vs 70.6 ± 5.9 bpm; p = 0.03) and lower maximum HR (84.1 ± 7.3 bpm vs 91.6 ± 7.8 bpm; p = 0.03) were observed in PSG with NIV. CONCLUSIONS The use of NIV in patients with moderate to severe stable COPD while they were sleeping increased REM sleep time and decreased sleep onset latency, the number of obstructive respiratory events, and the mean and maximum HR.
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13
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Mullins AE, Kam K, Parekh A, Bubu OM, Osorio RS, Varga AW. Obstructive Sleep Apnea and Its Treatment in Aging: Effects on Alzheimer's disease Biomarkers, Cognition, Brain Structure and Neurophysiology. Neurobiol Dis 2020; 145:105054. [PMID: 32860945 PMCID: PMC7572873 DOI: 10.1016/j.nbd.2020.105054] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 08/13/2020] [Accepted: 08/18/2020] [Indexed: 02/08/2023] Open
Abstract
Here we review the impact of obstructive sleep apnea (OSA) on biomarkers of Alzheimer's disease (AD) pathogenesis, neuroanatomy, cognition and neurophysiology, and present the research investigating the effects of continuous positive airway pressure (CPAP) therapy. OSA is associated with an increase in AD markers amyloid-β and tau measured in cerebrospinal fluid (CSF), by Positron Emission Tomography (PET) and in blood serum. There is some evidence suggesting CPAP therapy normalizes AD biomarkers in CSF but since mechanisms for amyloid-β and tau production/clearance in humans are not completely understood, these findings remain preliminary. Deficits in the cognitive domains of attention, vigilance, memory and executive functioning are observed in OSA patients with the magnitude of impairment appearing stronger in younger people from clinical settings than in older community samples. Cognition improves with varying degrees after CPAP use, with the greatest effect seen for attention in middle age adults with more severe OSA and sleepiness. Paradigms in which encoding and retrieval of information are separated by periods of sleep with or without OSA have been done only rarely, but perhaps offer a better chance to understand cognitive effects of OSA than isolated daytime testing. In cognitively normal individuals, changes in EEG microstructure during sleep, particularly slow oscillations and spindles, are associated with biomarkers of AD, and measures of cognition and memory. Similar changes in EEG activity are reported in AD and OSA, such as "EEG slowing" during wake and REM sleep, and a degradation of NREM EEG microstructure. There is evidence that CPAP therapy partially reverses these changes but large longitudinal studies demonstrating this are lacking. A diagnostic definition of OSA relying solely on the Apnea Hypopnea Index (AHI) does not assist in understanding the high degree of inter-individual variation in daytime impairments related to OSA or response to CPAP therapy. We conclude by discussing conceptual challenges to a clinical trial of OSA treatment for AD prevention, including inclusion criteria for age, OSA severity, and associated symptoms, the need for a potentially long trial, defining relevant primary outcomes, and which treatments to target to optimize treatment adherence.
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Affiliation(s)
- Anna E Mullins
- Mount Sinai Integrative Sleep Center, Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Korey Kam
- Mount Sinai Integrative Sleep Center, Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Ankit Parekh
- Mount Sinai Integrative Sleep Center, Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Omonigho M Bubu
- Center for Brain Health, Department of Psychiatry, NYU Langone Medical Center, New York, NY 10016, USA
| | - Ricardo S Osorio
- Center for Brain Health, Department of Psychiatry, NYU Langone Medical Center, New York, NY 10016, USA
| | - Andrew W Varga
- Mount Sinai Integrative Sleep Center, Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
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14
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Hang LW, Huang CS, Cheng WJ. Clinical characteristics of Asian patients with sleep apnea with low arousal threshold and sleep structure change with continuous positive airway pressure. Sleep Breath 2020; 25:1309-1317. [PMID: 33123927 DOI: 10.1007/s11325-020-02235-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 10/04/2020] [Accepted: 10/21/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Low respiratory arousal threshold (ArTH) has been observed to be prevalent in patients with obstructive sleep apnea (OSA), and is associated with poor adherence to continuous positive airway pressure (CPAP) treatment. This study aimed to examine the associations between low ArTH and clinical characteristics. The second aim was to examine sleep structure changes between diagnostic polysomnography (PSG) and CPAP titration studies. METHODS PSG data for 3718 adults who had an apnea-hypopnea index (AHI) ≥ 5 were reviewed retrospectively, as well as 206 CPAP titration studies among these participants. Participants were dichotomized into low- and high-ArTH groups according to their PSG parameters. The associations between low ArTH and clinical characteristics were examined by multivariate logistic regressions. The sleep structure changes between PSG and CPAP titration studies were examined by repeated measures ANOVA. RESULTS Fifty percent of patients with OSA had low ArTH. Compared with high-ArTH patients, low-ArTH patients were less obese and composed of a higher percentage of women. In logistic regression models, low ArTH was associated with bruxism and nocturia, but not with illnesses after adjusting for AHI and body mass index. Compared with diagnostic PSG studies, low-ArTH patients had significantly decreased stage changes and increased percentage of rapid eye movement sleep during CPAP titration studies. CONCLUSION Low ArTH was prevalent in this large sample of patients with OSA. Arousal threshold was not associated with an increased risk of physical illnesses but was with certain clinical complaints. Low-ArTH patients benefited from CPAP titration study for improved sleep structure.
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Affiliation(s)
- Liang-Wen Hang
- Sleep Medicine Center, Department of Pulmonary and Critical Care Medicine, China Medical University Hospital, Taichung, Taiwan.,School of Nursing & Graduate Institute of Nursing, China Medical University, Taichung, Taiwan
| | - Chun-Sen Huang
- Sleep Medicine Center, Department of Pulmonary and Critical Care Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Wan-Ju Cheng
- Department of Psychiatry, China Medical University Hospital, 2 Yude Road, Taichung, 40447, Taiwan. .,Department of Public Health, China Medical University, Taichung, Taiwan.
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15
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Penner CG, Gerardy B, Ryan R, Williams M. The Odds Ratio Product (An Objective Sleep Depth Measure): Normal Values, Repeatability, and Change With CPAP in Patients With OSA. J Clin Sleep Med 2020; 15:1155-1163. [PMID: 31482838 DOI: 10.5664/jcsm.7812] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The Odds Ratio Product (ORP) is an objective measure of sleep depth using the relationships of the powers of different electroencephalogram (EEG) frequencies in a single index. The range of the ORP is 0 (deeply asleep) to 2.5 (fully awake). This investigation seeks to elucidate normal values of non-rapid eye movement ORP (ORPNR) in healthy individuals, repeatability of the measure, and the change in ORPNR following continuous positive airway pressure (CPAP) treatment. METHODS Healthy individuals underwent a home sleep apnea test (HSAT) with EEG followed 1 week later by EEG alone. Another cohort with OSA underwent baseline HSAT with EEG followed by a second EEG study approximately 4 weeks into treatment with CPAP. RESULTS Thirty-eight healthy individuals completed the protocol (mean age of 34.9 ± 7.4 years, Epworth Sleepiness Scale score 3.6 ± 2.4, Insomnia Severity Index score 2.0 ± 1.6 and Functional Outcomes of Sleep Questionnaire - shorter version score 19 ± 1.2). The mean ORPNR for all nights was 0.52 ± 0.13. The difference between the first night and the second night was 0.024 ± 0.17 (not significant). The intraclass correlation coefficient was 0.525, suggesting only moderate agreement between the first and second nights. The normal value for ORPNR in healthy individuals is ≤ 0.78 units using two standard deviations as the cutoff. Forty participants completed the OSA protocol (mean age 49 ± 11 years, body mass index 35 ± 6 kg/m², apnea-hypopnea index 33.5 ± 28.4 events/h). The mean pre-CPAP ORPNR was 0.69 ± 0.24 and the mean post-CPAP ORPNR was 0.57 ± 0.22 (P = .02). CONCLUSIONS The ORPNR proves to have significant variability from night to night in healthy individuals. ORPNR objectively improves following CPAP treatment, providing further evidence that it measures sleep depth. CITATION Penner CG, Gerardy B, Ryan R, Williams M. The odds ratio product (an objective sleep depth measure): normal values, repeatability, and change with CPAP in patients with OSA. J Clin Sleep Med. 2019;15(8):1155-1163.
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Affiliation(s)
- Charles Gerhard Penner
- University of Manitoba, Winnipeg, Canada; Cerebra Health Inc., Winnipeg, Canada; RANA Respiratory Care Group, Brandon, Manitoba
| | | | - Rob Ryan
- RANA Respiratory Care Group, Brandon, Manitoba
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16
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Zhou X, Lu Q, Li S, Pu Z, Gao F, Zhou B. Risk factors associated with the severity of obstructive sleep apnea syndrome among adults. Sci Rep 2020; 10:13508. [PMID: 32782271 PMCID: PMC7421897 DOI: 10.1038/s41598-020-70286-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 07/21/2020] [Indexed: 12/05/2022] Open
Abstract
Obstructive sleep apnea syndrome (OSAS) is a complete or partial airway obstruction that causes significant physiologic disturbance with various clinical impacts. The aim of the study was to determine the risk factors associated with the severity of OSAS. 303 patients with OSAS and 199 patients without OSAS enrolled in the sleep disorder center from 2017 to 2019 were included in the study. All patients completed physical examination, Epworth sleepiness scale, and polysomnography. By apnea–hypopnea index (AHI), patients were separated into four subsets: AHI < 5 as non-OSAS group, AHI ≧ 5 and < 15 as mild group, AHI ≧ 15 and < 30 as moderate group and AHI ≧ 30 as severe group. AVONA analyses, chi-square test, univariate and multivariate linear regression analyses were conducted to assess the correlation between specific factors and AHI. Our study demonstrated that patients with severe OSAS were associated with higher body mass index, higher systolic blood pressure awake in the morning, lengthened latent period of slow wave sleep, lower level of average oxygen saturation and minimum oxygen saturation (P < 0.05). Our findings provide evidence regarding several potentially useful factors for recognizing OSAS in adults, and physicians should promote the early recognition, diagnosis and intervention of OSAS.
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Affiliation(s)
- Xiaobo Zhou
- Department of Psychosomatics, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China.
| | - Qiao Lu
- Department of Psychosomatics, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China
| | - Shaoping Li
- Department of Psychosomatics, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China
| | - Zhongyin Pu
- Department of Psychosomatics, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China
| | - Fang Gao
- Department of Psychosomatics, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China
| | - Bo Zhou
- Department of Psychosomatics, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China
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17
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Lee WH, Kwon SO, Kim JW. Effectiveness of sleep surgery versus a mandibular advancement device for obstructive sleep apnea in terms of nocturnal cardiac autonomic activity. Sleep Breath 2020; 24:1695-1703. [PMID: 32162279 DOI: 10.1007/s11325-020-02048-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 01/28/2020] [Accepted: 03/04/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Sleep surgery and mandibular advancement devices (MAD) are treatments for obstructive sleep apnea (OSA), but their comparative efficacy remains unclear. We compared their efficacy using various parameters. METHODS Subjects treated for OSA with sleep surgery or MAD (n = 30/group)-matched for sex, body mass index (BMI), and baseline apnea-hypopnea index (AHI)-were enrolled. The efficacy of these treatments according to polysomnographic parameters, sleep quality questionnaires, and heart rate variability (HRV) time- and frequency-domain parameters were compared between pre-treatment and 3-month post-treatment. RESULTS Polysomnographic and sleep quality questionnaire parameters improved significantly in both groups. In time-domain HRV analysis, average normal-to-normal intervals increased significantly in the surgery (942.2 ± 140.8 to 994.6 ± 143.1, P = 0.008) and MAD (901.1 ± 131.7 to 953.7 ± 123.1, P = 0.002) groups. Low frequency (LF) decreased significantly in the surgery group (P = 0.012); high frequency (HF) remained unchanged in both groups. The LF/HF ratio decreased in both groups (2.9 ± 1.8 to 2.3 ± 1.7, P = 0.017, vs. 3.0 ± 1.8 to 2.4 ± 1.4, P = 0.025). Normalized high frequency increased significantly in both groups (31.0 ± 13.2 to 36.8 ± 13.7, P = 0.009, vs. 29.1 ± 10.7 to 33.7 ± 12.5, P = 0.024), in contrast to normalized low frequency. However, no HRV parameter changes differed significantly between the groups after adjusting for age, BMI, and AHI. CONCLUSION Sleep surgery and MAD are equally effective treatments for OSA according to cardiac autonomic activity.
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Affiliation(s)
- Woo Hyun Lee
- Department of Otolaryngology, Kangwon National University Hospital, Chuncheon, South Korea
| | - Sung Ok Kwon
- Biomedical Research Institute, Kangwon National University Hospital, Chuncheon, South Korea
| | - Jeong-Whun Kim
- Department of Otorhinolaryngology, Seoul National University Bundang Hospital, 82 Gumi-ro 173th street, Bundang-gu, Seongnam, Gyeonggi-do, 13620, South Korea. .,Seoul National University College of Medicine, Seoul, South Korea.
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18
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Ren R, Covassin N, Zhang Y, Lei F, Yang L, Zhou J, Tan L, Li T, Li Y, Shi J, Lu L, Somers VK, Tang X. Interaction Between Slow Wave Sleep and Obstructive Sleep Apnea in Prevalent Hypertension. Hypertension 2020; 75:516-523. [PMID: 31865784 DOI: 10.1161/hypertensionaha.119.13720] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Due to frequent abnormal breathing events and their effects on sleep architecture, patients with obstructive sleep apnea (OSA) exhibit decreased amounts of slow wave sleep (SWS). Reduced SWS has been linked to hypertension in community-based studies. We sought to investigate whether SWS percentage modifies the association between OSA and prevalent hypertension. We studied 7107 patients with OSA and 1118 primary snorers who underwent in-laboratory polysomnography. Patients were classified into quartiles of percent SWS. Hypertension was defined based either on clinic blood pressure measures or on physician diagnosis. Multivariable logistic regression model showed a significant interaction effect of OSA and SWS on prevalent hypertension (P=0.002). Decreased SWS was associated with higher odds for hypertension in OSA but not in primary snoring, with patients with OSA exhibiting <0.1% SWS (OR, 1.44 [95% CI, 1.21-1.70]; P=0.001) and those with 0.1% to 4.8% SWS (OR, 1.20 [95% CI, 1.03-1.40]; P=0.02) being more likely to have hypertension compared with those with >11.1% SWS. In analysis stratified by OSA severity, significant associations between percent SWS and blood pressure emerged only in moderate and severe OSA. Effect modifications by sex (P=0.040) and age (P=0.007) were also only evident in OSA, indicating that decreased SWS was associated with hypertension only in men and in patients <60 years old. Decreased SWS is associated with a dose-dependent increase in odds of prevalent hypertension in patients with OSA. The effects of SWS are likely to be modulated by OSA severity. SWS may be implicated in the heightened risk of cardiovascular diseases exhibited by patients with OSA.
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Affiliation(s)
- Rong Ren
- From the Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Translational Neuroscience Center, State Key Laboratory, West China Hospital, Sichuan University, Chengdu, China (R.R., Y.Z., F.L., L.Y., J.Z., L.T., T.L., X.T.)
| | - Naima Covassin
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (N.C., V.K.S.)
| | - Ye Zhang
- From the Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Translational Neuroscience Center, State Key Laboratory, West China Hospital, Sichuan University, Chengdu, China (R.R., Y.Z., F.L., L.Y., J.Z., L.T., T.L., X.T.)
| | - Fei Lei
- From the Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Translational Neuroscience Center, State Key Laboratory, West China Hospital, Sichuan University, Chengdu, China (R.R., Y.Z., F.L., L.Y., J.Z., L.T., T.L., X.T.)
| | - Linghui Yang
- From the Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Translational Neuroscience Center, State Key Laboratory, West China Hospital, Sichuan University, Chengdu, China (R.R., Y.Z., F.L., L.Y., J.Z., L.T., T.L., X.T.)
| | - Junying Zhou
- From the Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Translational Neuroscience Center, State Key Laboratory, West China Hospital, Sichuan University, Chengdu, China (R.R., Y.Z., F.L., L.Y., J.Z., L.T., T.L., X.T.)
| | - Lu Tan
- From the Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Translational Neuroscience Center, State Key Laboratory, West China Hospital, Sichuan University, Chengdu, China (R.R., Y.Z., F.L., L.Y., J.Z., L.T., T.L., X.T.)
| | - Taomei Li
- From the Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Translational Neuroscience Center, State Key Laboratory, West China Hospital, Sichuan University, Chengdu, China (R.R., Y.Z., F.L., L.Y., J.Z., L.T., T.L., X.T.)
| | - Yun Li
- Sleep Medicine Center, Shantou University Medical College, Shantou, China (Y.L.)
| | - Jie Shi
- National Institute on Drug Dependence, Peking University Sixth Hospital, Institute of Mental Health and Key Laboratory of Mental Health, Peking University, Beijing, China (L.L., J.S.)
| | - Lin Lu
- National Institute on Drug Dependence, Peking University Sixth Hospital, Institute of Mental Health and Key Laboratory of Mental Health, Peking University, Beijing, China (L.L., J.S.)
| | - Virend K Somers
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (N.C., V.K.S.)
| | - Xiangdong Tang
- From the Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Translational Neuroscience Center, State Key Laboratory, West China Hospital, Sichuan University, Chengdu, China (R.R., Y.Z., F.L., L.Y., J.Z., L.T., T.L., X.T.)
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19
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Bubu OM, Andrade AG, Umasabor-Bubu OQ, Hogan MM, Turner AD, de Leon MJ, Ogedegbe G, Ayappa I, Jean-Louis G G, Jackson ML, Varga AW, Osorio RS. Obstructive sleep apnea, cognition and Alzheimer's disease: A systematic review integrating three decades of multidisciplinary research. Sleep Med Rev 2019; 50:101250. [PMID: 31881487 DOI: 10.1016/j.smrv.2019.101250] [Citation(s) in RCA: 190] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 11/25/2019] [Accepted: 11/28/2019] [Indexed: 12/29/2022]
Abstract
Increasing evidence links cognitive-decline and Alzheimer's disease (AD) to various sleep disorders, including obstructive sleep apnea (OSA). With increasing age, there are substantial differences in OSA's prevalence, associated comorbidities and phenotypic presentation. An important question for sleep and AD researchers is whether OSA's heterogeneity results in varying cognitive-outcomes in older-adults compared to middle-aged adults. In this review, we systematically integrated research examining OSA and cognition, mild cognitive-impairment (MCI) and AD/AD biomarkers; including the effects of continuous positive airway pressure (CPAP) treatment, particularly focusing on characterizing the heterogeneity of OSA and its cognitive-outcomes. Broadly, in middle-aged adults, OSA is often associated with mild impairment in attention, memory and executive function. In older-adults, OSA is not associated with any particular pattern of cognitive-impairment at cross-section; however, OSA is associated with the development of MCI or AD with symptomatic patients who have a higher likelihood of associated disturbed sleep/cognitive-impairment driving these findings. CPAP treatment may be effective in improving cognition in OSA patients with AD. Recent trends demonstrate links between OSA and AD-biomarkers of neurodegeneration across all age-groups. These distinct patterns provide the foundation for envisioning better characterization of OSA and the need for more sensitive/novel sleep-dependent cognitive assessments to assess OSA-related cognitive-impairment.
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Affiliation(s)
- Omonigho M Bubu
- Center for Brain Health, Department of Psychiatry, NYU Langone Medical Center, New York, NY, USA; Department of Population Health, New York University School of Medicine, Center for Healthful Behavior Change, New York, USA; Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL, USA; Department of Applied Health Sciences, Wheaton College, Wheaton, IL, USA.
| | - Andreia G Andrade
- Center for Brain Health, Department of Psychiatry, NYU Langone Medical Center, New York, NY, USA
| | | | - Megan M Hogan
- Department of Applied Health Sciences, Wheaton College, Wheaton, IL, USA
| | - Arlener D Turner
- Center for Brain Health, Department of Psychiatry, NYU Langone Medical Center, New York, NY, USA; Department of Human Services and Psychology, National Louis University, Chicago, IL, USA
| | - Mony J de Leon
- Center for Brain Health, Department of Psychiatry, NYU Langone Medical Center, New York, NY, USA; Department of Radiology, Weill Cornell Medicine, New York, NY 10065, USA
| | - Gbenga Ogedegbe
- Department of Population Health, New York University School of Medicine, Center for Healthful Behavior Change, New York, USA
| | - Indu Ayappa
- Division of Pulmonary, Critical Care and Sleep Medicine at the Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Girardin Jean-Louis G
- Center for Brain Health, Department of Psychiatry, NYU Langone Medical Center, New York, NY, USA; Department of Population Health, New York University School of Medicine, Center for Healthful Behavior Change, New York, USA
| | - Melinda L Jackson
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia; School of Health & Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Andrew W Varga
- Division of Pulmonary, Critical Care and Sleep Medicine at the Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ricardo S Osorio
- Center for Brain Health, Department of Psychiatry, NYU Langone Medical Center, New York, NY, USA.
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20
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PEREGRIM I, GREŠOVÁ S, ŠTIMMELOVÁ J, BAČOVÁ I, FULTON B, TOKÁROVÁ D, GÁBOROVÁ M, BRANDEBUROVÁ A, DONIČOVÁ V, RUSNÁKOVÁ S, TOMORI Z, DONIČ V. Strong Coincidence Between Slow Wave Sleep and Low AHI is Explainable by the High Instability of Slow Wave Sleep to Obstructive Apnea Exposure. Physiol Res 2019; 68:857-865. [DOI: 10.33549/physiolres.934025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
It is well known that in patients with obstructive sleep apnea syndrome (OSAS) the apnea-hypopnea index (AHI) is significantly decreased during slow wave sleep (SWS). It used to be explained by the ability of SWS to stabilize the upper airways against collapse. Another explanation, which is the focus of the current study, is that it is just a result of high instability of SWS to obstructive apnea exposure, i.e. high susceptibility of SWS to transition into lighter sleep stages during exposure to obstructive apneas. A retrospective chart review was performed on 560 males who underwent an overnight polysomnography. Two hundred and eighty-seven patients were eligible for the study. They were divided into 3 groups according to different AHI level. All three groups had a higher SWS occurrence in the lateral position than in the supine position. A special fourth group of patients was created with severe OSAS in the supine position but with very mild OSAS in the lateral position. This group had, in the lateral position, (A) higher AHI in NREM sleep (4.1±3.1/h vs. 0.7±1.2/h, p<0.001) as well as (B) higher SWS occurrence (27.7±15.0 % vs. 21.4±16.2 % of NREM sleep, p<0.05), than the group with the lowest AHI in the study, i.e. AHI<5/h in NREM sleep. These data suggest that strong coincidence between SWS and low AHI is the result of the high instability of SWS to obstructive apnea exposure. The data also support the presence of SWS-rebound in OSAS patients in the lateral body position.
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Affiliation(s)
- I. PEREGRIM
- Department of Medical Physiology, Faculty of Medicine, P. J. Šafárik University, Košice, Slovakia,
| | - S. GREŠOVÁ
- Department of Medical Physiology, Faculty of Medicine, P. J. Šafárik University, Košice, Slovakia,
| | - J. ŠTIMMELOVÁ
- Department of Medical Physiology, Faculty of Medicine, P. J. Šafárik University, Košice, Slovakia,
| | - I. BAČOVÁ
- Department of Medical Physiology, Faculty of Medicine, P. J. Šafárik University, Košice, Slovakia,
| | - B. FULTON
- Department of Biology, Belmont College, Tennessee, USA
| | - D. TOKÁROVÁ
- Department of Medical Physiology, Faculty of Medicine, P. J. Šafárik University, Košice, Slovakia,
| | - M. GÁBOROVÁ
- Department of Medical Physiology, Faculty of Medicine, P. J. Šafárik University, Košice, Slovakia,
| | - A. BRANDEBUROVÁ
- Department of Medical Physiology, Faculty of Medicine, P. J. Šafárik University, Košice, Slovakia,
| | - V. DONIČOVÁ
- Department of Pathological Physiology, Faculty of Medicine, P. J. Šafárik University, Košice, Slovakia
| | - S. RUSNÁKOVÁ
- Department of Pathological Physiology, Faculty of Medicine, P. J. Šafárik University, Košice, Slovakia
| | - Z. TOMORI
- Department of Medical Physiology, Faculty of Medicine, P. J. Šafárik University, Košice, Slovakia,
| | - V. DONIČ
- Department of Medical Physiology, Faculty of Medicine, P. J. Šafárik University, Košice, Slovakia,
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21
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Andrade AG, Bubu OM, Varga AW, Osorio RS. The Relationship between Obstructive Sleep Apnea and Alzheimer's Disease. J Alzheimers Dis 2019; 64:S255-S270. [PMID: 29782319 DOI: 10.3233/jad-179936] [Citation(s) in RCA: 124] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Obstructive sleep apnea (OSA) and Alzheimer's disease (AD) are highly prevalent conditions with growing impact on our aging society. While the causes of OSA are now better characterized, the mechanisms underlying AD are still largely unknown, challenging the development of effective treatments. Cognitive impairment, especially affecting attention and executive functions, is a recognized clinical consequence of OSA. A deeper contribution of OSA to AD pathogenesis is now gaining support from several lines of research. OSA is intrinsically associated with disruptions of sleep architecture, intermittent hypoxia and oxidative stress, intrathoracic and hemodynamic changes as well as cardiovascular comorbidities. All of these could increase the risk for AD, rendering OSA as a potential modifiable target for AD prevention. Evidence supporting the relevance of each of these mechanisms for AD risk, as well as a possible effect of AD in OSA expression, will be explored in this review.
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Affiliation(s)
- Andreia G Andrade
- Department of Neurology, Alzheimer's Disease Center, NYU Langone Medical Center, New York, NY, USA.,Department of Psychiatry, Center for Brain Health, NYU Langone Medical Center, New York, NY, USA
| | - Omonigho M Bubu
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL, USA
| | - Andrew W Varga
- Division of Pulmonary, Critical Care and Sleep Medicine at the Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ricardo S Osorio
- Department of Psychiatry, Center for Brain Health, NYU Langone Medical Center, New York, NY, USA.,Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York, NY, USA
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22
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Ju YES, Zangrilli MA, Finn MB, Fagan AM, Holtzman DM. Obstructive sleep apnea treatment, slow wave activity, and amyloid-β. Ann Neurol 2019; 85:291-295. [PMID: 30597615 DOI: 10.1002/ana.25408] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 12/05/2018] [Accepted: 12/22/2018] [Indexed: 12/31/2022]
Abstract
Obstructive sleep apnea (OSA) increases risk of dementia, a relationship that may be mediated by amyloid-β (Aβ) and downstream Alzheimer disease pathology. We previously showed that OSA may impair Aβ clearance and affect the relationship between slow wave activity (SWA) and Aβ. In this study, SWA and CSF Aβ were measured in participants with OSA before and 1 to 4 months after treatment. OSA treatment increased SWA, and SWA was significantly correlated with lower Aβ after treatment. Greater improvement in OSA was associated with greater decreases in Aβ. We propose a model whereby OSA treatment may affect both Aβ release and clearance. Ann Neurol 2018 ANN NEUROL 2019;85:291-295.
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Affiliation(s)
- Yo-El S Ju
- Department of Neurology, Washington University, Saint Louis, MO.,Hope Center for Neurological Disorders, Washington University, Saint Louis, MO
| | | | - Mary Beth Finn
- Department of Neurology, Washington University, Saint Louis, MO
| | - Anne M Fagan
- Department of Neurology, Washington University, Saint Louis, MO.,Hope Center for Neurological Disorders, Washington University, Saint Louis, MO
| | - David M Holtzman
- Department of Neurology, Washington University, Saint Louis, MO.,Hope Center for Neurological Disorders, Washington University, Saint Louis, MO
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23
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Sharma RA, Varga AW, Bubu OM, Pirraglia E, Kam K, Parekh A, Wohlleber M, Miller MD, Andrade A, Lewis C, Tweardy S, Buj M, Yau PL, Sadda R, Mosconi L, Li Y, Butler T, Glodzik L, Fieremans E, Babb JS, Blennow K, Zetterberg H, Lu SE, Badia SG, Romero S, Rosenzweig I, Gosselin N, Jean-Louis G, Rapoport DM, de Leon MJ, Ayappa I, Osorio RS. Obstructive Sleep Apnea Severity Affects Amyloid Burden in Cognitively Normal Elderly. A Longitudinal Study. Am J Respir Crit Care Med 2018; 197:933-943. [PMID: 29125327 PMCID: PMC6020410 DOI: 10.1164/rccm.201704-0704oc] [Citation(s) in RCA: 164] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 11/09/2017] [Indexed: 12/13/2022] Open
Abstract
RATIONALE Recent evidence suggests that obstructive sleep apnea (OSA) may be a risk factor for developing mild cognitive impairment and Alzheimer's disease. However, how sleep apnea affects longitudinal risk for Alzheimer's disease is less well understood. OBJECTIVES To test the hypothesis that there is an association between severity of OSA and longitudinal increase in amyloid burden in cognitively normal elderly. METHODS Data were derived from a 2-year prospective longitudinal study that sampled community-dwelling healthy cognitively normal elderly. Subjects were healthy volunteers between the ages of 55 and 90, were nondepressed, and had a consensus clinical diagnosis of cognitively normal. Cerebrospinal fluid amyloid β was measured using ELISA. Subjects received Pittsburgh compound B positron emission tomography scans following standardized procedures. Monitoring of OSA was completed using a home sleep recording device. MEASUREMENTS AND MAIN RESULTS We found that severity of OSA indices (AHIall [F1,88 = 4.26; P < 0.05] and AHI4% [F1,87 = 4.36; P < 0.05]) were associated with annual rate of change of cerebrospinal fluid amyloid β42 using linear regression after adjusting for age, sex, body mass index, and apolipoprotein E4 status. AHIall and AHI4% were not associated with increases in ADPiB-mask (Alzheimer's disease vulnerable regions of interest Pittsburg compound B positron emission tomography mask) most likely because of the small sample size, although there was a trend for AHIall (F1,28 = 2.96, P = 0.09; and F1,28 = 2.32, not significant, respectively). CONCLUSIONS In a sample of cognitively normal elderly, OSA was associated with markers of increased amyloid burden over the 2-year follow-up. Sleep fragmentation and/or intermittent hypoxia from OSA are likely candidate mechanisms. If confirmed, clinical interventions for OSA may be useful in preventing amyloid build-up in cognitively normal elderly.
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Affiliation(s)
- Ram A. Sharma
- Center for Brain Health, Department of Psychiatry, and
| | - Andrew W. Varga
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Omonigho M. Bubu
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, Florida
| | | | - Korey Kam
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ankit Parekh
- College of Engineering, The University of Iowa, Iowa City, Iowa
| | | | | | | | - Clifton Lewis
- Center for Brain Health, Department of Psychiatry, and
| | | | - Maja Buj
- Center for Brain Health, Department of Psychiatry, and
| | - Po L. Yau
- Center for Brain Health, Department of Psychiatry, and
| | - Reem Sadda
- Harlem Hospital–Columbia University Medical Center, New York, New York
| | - Lisa Mosconi
- Center for Brain Health, Department of Psychiatry, and
| | - Yi Li
- Center for Brain Health, Department of Psychiatry, and
| | - Tracy Butler
- Center for Brain Health, Department of Psychiatry, and
| | - Lidia Glodzik
- Center for Brain Health, Department of Psychiatry, and
| | - Els Fieremans
- Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York
| | - James S. Babb
- Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York
| | - Kaj Blennow
- Institute of Neuroscience and Psychiatry, Department of Psychiatry and Neurochemistry, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Henrik Zetterberg
- Institute of Neuroscience and Psychiatry, Department of Psychiatry and Neurochemistry, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Molecular Neuroscience, UCL Institute of Neurology, Queen Square, London, United Kingdom
| | - Shou E. Lu
- Department of Biostatistics, Rutgers School of Public Health, Piscataway, New Jersey
| | - Sandra G. Badia
- Sleep Unit, Respiratory Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Institute for Biomedical Research Sant Pau, CIBERSAM, Barcelona, Spain
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain
| | - Sergio Romero
- Biomedical Engineering Research Centre, Department of Automatic Control, Universitat Politècnica de Catalunya, Barcelona, Spain
- CIBER de Bioingeniería, Biomateriales y Nanomedicina, Barcelona, Spain
| | - Ivana Rosenzweig
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- Sleep Disorders Centre, Guy’s and St. Thomas’ Hospital, GSTT NHS Trust, London, United Kingdom
| | - Nadia Gosselin
- Center for Advanced Research in Sleep Medicine, Hospital du Sacre-Coeur de Montreal, Montreal, Quebec, Canada; and
- Department of Psychology, Universite de Montreal, Montreal, Quebec, Canada
| | - Girardin Jean-Louis
- Center for Healthful Behavior Change, Division of Health and Behavior, Department of Population Health, New York University Langone Medical Center, New York, New York
| | - David M. Rapoport
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Indu Ayappa
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
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24
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Nigam G, Camacho M, Riaz M. Rapid Eye Movement (REM) rebound on initial exposure to CPAP therapy: a systematic review and meta-analysis. SLEEP SCIENCE AND PRACTICE 2017. [DOI: 10.1186/s41606-017-0014-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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25
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Palen BN, Donovan LM, Parsons EC. An Unexpected Polysomnogram Finding. J Clin Sleep Med 2016; 12:1567-1569. [PMID: 27707444 DOI: 10.5664/jcsm.6294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 08/22/2016] [Indexed: 11/13/2022]
Affiliation(s)
- Brian N Palen
- Division of Pulmonary & Critical Care Medicine, VA Puget Sound Health Care System, Seattle, WA.,Division of Pulmonary & Critical Care Medicine, University of Washington, Seattle, WA
| | - Lucas M Donovan
- Division of Pulmonary & Critical Care Medicine, University of Washington, Seattle, WA
| | - Elizabeth C Parsons
- Division of Pulmonary & Critical Care Medicine, VA Puget Sound Health Care System, Seattle, WA.,Division of Pulmonary & Critical Care Medicine, University of Washington, Seattle, WA
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26
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Koo DL, Nam H. Clinical Considerations of Obstructive Sleep Apnea with Little REM Sleep. J Clin Neurol 2016; 12:426-433. [PMID: 27486934 PMCID: PMC5063868 DOI: 10.3988/jcn.2016.12.4.426] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 02/24/2016] [Accepted: 02/25/2016] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND AND PURPOSE Obstructive sleep apnea (OSA) is more severe during rapid eye movement (REM) sleep than during non-REM sleep. We aimed to determine the features of patients with OSA who experience little REM sleep. METHODS Patients with a chief complaint of sleep-disordered breathing were enrolled. All subjects underwent overnight polysomnography (PSG) and completed questionnaires on sleep quality. Patients were divided into the following three groups according to the proportion of REM sleep detected in overnight PSG: little REM sleep [REM sleep <20% of total sleep time (TST)], normal REM sleep (20-25% of TST), and excessive REM sleep (>25% of TST). Multiple logistic regression analyses were applied to the data. The success rate of continuous positive airway pressure (CPAP) titration was estimated in these groups. RESULTS The age and body mass index of the patients were 47.9±15.9 years (mean±SD) and 25.2±4.1 kg/m², respectively. The 902 patients comprised 684 (76%) men and 218 (24%) women. The apnea-hypopnea index (AHI) in the little-REM-sleep group was 22.1±24.4 events/hour, which was significantly higher than those in the other two groups (p<0.05). Multiple logistic regression showed that a higher AHI (p<0.001; odds ratio, 1.512; 95% confidence interval, 1.020-1.812) was independently predictive of little REM sleep. The titration success rate was lower in the little-REM-sleep group than in the normal-REM-sleep group (p=0.038). CONCLUSIONS The AHI is higher and the success rate of CPAP titration is lower in OSA patients with little REM sleep than those with normal REM sleep.
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Affiliation(s)
- Dae Lim Koo
- Department of Neurology, Seoul National University Boramae Hospital, Seoul, Korea
| | - Hyunwoo Nam
- Department of Neurology, Seoul National University Boramae Hospital, Seoul, Korea.
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27
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First Exposure to Continuous Positive Airway Pressure Therapy for a Patient with Symptoms Suggestive of Severe Obstructive Sleep Apnea. Ann Am Thorac Soc 2015; 12:1410-2. [DOI: 10.1513/annalsats.201505-286cc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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28
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Extreme REM Rebound during Continuous Positive Airway Pressure Titration for Obstructive Sleep Apnea in a Depressed Patient. Case Rep Med 2014; 2014:292181. [PMID: 24876843 PMCID: PMC4024427 DOI: 10.1155/2014/292181] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 04/06/2014] [Indexed: 11/17/2022] Open
Abstract
A 20% increase in REM sleep duration has been proposed as a threshold to identify REM rebound in patients with obstructive sleep apnea (OSA) who start continuous positive airway pressure (CPAP) treatment. We describe the case of one patient with OSA who showed an unexpectedly high degree of REM rebound during titration of CPAP. A 34-year-old man was diagnosed with OSA. He remained untreated for many years, during which he developed systemic hypertension, depression, and severe daytime somnolence. When he was reevaluated sixteen years later, his Epworth sleepiness score was 18, and his OSA had greatly worsened (apnea/hypopnea index: 47, lowest nocturnal saturation: 57%). He underwent a successful CPAP titration during nocturnal polysomnography. Electroencephalographic analysis of the sleep recording revealed a huge amount of REM sleep, accounting for 72% of the total sleep time. When asked, the patient referred that he had suddenly interrupted paroxetine assumption three days before the polysomnography. The very large REM rebound observed in this patient could be due to additional effects of initiation of CPAP therapy and suspension of antidepressive treatment. This case does not report any dangerous consequence, but sudden antidepressive withdrawal could be dangerous for patients with OSA who develop hypoventilation during REM sleep with CPAP application.
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29
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Cardiopulmonary coupling analysis: changes before and after treatment with a mandibular advancement device. Sleep Breath 2014; 18:891-6. [PMID: 24699839 DOI: 10.1007/s11325-014-0961-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 02/17/2014] [Accepted: 02/18/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE The aim of this study is to evaluate the changes of sleep quality in patients using a mandibular advancement device (MAD) for obstructive sleep apnea (OSA) based upon cardiopulmonary coupling (CPC). METHODS A total of 52 patients (mean age 53.7±9.6 years, range 33-74 years) were included in this study. Of them, there were 47 males (90.4%). All subjects were diagnosed with OSA after in-laboratory full-night polysomnography and reevaluated after 3-month use of a MAD. At baseline, apnea-hypopnea index (AHI) was 33.6±17.0, Epworth sleepiness scale was 10.5±4.8, and Pittsburgh sleep quality index was 5.8±2.8. The CPC parameters were extracted from single-lead electrocardiography of polysomnography. We compared CPC parameters at baseline with those after 3-month use of a MAD. RESULTS All respiratory indices improved with the use of MAD. However, there were no differences in the sleep architectures except N3 sleep (3.7±4.3 to 6.9±6.4%, p<0.001). The CPC parameters showed a significant improvement with the use of MAD. Low-frequency coupling (59.5±16.1 to 47.7±14.8%, p<0.001) and elevated low-frequency coupling (44.6±18.4 to 32.6±15.7%, p<0.001) significantly decreased. High-frequency coupling (28.6±16.0 to 36.5±15.7%, p=0.004) and very low frequency coupling (11.7±7.2 to 15.3±6.6%, p=0.028) significantly increased. The change of AHI significantly correlated with changes of the CPC parameters: negatively correlated with high-frequency coupling change (r=-0.572, p<0.001) and positively correlated with low-frequency and elevated low-frequency coupling changes (r=0.604 and 0.497, respectively; p<0.001 in both). However, the changes of Epworth sleepiness scale and Pittsburgh sleep quality index after MAD therapy showed no significant correlation with the changes in the CPC parameters. CONCLUSIONS To our knowledge, this is the first study to evaluate the quality of sleep in patients using a MAD for their OSA based upon CPC analysis. Low-frequency coupling decreased as AHI improved, while high-frequency coupling increased as AHI improved. The CPC parameters showed that the sleep quality was improved by MAD therapy.
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30
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Effect of musculoskeletal pain on sleep architecture in patients with obstructive sleep apnea. Sleep Breath 2014; 18:571-7. [DOI: 10.1007/s11325-013-0920-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 11/04/2013] [Accepted: 11/21/2013] [Indexed: 10/25/2022]
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31
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Neikrug AB, Liu L, Avanzino JA, Maglione JE, Natarajan L, Bradley L, Maugeri A, Corey-Bloom J, Palmer BW, Loredo JS, Ancoli-Israel S. Continuous positive airway pressure improves sleep and daytime sleepiness in patients with Parkinson disease and sleep apnea. Sleep 2014; 37:177-85. [PMID: 24470706 DOI: 10.5665/sleep.3332] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA), common in Parkinson disease (PD), contributes to sleep disturbances and daytime sleepiness. We assessed the effect of continuous positive airway pressure (CPAP) on OSA, sleep, and daytime sleepiness in patients with PD. DESIGN This was a randomized placebo-controlled, crossover design. Patients with PD and OSA were randomized into 6 w of therapeutic treatment or 3 w of placebo followed by 3 w of therapeutic treatment. Patients were evaluated by polysomnography (PSG) and multiple sleep latency test (MSLT) pretreatment (baseline), after 3 w, and after 6 w of CPAP treatment. Analyses included mixed models, paired analysis, and within-group analyses comparing 3 w to 6 w of treatment. SETTING Sleep laboratory. PARTICIPANTS Thirty-eight patients with PD (mean age = 67.2 ± 9.2 y; 12 females). INTERVENTION Continuous positive airway pressure. MEASUREMENTS PSG OUTCOME MEASURES: sleep efficiency, %sleep stages (N1, N2, N3, R), arousal index, apnea-hypopnea index (AHI), and % time oxygen saturation < 90% (%time SaO2 < 90%). MSLT outcome measures: mean sleep-onset latency (MSL). RESULTS There were significant group-by-time interactions for AHI (P < 0.001), % time SaO2 < 90% (P = 0.02), %N2 (P = 0.015) and %N3 (P = 0.014). Subjects receiving therapeutic CPAP showed significant decrease in AHI, %time SaO2 < 90%, %N2, and significant increase in %N3 indicating effectiveness of CPAP in the treatment of OSA, improvement in nighttime oxygenation, and in deepening sleep. The paired sample analyses revealed that 3 w of therapeutic treatment resulted in significant decreases in arousal index (t = 3.4, P = 0.002). All improvements after 3 w were maintained at 6 w. Finally, 3 w of therapeutic CPAP also resulted in overall decreases in daytime sleepiness (P = 0.011). CONCLUSIONS Therapeutic continuous positive airway pressure versus placebo was effective in reducing apnea events, improving oxygen saturation, and deepening sleep in patients with Parkinson disease and obstructive sleep apnea. Additionally, arousal index was reduced and effects were maintained at 6 weeks. Finally, 3 weeks of continuous positive airway pressure treatment resulted in reduced daytime sleepiness measured by multiple sleep latency test. These results emphasize the importance of identifying and treating obstructive sleep apnea in patients with Parkinson disease.
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Affiliation(s)
- Ariel B Neikrug
- San Diego State University and University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA
| | - Lianqi Liu
- Department of Psychiatry, University of California San Diego, San Diego, CA
| | - Julie A Avanzino
- Department of Psychiatry, University of California San Diego, San Diego, CA
| | - Jeanne E Maglione
- Department of Psychiatry, University of California San Diego, San Diego, CA
| | - Loki Natarajan
- Department of Family and Preventive Medicine, University of California San Diego, San Diego, CA
| | - Lenette Bradley
- Department of Psychiatry, University of California San Diego, San Diego, CA
| | - Alex Maugeri
- Department of Psychiatry, University of California San Diego, San Diego, CA
| | - Jody Corey-Bloom
- Department of Neurosciences, University of California San Diego, San Diego, CA
| | - Barton W Palmer
- San Diego State University and University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA ; Department of Psychiatry, University of California San Diego, San Diego, CA ; Veterans Medical Research Foundation, San Diego, CA
| | - Jose S Loredo
- Department of Medicine, University of California San Diego, San Diego, CA
| | - Sonia Ancoli-Israel
- San Diego State University and University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA ; Department of Psychiatry, University of California San Diego, San Diego, CA ; Department of Medicine, University of California San Diego, San Diego, CA ; Veterans Affairs Center of Excellence for Stress and Mental Health, San Diego, CA
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32
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PEREGRIM I, GREŠOVÁ S, PALLAYOVÁ M, FULTON BL, ŠTIMMELOVÁ J, BAČOVÁ I, MIKUĽAKOVÁ A, TOMORI Z, DONIČ V. Does Obstructive Sleep Apnea Worsen During REM Sleep? Physiol Res 2013; 62:569-75. [DOI: 10.33549/physiolres.932457] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Although it is thought that obstructive sleep apnea (OSA) is worse during rapid eye movement (REM) sleep than in non-REM (NREM) sleep there are some uncertainties, especially about apnoe-hypopnoe-index (AHI). Several studies found no significant difference in AHI between both sleep stages. However, REM sleep is associated more with side sleeping compared to NREM sleep, which suggests that body position is a possible confounding factor. The main purpose of this study was to compare the AHI in REM and NREM sleep in both supine and lateral body position. A retrospective study was performed on 422 consecutive patients who underwent an overnight polysomnography. Women had higher AHI in REM sleep than NREM sleep in both supine (46.05±26.26 vs. 23.91±30.96, P<0.01) and lateral (18.16±27.68 vs. 11.30±21.09, P<0.01) body position. Men had higher AHI in REM sleep than NREM sleep in lateral body position (28.94±28.44 vs. 23.58±27.31, P<0.01), however, they did not reach statistical significance in supine position (49.12±32.03 in REM sleep vs. 45.78±34.02 in NREM sleep, P=0.50). In conclusion, our data suggest that REM sleep is a contributing factor for OSA in women as well as in men, at least in lateral position.
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Affiliation(s)
- I. PEREGRIM
- Department of Medical Physiology, Faculty of Medicine, P. J. Šafárik University, Košice, Slovakia
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Eves ND, Song Y, Piper A, Maher TM. Year in review 2012: acute lung injury, interstitial lung diseases, sleep and physiology. Respirology 2013; 18:555-64. [PMID: 23336426 DOI: 10.1111/resp.12053] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Accepted: 01/16/2013] [Indexed: 01/14/2023]
Affiliation(s)
- Neil D Eves
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
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Wang L, Kim PY, McCarty DE, Frilot C, Chesson AL, Carrubba S, Marino AA. EEG recurrence markers and sleep quality. J Neurol Sci 2013; 331:26-30. [DOI: 10.1016/j.jns.2013.04.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 04/15/2013] [Accepted: 04/18/2013] [Indexed: 11/27/2022]
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Jurysta F, Kempenaers C, Lanquart JP, Noseda A, van de Borne P, Linkowski P. Long-term CPAP treatment partially improves the link between cardiac vagal influence and delta sleep. BMC Pulm Med 2013; 13:29. [PMID: 23628083 PMCID: PMC3685543 DOI: 10.1186/1471-2466-13-29] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Accepted: 04/18/2013] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Continuous positive airway pressure (CPAP) treatment improves the risk of cardiovascular events in patients suffering from severe sleep apnea-hypopnea syndrome (SAHS) but its effect on the link between delta power band that is related to deep sleep and the relative cardiac vagal component of heart rate variability, HF(nu) of HRV, is unknown. Therefore, we tested the hypothesis that CPAP restores the link between cardiac autonomic activity and delta sleep across the night. METHODS Eight patients suffering from severe SAHS before and after 4 ± 3 years of nasal CPAP treatment were matched with fourteen healthy controls. Sleep EEG and ECG were analysed to obtain spectral sleep and HRV components. Coherence analysis was applied between HF(nu) and delta power bands across the first three sleep cycles. RESULTS Sleep characteristics and spectral HRV components were similar between untreated patients, treated patients and controls, with the exception of decreased Rapid Eye Movement duration in untreated patients. Coherence and gain values between HF(nu) and delta EEG variability were decreased in untreated patients while gain values normalized in treated patients. In patients before and during long-term CPAP treatment, phase shift and delay between modifications in HF(nu) and delta EEG variability did not differ from controls but were not different from zero. In healthy men, changes in cardiac vagal activity appeared 9 ± 7 minutes before modifications in delta sleep. CONCLUSIONS Long-term nasal CPAP restored, in severe SAHS, the information between cardiovascular and sleep brainstem structures by increasing gain, but did not improve its tightness or time shift.
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Affiliation(s)
- Fabrice Jurysta
- Sleep Laboratory and Laboratory of Psychiatric Research, Department of Psychiatry, Erasme Academic Hospital - ULB, Brussels, Belgium
| | - Chantal Kempenaers
- Sleep Laboratory and Laboratory of Psychiatric Research, Department of Psychiatry, Erasme Academic Hospital - ULB, Brussels, Belgium
| | - Jean-Pol Lanquart
- Sleep Laboratory and Laboratory of Psychiatric Research, Department of Psychiatry, Erasme Academic Hospital - ULB, Brussels, Belgium
| | - André Noseda
- Chest Department, Erasme Academic Hospital-ULB, Brussels, Belgium
| | - Philippe van de Borne
- Department of Cardiology and Hypertension Clinic, Erasme Academic Hospital - ULB, Brussels, Belgium
| | - Paul Linkowski
- Sleep Laboratory and Laboratory of Psychiatric Research, Department of Psychiatry, Erasme Academic Hospital - ULB, Brussels, Belgium
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Farid-Moayer M, Siegel LC, Black J. A feasibility evaluation of oral pressure therapy for the treatment of obstructive sleep apnea. Ther Adv Respir Dis 2012. [DOI: 10.1177/1753465812468043] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Objective: This feasibility study examined the initial-use safety and potential utility of a novel noninvasive oral pressure therapy (OPT) system designed to reduce airway obstruction during sleep. Methods: This was a single-center, proof-of-concept, single-treatment-night study in which subjects with obstructive sleep apnea (OSA) underwent a baseline polysomnography (PSG) study followed by PSG during use of an OPT system. The OPT system is composed of a bedside console, a polymer mouthpiece, and a flexible tube connecting the mouthpiece to the console. The console contains a pump that creates vacuum intended to pull the soft palate anteriorly and stabilize the tongue to reduce obstruction during sleep. Results: Fifty-four men and 17 women, aged 53.2 ± 11.5 years (mean ± SD) had a baseline apnea–hypopnea index (AHI) greater than 5 events per hour. OPT was generally well tolerated with no serious adverse events. OPT significantly decreased AHI from 34.4 ± 28.9 events per hour (mean ± SD) at baseline to 20.7 ± 23.3 ( p < 0.001). Treatment produced an AHI less than 10 in 48% of the subjects. OPT significantly improved oxygen desaturation index ( p < 0.001) and increased the percentage of the night with oxygen saturation of 90% or greater ( p = 0.028). Stage-N1 sleep shifts, total sleep-stage shifts, awakenings and the percentage of sleep time spent in N1 sleep were significantly reduced with treatment. Conclusion: This proof-of-concept study suggests that OPT can produce clinically relevant relief of OSA in certain subjects who are readily identified by PSG during trial use of the noninvasive system. OPT shows promise as a new treatment option for OSA in appropriate patients.
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Affiliation(s)
- Mehran Farid-Moayer
- Peninsula Sleep Center, Suite 707, 1828 El Camino Real, Burlingame, CA 94010, USA
| | - Lawrence C. Siegel
- Stanford University School of Medicine and ApniCure, Inc., Palo Alto, CA, USA
| | - Jed Black
- Stanford Center for Sleep Research and Medicine, Stanford University School of Medicine, Redwood City, CA, USA
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