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Puretić H, Bosnar Puretić M, Pavliša G, Jakopović M. Revisiting the Epworth sleepiness scale : Is excessive daytime sleepiness still a valid screening tool for obstructive sleep apnea in a population at risk? Wien Klin Wochenschr 2024; 136:390-397. [PMID: 37273017 DOI: 10.1007/s00508-023-02213-4] [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: 10/18/2022] [Accepted: 04/20/2023] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Obstructive sleep apnea (OSA) is a common medical problem with numerous comorbidities and high costs. Since the introduction of the Epworth sleepiness scale (ESS), excessive daytime sleepiness (EDS) has been considered the most common and prominent symptom of OSA. Aim of this study was to re-evaluate the ESS for detection of OSA in a population at risk compared to the gold standard overnight polysomnography (PSG). METHODS A total of 266 patients (mean age 57.9 ± 11.6 years; 189 men and 77 women), referred to our sleep laboratory for probable OSA, were given ESS followed by an overnight PSG. The ESS values were compared to PSG apnea hypopnea index (AHI) with sensitivity (SE), specificity (SP), positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy (DA) calculated for ESS. The positive cut-off value for ESS was ≥ 10 and for AHI ≥ 5. RESULTS Only 92 (34.6%) subjects had a positive ESS. An OSA was diagnosed by PSG in 213 (80.1%) subjects: 46 having mild, 37 moderate and 130 severe apnea. Most subjects with positive ESS (88.0%) were found to have OSA but most subjects with a negative ESS (75.9%) were also positive for OSA (42% with AHI ≥ 30). The area under the receiver operating characteristic (ROC) curve for ESS was 0.60 (95% confidence interval, CI 0.54-0.66; p = 0.020) with SE 38.0%, SP 79.3%, PPV 88.0%, NPV 24.1% and DA 46.2%. CONCLUSION It was found that excessive daytime sleepiness, measured by ESS, is not a valuable screening tool for OSA, especially when the test is negative. Other screening tests that involve additional parameters, beside daytime sleepiness alone, should be considered.
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Affiliation(s)
- Hrvoje Puretić
- University Department of Pulmonology, University Hospital Centre Zagreb, Zagreb, Croatia.
- Laboratory for sleep-related breathing disorders, University Department of Pulmonology, University Hospital Centre Zagreb, Jordanovac 104, Zagreb, 10000, Croatia.
| | - Marijana Bosnar Puretić
- University Department of Neurology , Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
- Faculty of Education and Rehabilitation Sciences , University of Zagreb, Zagreb, Croatia
| | - Gordana Pavliša
- University Department of Pulmonology, University Hospital Centre Zagreb, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Marko Jakopović
- University Department of Pulmonology, University Hospital Centre Zagreb, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
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Pahari P, Korkalainen H, Karhu T, Arnardottir ES, Töyräs J, Leppänen T, Nikkonen S. Reaction time in psychomotor vigilance task is related to hypoxic load in males with sleep apnea. J Sleep Res 2024; 33:e13988. [PMID: 37448111 DOI: 10.1111/jsr.13988] [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: 12/08/2022] [Revised: 06/06/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023]
Abstract
Oxygen saturation (SpO2 )-based parameters are more strongly linked to impaired daytime vigilance than the conventional diagnostic metrics in patients with obstructive sleep apnea (OSA). However, whether the association between SpO2 -based parameters and impaired daytime vigilance is modulated by sex, remains unknown. Hence, we investigated the interplay between sex and detailed SpO2 -based metrics and their association with impaired vigilance in patients with OSA. The study population consisted of 855 (473 males, 382 females) patients with suspected OSA who underwent overnight polysomnography and psychomotor vigilance task (PVT). The population was grouped by sex and divided into quartiles (Q1-Q4) based on median reaction times (RTs) in the PVT. In addition to conventional diagnostic metrics, desaturation severity (DesSev), fall severity (FallSev), and recovery severity (RecovSev) were compared between the sexes and between the best (Q1) and worst (Q4) performing quartiles by using cumulative distribution functions (CDFs). Additionally, sex-specific covariate-adjusted linear regression models were used to investigate the connection between the parameters and RTs. The CDFs showed significantly higher hypoxic load in Q4 in males compared to females. In addition, the DesSev (β = 8.05, p < 0.01), FallSev (β = 6.48, p = 0.02), RecovSev (β = 9.13, p < 0.01), and Oxygen Desaturation Index (β = 12.29, p < 0.01) were associated with increased RTs only in males. Conversely, the Arousal Index (β = 10.75-11.04, p < 0.01) was associated with impaired vigilance in females. The severity of intermittent hypoxaemia was strongly associated with longer RTs in males whereas the Arousal Index had the strongest association in females. Thus, the impact of hypoxic load on impaired vigilance seems to be stronger in males than females.
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Affiliation(s)
- Purbanka Pahari
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Henri Korkalainen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Tuomas Karhu
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Erna Sif Arnardottir
- Reykjavik University Sleep Institute, School of Technology, Reykjavik University, Reykjavik, Iceland
- Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland
| | - Juha Töyräs
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- School of Electrical Engineering and Computer Science, The University of Queensland, Brisbane, Queensland, Australia
- Science Service Center, Kuopio University Hospital, Kuopio, Finland
| | - Timo Leppänen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
- School of Electrical Engineering and Computer Science, The University of Queensland, Brisbane, Queensland, Australia
| | - Sami Nikkonen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
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Parekh A, Kam K, Wickramaratne S, Tolbert TM, Varga A, Osorio R, Andersen M, de Godoy LBM, Palombini LO, Tufik S, Ayappa I, Rapoport DM. Ventilatory Burden as a Measure of Obstructive Sleep Apnea Severity Is Predictive of Cardiovascular and All-Cause Mortality. Am J Respir Crit Care Med 2023; 208:1216-1226. [PMID: 37698405 PMCID: PMC10868353 DOI: 10.1164/rccm.202301-0109oc] [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: 01/17/2023] [Accepted: 08/21/2023] [Indexed: 09/13/2023] Open
Abstract
Rationale: The apnea-hypopnea index (AHI), used for the diagnosis of obstructive sleep apnea, captures only the frequency of respiratory events and has demonstrable limitations. Objectives: We propose a novel automated measure, termed "ventilatory burden" (VB), that represents the proportion of overnight breaths with less than 50% normalized amplitude, and we show its ability to overcome limitations of AHI. Methods: Data from two epidemiological cohorts (EPISONO [Sao Paolo Epidemiological Study] and SHHS [Sleep Heart Health Study]) and two retrospective clinical cohorts (DAYFUN; New York University Center for Brain Health) were used in this study to 1) derive the normative range of VB, 2) assess the relationship between degree of upper airway obstruction and VB, and 3) assess the relationship between VB and all-cause and cardiovascular disease (CVD) mortality with and without hypoxic burden that was derived using an in-house automated algorithm. Measurements and Main Results: The 95th percentiles of VB in asymptomatic healthy subjects across the EPISONO and the DAYFUN cohorts were 25.2% and 26.7%, respectively (median [interquartile range], VBEPISONO, 5.5 [3.5-9.7]%; VBDAYFUN, 9.8 [6.4-15.6]%). VB was associated with the degree of upper airway obstruction in a dose-response manner (VBuntreated, 31.6 [27.1]%; VBtreated, 7.2 [4.7]%; VBsuboptimally treated, 17.6 [18.7]%; VBoff-treatment, 41.6 [18.1]%) and exhibited low night-to-night variability (intraclass correlation coefficient [2,1], 0.89). VB was predictive of all-cause and CVD mortality in the SHHS cohort before and after adjusting for covariates including hypoxic burden. Although AHI was predictive of all-cause mortality, it was not associated with CVD mortality in the SHHS cohort. Conclusions: Automated VB can effectively assess obstructive sleep apnea severity, is predictive of all-cause and CVD mortality, and may be a viable alternative to the AHI.
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Affiliation(s)
- Ankit Parekh
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Korey Kam
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sajila Wickramaratne
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Thomas M. Tolbert
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Andrew Varga
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ricardo Osorio
- Center for Brain Health, New York University Langone, New York, New York; and
| | - Monica Andersen
- Disciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de São Paulo, Sao Paulo, Brazil
| | - Luciana B. M. de Godoy
- Disciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de São Paulo, Sao Paulo, Brazil
| | - Luciana O. Palombini
- Disciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de São Paulo, Sao Paulo, Brazil
| | - Sergio Tufik
- Disciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de São Paulo, Sao Paulo, Brazil
| | - Indu Ayappa
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, 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
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Pahari P, Korkalainen H, Karhu T, Rissanen M, Arnardottir ES, Hrubos‐Strøm H, Duce B, Töyräs J, Leppänen T, Nikkonen S. Obstructive sleep apnea‐related intermittent hypoxaemia is associated with impaired vigilance. J Sleep Res 2022; 32:e13803. [PMID: 36482788 DOI: 10.1111/jsr.13803] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/10/2022] [Accepted: 11/25/2022] [Indexed: 12/13/2022]
Abstract
Obstructive sleep apnea (OSA)-related intermittent hypoxaemia is a potential risk factor for different OSA comorbidities, for example cardiovascular disease. However, conflicting results are found as to whether intermittent hypoxaemia is associated with impaired vigilance. Therefore, we aimed to investigate how desaturation characteristics differ between the non-impaired vigilance and impaired vigilance patient groups formed based on psychomotor vigilance task (PVT) performance and compared with traditional OSA severity parameters. The study population comprised 863 patients with suspected OSA who underwent a PVT test before polysomnography. The conventional OSA parameters, for example, the apnea-hypopnea index, oxygen desaturation index, and arousal index were computed. Furthermore, the median desaturation area, fall area, recovery area, and desaturation depth were computed with the pre-event baseline reference and with reference to the 100% oxygen saturation level. Patients were grouped into best- and worst-performing quartiles based on the number of lapses in PVT (Q1: PVT lapses <5 and Q4: PVT lapses >36). The association between parameters and impaired vigilance was evaluated by cumulative distribution functions (CDFs) and binomial logistic regression. Based on the CDFs, patients in Q4 had larger desaturation areas, recovery areas, and deeper desaturations when these were referenced to 100% saturation compared with Q1. The odds ratio (OR) of the median desaturation area (OR = 1.56), recovery area (OR = 1.71), and depth (OR = 1.65) were significantly elevated in Q4 in regression models. However, conventional OSA parameters were not significantly associated with impaired vigilance (ORs: 0.79-1.09). Considering desaturation parameters with a 100% SpO2 reference in the diagnosis of OSA could provide additional information on the severity of OSA and related daytime vigilance impairment.
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Affiliation(s)
- Purbanka Pahari
- Department of Applied Physics University of Eastern Finland Kuopio Finland
- Diagnostic Imaging Centre Kuopio University Hospital Kuopio Finland
| | - Henri Korkalainen
- Department of Applied Physics University of Eastern Finland Kuopio Finland
- Diagnostic Imaging Centre Kuopio University Hospital Kuopio Finland
| | - Tuomas Karhu
- Department of Applied Physics University of Eastern Finland Kuopio Finland
- Diagnostic Imaging Centre Kuopio University Hospital Kuopio Finland
| | - Marika Rissanen
- Department of Applied Physics University of Eastern Finland Kuopio Finland
- Diagnostic Imaging Centre Kuopio University Hospital Kuopio Finland
| | - Erna Sif Arnardottir
- Reykjavik University Sleep Institute, School of Technology Reykjavik University Reykjavik Iceland
- Landspitali The National University Hospital of Iceland Reykjavik Iceland
| | - Harald Hrubos‐Strøm
- Department of Ear, Nose and Throat Surgery Akershus University Hospital Lørenskog Norway
- Department of Behavioural Medicine, Faculty of Medicine, Institute of Basic Medical Sciences University of Oslo Oslo Norway
| | - Brett Duce
- Department of Respiratory & Sleep Medicine, Sleep Disorders Centre Princess Alexandra Hospital Brisbane Queensland Australia
- Institute for Health and Biomedical Innovation Queensland University of Technology Brisbane Queensland Australia
| | - Juha Töyräs
- Department of Applied Physics University of Eastern Finland Kuopio Finland
- School of Information Technology and Electrical Engineering The University of Queensland Brisbane Queensland Australia
- Science Service Centre Kuopio University Hospital Kuopio Finland
| | - Timo Leppänen
- Department of Applied Physics University of Eastern Finland Kuopio Finland
- Diagnostic Imaging Centre Kuopio University Hospital Kuopio Finland
- School of Information Technology and Electrical Engineering The University of Queensland Brisbane Queensland Australia
| | - Sami Nikkonen
- Department of Applied Physics University of Eastern Finland Kuopio Finland
- Diagnostic Imaging Centre Kuopio University Hospital Kuopio Finland
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Skyving M, Forsman Å, Dukic Willstrand T, Laflamme L, Möller J. Medical impairment and road traffic crashes among older drivers in Sweden - A national, population-based, case-control study. ACCIDENT; ANALYSIS AND PREVENTION 2021; 163:106434. [PMID: 34700248 DOI: 10.1016/j.aap.2021.106434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 09/23/2021] [Accepted: 10/05/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Several medical conditions are known to impair sensory, cognitive and motor functions and are associated with road traffic crashes (RTC). For the drivers of today, we lack updated knowledge on how driving-impairing conditions are associated with RTCs, across all driving-impairing conditions in a given population. We aim to determine this among older drivers in Sweden. METHODS A national, population register-based, matched case-control study comparing acknowledged driving-impairing health conditions among all older drivers (65 years or older) involved in an injurious RTC in the period 2011-2016 (n = 13,701) with those of controls: older drivers not involved in any RTC (n = 26,525) matched to the cases by age, sex and residential area. The medical conditions, extracted from the National Patient Register from 1997 up until date of RTC, were identified based on ICD-10 diagnosis codes and categorized into the 13 groups of medical conditions listed in the Swedish driver's license regulations. Conditional logistic regression was used to estimate crude and adjusted odds ratios (ORs) with 95% confidence intervals. RESULTS Unadjusted ORs for RTC were increased for all conditions. After taking the other 12 medical conditions into account, the ORs remained significant in 11 out of the 13. A strong association was found for the group "ADHD and autism spectrum disorders" (OR 2.79, CI 1.47-5.30), although with very low prevalence among cases (0.2%). Moderate associations were found for three conditions with a case prevalence between 1.3% and 8.5%: epilepsy and seizure disorders (OR 1.53, CI 1.25-1.89), substance abuse and dependence (OR 1.45, CI 1.29-1.63), psychological diseases and mental disorders (OR 1.28, CI 1.18-1.39) and for one condition with a case prevalence of 14.7%, diabetes (OR 1.28, CI 1.20-1.36). CONCLUSIONS In Sweden, in the current generation of older drivers, acknowledged driving-impairing medical conditions at the national and European levels remain a concern. After adjustment for one another, all but 2 of the conditions are associated with RTCs albeit to varying degrees and more pronounced in the age group 65-79 compared to 80 or older. To promote and sustain older people's mobility, addressing this issue will require a blend of interventions where, hopefully, technological and infrastructural innovations may help counteracting individual health-related shortcomings.
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Affiliation(s)
- Marie Skyving
- Karolinska Institutet, Department of Global Public Health, Solnavägen 1E, SE-11365 Stockholm, Sweden; Swedish Transport Agency, Department of Road and Rail, Isafjordsgatan 1, SE-16440 Kista, Sweden.
| | - Åsa Forsman
- The Swedish National Road and Transport Research Institute (VTI), Olaus Magnus väg 37, SE-58195 Linköping, Sweden.
| | | | - Lucie Laflamme
- Karolinska Institutet, Department of Global Public Health, Tomtebodavägen 18 A, SE-17165 Stockholm, Sweden.
| | - Jette Möller
- Karolinska Institutet, Department of Global Public Health, Solnavägen 1E, SE-11365 Stockholm, Sweden.
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Sleepiness Behind the Wheel and the Implementation of European Driving Regulations. Sleep Med Clin 2021; 16:533-543. [PMID: 34325829 DOI: 10.1016/j.jsmc.2021.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Sleep disturbance and sleepiness are established risk factors for driving accidents and obstructive sleep apnea (OSA) is the most prevalent medical disorder associated with excessive daytime sleepiness. Because effective treatment of OSA reduces accident risk, several jurisdictions have implemented regulations concerning the ability of patients with OSA to drive, unless effectively treated. This review provides a practical guide for clinicians who may be requested to certify a patient with OSA as fit to drive regarding the scope of the problem, the role of questionnaires and driving simulators to evaluate sleepiness, and the benefit of treatment on accident risk.
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Fanfulla F, Pinna GD, Marrone O, D’Artavilla Lupo N, Arcovio S, Bonsignore MR, Morrone E. Determinants of Sleepiness at Wheel and Missing Accidents in Patients With Obstructive Sleep Apnea. Front Neurosci 2021; 15:656203. [PMID: 33927591 PMCID: PMC8076750 DOI: 10.3389/fnins.2021.656203] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 03/23/2021] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES Motor-vehicle crashes are frequent in untreated OSA patients but there is still uncertainty on prevalence as well as physiological or clinical determinants of sleepiness at the wheel (SW) in OSA patients. We assessed determinants of SW or sleepiness related near-miss car accident (NMA) in a group of non-professional drivers with OSA. METHODS A 237 consecutive, treatment-naïve PSG-diagnosed OSA patients (161 males, 53.1 ± 12.6 years) were enrolled. Self-reported SW was assessed by positive answer to the question, "Have you had episodes of falling asleep while driving or episodes of drowsiness at wheel that could interfere with your driving skill in the last year?" Occurrence of NMA in the last 3 years was also individually recorded. Habitual self-reported average sleep time was collected. RESULTS SW was found in 41.3% of patients but one-quarter of patients with SW did not report excessive daytime sleepiness. Predictors of SW were the following subjective factors: Epworth sleepiness scale score (ESS-OR 1.26; IC 1.1-1.4; p < 0.0001), depressive symptoms (BDI-OR 1.2; IC 1.06-1.18; p < 0.0001) and level of risk exposure (annual mileage-OR 1.9; IC 1.15-3.1; p = 0.007). NMAs were reported by 9.7% of patients, but more frequently by SW+ than SW- (22.4% vs. 0.7%; χ2 31, p < 0.0001). The occurrence of NMAs was significantly associated to ESS, BDI, habitual sleep duration and ODI (R 2 = 0.41). CONCLUSION SW is not predicted by severity of OSA. Evaluation of risk exposure, assessment of depressive symptoms, and reported NMA should be included in the clinical evaluation, particularly in patients with reduced habitual sleep time and severe nocturnal hypoxia.
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Affiliation(s)
- Francesco Fanfulla
- Sleep and Respiratory Function Unit of the Pavia and Montescano Institutes, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Gian Domenico Pinna
- Department of Biomedical Engineering of the Montescano Institute, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Oreste Marrone
- Istituto per la Ricerca e l’Innovazione Biomedica (IRIB), National Research Council (CNR), Palermo, Italy
| | - Nadia D’Artavilla Lupo
- Sleep and Respiratory Function Unit of the Pavia and Montescano Institutes, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Simona Arcovio
- Sleep and Respiratory Function Unit of the Pavia and Montescano Institutes, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Maria R. Bonsignore
- Division of Respiratory Medicine, Dipartimento di Promozione Della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza “G. D’Alessandro” (PROMISE), University of Palermo, Palermo, Italy
| | - Elisa Morrone
- Sleep and Respiratory Function Unit of the Pavia and Montescano Institutes, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
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Bonsignore MR, Randerath W, Schiza S, Verbraecken J, Elliott MW, Riha R, Barbe F, Bouloukaki I, Castrogiovanni A, Deleanu O, Goncalves M, Leger D, Marrone O, Penzel T, Ryan S, Smyth D, Teran-Santos J, Turino C, McNicholas WT. European Respiratory Society statement on sleep apnoea, sleepiness and driving risk. Eur Respir J 2020; 57:13993003.01272-2020. [DOI: 10.1183/13993003.01272-2020] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 08/25/2020] [Indexed: 12/22/2022]
Abstract
Obstructive sleep apnoea (OSA) is highly prevalent and is a recognised risk factor for motor vehicle accidents (MVA). Effective treatment with continuous positive airway pressure has been associated with a normalisation of this increased accident risk. Thus, many jurisdictions have introduced regulations restricting the ability of OSA patients from driving until effectively treated. However, uncertainty prevails regarding the relative importance of OSA severity determined by the apnoea–hypopnoea frequency per hour and the degree of sleepiness in determining accident risk. Furthermore, the identification of subjects at risk of OSA and/or accident risk remains elusive. The introduction of official European regulations regarding fitness to drive prompted the European Respiratory Society to establish a task force to address the topic of sleep apnoea, sleepiness and driving with a view to providing an overview to clinicians involved in treating patients with the disorder. The present report evaluates the epidemiology of MVA in patients with OSA; the mechanisms involved in this association; the role of screening questionnaires, driving simulators and other techniques to evaluate sleepiness and/or impaired vigilance; the impact of treatment on MVA risk in affected drivers; and highlights the evidence gaps regarding the identification of OSA patients at risk of MVA.
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Abelleira R, Zamarrón C, Ruano A, Lourido T, Rodríguez-Núñez N, González-Barcala FJ, Toubes ME, Álvarez-Dobaño JM, Ricoy J, Valdés L. Impact of sleep apnoea-hypopnoea syndrome on diabetic neuropathy. A systematic review. Med Clin (Barc) 2020; 157:106-113. [PMID: 32829922 DOI: 10.1016/j.medcli.2020.05.060] [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: 01/12/2020] [Revised: 05/12/2020] [Accepted: 05/14/2020] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Diabetes mellitus and sleep apnoea-hypopnoea syndrome appear to be related, but it is not well defined whether there is an increased risk of peripheral neuropathy in patients with both diseases. For this reason, we conducted a systematic review. METHODS Bibliographic search in 3 electronic databases using a predefined strategy and the PRISMA methodology. Only original studies (any type of design) published from 2000 onwards in English, French, Portuguese or Spanish were included. A study quality scale was established. RESULTS Twelve articles were selected, of which six studied type 2 diabetic patients. The overall prevalence of sleep apnoea-hypopnoea syndrome was 43.7% (1,559/3,564 patients). Diabetic neuropathy was more frequent in patients with sleep apnoea-hypopnoea syndrome in nine studies, although significantly only in four (60% vs 27%, P<.001; 64.5% vs 36%, P=.03; 37% vs 23.4%, P<.02; 66.6% vs 0%, P=.007). In one study, diabetic neuropathy was more frequent in patients without sleep apnoea-hypopnoea syndrome (although not statistically significant) and in 2 no comparison was made between patients with/without sleep apnoea/hypopnoea syndrome. CONCLUSIONS The observed results suggest a relationship between diabetes mellitus and sleep apnoea-hypopnoea syndrome in the occurrence of diabetic neuropathy.
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Affiliation(s)
- Romina Abelleira
- Servicio de Neumología, Hospital Universitario de Santiago de Compostela, Santiago de Compostela, España.
| | - Carlos Zamarrón
- Servicio de Neumología, Hospital Universitario de Santiago de Compostela, Santiago de Compostela, España
| | - Alberto Ruano
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Santiago de Compostela, Santiago de Compostela, España; CIBER de Epidemiología y Salud Pública, CIBERESP, Hospital Universitario de Santiago de Compostela, Santiago de Compostela, España; Grupo de Epidemiología, Salud Pública y Evaluación de Servicios de Salud, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Hospital Universitario de Santiago de Compostela, Santiago de Compostela, España
| | - Tamara Lourido
- Servicio de Neumología, Hospital Universitario de Santiago de Compostela, Santiago de Compostela, España
| | - Nuria Rodríguez-Núñez
- Servicio de Neumología, Hospital Universitario de Santiago de Compostela, Santiago de Compostela, España
| | - Francisco J González-Barcala
- Servicio de Neumología, Hospital Universitario de Santiago de Compostela, Santiago de Compostela, España; Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Hospital Universitario de Santiago de Compostela, Santiago de Compostela, España
| | - María E Toubes
- Servicio de Neumología, Hospital Universitario de Santiago de Compostela, Santiago de Compostela, España
| | - José M Álvarez-Dobaño
- Servicio de Neumología, Hospital Universitario de Santiago de Compostela, Santiago de Compostela, España; Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Hospital Universitario de Santiago de Compostela, Santiago de Compostela, España
| | - Jorge Ricoy
- Servicio de Neumología, Hospital Universitario de Santiago de Compostela, Santiago de Compostela, España
| | - Luis Valdés
- Servicio de Neumología, Hospital Universitario de Santiago de Compostela, Santiago de Compostela, España; Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Hospital Universitario de Santiago de Compostela, Santiago de Compostela, España
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Huang KT, Chen YC, Tseng CC, Chang HC, Su MC, Wang TY, Lin YY, Zheng YX, Chang JC, Chin CH, Hsiao CC, Lin MC. Aberrant DNA methylation of the toll-like receptors 2 and 6 genes in patients with obstructive sleep apnea. PLoS One 2020; 15:e0228958. [PMID: 32069296 PMCID: PMC7028278 DOI: 10.1371/journal.pone.0228958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 01/27/2020] [Indexed: 11/18/2022] Open
Abstract
Obstructive sleep apnea (OSA) is a syndrome leading to chronic intermittent hypoxia, and the up-regulation of toll-like receptors (TLR) 2 and 6 on peripheral blood cells has been reported. We hypothesized that DNA methylation in TLR2 and TLR6 genes may play a role in the development of OSA and its excessive daytime sleepiness (EDS) phenotype. DNA methylation over 28 cytosine-phosphate-guanine (CpG) sites of the TLR2 promoter region and 3 CpG sites of the TLR6 gene body, and their protein expressions were measured by using pyrosequencing and ELISA methods in 18 heathy subjects (HS) and 58 patients with severe OSA (divided into 18 non-EDS and 40 EDS group). Patients with severe OSA had higher DNA methylation levels over five CpG sites (#1, #2, #3, #25 and #28) and lower DNA methylation levels over CpG site #18 of the TLR2 promoter region, higher DNA methylation levels over two CpG sites (#1 and #3) of the TLR6 gene body, and higher protein expressions of TLR6 than HS. The CpG site #2 of the TLR6 gene body was hypermethylated in severe OSA patients with EDS. Both DNA methylation levels over CpG site #1 of the TLR6 gene body and protein expressions of TLR6 were reduced after more than 6 months of nasal CPAP treatment in seven selected patients. Aberrant DNA methylation of the TLR2 promoter region and TLR6 gene body are associated with the consequence of severe OSA and its EDS phenotype.
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Affiliation(s)
- Kuo-Tung Huang
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Sleep Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Division of Pulmonary and Critical Care Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Department of Nursing, Meiho University, Pingtung, Taiwan
| | - Yung-Che Chen
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Sleep Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Division of Pulmonary and Critical Care Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chia-Cheng Tseng
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Sleep Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Division of Pulmonary and Critical Care Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Huang-Chih Chang
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Sleep Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Division of Pulmonary and Critical Care Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Mao-Chang Su
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Sleep Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Chang Gung University of Science and Technology, Chia-yi, Taiwan
| | - Ting-Ya Wang
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yong-Yong Lin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yi-Xin Zheng
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Jen-Chieh Chang
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chien-Hung Chin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Sleep Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chang-Chun Hsiao
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Division of Pulmonary and Critical Care Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Meng-Chih Lin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Sleep Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Chang Gung University of Science and Technology, Chia-yi, Taiwan
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Dwarakanath A, Elliott MW. Assessment of Sleepiness in Drivers: Current Methodology and Future Possibilities. Sleep Med Clin 2019; 14:441-451. [PMID: 31640872 DOI: 10.1016/j.jsmc.2019.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Many patients with obstructive sleep apnea syndrome (OSAS) drive a vehicle both for pleasure and as part of their employment. Some, but not all, patients with OSAS are at increased risk of being involved in road traffic accidents. Clinicians are often asked to make recommendations about an individual's fitness to drive, and these are likely to be inconsistent in the absence of objective criteria. This article discusses the current practice of the assessment of individuals' sleepiness with respect to driving, the limitations of available techniques, and future possibilities.
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Affiliation(s)
- Akshay Dwarakanath
- Department of Respiratory Medicine, Sleep and Non-invasive Ventilation Service, Mid Yorkshire Hospitals NHS Trust, Aberford Road, Wakefield, West Yorkshire WF2 9EU, UK
| | - Mark W Elliott
- Department of Respiratory Medicine, Sleep and Non-invasive Ventilation Service, St. James's University Hospital, Beckett Street, Leeds, West Yorkshire LS9 7TF, UK.
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Hidalgo Armas L, Turino C, Cordero-Guevara J, Manjón JL, Durán-Carro J, Barbé F, Vaca R, Durán-Cantolla J. A new postural device for the treatment of positional obstructive sleep apnea. A pilot study. Respir Med 2019; 151:111-117. [DOI: 10.1016/j.rmed.2019.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 02/01/2019] [Accepted: 02/02/2019] [Indexed: 11/26/2022]
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Derivation and validation of a clinical prediction rule for sleep apnoea syndrome for use in primary care. BJGP Open 2018; 2:bjgpopen18X101481. [PMID: 30564714 PMCID: PMC6184092 DOI: 10.3399/bjgpopen18x101481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 02/06/2018] [Indexed: 12/05/2022] Open
Abstract
Background Several clinical prediction rules (CPRs) are available for sleep apnoea-hypopnoea syndrome (OSAH), but they are difficult to apply in primary care (PC). Aim Derivation and validation of a CPR using simple measurements available in PC. Design & setting A prospective study conducted in health centres from the area of influence of three Spanish hospitals. Method Patients (aged 18–70 years) who attended for any reason; who presented with at least one of the three key symptoms for OSAH (snoring, breathing pauses while sleeping, and daytime sleepiness); and who were not undergoing non-invasive ventilation or prior treatment with continuous positive airway pressure (CPAP) were included. Anthropometric data, smoking habit, comorbidities, and Epworth test were collected. Patients were subsequently referred to the sleep unit (SU), where the decision was taken whether or not to instigate treatment. A multivariate logistic model was constructed using a sub-sample and scores assigned based on the regression coefficients; the CPR was validated with the remaining sample. Both receiver operating characteristic (ROC) curves were plotted and the sensitivity, specificity, and predictive values calculated. Results The derivation sample comprised 352 patients, with 260 in the validation sample. The final factors (arterial hypertension [AHT], age, body mass index [BMI], and sex) were used to develop a rule with scores ranging from 0.00–5.50. The cut-off point that optimises the area under the curve (AUC) is ≥2.50 points (AUC = 0.78; sensitivity = 86%; specificity = 54%; positive predictive value [PPV] = 45%; negative predictive value [NPV] = 90%; likelihood ratio [LR] = 0.26). The properties for the validation sample with this cut-off point are as follows: AUC = 0.68; sensitivity = 81%; specificity = 43%; PPV = 61%; NPV = 68%; LR = 0.44. Conclusion As in similar cases, the specificity is low, meaning that healthy people are referred to a specialist. A negative result rules out the disease in most cases.
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Yan B, Jin Y, Hu Y, Li S. Effects of continuous positive airway pressure on elderly patients with obstructive sleep apnea: a meta-analysis. Med Sci (Paris) 2018; 34 Focus issue F1:66-73. [PMID: 30403178 DOI: 10.1051/medsci/201834f112] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE the aim of the study was to evaluate the efficacy of continuous positive airway pressure (CPAP) for the treatment of obstructive sleep apnea in the elderly. METHOD a comprehensive search for qualified clinical trials was performed on April, 2016. Basic demographic information of enrolled subjects, study design, survival rate, cardiovascular events, quality of life scores, and neurocognitive data were extracted for analysis. RESULTS A total of seven clinical trials were included in this meta-analysis, in which untreated elderly patients exhibited worse survival rate than those with CPAP (OR=2.22, 95% CI=1.64 to 3.01, P< 0.00001). Treated elderly patients exhibited less cardiovascular risk than those without CPAP (RR=0.49, 95% CI=0.36 to 0.66, P<0.00001) and a statistically significant improvement on all the domains of Quebec Sleepiness Questionnaire, supported by pooled weighted mean difference. Furthermore, CPAP treatment partially improved the cognitive functions. CONCLUSION CPAP treatment achieves improvements in decreasing mortality and controlling cardiovascular events and exhibits few effects on neurocognitive function. Further large-scale, well-designed interventional investigation is needed.
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Affiliation(s)
- Binhong Yan
- Department of Nursing, The Shanghai Seventh People's affiliated Hospital to the Shanghai University of Traditional Chinese Medicine, Shanghai, China. 358 Datong Road, Shanghai 200137, China
| | - Yongmei Jin
- Department of General Surgery, The Shanghai Seventh People's affiliated Hospital to the Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yi Hu
- Department of Nursing, The Shanghai Seventh People's affiliated Hospital to the Shanghai University of Traditional Chinese Medicine, Shanghai, China. 358 Datong Road, Shanghai 200137, China
| | - Shu Li
- Department of Nursing, The Shanghai Seventh People's affiliated Hospital to the Shanghai University of Traditional Chinese Medicine, Shanghai, China. 358 Datong Road, Shanghai 200137, China
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15
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[Diagnostic accuracy of STOP-Bang questionnaire on moderate sleep apnoea in primary care]. GACETA SANITARIA 2018; 33:421-426. [PMID: 30033095 DOI: 10.1016/j.gaceta.2018.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 04/23/2018] [Accepted: 05/11/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVE We aimed to compare the diagnostic utility of the STOP-Bang questionnaire for moderate apnoea against the gold standard (type I polysomnography) in a primary care setting. METHOD Study of diagnostic utility in primary care. Estimated sample: 85 cases and 85 healthy controls. In convenience sampling, 203 patients were recruited by their physicians at six health centres. Twenty-five were excluded, and 57 women and 121 men, of whom 74 had apnoea-hypopnoea index (AHI) ≥15, were analyzed. STOP-Bang was validated by comparing scores in the same patient with the apnoea-hypopnoea index observed in polysomnography, as a gold standard. Sample size, ROC curve analysis and optimal cut-off points were identified with the easyROC, pROC, and OptimalCutpoints packages. RESULTS The area under the curve in moderate apnoea (AHI ≥15) of the STOP-Bang was 0.777 (0.667-0.808), with optimal cut-off points different by sex (4 in women and 6 in men). In the cross-validation with k=10, the area under the curve for the STOP-Bang was 0.678. CONCLUSIONS The STOP-Bang presents a diagnostic moderate utility for AHI≥15, but superior to other scales, in a community population. Its performance is more appropriate in women.
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Urtnasan E, Park JU, Lee KJ. Multiclass classification of obstructive sleep apnea/hypopnea based on a convolutional neural network from a single-lead electrocardiogram. Physiol Meas 2018; 39:065003. [PMID: 29794342 DOI: 10.1088/1361-6579/aac7b7] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE In this paper, we propose a convolutional neural network (CNN)-based deep learning architecture for multiclass classification of obstructive sleep apnea and hypopnea (OSAH) using single-lead electrocardiogram (ECG) recordings. OSAH is the most common sleep-related breathing disorder. Many subjects who suffer from OSAH remain undiagnosed; thus, early detection of OSAH is important. APPROACH In this study, automatic classification of three classes-normal, hypopnea, and apnea-based on a CNN is performed. An optimal six-layer CNN model is trained on a training dataset (45 096 events) and evaluated on a test dataset (11 274 events). The training set (69 subjects) and test set (17 subjects) were collected from 86 subjects with length of approximately 6 h and segmented into 10 s durations. MAIN RESULTS The proposed CNN model reaches a mean [Formula: see text]-score of 93.0 for the training dataset and 87.0 for the test dataset. SIGNIFICANCE Thus, proposed deep learning architecture achieved a high performance for multiclass classification of OSAH using single-lead ECG recordings. The proposed method can be employed in screening of patients suspected of having OSAH.
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Affiliation(s)
- Erdenebayar Urtnasan
- Department of Biomedical Engineering, College of Health Science, Yonsei University, Wonju-si, Gangwon-do 26493, Republic of Korea
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Riva MM, Cantamessa F, Borleri D, Mosconi G. Occupational health and safety of road haulage company employees. LA MEDICINA DEL LAVORO 2018; 109:180-9. [PMID: 29943749 PMCID: PMC7689798 DOI: 10.23749/mdl.v109i3.6827] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 03/27/2018] [Indexed: 11/30/2022]
Abstract
Background: This paper follows up on a project that was launched in 2008 and contributed to the development of the new Italian Society of Occupational Medicine (SIML) guidelines for the road haulage industry. Objective: To reach a better understanding of occupational illness amongst truck drivers, in order to define appropriate health monitoring protocols and promote a healthy life-style. Methods: We assessed 673 male drivers (mean age 43.85 years, SD 9.56; mean working seniority 27.28 years, SD 10.59), employed by 46 different companies. The drivers, who were gradually recruited in the study over the years, had a maximum of 8 re-assessments each, for a total of 2608 examinations. We applied a survey protocol consisting in a medical examination, questionnaires for the most common risks and instrumental and laboratory tests in compliance with SIML guidelines. Results: We identified a total of 44 work-related diseases: 22 cases of noise-induced hearing loss (NIHL) and 22 cases of lumbar degenerative disc disease. As regards metabolic disorders, we observed 28 cases of diabetes mellitus, in most cases (71.4%) as a first diagnosis or under poor therapeutic control. We observed poorly-controlled hypertension in 103 drivers, the majority of whom (54%) were diagnosed for the first time. Over 30% of the workers in our study were obese and approximately 40% were tobacco smokers. We identified just 9 individuals (1.3%) with a positive toxicological screening for use of recreational drugs. Our data confirm a high prevalence of occupational illness amongst truck drivers. Cardiovascular and metabolic conditions require close monitoring.
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Affiliation(s)
- Matteo Marco Riva
- UOC Medicina del Lavoro Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII.
| | - Francesco Cantamessa
- UOC Medicina del Lavoro Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII.
| | - Daniela Borleri
- UOC Medicina del Lavoro Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII.
| | - Giovanni Mosconi
- UOC Medicina del Lavoro Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII.
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18
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Taşbakan MS, Ekren PK, Uysal FE, Başoğlu ÖK. Evaluation of Traffic Accident Risk in In-City Bus Drivers: The Use of Berlin Questionnaire. Turk Thorac J 2018; 19:73-76. [PMID: 29755810 DOI: 10.5152/turkthoracj.2018.17080] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 11/14/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Traffic accidents associated with high mortality rate may produce serious problems especially in highways. Obstructive sleep apnea (OSA) has been associated with a high risk for traffic accidents due to excessive daytime sleepiness even in in-city drivers. In the present study, it was aimed to evaluate the rate of OSA symptoms and to identify risk factors associated with traffic accidents in in-city bus drivers. MATERIAL AND METHODS A self-administered questionnaire including demographic and anthropometric features, sleep and work schedules, Berlin questionnaire, Epworth sleepiness score (ESS), and history of traffic accidents was used. RESULTS The questionnaire was conducted for 1400 male bus drivers (mean age, 38.0±6.4 y, body mass index, 27.8±3.9 kg/m2). A total of 1058 (75.6%) drivers had one or more accidents while driving bus. According to the Berlin questionnaire, 176 (12.6%) drivers were found to have high OSA risk and the accident rate was 83.0% in high-risk group, whereas 74.5% of low-risk drivers had accidents (p=0.043). The drivers with a history of traffic accident were older (p=0.030), had higher ESS (p=0.019), and were more in the high-risk OSA group according to the Berlin questionnaire (p=0.015). In multivariate linear regression analysis, traffic accident was associated with only Berlin questionnaire (p=0.015). CONCLUSION The present results support that city bus drivers with high OSA risk according to Berlin questionnaire have increased accident rates. Therefore, we suggest using Berlin questionnaire for screening sleep apnea not only in highway drivers but also in in-city bus drivers.
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Affiliation(s)
| | | | - Funda Elmas Uysal
- Department of Pulmonology, Ege University School of Medicine, İzmir, Turkey
| | - Özen K Başoğlu
- Department of Pulmonology, Ege University School of Medicine, İzmir, Turkey
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Abstract
Obstructive sleep apnoea (OSA) is increasing in prevalence due to rising obesity. While OSA is a disorder primarily of the upper airway during sleep, its pathophysiological impact on other body systems is increasingly recognised. There has been interest in the prevalence of OSA in different ophthalmic conditions and possible causation has been postulated. As OSA is common, it can be expected that people with co-existent OSA will be found in any ophthalmic disease population studied. To determine with confidence the significance of finding patients with OSA in a particular cohort requires a well matched control group, ideally matched for age, obesity, gender and co-morbidities. Only if one can say with certainty that the prevalence of OSA is higher in a group with a particular co-existent ophthalmic disease can we begin to speculate about possible mechanisms for the overlap in these conditions. Possible mechanisms for how OSA might affect the eye are discussed in this review. The current literature is reviewed with respect to diabetic retinopathy, glaucoma, floppy eyelid syndrome, non-arteritic ischaemic optic neuropathy, keratoconus and AMD. Associations with OSA have been found, but robust prospective studies using multi-channel sleep studies to diagnose OSA are lacking. Gaps remain in the evidence and in our knowledge. It is hoped that this review will highlight the need for ophthalmologists to consider OSA in their patients. It also makes recommendations for future research, especially to consider whether therapies for OSA can also be effective for ophthalmic disorders.
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Affiliation(s)
- Sophie D West
- Newcastle Regional Sleep Service, Newcastle upon Tyne Hospitals NHS Trust, Newcastle, UK.
| | - Chris Turnbull
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals, Oxford, UK
- NIHR Biomedical Research Centre Oxford, University of Oxford, Churchill Campus, Oxford, UK
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Automated Detection of Obstructive Sleep Apnea Events from a Single-Lead Electrocardiogram Using a Convolutional Neural Network. J Med Syst 2018; 42:104. [DOI: 10.1007/s10916-018-0963-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 04/16/2018] [Indexed: 10/17/2022]
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21
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Goatly G, Guidozzi N, Khan M. Optimal ventilator strategies for trauma-related ARDS. J ROY ARMY MED CORPS 2018; 165:193-197. [PMID: 29599209 DOI: 10.1136/jramc-2017-000889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 03/02/2018] [Accepted: 03/05/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND Acute respiratory distress syndrome (ARDS) was first described in the 1960s and has become a major area of research due to the mortality and morbidity associated with it. ARDS is currently defined using the Berlin Consensus; however, this is not wholly applicable for trauma-related ARDS. METHODS A systematic review of the literature was undertaken using the Preferred Reporting for Systematic Reviews and Meta Analyses methodology. The Ovid Medline, Web of Science and PubMed online databases were interrogated for papers published between 1 January 1995 and 31 December 2017. RESULTS The literature search yielded a total of 64 papers that fulfilled the search criteria. CONCLUSIONS Despite decades of dedicated research into different treatment modalities, ARDS continues to carry a high burden of mortality. The ARDS definitions laid out in the Berlin consensus are not entirely suited to trauma. While trauma-related ARDS represents a small portion of the available research, the evidence continues to favour low tidal volume ventilation as the benchmark for current practice. Positive end expiratory ventilation and airway pressure release ventilation in trauma cohorts may be beneficial; however, the evidence to date does not show this.
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Affiliation(s)
- Giles Goatly
- Department of Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - N Guidozzi
- Department of Surgery, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - M Khan
- Department of Surgery, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
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Lee S, Kim HR, Byun J, Jang T. Sleepiness while driving and shiftwork patterns among Korean bus drivers. Ann Occup Environ Med 2017; 29:48. [PMID: 29043087 PMCID: PMC5632830 DOI: 10.1186/s40557-017-0203-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 09/21/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sleepiness while driving has been regarded as a major cause of death due to traffic accidents. We compared the degree of sleepiness across five different working time periods (first, morning, post-lunch, afternoon, and last) among Korean bus drivers with different shift types (Daily two shift/Alternating day shift). METHOD We interviewed 332 bus drivers with two shift types (Daily two shift, 128; Alternating day shift, 204). The questionnaire included demographic information (age, alcohol consumption and history of disease), a sleep disorder diagnosed by a doctor, job duration, the number of workdays in the past month, average working hours per workday and week, sleepiness while driving (Karolinska Sleepiness Scale), and sleeping time for both workdays and off-days. We conducted log-binomial regression analyses and produced prevalence ratios (PRs) of severe sleepiness (KSS ≥ 7) while driving with 95% confidence intervals (95% CI) to identify the difference in sleepiness for five working times between both groups. RESULTS For the first and morning periods, there were no statistically significant differences in the KSS scores between the two groups. However, from lunch to last driving, drivers with Alternating day shift had a much larger proportion of severe sleepiness than those on Daily two shift. Thirteen (10.2%), 2 (1.6%) and 7 (5.5%) Daily two shift workers reported severe sleepiness in the post-lunch, afternoon and last periods. In contrast, 81 (39.7%), 63 (30.9%) and 64 (31.4%) of Alternating day shift drivers experienced severe sleepiness during the post-lunch, afternoon and last driving periods (p < 0.0001). According to the log-binomial regression analyses, Alternating day shift was associated with severe sleepiness from lunch to last driving. After adjusting for job duration, alcohol consumption and sleeping time on workdays, the PRs were 3.97 (95% CI: 2.29-6.90) post-lunch, 18.26 (95% CI: 4.51-73.89) in the afternoon and 5.71 (95% CI: 2.51-12.99) for the last driving period. CONCLUSION We found that Alternating day shift bus drivers suffered from more sleepiness while driving from lunch to last driving than Daily two shift bus drivers. This difference may be because Alternating day shift drivers had more irregular work schedules and longer working hours per day and week.
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Affiliation(s)
- Seyoung Lee
- Department of Occupational & Environmental Medicine, College of Medicine, The Catholic University of Korea, 222 Banpo-Daero, Seocho-Gu, Seoul, 137701 Republic of Korea
| | - Hyoung-Ryoul Kim
- Department of Occupational & Environmental Medicine, College of Medicine, The Catholic University of Korea, 222 Banpo-Daero, Seocho-Gu, Seoul, 137701 Republic of Korea
| | - Junsu Byun
- Department of Occupational & Environmental Medicine, College of Medicine, The Catholic University of Korea, 222 Banpo-Daero, Seocho-Gu, Seoul, 137701 Republic of Korea
| | - Taewon Jang
- Department of Occupational and Environmental Medicine, Hanyang University Guri Hospital, Seoul, Republic of Korea
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Turino C, Bertran S, Gavaldá R, Teixidó I, Woehrle H, Rué M, Solsona F, Escarrabill J, Colls C, García-Altés A, de Batlle J, Sánchez de-la-Torre M, Barbé F. Characterization of the CPAP-treated patient population in Catalonia. PLoS One 2017; 12:e0185191. [PMID: 28934303 PMCID: PMC5608364 DOI: 10.1371/journal.pone.0185191] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 09/07/2017] [Indexed: 11/18/2022] Open
Abstract
There are different phenotypes of obstructive sleep apnoea (OSA), many of which have not been characterised. Identification of these different phenotypes is important in defining prognosis and guiding the therapeutic strategy. The aim of this study was to characterise the entire population of continuous positive airway pressure (CPAP)-treated patients in Catalonia and identify specific patient profiles using cluster analysis. A total of 72,217 CPAP-treated patients who contacted the Catalan Health System (CatSalut) during the years 2012 and 2013 were included. Six clusters were identified, classified as “Neoplastic patients” (Cluster 1, 10.4%), “Metabolic syndrome patients” (Cluster 2, 27.7%), “Asthmatic patients” (Cluster 3, 5.8%), “Musculoskeletal and joint disorder patients” (Cluster 4, 10.3%), “Patients with few comorbidities” (Cluster 5, 35.6%) and “Oldest and cardiac disease patients” (Cluster 6, 10.2%). Healthcare facility use and mortality were highest in patients from Cluster 1 and 6. Conversely, patients in Clusters 2 and 4 had low morbidity, mortality and healthcare resource use. Our findings highlight the heterogeneity of CPAP-treated patients, and suggest that OSA is associated with a different prognosis in the clusters identified. These results suggest the need for a comprehensive and individualised approach to CPAP treatment of OSA.
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Affiliation(s)
- Cecilia Turino
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Sandra Bertran
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Ricard Gavaldá
- Department of Computer Science, UPC-BarcelonaTech, Barcelona, Spain
| | - Ivan Teixidó
- Department of Computer Science & INSPIRES, University of Lleida, Lleida, Spain
| | - Holger Woehrle
- Sleep and Ventilation Center Blaubeuren, Respiratory Center Ulm, Ulm, Germany
| | - Montserrat Rué
- Unit of Bioestatistics and Epidemiology, IRBLleida, Lleida, Spain
| | - Francesc Solsona
- Department of Computer Science & INSPIRES, University of Lleida, Lleida, Spain
| | - Joan Escarrabill
- Chronic Care Program (Hospital Clínic) & Master Plan for Respiratory Diseases (Ministry of Health, Catalonia) & REDISSEC, Barcelona, Spain
| | - Cristina Colls
- Public Health Department, Government of Catalonia, Barcelona, Spain
| | | | - Jordi de Batlle
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Manuel Sánchez de-la-Torre
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Ferran Barbé
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
- * E-mail:
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Li Y, Vgontzas A, Kritikou I, Fernandez-Mendoza J, Basta M, Pejovic S, Gaines J, Bixler EO. Psychomotor Vigilance Test and Its Association With Daytime Sleepiness and Inflammation in Sleep Apnea: Clinical Implications. J Clin Sleep Med 2017; 13:1049-1056. [PMID: 28728622 PMCID: PMC5566460 DOI: 10.5664/jcsm.6720] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 05/18/2017] [Accepted: 06/13/2017] [Indexed: 02/05/2023]
Abstract
STUDY OBJECTIVES Excessive daytime sleepiness (EDS) is a key symptom of obstructive sleep apnea (OSA). The Psychomotor Vigilance Task (PVT) has been suggested as an objective easy-to-use, inexpensive alternative to the Multiple Sleep Latency Test (MSLT) to measure EDS. In patients with OSA, physiological sleepiness, but not subjective EDS (Epworth Sleepiness Scale [ESS]), has been associated with increased levels of the sleep- inducing proinflammatory cytokine interleukin-6 (IL-6). The goal of this study was to assess the association of PVT with objectively measured sleepiness (MSLT) and subjectively measured sleepiness (ESS) and IL-6 levels in patients with OSA. METHODS We studied 58 untreated patients with OSA who underwent an 8-hour in-laboratory polysomnography for 4 consecutive nights. MSLT, PVT, and 24-hour serial profiles of IL-6 were assessed on the fourth day. PVT variables included number of lapses, mean reciprocal of the fastest 10% and slowest 10% reaction times, and median of 1/reaction time. ESS was assessed on day 1 of the study. RESULTS Higher ESS scores were significantly associated with greater number of lapses (β = .34, P = .02) and lower values of 1/RT (β = -.36, P = .01) and slowest 10% RTs (β = -.30, P = .04). No significant association was observed between PVT and MSLT, nor PVT and IL-6 levels. CONCLUSIONS Our findings suggest that PVT is associated with subjectively assessed daytime sleepiness, but not with physiological sleepiness nor IL-6 levels in patients with OSA. It appears that ESS and PVT may be useful in predicting risks associated with impaired performance, such as traffic accidents, in patients with OSA.
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Affiliation(s)
- Yun Li
- Sleep Research and Treatment Center, Department of Psychiatry, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
- Mental Health Center, Shantou University Medical College, China
| | - Alexandros Vgontzas
- Sleep Research and Treatment Center, Department of Psychiatry, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
- Address correspondence to: Alexandros N. Vgontzas, MD, Penn State University College of Medicine, Department of Psychiatry H073, 500 University Drive, Hershey, PA 17033(717) 531-7278(717) 531-6491
| | - Ilia Kritikou
- Sleep Research and Treatment Center, Department of Psychiatry, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Julio Fernandez-Mendoza
- Sleep Research and Treatment Center, Department of Psychiatry, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Maria Basta
- Sleep Research and Treatment Center, Department of Psychiatry, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Slobodanka Pejovic
- Sleep Research and Treatment Center, Department of Psychiatry, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Jordan Gaines
- Sleep Research and Treatment Center, Department of Psychiatry, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Edward O. Bixler
- Sleep Research and Treatment Center, Department of Psychiatry, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
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25
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Huang W, Guo B, Shen Y, Tang X. A novel method to precisely detect apnea and hypopnea events by airflow and oximetry signals. Comput Biol Med 2017; 88:32-40. [DOI: 10.1016/j.compbiomed.2017.06.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 06/07/2017] [Accepted: 06/14/2017] [Indexed: 01/06/2023]
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26
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Szentkirályi A, Wong KKH, Grunstein RR, D'Rozario AL, Kim JW. Performance of an automated algorithm to process artefacts for quantitative EEG analysis during a simultaneous driving simulator performance task. Int J Psychophysiol 2017; 121:12-17. [PMID: 28821403 DOI: 10.1016/j.ijpsycho.2017.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 07/01/2017] [Accepted: 08/14/2017] [Indexed: 11/28/2022]
Affiliation(s)
- András Szentkirályi
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, The University of Sydney, PO Box M77, Missenden Road, 2050, NSW, Australia; Institute of Epidemiology and Social Medicine, Westfälische Wilhelms-University of Münster, Domagkstraße 3, D-48149 Münster, Germany; Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, PO Box M30, Sydney Local Health District, Missenden Road, Sydney 2050, NSW, Australia.
| | - Keith K H Wong
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, The University of Sydney, PO Box M77, Missenden Road, 2050, NSW, Australia; School of Psychology, Brain and Mind Centre and Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia.
| | - Ronald R Grunstein
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, The University of Sydney, PO Box M77, Missenden Road, 2050, NSW, Australia; School of Psychology, Brain and Mind Centre and Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia.
| | - Angela L D'Rozario
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, The University of Sydney, PO Box M77, Missenden Road, 2050, NSW, Australia; Institute of Epidemiology and Social Medicine, Westfälische Wilhelms-University of Münster, Domagkstraße 3, D-48149 Münster, Germany; Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, PO Box M30, Sydney Local Health District, Missenden Road, Sydney 2050, NSW, Australia; School of Psychology, Brain and Mind Centre and Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia.
| | - Jong Won Kim
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, The University of Sydney, PO Box M77, Missenden Road, 2050, NSW, Australia; Department of Healthcare IT, Inje University, Inje-ro 197, Kimhae, Kyunsangnam-do 50834, Republic of Korea.
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27
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Severe obstructive sleep apnea treatment with oral appliance: the impact on obstructive, central and mixed events. Sleep Breath 2017; 22:91-98. [PMID: 28702829 DOI: 10.1007/s11325-017-1535-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 06/22/2017] [Accepted: 07/03/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE The aim of this study is to evaluate the effectiveness of two types of oral appliance (OA) in the treatment of severe obstructive sleep apnea syndrome (OSAS) and their impact on the reduction of obstructive, central and mixed apneas. METHODS Forty-eight patients suffering from severe OSAS with a history of non-adherence to positive airway pressure therapy were treated with OA (lingual orthosis and combined orthosis). Polysomnography exams were performed before and after treatment. Computed tomography and cephalometric radiography were requested for all patients to evaluate the titrated position of the OA and the airspace obtained. Statistical tests used the Minitab, version 17, program. The level of statistical significance was 5%. RESULTS Before treatment, the mean AHI was 56.3 ± 19.1 events/h. It decreased to 8.1 ± 5.2 after the OA titration (p ≤ 0.001). There was a significant reduction in obstructive events from 43.0 ± 20.2 to 7.1 ± 4.6 events/h (p ≤ 0.001). The reduction in central events after OA treatment was also significant (from 5.1 ± 9.3 to 0.8 ± 1.9 events/h; p ≤ 0.001), whereas that in mixed events decreased from 6.4 ± 9.5 to 0.1 ± 0.3 events/h (p ≤ 0.001). The minimum oxygen saturation also showed significant improvement after treatment (p ≤ 0.001). There was no statistically significant difference between both OA with respect to central events (p = 0.22) or mixed events (p = 0.98). CONCLUSION The treatment was effective in reducing obstructive events which were evaluated through the AHI and minimum oxygen saturation. The oral appliances also normalized central and mixed events among patients with severe OSAS.
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28
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Fu Y, Xu H, Xia Y, Qian Y, Li X, Zou J, Wang Y, Meng L, Tang X, Zhu H, Zhou H, Su K, Yu D, Yi H, Guan J, Yin S. Excessive daytime sleepiness and metabolic syndrome in men with obstructive sleep apnea: a large cross-sectional study. Oncotarget 2017; 8:79693-79702. [PMID: 29108349 PMCID: PMC5668082 DOI: 10.18632/oncotarget.19113] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 06/18/2017] [Indexed: 12/20/2022] Open
Abstract
Purpose Excessive daytime sleepiness is a common symptom in obstructive sleep apnea (OSA). Previous studies have showed that excessive daytime sleepiness is associated with some individual components of metabolic syndrome. We performed a large cross-sectional study to explore the relationship between excessive daytime sleepiness and metabolic syndrome in male OSA patients. Methods A total of 2241 suspected male OSA patients were consecutively recruited from 2007 to 2013. Subjective daytime sleepiness was assessed using the Epworth sleepiness scale. Anthropometric, metabolic, and polysomnographic parameters were measured. Metabolic score was used to evaluate the severity of metabolic syndrome. Results Among the male OSA patients, most metabolic parameters varied by excessive daytime sleepiness. In the severe group, male OSA patients with excessive daytime sleepiness were more obese, with higher blood pressure, more severe insulin resistance and dyslipidemia than non-sleepy patients. Patients with metabolic syndrome also had a higher prevalence of excessive daytime sleepiness and scored higher on the Epworth sleepiness scale. Excessive daytime sleepiness was independently associated with an increased risk of metabolic syndrome (odds ratio =1.242, 95% confidence interval: 1.019-1.512). No substantial interaction was observed between excessive daytime sleepiness and OSA/ obesity. Conclusions Excessive daytime sleepiness was related to metabolic disorders and independently associated with an increased risk of metabolic syndrome in men with OSA. Excessive daytime sleepiness should be taken into consideration for OSA patients, as it may be a simple and useful clinical indicator for evaluating the risk of metabolic syndrome.
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Affiliation(s)
- Yiqun Fu
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Otolaryngological Institute of Shanghai Jiao Tong University, Shanghai, China.,Clinical Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huajun Xu
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Otolaryngological Institute of Shanghai Jiao Tong University, Shanghai, China.,Clinical Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yunyan Xia
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Otolaryngological Institute of Shanghai Jiao Tong University, Shanghai, China.,Clinical Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yingjun Qian
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Otolaryngological Institute of Shanghai Jiao Tong University, Shanghai, China.,Clinical Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xinyi Li
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Otolaryngological Institute of Shanghai Jiao Tong University, Shanghai, China.,Clinical Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jianyin Zou
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Otolaryngological Institute of Shanghai Jiao Tong University, Shanghai, China.,Clinical Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuyu Wang
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Otolaryngological Institute of Shanghai Jiao Tong University, Shanghai, China.,Clinical Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lili Meng
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Otolaryngological Institute of Shanghai Jiao Tong University, Shanghai, China
| | - Xulan Tang
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Otolaryngological Institute of Shanghai Jiao Tong University, Shanghai, China
| | - Huaming Zhu
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Otolaryngological Institute of Shanghai Jiao Tong University, Shanghai, China
| | - Huiqun Zhou
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Otolaryngological Institute of Shanghai Jiao Tong University, Shanghai, China
| | - Kaiming Su
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Otolaryngological Institute of Shanghai Jiao Tong University, Shanghai, China
| | - Dongzhen Yu
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Otolaryngological Institute of Shanghai Jiao Tong University, Shanghai, China
| | - Hongliang Yi
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Otolaryngological Institute of Shanghai Jiao Tong University, Shanghai, China
| | - Jian Guan
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Otolaryngological Institute of Shanghai Jiao Tong University, Shanghai, China
| | - Shankai Yin
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Otolaryngological Institute of Shanghai Jiao Tong University, Shanghai, China
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29
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Erdenebayar U, Park JU, Jeong P, Lee KJ. Obstructive Sleep Apnea Screening Using a Piezo-Electric Sensor. J Korean Med Sci 2017; 32:893-899. [PMID: 28480645 PMCID: PMC5426252 DOI: 10.3346/jkms.2017.32.6.893] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 03/04/2017] [Indexed: 11/20/2022] Open
Abstract
In this study, we propose a novel method for obstructive sleep apnea (OSA) detection using a piezo-electric sensor. OSA is a relatively common sleep disorder. However, more than 80% of OSA patients remain undiagnosed. We investigated the feasibility of OSA assessment using a single-channel physiological signal to simplify the OSA screening. We detected both snoring and heartbeat information by using a piezo-electric sensor, and snoring index (SI) and features based on pulse rate variability (PRV) analysis were extracted from the filtered piezo-electric sensor signal. A support vector machine (SVM) was used as a classifier to detect OSA events. The performance of the proposed method was evaluated on 45 patients from mild, moderate, and severe OSA groups. The method achieved a mean sensitivity, specificity, and accuracy of 72.5%, 74.2%, and 71.5%; 85.8%, 80.5%, and 80.0%; and 70.3%, 77.1%, and 71.9% for the mild, moderate, and severe groups, respectively. Finally, these results not only show the feasibility of OSA detection using a piezo-electric sensor, but also illustrate its usefulness for monitoring sleep and diagnosing OSA.
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Affiliation(s)
- Urtnasan Erdenebayar
- Department of Biomedical Engineering, School of Health Science, Yonsei University, Wonju, Korea
| | - Jong Uk Park
- Department of Biomedical Engineering, School of Health Science, Yonsei University, Wonju, Korea
| | - Pilsoo Jeong
- Department of Biomedical Engineering, School of Health Science, Yonsei University, Wonju, Korea
| | - Kyoung Joung Lee
- Department of Biomedical Engineering, School of Health Science, Yonsei University, Wonju, Korea.
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30
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Ghosh D, Mackay TW, Riha RL. European Union directive 2014/85/EU on driver licensing in obstructive sleep apnoea: early experiences with its application in the UK. Breathe (Sheff) 2017; 12:e59-e63. [PMID: 28194236 PMCID: PMC5298899 DOI: 10.1183/20734735.008016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Obstructive sleep apnoea (OSA) is a prevalent condition, affecting up to 20% of the population in first world countries [1]. The obstructive sleep apnoea hypopnea syndrome (OSAHS) is diagnosed when symptoms of excessive daytime somnolence or cognitive impairment are present in the context of an elevated apnoea-hypopnoea index (AHI) per hour of sleep. The definitions vary according to the lower cut-off for the AHI, which can range from >5 to >15 events per hour [2]. However, as with any sleep disorder, it is important to establish whether the sleep disordered breathing (SDB) per se is the true cause of symptoms of daytime somnolence. As is apparent to everyone who practises in the area, a large number of other factors can intervene, such as shift work, sleep insufficiency, psychiatric disorders, metabolic disorders and nutritional deficiencies, which may be the true cause of the somnolence rather than the AHI as measured on polysomnography. Additionally, a true AHI cannot be reported on the basis of any respiratory measurements conducted during sleep, if no electroencephalogram is simultaneously recorded [2]. OSA patients’ risk of RTA should be assessed using detailed driving history with specific focus on “red flags”http://ow.ly/mxPi305isni
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Affiliation(s)
- Dipansu Ghosh
- Sleep and Non-invasive Ventilation Services, St. James's University Hospital, Leeds, UK
| | - Thomas W Mackay
- Dept of Sleep Medicine, Royal Infirmary Edinburgh, Edinburgh, UK
| | - Renata L Riha
- Dept of Sleep Medicine, Royal Infirmary Edinburgh, Edinburgh, UK
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31
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Turino C, de Batlle J, Woehrle H, Mayoral A, Castro-Grattoni AL, Gómez S, Dalmases M, Sánchez-de-la-Torre M, Barbé F. Management of continuous positive airway pressure treatment compliance using telemonitoring in obstructive sleep apnoea. Eur Respir J 2017; 49:49/2/1601128. [PMID: 28179438 DOI: 10.1183/13993003.01128-2016] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Continuous positive airway pressure (CPAP) is an effective treatment for obstructive sleep apnoea (OSA), but treatment compliance is often unsatisfactory. This study investigated the efficacy and cost-effectiveness of telemonitoring for improving CPAP compliance.100 newly diagnosed OSA patients requiring CPAP (apnoea-hypopnoea index >15 events·h-1) were randomised to standard management or a telemonitoring programme that collected daily information about compliance, air leaks and residual respiratory events, and initiated patient contact to resolve issues. Clinical/anthropometric variables, daytime sleepiness and quality of life were recorded at baseline and after 3 months. Patient satisfaction, additional visits/calls, side-effects and total costs were assessed.There were no significant differences between the standard and telemedicine groups in terms of CPAP compliance (4.9±2.2 versus 5.1±2.1 h·night-1), symptoms, clinical variables, quality of life and unwanted effects. Telemedicine was less expensive than standard management (EUR123.65 versus EUR170.97; p=0.022) and was cost-effective (incremental cost-effectiveness ratio EUR17 358.65 per quality-adjusted life-year gained). Overall patient satisfaction was high, but significantly more patients rated satisfaction as high/very high in the standard management versus telemedicine group (96% versus 74%; p=0.034).Telemonitoring did not improve CPAP treatment compliance and was associated with lower patient satisfaction. However, it was more cost-effective than traditional follow-up.
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Affiliation(s)
- Cecilia Turino
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain.,These authors are joint first authors and contributed equally to this work
| | - Jordi de Batlle
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain.,These authors are joint first authors and contributed equally to this work
| | - Holger Woehrle
- Sleep and Ventilation Centre Blaubeuren, Respiratory Centre Ulm, Ulm, Germany.,ResMed Science Centre, ResMed Germany, Martinsried, Germany
| | | | - Anabel Lourdes Castro-Grattoni
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
| | - Sílvia Gómez
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
| | - Mireia Dalmases
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
| | - Manuel Sánchez-de-la-Torre
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain .,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Ferran Barbé
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
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32
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Nilius G, Domanski U, Schroeder M, Franke KJ, Hogrebe A, Margarit L, Stoica M, d'Ortho MP. A randomized controlled trial to validate the Alice PDX ambulatory device. Nat Sci Sleep 2017; 9:171-180. [PMID: 28652835 PMCID: PMC5476768 DOI: 10.2147/nss.s133789] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is a highly prevalent condition; however, the majority of patients remain undiagnosed. There is a potential to expand the diagnostic capacity of sleep laboratories. The study objective was to validate a portable respiratory monitoring device (Alice PDX) against polysomnography (PSG) in the laboratory and to assess its reliability at home. METHODS A total of 85 patients with suspected OSA (80% male, mean age 49.1±13.5 years, body mass index 29.7±6.9 kg/m2, Epworth Sleepiness Scale 10.0±5.1) were randomized to 3 diagnostic nights: 1 night simultaneous in-laboratory PSG and PDX recording; 1 night self-applied PDX at home, and 1 night in-laboratory PSG. Study data were manually scored according to American Academy of Sleep Medicine criteria. RESULTS The Alice PDX was in diagnostic agreement with simultaneously recorded reference PSG in 96.4% of studies. In 2.4% of studies the in-laboratory PDX underestimated and in 1.2% of studies it overestimated the apnea hypopnea index (AHI). The difference between the AHI from the reference PSG and the home study was similar to the difference between the PSGs (2.79 vs 0.79, p=0.08). CONCLUSION In a population with a high suspicion of OSA, the Alice PDX showed a high level of diagnostic agreement with a simultaneous PSG and performed valid home diagnostic studies for OSA. If manually scored, the portable device can be used by sleep specialists for diagnosing moderate-to-severe obstructive sleep apnea in cases with a high pretest probability for the disease over a wide range of disease severity. The technology can be deployed reliably outside of the sleep laboratory setting.
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Affiliation(s)
- Georg Nilius
- HELIOS-Klinik Ambrock, Universität Witten-Herdecke, Hagen, Germany
| | - Ulrike Domanski
- HELIOS-Klinik Ambrock, Universität Witten-Herdecke, Hagen, Germany
| | - Maik Schroeder
- HELIOS-Klinik Ambrock, Universität Witten-Herdecke, Hagen, Germany
| | | | - Anke Hogrebe
- HELIOS-Klinik Ambrock, Universität Witten-Herdecke, Hagen, Germany
| | - Laurent Margarit
- Service de Physiologie - Explorations Fonctionnelles DHU FIRE, Groupe Hospitalier Bichat-Claude Bernard, Assistance Publique-Hopitaux de Paris
| | - Maria Stoica
- Service de Physiologie - Explorations Fonctionnelles DHU FIRE, Groupe Hospitalier Bichat-Claude Bernard, Assistance Publique-Hopitaux de Paris
| | - Marie-Pia d'Ortho
- Service de Physiologie - Explorations Fonctionnelles DHU FIRE, Groupe Hospitalier Bichat-Claude Bernard, Assistance Publique-Hopitaux de Paris.,Université Denis Diderot Paris 7, Paris, France
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33
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Ghosh D, Jamson SL, Baxter PD, Elliott MW. Factors that affect simulated driving in patients with obstructive sleep apnoea. ERJ Open Res 2016; 1:00074-2015. [PMID: 27730161 PMCID: PMC5005126 DOI: 10.1183/23120541.00074-2015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 10/26/2015] [Indexed: 11/05/2022] Open
Abstract
Patients with obstructive sleep apnoea syndrome (OSAS) are at increased risk of involvement in road traffic accidents (RTAs) [1]. Clinicians diagnosing OSAS need to advise patients about driving but there are no validated tools and no robust objective data about which factors are important [2]. There are position statements, based solely on expert opinion, from various professional bodies [3–6]. In general, they conclude that a patient with significant daytime sleepiness and a recent RTA or near miss attributable to sleepiness, fatigue or inattention, should be considered a high-risk driver [3–6]. In a recent survey using clinical vignettes, we have shown that there is considerable variability in the advice that patients are likely to receive [7]. This indicates that clinicians require more robust guidance. Objective data for advising sleep apnoea sufferers whether they are at increased risk of an accident when drivinghttp://ow.ly/TWPgm
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Affiliation(s)
- Dipansu Ghosh
- Dept of Respiratory Medicine, St James' University Hospital, Leeds, UK
| | - Samantha L Jamson
- Safety and Technology Group, Institute for Transport Studies, University of Leeds, Leeds, UK
| | - Paul D Baxter
- Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), Division for Epidemiology and Biostatistics, University of Leeds, Leeds, UK
| | - Mark W Elliott
- Dept of Respiratory Medicine, St James' University Hospital, Leeds, UK
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Matsui K, Sasai-Sakuma T, Ishigooka J, Inoue Y. Insufficient sleep rather than the apnea-hypopnea index can be associated with sleepiness-related driving problems of Japanese obstructive sleep apnea syndrome patients residing in metropolitan areas. Sleep Med 2016; 33:19-22. [PMID: 28449900 DOI: 10.1016/j.sleep.2016.07.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 06/07/2016] [Accepted: 07/10/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Obstructive sleep apnea syndrome (OSAS) and insufficient sleep might increase the risk of drowsy driving and sleepiness-related vehicular accidents. This study retrospectively investigated the factors associated with these driving problems, particularly addressing OSAS severity and sleep amounts of affected drivers. METHODS This study examined 161 patients (146 male and 15 female) with OSAS (apnea-hypopnea index [AHI] ≥ 5) who drove on a routine basis and who completed study questionnaires. To investigate factors associated with drowsy driving during the prior year and sleepiness-related vehicular accidents or near-miss events during the prior five years, logistic regression analyses were performed with age, body mass index, monthly driving distance, habitual sleep duration on weekdays, the Japanese version of Epworth Sleepiness Scale score, AHI, and periodic limb movement index as independent variables. RESULTS Of the patients, 68 (42.2%) reported drowsy driving experiences, and 86 (53.4%) reported sleepiness-related vehicular accidents or near-miss events. Analyses revealed the following: older age (46-65 years, ≥66 years) was negatively associated with drowsy driving (p <0.05, p <0.05), and habitually shorter sleep duration on weekdays (≤6 hours) was positively associated with drowsy driving (p <0.01). Habitual sleep duration of ≤6 hours (p <0.01) and Epworth Sleepiness Scale score of ≥11 (p <0.01) were positively associated with sleepiness-related vehicular accidents and near-miss events. However, AHI was not associated with these driving problems. CONCLUSION Insufficient sleep, rather than severity of OSAS, was associated with sleepiness-related driving problems in these Japanese OSAS patients.
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Affiliation(s)
- Kentaro Matsui
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan; Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo, Japan
| | - Taeko Sasai-Sakuma
- Department of Somnology, Tokyo Medical University, Tokyo, Japan; Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo, Japan; Department of Life Sciences and Bio-informatics, Division of Biomedical Laboratory Sciences, Graduate School of Health Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Jun Ishigooka
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan
| | - Yuichi Inoue
- Department of Somnology, Tokyo Medical University, Tokyo, Japan; Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo, Japan.
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Kim KB. How has our interest in the airway changed over 100 years? Am J Orthod Dentofacial Orthop 2016; 148:740-7. [PMID: 26522033 DOI: 10.1016/j.ajodo.2015.08.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 08/01/2015] [Accepted: 08/01/2015] [Indexed: 12/01/2022]
Abstract
Since the beginning of our specialty, our understanding of the link between function and facial growth and development has progressively improved. Today, we know that children with sleep-related breathing problems will often develop distinctive facial characteristics. In adults, sleep apnea can result in serious morbidity and mortality. Orthodontists can ask sleep-related questions in the health history to help identify sleep breathing disorders. Treating these patients presents unique opportunities for orthodontists to collaborate with other medical specialties to improve a patient's health and treatment outcome. Research presented in our Journal in the next century may shed new light that will help us better identify the problem and aid the specialty in developing more effective evidence-based treatment. Additional efforts are needed to understand the physiology, neurology, and genetics of sleep breathing disorders.
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Affiliation(s)
- Ki Beom Kim
- Associate professor, Department of Orthodontics, Center for Advanced Dental Education, Saint Louis University, St Louis, Mo.
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Cooksey JA, Balachandran JS. Portable Monitoring for the Diagnosis of OSA. Chest 2016; 149:1074-81. [PMID: 26539918 DOI: 10.1378/chest.15-1076] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 10/05/2015] [Accepted: 10/14/2015] [Indexed: 11/01/2022] Open
Abstract
In-laboratory, attended polysomnography has long been the gold standard for the diagnosis of sleep-disordered breathing (SDB). In recent years, economic pressures and long wait times have driven interest in home sleep testing, which has, in turn, led to the development of algorithms that bypass the sleep laboratory in favor of portable monitoring studies and in-home initiation of positive airway pressure therapy. For appropriately selected outpatients, evidence is accumulating that portable monitors are a reasonable substitute for in-laboratory polysomnography. In the inpatient setting, in which SDB is both highly prevalent and associated with adverse outcomes in certain populations, the literature is evolving on the use of portable monitors to expedite diagnosis and treatment of SDB. This review discusses society guidelines and recent research in the growing field of portable monitoring.
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Affiliation(s)
- Jessica A Cooksey
- Section of Pulmonary and Critical Care, University of Chicago, Chicago, IL
| | - Jay S Balachandran
- Section of Pulmonary and Critical Care, University of Chicago, Chicago, IL.
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Turnbull CD, Manuel AR, Stradling JR. Does either obesity or OSA severity influence the response of autotitrating CPAP machines in very obese subjects? Sleep Breath 2015; 20:647-52. [DOI: 10.1007/s11325-015-1267-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 08/12/2015] [Accepted: 09/21/2015] [Indexed: 11/29/2022]
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Jin H, Lee LA, Song L, Li Y, Peng J, Zhong N, Li HY, Zhang X. Acoustic Analysis of Snoring in the Diagnosis of Obstructive Sleep Apnea Syndrome: A Call for More Rigorous Studies. J Clin Sleep Med 2015; 11:765-71. [PMID: 25766705 DOI: 10.5664/jcsm.4856] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 02/08/2015] [Indexed: 12/26/2022]
Abstract
BACKGROUND Snoring is a common symptom of obstructive sleep apnea syndrome (OSA) and has recently been considered for diagnosis of OSA. OBJECTIVES The goal of the current study was to systematically determine the accuracy of acoustic analysis of snoring in the diagnosis of OSA using a meta-analysis. METHODS PubMed, Cochrane Library database, and EMBASE were searched up to July 15, 2014. A systematic review and meta-analysis of sensitivity, specificity, and other measures of accuracy of acoustic analysis of snoring in the diagnosis of OSA were conducted. The median of apneahypopnea index threshold was 10 events/h, range: 5-15 or 10-15 if aforementioned suggestion is adopted. RESULTS A total of seven studies with 273 patients were included in the meta-analysis. The pooled estimates were as follows: sensitivity, 88% (95% confidence interval [CI]: 82-93%); specificity, 81% (95% CI: 72-88%); positive likelihood ratio (PLR), 4.44 (95% CI: 2.39-8.27); negative likelihood ratio (NLR), 0.15 (95% CI: 0.10-0.24); and diagnostic odds ratio (DOR), 32.18 (95% CI: 13.96-74.81). χ(2) values of sensitivity, specificity, PLR, NLR, and DOR were 2.37, 10.39, 12.57, 3.79, and 6.91 respectively (All p > 0.05). The area under the summary receiver operating characteristic curve was 0.93. Sensitivity analysis demonstrated that the pooled estimates were stable and reliable. The results of publication bias were not significant (p = 0.30). CONCLUSIONS Acoustic analysis of snoring is a relatively accurate but not a strong method for diagnosing OSA. There is an urgent need for rigorous studies involving large samples and single snore event tests with an efficacy criterion that reflects the particular features of snoring acoustics for OSA diagnosis.
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Affiliation(s)
- Hui Jin
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Li-Ang Lee
- Department of Otolaryngology, Sleep Center, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan
| | - Lijuan Song
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yanmei Li
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Jianxin Peng
- Department of Physics, School of Science, South China University of Technology, Guangzhou, China
| | - Nanshan Zhong
- State Key Laboratory of Respiratory Disease, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Hsueh-Yu Li
- Department of Otolaryngology, Sleep Center, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan
| | - Xiaowen Zhang
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
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Garbarino S, Pitidis A, Giustini M, Taggi F, Sanna A. Motor vehicle accidents and obstructive sleep apnea syndrome. Chron Respir Dis 2015; 12:320-8. [DOI: 10.1177/1479972315594624] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The association between motor vehicle accidents (MVAs) and obstructive sleep apnea syndrome (OSAS) has always been quantified as risk of MVAs for individual drivers with OSAS. We evaluated the expected injured patients per year attributable to OSAS-dependent MVAs in a general population. By combining OSAS prevalence and OSAS-dependent MVAs odds ratio, we assessed the population attributable fraction (PAF), an epidemiological tool that can be used to quantify the proportion of road traffic injuries (RTIs) attributable to OSAS. For an apnea hypopnea index >5, the weighed median and combined average of OSAS prevalence were 4.4 (95% confidence interval (CI): 3.7–7.5) and 4.7 (95% CI: 4.2–5.2), respectively; values of risk of OSAS-dependent MVAs were 2.83 (95% CI: 2.72–3.08) and 2.52 (95% CI: 2.07–3.08), respectively. The PAF showed weighed median and combined average values of 6.6 (95% CI: 4.3–9.8) and 7.3% (95% CI: 6.0–13.5), respectively. Our results show that about 7% of RTIs for a population of male drivers involved in MVAs are attributable to OSAS. This value can be used to assess the potential impact, on the reduction of incidence of the motor vehicle injuries, of prevention programs aimed at reducing the number of subjects with an undiagnosed and/or untreated OSAS.
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Affiliation(s)
- Sergio Garbarino
- Department of Neuroscience, Ophthalmology and Genetics, Sleep Medicine Center, University of Genoa, Genoa, Italy
- State Police Health Service Department, Ministry of the Interior, Rome, Italy
| | - Alessio Pitidis
- Department of Environment and Primary Prevention, Environment and Trauma Unit, National Institute of Health, Rome, Italy
| | - Marco Giustini
- Department of Environment and Primary Prevention, Environment and Trauma Unit, National Institute of Health, Rome, Italy
| | - Franco Taggi
- Department of Environment and Primary Prevention, Environment and Trauma Unit, National Institute of Health, Rome, Italy
| | - Antonio Sanna
- Pneumology Unit, Azienda USL 3 Pistoia – Pneumology Unit, San Jacopo Hospital, Pistoia, Italy
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Djonlagic I, Guo M, Matteis P, Carusona A, Stickgold R, Malhotra A. First night of CPAP: impact on memory consolidation attention and subjective experience. Sleep Med 2015; 16:697-702. [PMID: 25953301 DOI: 10.1016/j.sleep.2015.01.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 12/23/2014] [Accepted: 01/23/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Neurocognitive deficits are common and serious consequences of obstructive sleep apnea (OSA). Currently, the gold standard treatment is continuous positive air pressure (CPAP) therapy, although the clinical responses to this intervention can be variable. This study examined the effect of one night of CPAP therapy on sleep-dependent memory consolidation, attention, and vigilance as well as subjective experience. METHODS Fifteen healthy controls and 29 patients with obstructive sleep apnea of whom 14 underwent a full-night CPAP titration completed the psychomotor vigilance test (PVT) and motor sequence learning task (MST) in the evening and the morning after undergoing overnight polysomnography. All participants also completed subjective evaluations of sleep quality. RESULTS Participants with OSA showed significantly less overnight improvement on the MST compared to controls without OSA, independent of whether or not they had received CPAP treatment, while there was no significant difference between the untreated OSA and CPAP-treated patients. Within the OSA group, only those receiving CPAP exhibited faster reaction times on the PVT in the morning. Compared to untreated OSA patients, they also felt subjectively more rested and reported that they slept better. CONCLUSION Our results demonstrate an instant augmentation of subjective experience and, based on PVT results, attention and vigilance after one night of CPAP, but a lack of an effect on offline sleep-dependent motor memory consolidation. This dissociation may be explained by different brain structures underlying these processes, some of which might require longer continued adherence to CPAP to generate an effect.
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Affiliation(s)
- Ina Djonlagic
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA; Center for Sleep and Cognition, Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA; Division of Sleep Medicine, Sleep Disorders Program Brigham & Women's Hospital and Harvard Medical School, Boston, MA, USA.
| | - Mengshuang Guo
- Center for Sleep and Cognition, Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA; Division of Sleep Medicine, Sleep Disorders Program Brigham & Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Paul Matteis
- Center for Sleep and Cognition, Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA; Division of Sleep Medicine, Sleep Disorders Program Brigham & Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Andrea Carusona
- Division of Sleep Medicine, Sleep Disorders Program Brigham & Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Robert Stickgold
- Center for Sleep and Cognition, Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Atul Malhotra
- Division of Sleep Medicine, Sleep Disorders Program Brigham & Women's Hospital and Harvard Medical School, Boston, MA, USA; Division of Pulmonary and Critical Care, University of California San Diego, La Jolla, CA, USA
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Affiliation(s)
- Jon Tippin
- Department of Neurology University of Iowa Veterans Affairs Medical Center Iowa City, Iowa
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The relationship between driving simulation performance and obstructive sleep apnoea risk, daytime sleepiness, obesity and road traffic accident history of commercial drivers in Turkey. Sleep Breath 2015; 19:865-72. [DOI: 10.1007/s11325-014-1114-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 11/24/2014] [Accepted: 12/23/2014] [Indexed: 10/24/2022]
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Gonçalves M, Amici R, Lucas R, Åkerstedt T, Cirignotta F, Horne J, Léger D, McNicholas WT, Partinen M, Téran-Santos J, Peigneux P, Grote L. Sleepiness at the wheel across Europe: a survey of 19 countries. J Sleep Res 2015; 24:242-53. [DOI: 10.1111/jsr.12267] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Accepted: 11/01/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Marta Gonçalves
- Portuguese Sleep Association; Porto Portugal
- Assembly of National Sleep Societies; Associate Membership Body of the ESRS; Regensburg Germany
- European Sleep Research Society; Regensburg Germany
- Institute of Public Health - University of Porto (ISPUP); Porto Portugal
| | | | - Raquel Lucas
- Institute of Public Health - University of Porto (ISPUP); Porto Portugal
| | - Torbjörn Åkerstedt
- European Sleep Research Society; Regensburg Germany
- ESRS ‘Sleep and Driving’ Expert Panel; Regensburg Germany
| | - Fabio Cirignotta
- European Sleep Research Society; Regensburg Germany
- ESRS ‘Sleep and Driving’ Expert Panel; Regensburg Germany
| | - Jim Horne
- European Sleep Research Society; Regensburg Germany
- ESRS ‘Sleep and Driving’ Expert Panel; Regensburg Germany
| | - Damien Léger
- European Sleep Research Society; Regensburg Germany
- ESRS ‘Sleep and Driving’ Expert Panel; Regensburg Germany
| | - Walter T. McNicholas
- European Sleep Research Society; Regensburg Germany
- ESRS ‘Sleep and Driving’ Expert Panel; Regensburg Germany
| | - Markku Partinen
- European Sleep Research Society; Regensburg Germany
- ESRS ‘Sleep and Driving’ Expert Panel; Regensburg Germany
| | - Joaquín Téran-Santos
- European Sleep Research Society; Regensburg Germany
- ESRS ‘Sleep and Driving’ Expert Panel; Regensburg Germany
| | | | - Ludger Grote
- Assembly of National Sleep Societies; Associate Membership Body of the ESRS; Regensburg Germany
- European Sleep Research Society; Regensburg Germany
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Martínez Cerón E, Casitas Mateos R, García-Río F. Sleep apnea-hypopnea syndrome and type 2 diabetes. A reciprocal relationship? Arch Bronconeumol 2014; 51:128-39. [PMID: 25145320 DOI: 10.1016/j.arbres.2014.06.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 06/15/2014] [Accepted: 06/16/2014] [Indexed: 01/03/2023]
Abstract
Epidemiological data suggest that sleep apnea-hypopnea syndrome (SAHS) is independently associated with the development of insulin resistance and glucose intolerance. Moreover, despite significant methodological limitations, some studies report a high prevalence of SAHS in patients with type 2 diabetes mellitus (DM2). A recent meta-analysis shows that moderate-severe SAHS is associated with an increased risk of DM2 (relative risk=1.63 [1.09 to 2.45]), compared to the absence of apneas and hypopneas. Common alterations in various pathogenic pathways add biological plausibility to this relationship. Intermittent hypoxia and sleep fragmentation, caused by successive apnea-hypopnea episodes, induce several intermediate disorders, such as activation of the sympathetic nervous system, oxidative stress, systemic inflammation, alterations in appetite-regulating hormones and activation of the hypothalamic-pituitary-adrenal axis which, in turn, favor the development of insulin resistance, its progression to glucose intolerance and, ultimately, to DM2. Concomitant SAHS seems to increase DM2 severity, since it worsens glycemic control and enhances the effects of atherosclerosis on the development of macrovascular complications. Furthermore, SAHS may be associated with the development of microvascular complications: retinopathy, nephropathy or diabetic neuropathy in particular. Data are still scant, but it seems that DM2 may also worsen SAHS progression, by increasing the collapsibility of the upper airway and the development of central apneas and hypopneas.
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Affiliation(s)
| | | | - Francisco García-Río
- Servicio de Neumología, Hospital Universitario La Paz, IdiPAZ, Madrid, España; Universidad Autónoma de Madrid, Madrid, España; CIBER de enfermedades respiratorias (CIBERES), Madrid, España.
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Szentkirályi A, Madarász CZ, Novák M. Sleep disorders: impact on daytime functioning and quality of life. Expert Rev Pharmacoecon Outcomes Res 2014; 9:49-64. [DOI: 10.1586/14737167.9.1.49] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Irwin ED, Reicks P, Beal A, Byrnes M, Matticks C, Beilman G. A prospective study of the role of sleep related disordered breathing as a risk factor for motor vehicle crashes and the development of systemic complications in non-commercial drivers. World J Emerg Surg 2014; 9:2. [PMID: 24397859 PMCID: PMC3933287 DOI: 10.1186/1749-7922-9-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 11/18/2013] [Indexed: 11/11/2022] Open
Abstract
Introduction Sleep related disordered breathing (SRDB), is an established risk factor for motor vehicle crashes (MVCs) involving commercial drivers. The role of SRDB in motor vehicle crashes involving non-commercial drivers is not well established. Methods Drivers involved in MVCs who were admitted to an American College of Surgeons accredited Level I trauma center for treatment of their injuries, and who could give informed consent and provide verbal responses to screening questionnaires were eligible for enrolment in this study. Two questionnaires previously validated for screening patients at risk for sleep disturbances (The Epworth Sleepiness Scale (ESS) and The Berlin Questionnaire (BQ)) were administered. Questionnaire results associated with an 85% sensitivity for predicting obstructive sleep apnea were considered positive. In this study we tested the hypothesis that patients at risk for SRDB, as measured by validated questionnaires, are at an increased risk being involved in MVCs. Results Between March and October 2010, 71 consecutive patients were offered enrolment in this study with 56 agreeing to participate in this study. Six were previously diagnosed with SRDB with only one being compliant and effectively treated at the time of their MVC. Forty-two patients (75%) had responses to the questionnaires that indicated that the patients were at high risk for SRDB. Six patients suffered systemic complications, including pleural effusions, pneumonia and arrhythmias, during their hospitalization with five (83%) having abnormal questionnaire responses indicating that the patient was at high risk for SRDB. Conclusions The high incidence of positive responses to the sleep questionnaires is consistent with the hypothesis that SRDB is potentially a significant risk factor for MVCs. Furthermore the observation that systemic complications were seen more commonly in those with SRDB, while not unexpected, is a novel observation. Further studies are needed to validate these findings in a larger cohort of patients as well as determining if these patients are truly at a greater risk for systemic complications. If replicated these observations would suggest that effective therapy for disordered sleep could play a significant role in an injury prevention process.
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Abstract
ABSTRACT
Trauma and obesity are large-scale epidemics that can be associated with significant morbidity and mortality. In few studies, it has noted that there is the ‘obesity paradox’ (obesity has been found to be protective against mortality) due to certain causes, i.e. heart failure or cardiovascular disease. Subcutaneous fat can show great variability between individuals and increased subcutaneous fat may be protective against injuries by cushioning the internal abdominal organs against injurious forces in road traffic accidents. Many factors including the body fat distribution, body shape, and center of gravity may play an important role in the different injury patterns and severity of injury between men and women. A better understanding of how obesity influences trauma related injuries not only will help to improve the outcome but also foster the development of interventions to address the most salient and modifiable risk factors to reduce obesity related morbidity and mortality. In present article, we review the relevant literature with special considerations to understand the interactions of obesity and trauma with their impact on patient management and outcomes.
How to cite this article
Agrawal A. Complex Interaction between Obesity and Trauma. Panam J Trauma Crit Care Emerg Surg 2014;3(3):109-113.
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KALES SN, STRAUBEL MG. Obstructive sleep apnea in North American commercial drivers. INDUSTRIAL HEALTH 2014; 52:13-24. [PMID: 24317450 PMCID: PMC4202769 DOI: 10.2486/indhealth.2013-0206] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Accepted: 12/03/2013] [Indexed: 05/20/2023]
Abstract
The most common medical cause of excessive daytime sleepiness (EDS) is obstructive sleep apnea (OSA). Specifically, among an estimated 14 million US commercial drivers, 17-28% or 2.4 to 3.9 million are expected to have OSA. Based on existing epidemiologic evidence, most of these drivers are undiagnosed and not adequately treated. Untreated OSA increases the risk of vehicular crashes as documented in multiple independent studies and by meta-analysis. Therefore, identifying commercial drivers with OSA and having them effectively treated should decrease crash-related fatalities and injuries. Several strategies are available for screening and identifying drivers with OSA. The simplest and most effective objective strategies use body mass index (BMI) cutoffs for obesity. Functional screens are promising adjuncts to other objective tests. The most effective approach will likely be a combination of a good questionnaire; BMI measures; and a careful physician-obtained history complemented by a functional screen.
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Affiliation(s)
- Stefanos N. KALES
- Environmental and Occupational Medicine and Epidemiology,
Harvard School of Public Health, USA
- Division of Sleep Medicine, Harvard Medical School,
USA
- Employee and Industrial Medicine, Cambridge Health Alliance,
USA
- To whom correspondence should be addressed. E-mail: ,
.
| | - Madeleine G. STRAUBEL
- Environmental and Occupational Medicine and Epidemiology,
Harvard School of Public Health, USA
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