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Wang Y, Deng T, Zhao X, Shao L, Chen J, Fu C, He W, Wang X, Wang H, Yuan F, Wang S. Control of breathing by orexinergic signaling in the nucleus tractus solitarii. Sci Rep 2024; 14:7473. [PMID: 38553555 PMCID: PMC10980752 DOI: 10.1038/s41598-024-58075-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 03/25/2024] [Indexed: 04/02/2024] Open
Abstract
Orexin signaling plays a facilitatory role in respiration. Abnormalities in orexin levels correlate with disordered breathing patterns and impaired central respiratory chemoreception. Nucleus tractus solitarii (NTS) neurons expressing the transcription factor Phox2b contribute to the chemoreceptive regulation of respiration. However, the extent to which orexinergic signaling modulates respiratory activity in these Phox2b-expressing NTS neurons remains unclear. In the present study, the injection of orexin A into the NTS significantly increased the firing rate of the phrenic nerve. Further analysis using fluorescence in situ hybridization and immunohistochemistry revealed that orexin 1 receptors (OX1Rs) were primarily located in the ventrolateral subdivision of the NTS and expressed in 25% of Phox2b-expressing neurons. Additionally, electrophysiological recordings showed that exposure to orexin A increased the spontaneous firing rate of Phox2b-expressing neurons. Immunostaining experiments with cFos revealed that the OX1R-residing Phox2b-expressing neurons were activated by an 8% CO2 stimulus. Crucially, OX1R knockdown in these NTS neurons notably blunted the ventilatory response to 8% CO2, alongside an increase in sigh-related apneas. In conclusion, orexinergic signaling in the NTS facilitates breathing through the activation of OX1Rs, which induces the depolarization of Phox2b-expressing neurons. OX1Rs are essential for the involvement of Phox2b-expressing NTS neurons in the hypercapnic ventilatory response.
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Affiliation(s)
- Yakun Wang
- Department of Neurobiology, Hebei Medical University, Shijiazhuang, Hebei, China
- Department of Sleep Medicine, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Tianjiao Deng
- Department of Neurobiology, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Xue Zhao
- Department of Neurobiology, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Liuqi Shao
- Department of Neurobiology, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Jinting Chen
- Department of Neurobiology, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Congrui Fu
- Nursing School, Hebei Medical University, Shijiazhuang, China
| | - Wei He
- Department of Neurobiology, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Xiaoyi Wang
- Department of Neurobiology, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Hanqiao Wang
- Department of Sleep Medicine, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Fang Yuan
- Department of Neurobiology, Hebei Medical University, Shijiazhuang, Hebei, China
- Hebei Key Laboratory of Neurophysiology, Shijiazhuang, China
| | - Sheng Wang
- Department of Neurobiology, Hebei Medical University, Shijiazhuang, Hebei, China.
- Hebei Key Laboratory of Neurophysiology, Shijiazhuang, China.
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Ibdah RK, Zaitoun KJ, Altawalbeh RB, Tayyem SH, Nazzal UA, Rawashdeh SI, Khader YS, Al-Mistarehi AHW, Khassawneh BY. Prevalence of Obstructive Sleep Apnea Among Atrial Fibrillation Patients: A Cross-Sectional Study from Jordan. J Multidiscip Healthc 2024; 17:701-710. [PMID: 38375526 PMCID: PMC10875174 DOI: 10.2147/jmdh.s452589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 02/01/2024] [Indexed: 02/21/2024] Open
Abstract
Background Obstructive Sleep Apnea (OSA) is a common respiratory disorder that causes intermittent upper airway collapse during sleep and can lead to various acute cardiovascular complications. Atrial Fibrillation (AF) is the most common sustained cardiac arrhythmia and is associated with an increased risk of cardiovascular hospitalization and all-cause mortality. Our study aimed to investigate the prevalence of individuals with AF and those considered at high risk for OSA. Methods A cross-sectional study was conducted with a population comprising patients who had visited KAUH cardiology clinics between 2017-2019; subjects were categorized into AF patients and general cardiology patients. Patients were surveyed for OSA using the Berlin Questionnaire to assess the degree of OSA symptoms and to classify patients into high- or low-risk groups based on their responses. Results Of the 656 patients, 545 met our inclusion criteria, of whom 192 were diagnosed with AF. Comparable demographic characteristics were observed between the AF and non-AF groups, barring higher rates of obesity (p=0.001) and smoking (p=0.042) in the AF group. The prevalence of high-risk OSA was significantly higher in AF patients (68.2%) compared to non-AF patients (29.4%), with an adjusted odds ratio of 2.473 times (95% CI: 1.434 -4.266, p=0.001) greater for AF. The age, gender, and BMI categories did not differ significantly between the two groups. Binary logistic regression revealed significant associations between OSA and risk factors such as asthma (OR=4.408, 95% CI: 2.634-7.376, p=0.001). Conclusion These results serve to display a statistically significant increase in high-risk OSA in existing AF patients, irrespective of the presence of conventional OSA risk factors; this could imply a more immediate and direct relationship between both diseases and calls to include routine screening for OSA in patients diagnosed, newly or otherwise, with AF.
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Affiliation(s)
- Rasheed K Ibdah
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Khaled J Zaitoun
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Rana B Altawalbeh
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Saad H Tayyem
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Ulla A Nazzal
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Sukaina I Rawashdeh
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Yousef S Khader
- Department of Community Medicine, Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | | | - Basheer Y Khassawneh
- Department of Internal Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan
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Cade BE, Redline S. Heritability and genetic correlations for sleep apnea, insomnia, and hypersomnia in a large clinical biobank. Sleep Health 2024; 10:S157-S160. [PMID: 38101993 PMCID: PMC11031312 DOI: 10.1016/j.sleh.2023.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 10/31/2023] [Accepted: 11/01/2023] [Indexed: 12/17/2023]
Abstract
RATIONALE Comorbid insomnia and sleep apnea is reported to have worse outcomes than either condition alone. The local genetic correlations of these disorders are unknown. OBJECTIVES To identify local genomic regions with heritability for clinically diagnosed sleep apnea and insomnia, and to identify local genetic correlations between these disorders and/or hypersomnia. METHODS Fifty thousand two hundred seventeen patients of European ancestry were examined. Global and local heritability and genetic correlations for independent regions were calculated, adjusting for obesity and other covariates. RESULTS Sleep apnea and insomnia were significantly globally heritable and had 118 and 168 genetic regions with local heritability p-values <.05, respectively. One region had a significant genetic correlation for sleep apnea and hypersomnia (p-value = 9.85 × 10-4). CONCLUSIONS Clinically diagnosed sleep apnea and insomnia have minimal shared genetic architecture, supporting genetically distinct comorbid insomnia and sleep apnea components. However, additional correlated regions may be identified with additional sample size and methodological improvements.
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Affiliation(s)
- Brian E Cade
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA.
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
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Du D, Zhang G, Xu D, Liu L, Hu X, Chen L, Li X, Shen Y, Wen F. Prevalence and clinical characteristics of sleep disorders in chronic obstructive pulmonary disease: A systematic review and meta-analysis. Sleep Med 2023; 112:282-290. [PMID: 37950939 DOI: 10.1016/j.sleep.2023.10.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/28/2023] [Accepted: 10/30/2023] [Indexed: 11/13/2023]
Abstract
BACKGROUND Sleep disorders, including obstructive sleep apnea (OSA), restless leg syndrome (RLS) and insomnia, are present in chronic obstructive pulmonary disease (COPD) with varied prevalence. The aim of this systematic review and meta-analysis was to investigate prevalence of OSA, RLS and insomnia in patients with COPD and summarize their clinical characteristics. METHODS We searched PubMed, Web of Science and Scopus for eligible articles reporting the prevalence of OSA, RLS, and insomnia in COPD patients. The Newcastle‒Ottawa scale was applied for quality assessment. Odds ratios or mean differences with 95 % confidence intervals (CIs) were applied for the overall prevalence calculation and clinical characteristics assessment. Sensitivity analysis, subgroup analysis and meta-regression were conducted to evaluate the heterogeneity of the results. RESULTS Sixty articles reporting the prevalence of sleep disorders in patients with COPD were included, and the prevalence of OSA, RLS, and insomnia reached 29.1 %(95%CI 27.2%-30.9 %), 21.6 %(95%CI 11.8%-33.3 %) and 29.5 %(95%CI 16.9%-44.0 %), respectively. COPD patients with OSA were characterized by male sex (OR 1.631 95 % CI: 1.231-2.161), obesity(kg/m2) (MD 4.435, 95 % CI 3.218-5.652), higher Epworth Sleepiness Scale (MD: 3.741, 95 % CI: 0.655-6.828, p = 0.018), better pulmonary function (MD 5.66, 95 % CI 3.546-7.774) and higher risks of hypertension (OR 1.933 95 % CI 1.382-2.70) and diabetes (OR 1.898 95 % CI 1.264-2.849). COPD patients with RLS were associated with a higher Epworth sleepiness scale (ESS) score (MD 3.444, 95 % CI 1.880-5.008) and a longer COPD duration(year) (MD: 3.656, 95 % CI: 2.209-5.103). COPD patients with insomnia were characterized by female sex(OR 0.556, 95%CI 0.545,0.567, p < 0.001). CONCLUSION Our study suggests that OSA, RLS and insomnia are common in COPD patients with specific clinical characteristics. Further studies are needed to explore the interactions between COPD and sleep disorders.
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Affiliation(s)
- Dongru Du
- Department of Pulmonary and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu, 610041, China; West China School of Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Guangyue Zhang
- West China School of Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Dan Xu
- Department of Pulmonary and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu, 610041, China
| | - Lian Liu
- Department of Pulmonary and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu, 610041, China
| | - Xueru Hu
- Department of Pulmonary and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu, 610041, China
| | - Lei Chen
- Department of Pulmonary and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu, 610041, China
| | - Xiaoou Li
- Department of Pulmonary and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu, 610041, China.
| | - Yongchun Shen
- Department of Pulmonary and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu, 610041, China.
| | - Fuqiang Wen
- Department of Pulmonary and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu, 610041, China
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Fidler AL, Zhang N, Simakajornboon N, Epstein JN, Kirk S, Beebe DW. Comparing the Driving Skills of Adolescents with Obstructive Sleep Apnea to Healthy Controls: The Results of a Case-Controlled Observational Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1624. [PMID: 37892287 PMCID: PMC10605283 DOI: 10.3390/children10101624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/25/2023] [Accepted: 09/28/2023] [Indexed: 10/29/2023]
Abstract
Auto crashes are a leading cause of death and injury among adolescents. Untreated obstructive sleep apnea (OSA) can cause sleepiness and inattention, which could negatively impact novice drivers, but OSA-related studies have focused on older drivers. This study used a driving simulator to examine whether licensed 16-19-year-old adolescents with OSA have diminished driving skills. Twenty-one adolescents with OSA and twenty-eight without OSA (both confirmed using polysomnography) completed two randomly ordered driving trials in a simulator (with induced distractions versus without). A mixed ANOVA examined the between-subjects effect of the OSA group, the within-subjects effect of the distraction condition, and the group-by-condition interaction effect on the ability to maintain lane position and the frequency of extended eye glances away from the roadway. T-tests were also used to examine group differences in reported sleepiness and inattention during daily life. The distraction task increased extended off-road glances and difficulties maintaining lane position (p < 0.001). However, adolescents with OSA did not display worse eye glance or lane position than controls and there were no significant group-by-condition interactions. Although the groups differed on polysomonographic features, there were also no significant differences in reported sleepiness or inattention. The distraction task negatively impacted both groups of adolescent drivers, but those with OSA did not fare differentially worse. Most adolescents in our study had mild OSA (median obstructive apnea-hypopnea index = 4.4), the most common form in the community. It remains possible that youth with more severe OSA would show increased driving impairment.
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Affiliation(s)
- Andrea L. Fidler
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Nanhua Zhang
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
| | - Narong Simakajornboon
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
- Sleep Center, Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Jeffery N. Epstein
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
| | - Shelley Kirk
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
- The Center for Better Health and Nutrition of the Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Dean W. Beebe
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
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6
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Wojcik R, Morris A. Aiming to Improve Equity in Lung Health: Sex and Gender. Clin Chest Med 2023; 44:613-622. [PMID: 37517839 DOI: 10.1016/j.ccm.2023.03.014] [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: 08/01/2023]
Abstract
Sex and gender impact risk factors, presentations of, and response to therapy in lung diseases such as chronic obstructive pulmonary disease, asthma, lung cancer, interstitial lung disease, and obstructive sleep apnea. Many physicians lack training in the impact of sex and gender on lung disease, resulting in diagnostic delays. Scales and indices taught in the health care system are largely validated in male populations, thereby limiting their application to females. For transgender and lesbian, gay, bisexual, transgender, and questioning + patients, high rates of bias in health care may limit patients' willingness to seek health care.
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Affiliation(s)
- Rachel Wojcik
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Alison Morris
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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7
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Arish N, Izbicki G, Rokach A, Jarjou'i A, Kalak G, Goldberg S. Association of the risk of obstructive sleep apnoea with the severity of COVID-19. PLoS One 2023; 18:e0284063. [PMID: 37463178 DOI: 10.1371/journal.pone.0284063] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 03/23/2023] [Indexed: 07/20/2023] Open
Abstract
Patients with coronavirus 2019 (COVID-19) and obstructive sleep apnoea (OSA) have a worse prognosis than COVID-19 patients without OSA. This study aimed to examine the relationship between OSA risk and the severity of COVID-19 in patients undiagnosed with OSA. Patients diagnosed with COVID-19 and hospitalized or admitted to a community hotel were recruited for the study after recovery during a clinic check-up visit 6-8 weeks after discharge. At this visit, they answered the Epworth Sleeping Scale (ESS) and Berlin questionnaire. Demographic and clinical details were collected from electronic medical records. OSA risk was observed in 37 of 119 included patients (31.1%). Patients with high OSA risk were male, significantly older, had a higher body mass index (BMI), and had higher rates of hypertension and snoring than patients with low OSA risk. Moreover, OSA risk was associated with COVID-19 severity; 48.6% of patients with high risk for OSA suffered from severe COVID-19 compared to 22% of patients with low risk for OSA (p = 0.007). The duration of hospitalization for patients with a high OSA risk was 10.97±9.43 days, while that for those with a low OSA risk was 4.71±6.86 days (p = 0.001). After adjusting for BMI, age, hypertension, and chronic disease, the odds ratio was 4.3 (95%CI, 1.2-16, p = 0.029). A high OSA risk was associated with severe COVID-19 and longer hospitalization. Thus, we recommend that the Berlin and ESS questionnaires be completed for every COVID-19-infected patient at hospitalization, especially in the presence of comorbidities.
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Affiliation(s)
- Nissim Arish
- Respiratory Research Unit, Pulmonary Institute, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Gabriel Izbicki
- Respiratory Research Unit, Pulmonary Institute, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ariel Rokach
- Respiratory Research Unit, Pulmonary Institute, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Amir Jarjou'i
- Respiratory Research Unit, Pulmonary Institute, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - George Kalak
- Respiratory Research Unit, Pulmonary Institute, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Shmuel Goldberg
- Pediatric Unit, Pulmonary Institute, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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8
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Bucklin AA, Ganglberger W, Quadri SA, Tesh RA, Adra N, Da Silva Cardoso M, Leone MJ, Krishnamurthy PV, Hemmige A, Rajan S, Panneerselvam E, Paixao L, Higgins J, Ayub MA, Shao YP, Ye EM, Coughlin B, Sun H, Cash SS, Thompson BT, Akeju O, Kuller D, Thomas RJ, Westover MB. High prevalence of sleep-disordered breathing in the intensive care unit - a cross-sectional study. Sleep Breath 2023; 27:1013-1026. [PMID: 35971023 PMCID: PMC9931933 DOI: 10.1007/s11325-022-02698-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 07/08/2022] [Accepted: 08/08/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE Sleep-disordered breathing may be induced by, exacerbate, or complicate recovery from critical illness. Disordered breathing during sleep, which itself is often fragmented, can go unrecognized in the intensive care unit (ICU). The objective of this study was to investigate the prevalence, severity, and risk factors of sleep-disordered breathing in ICU patients using a single respiratory belt and oxygen saturation signals. METHODS Patients in three ICUs at Massachusetts General Hospital wore a thoracic respiratory effort belt as part of a clinical trial for up to 7 days and nights. Using a previously developed machine learning algorithm, we processed respiratory and oximetry signals to measure the 3% apnea-hypopnea index (AHI) and estimate AH-specific hypoxic burden and periodic breathing. We trained models to predict AHI categories for 12-h segments from risk factors, including admission variables and bio-signals data, available at the start of these segments. RESULTS Of 129 patients, 68% had an AHI ≥ 5; 40% an AHI > 15, and 19% had an AHI > 30 while critically ill. Median [interquartile range] hypoxic burden was 2.8 [0.5, 9.8] at night and 4.2 [1.0, 13.7] %min/h during the day. Of patients with AHI ≥ 5, 26% had periodic breathing. Performance of predicting AHI-categories from risk factors was poor. CONCLUSIONS Sleep-disordered breathing and sleep apnea events while in the ICU are common and are associated with substantial burden of hypoxia and periodic breathing. Detection is feasible using limited bio-signals, such as respiratory effort and SpO2 signals, while risk factors were insufficient to predict AHI severity.
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Affiliation(s)
- Abigail A Bucklin
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
| | - Wolfgang Ganglberger
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
- Sleep & Health Zurich, University of Zurich, Zurich, Switzerland
- Henry and Allison McCance Center for Brain Health, MGH, Boston, MA, USA
| | - Syed A Quadri
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
| | - Ryan A Tesh
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
| | - Noor Adra
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
| | - Madalena Da Silva Cardoso
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
| | - Michael J Leone
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
| | - Parimala Velpula Krishnamurthy
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
| | - Aashritha Hemmige
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
| | - Subapriya Rajan
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
| | - Ezhil Panneerselvam
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
| | - Luis Paixao
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
| | - Jasmine Higgins
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
| | - Muhammad Abubakar Ayub
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
| | - Yu-Ping Shao
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
| | - Elissa M Ye
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
| | - Brian Coughlin
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA
| | - Haoqi Sun
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
- Henry and Allison McCance Center for Brain Health, MGH, Boston, MA, USA
| | - Sydney S Cash
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
| | | | - Oluwaseun Akeju
- Henry and Allison McCance Center for Brain Health, MGH, Boston, MA, USA
- Department of Anesthesia, Critical Care and Pain Medicine, MGH, Boston, MA, USA
| | | | - Robert J Thomas
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
- Department of Medicine, Division of Pulmonary, Critical Care & Sleep, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - M Brandon Westover
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA.
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA.
- Henry and Allison McCance Center for Brain Health, MGH, Boston, MA, USA.
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9
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de Azevedo PG, Guimarães MDLR, Albuquerque ALB, Alves RB, Gomes Fernandes B, Marques de Melo F, Guimaraes Corrêa Do Carmo Lisboa Cardenas R, Friedman E, De Marco L, Bastos-Rodrigues L. Whole-exome identifies germline variants in families with obstructive sleep apnea syndrome. Front Genet 2023; 14:1137817. [PMID: 37229194 PMCID: PMC10203477 DOI: 10.3389/fgene.2023.1137817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 04/26/2023] [Indexed: 05/27/2023] Open
Abstract
Background: Obstructive sleep apnea syndrome (OSAS) (OMIM #107650) is characterized by complete or partial obstruction of the upper airways, resulting in periods of sleep associated apnea. OSAS increases morbidity and mortality risk from cardiovascular and cerebrovascular diseases. While heritability of OSAS is estimated at ∼40%, the precise underlying genes remain elusive. Brazilian families with OSAS that follows as seemingly autosomal dominant inheritance pattern were recruited. Methods: The study included nine individuals from two Brazilian families displaying a seemingly autosomal dominant inheritance pattern of OSAS. Whole exome sequencing of germline DNA were analyzed using Mendel, MD software. Variants selected were analyzed using Varstation® with subsequent analyses that included validation by Sanger sequencing, pathogenic score assessment by ACMG criteria, co-segregation analyses (when possible) allele frequency, tissue expression patterns, pathway analyses, effect on protein folding modeling using Swiss-Model and RaptorX. Results: Two families (six affected patients and three unaffected controls) were analyzed. A comprehensive multistep analysis yielded variants in COX20 (rs946982087) (family A), PTPDC1 (rs61743388) and TMOD4 (rs141507115) (family B) that seemed to be strong candidate genes for being OSAS associated genes in these families. Conclusion: Sequence variants in COX20, PTPDC1 and TMOD4 seemingly are associated with OSAS phenotype in these families. Further studies in more, ethnically diverse families and non-familial OSAS cases are needed to better define the role of these variants as contributors to OSAS phenotype.
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Affiliation(s)
- Pedro Guimarães de Azevedo
- Centro de Tecnologia em Medicina Molecular, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Anna Luiza Braga Albuquerque
- Centro de Tecnologia em Medicina Molecular, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Rayane Benfica Alves
- Centro de Tecnologia em Medicina Molecular, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Bianca Gomes Fernandes
- Centro de Tecnologia em Medicina Molecular, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Flavia Marques de Melo
- Centro de Tecnologia em Medicina Molecular, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Eitan Friedman
- The Preventive Personalized Medicine Center, Assuta Medical Center and the Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Luiz De Marco
- Centro de Tecnologia em Medicina Molecular, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Department of Surgery, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Luciana Bastos-Rodrigues
- Centro de Tecnologia em Medicina Molecular, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Department of Nutrition, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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10
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Schneider G. Obstructive Sleep Apnea - Influence on the Cardiovascular System and Cognition. Laryngorhinootologie 2023; 102:S101-S114. [PMID: 37130534 PMCID: PMC10184569 DOI: 10.1055/a-1963-9957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Kardiovaskuläre und kognitive Erkrankungen sind ebenso wie die obstruktive Schlafapnoe sehr häufige Krankheiten mit einer erheblichen Beeinträchtigung der Lebensqualität und einer deutlichen sozioökonomischen Bedeutung. Die Auswirkungen einer unbehandelten obstruktiven Schlafapnoe (OSA) auf das kardiovaskuläre und kognitive Erkrankungsrisiko und die Therapieeffekte einer OSA sind für die meisten kardiovaskulären und kognitiven Folgeerkrankungen wissenschaftlich nachgewiesen. Für die klinische Praxis besteht ein deutlicher Bedarf nach mehr Interdisziplinarität. Aus schlafmedizinischer Sicht müssen bei der Therapieindikation das individuelle kardiovaskuläre und kognitive Risiko berücksichtigt und kognitive Erkrankungen bei der Beurteilung der Therapieintoleranz und residuellen Symptomatik beachtet werden. Aus internistischer Sicht sollte bei Patienten mit schlecht einstellbarem Hypertonus, Vorhofflimmern, koronarer Herzkrankheit und Schlaganfall die Abklärung einer OSA in die Diagnostik integriert werden. Bei Patienten mit milder kognitiver Beeinträchtigung, Alzheimer-Krankheit und Depression können sich die typischen Symptome wie Fatigue, Tagesmüdigkeit und Reduktion der kognitiven Leistungen mit OSA-Symptomen überschneiden. Die Diagnostik einer OSA sollte in die Abklärung dieser Krankheitsbilder integriert werden, da eine Therapie der OSA die kognitiven Beeinträchtigungen reduzieren und die Lebensqualität verbessern kann.
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11
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Cade BE, Gharib SA. Breath of Fresh Air: Toward Unraveling the Molecular Underpinnings of Sleep Apnea. Am J Respir Crit Care Med 2022; 206:1450-1451. [PMID: 35944212 PMCID: PMC9757082 DOI: 10.1164/rccm.202207-1410ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Brian E. Cade
- Division of Sleep and Circadian DisordersBrigham and Women’s HospitalBoston, Massachusetts,Division of Sleep MedicineHarvard Medical SchoolBoston, Massachusetts
| | - Sina A. Gharib
- Division of Pulmonary, Critical Care, and Sleep MedicineUniversity of WashingtonSeattle, Washington
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12
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Chun S, Akle S, Teodosiadis A, Cade BE, Wang H, Sofer T, Evans DS, Stone KL, Gharib SA, Mukherjee S, Palmer LJ, Hillman D, Rotter JI, Hanis CL, Stamatoyannopoulos JA, Redline S, Cotsapas C, Sunyaev SR. Leveraging pleiotropy to discover and interpret GWAS results for sleep-associated traits. PLoS Genet 2022; 18:e1010557. [PMID: 36574455 PMCID: PMC9829185 DOI: 10.1371/journal.pgen.1010557] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/09/2023] [Accepted: 12/06/2022] [Indexed: 12/28/2022] Open
Abstract
Genetic association studies of many heritable traits resulting from physiological testing often have modest sample sizes due to the cost and burden of the required phenotyping. This reduces statistical power and limits discovery of multiple genetic associations. We present a strategy to leverage pleiotropy between traits to both discover new loci and to provide mechanistic hypotheses of the underlying pathophysiology. Specifically, we combine a colocalization test with a locus-level test of pleiotropy. In simulations, we show that this approach is highly selective for identifying true pleiotropy driven by the same causative variant, thereby improves the chance to replicate the associations in underpowered validation cohorts and leads to higher interpretability. Here, as an exemplar, we use Obstructive Sleep Apnea (OSA), a common disorder diagnosed using overnight multi-channel physiological testing. We leverage pleiotropy with relevant cellular and cardio-metabolic phenotypes and gene expression traits to map new risk loci in an underpowered OSA GWAS. We identify several pleiotropic loci harboring suggestive associations to OSA and genome-wide significant associations to other traits, and show that their OSA association replicates in independent cohorts of diverse ancestries. By investigating pleiotropic loci, our strategy allows proposing new hypotheses about OSA pathobiology across many physiological layers. For example, we identify and replicate the pleiotropy across the plateletcrit, OSA and an eQTL of DNA primase subunit 1 (PRIM1) in immune cells. We find suggestive links between OSA, a measure of lung function (FEV1/FVC), and an eQTL of matrix metallopeptidase 15 (MMP15) in lung tissue. We also link a previously known genome-wide significant peak for OSA in the hexokinase 1 (HK1) locus to hematocrit and other red blood cell related traits. Thus, the analysis of pleiotropic associations has the potential to assemble diverse phenotypes into a chain of mechanistic hypotheses that provide insight into the pathogenesis of complex human diseases.
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Affiliation(s)
- Sung Chun
- Division of Genetics, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Division of Pulmonary Medicine, Boston Children’s Hospital, Boston, Massachusetts, United States of America
- Altius Institute for Biomedical Sciences, Seattle, Washington, United States of America
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Sebastian Akle
- Division of Genetics, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Altius Institute for Biomedical Sciences, Seattle, Washington, United States of America
- Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, Massachusetts, United States of America
| | | | - Brian E. Cade
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Broad Institute of Harvard and MIT, Cambridge, Massachusetts, United States of America
| | - Heming Wang
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Broad Institute of Harvard and MIT, Cambridge, Massachusetts, United States of America
| | - Tamar Sofer
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Daniel S. Evans
- California Pacific Medical Center Research Institute, San Francisco, California, United States of America
| | - Katie L. Stone
- California Pacific Medical Center Research Institute, San Francisco, California, United States of America
| | - Sina A. Gharib
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington, United States of America
- Computational Medicine Core at Center for Lung Biology, University of Washington, Seattle, Washington, United States of America
| | - Sutapa Mukherjee
- Respiratory and Sleep Services, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia
- Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia
| | - Lyle J. Palmer
- School of Public Health, University of Adelaide, Adelaide, South Australia, Australia
| | - David Hillman
- Centre for Sleep Science, University of Western Australia, Perth, Australia
- Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, Australia
| | - Jerome I. Rotter
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California, United States of America
| | - Craig L. Hanis
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas, United States of America
| | - John A. Stamatoyannopoulos
- Altius Institute for Biomedical Sciences, Seattle, Washington, United States of America
- Departments of Medicine and Genome Sciences, University of Washington, Seattle, Washington, United States of America
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Chris Cotsapas
- Altius Institute for Biomedical Sciences, Seattle, Washington, United States of America
- Broad Institute of Harvard and MIT, Cambridge, Massachusetts, United States of America
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut, United States of America
- Department of Genetics, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Shamil R. Sunyaev
- Division of Genetics, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Altius Institute for Biomedical Sciences, Seattle, Washington, United States of America
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, United States of America
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Folmer RL, Smith CJ, Boudreau EA, Totten AM, Chilakamarri P, Atwood CW, Sarmiento KF. Sleep disorders among rural Veterans: Relative prevalence, comorbidities, and comparisons with urban Veterans. J Rural Health 2022. [DOI: 10.1111/jrh.12722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Robert L. Folmer
- National Center for Rehabilitative Auditory Research (NCRAR) VA Portland Healthcare System Portland Oregon USA
- Department of Otolaryngology Oregon Health & Science University Portland Oregon USA
| | - Connor J. Smith
- Department of Medical Informatics and Clinical Epidemiology Oregon Health & Science University Portland Oregon USA
| | - Eilis A. Boudreau
- Department of Medical Informatics and Clinical Epidemiology Oregon Health & Science University Portland Oregon USA
- Department of Neurology Oregon Health & Science University Portland Oregon USA
| | - Annette M. Totten
- Department of Medical Informatics and Clinical Epidemiology Oregon Health & Science University Portland Oregon USA
| | - Priyanka Chilakamarri
- San Francisco VA Health Care System San Francisco California USA
- Department of Neurology University of California San Francisco California USA
| | - Charles W. Atwood
- Pulmonary Section and Sleep Medicine VA Pittsburgh Healthcare System Pittsburgh Pennsylvania USA
- Division of Pulmonary Allergy Critical Care Medicine UPMC and University of Pittsburgh Pittsburgh Pennsylvania USA
| | - Kathleen F. Sarmiento
- San Francisco VA Health Care System San Francisco California USA
- Department of Medicine University of California San Francisco California USA
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14
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Wachinou AP, Houehanou C, Ade S, Totah T, Berger M, Solelhac G, Amidou S, Fiogbe AA, Alovokpinhou F, Lacroix P, Preux PM, Marques-Vidal P, Agodokpessi G, Houinato D, Heinzer R. Prevalence of sleep-disordered breathing in an African general population: The Benin Society and Sleep (BeSAS) study. THE LANCET. RESPIRATORY MEDICINE 2022; 10:831-839. [PMID: 35405141 DOI: 10.1016/s2213-2600(22)00046-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/26/2022] [Accepted: 01/27/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Data on the prevalence of sleep-disordered breathing (SDB) in the African general population are scarce, and a better understanding is urgently needed. Our study aimed to objectively determine the prevalence of, and factors associated with, SDB in a large sample in Benin, west Africa. METHODS In the Benin Society and Sleep (BeSAS) cross-sectional study, participants aged 25 years and older were recruited from both urban and rural areas. Rural participants were recruited from Tanve, a village located 200 km north of Cotonou, and urban participants were recruited from Cotonou. The participants underwent respiratory polygraphy at home using a type-3 device that measures airflow through a nasal pressure sensor, respiratory effort (thoracic movement), and pulse oximetry. Clinical and morphometric data were also collected. SDB severity categories were defined according to the apnoea-hypopnoea index (AHI), with mild-to-severe SDB (AHI ≥5/h), moderate-to-severe SDB (AHI ≥15/h), and severe SDB (AHI ≥30/h). FINDINGS The study was completed from April 4, 2018 to Jan 15, 2021. Of 2909 participants recruited in the BeSAS study, 2168 (74·5%) underwent respiratory polygraphy. For the 1810 participants with complete polygraphic data (mean age 46 years, SD 15; 1163 [64·2%] women), the prevalence of mild-to-severe SDB (AHI ≥5/h) was 43·2% (95% CI 40·9-45·5), of moderate-to-severe SDB (AHI ≥15/h) was 11·6% (10·2-13·1), and of severe SDB (AHI ≥30/h) was 2·7% (2·0-3·5). Factors independently associated with SDB were advanced age, male sex, large neck circumference, abdominal obesity, overweight or obesity, and snoring. After multivariable adjustment, severe SDB was independently associated with hypertension in women (odds ratio 3·99, 95% CI 1·04-15·33; ptrend=0·044), but not in men (odds ratio 0·67, 0·22-2·05; Ptrend=0·63). INTERPRETATION The BeSAS study provides the first large-scale objective evaluation of SDB prevalence and associated factors in Africa. The high prevalence of SDB identified should stimulate the development of public health policies to prevent and treat this condition in African countries. FUNDING Ligue Pulmonaire Vaudoise, Switzerland.
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Affiliation(s)
- Ablo Prudence Wachinou
- Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin; Laboratory of Epidemiology of Chronic and Neurological Diseases, Cotonou, Benin; National Teaching Hospital for Tuberculosis and Pulmonary Diseases, Cotonou, Benin.
| | - Corinne Houehanou
- Laboratory of Epidemiology of Chronic and Neurological Diseases, Cotonou, Benin; National School of Public Health, University of Parakou, Parakou, Benin
| | - Serge Ade
- Faculty of Medicine, University of Parakou, Parakou, Benin
| | - Terence Totah
- Laboratory of Epidemiology of Chronic and Neurological Diseases, Cotonou, Benin
| | - Mathieu Berger
- Centre of Investigation and Research on Sleep, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Geoffroy Solelhac
- Centre of Investigation and Research on Sleep, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Salmane Amidou
- Laboratory of Epidemiology of Chronic and Neurological Diseases, Cotonou, Benin
| | | | | | - Philipe Lacroix
- Inserm U1094, University Hospital of Limoges-Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
| | - Pierre-Marie Preux
- Inserm U1094, University Hospital of Limoges-Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
| | - Pedro Marques-Vidal
- Department of Internal Medicine, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Gildas Agodokpessi
- Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin; National Teaching Hospital for Tuberculosis and Pulmonary Diseases, Cotonou, Benin
| | - Dismand Houinato
- Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin; Laboratory of Epidemiology of Chronic and Neurological Diseases, Cotonou, Benin
| | - Raphael Heinzer
- Centre of Investigation and Research on Sleep, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
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Zhu J, Sanford LD, Ren R, Zhang Y, Tang X. Multiple Machine Learning Methods Reveal Key Biomarkers of Obstructive Sleep Apnea and Continuous Positive Airway Pressure Treatment. Front Genet 2022; 13:927545. [PMID: 35910196 PMCID: PMC9326093 DOI: 10.3389/fgene.2022.927545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 06/24/2022] [Indexed: 11/13/2022] Open
Abstract
Obstructive sleep apnea (OSA) is a worldwide health issue that affects more than 400 million people. Given the limitations inherent in the current conventional diagnosis of OSA based on symptoms report, novel diagnostic approaches are required to complement existing techniques. Recent advances in gene sequencing technology have made it possible to identify a greater number of genes linked to OSA. We identified key genes in OSA and CPAP treatment by screening differentially expressed genes (DEGs) using the Gene Expression Omnibus (GEO) database and employing machine learning algorithms. None of these genes had previously been implicated in OSA. Moreover, a new diagnostic model of OSA was developed, and its diagnostic accuracy was verified in independent datasets. By performing Single Sample Gene Set Enrichment Analysis (ssGSEA) and Counting Relative Subsets of RNA Transcripts (CIBERSORT), we identified possible immunologic mechanisms, which led us to conclude that patients with high OSA risk tend to have elevated inflammation levels that can be brought down by CPAP treatment.
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Affiliation(s)
- Jie Zhu
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Larry D. Sanford
- Sleep Research Laboratory, Center for Integrative Neuroscience and Inflammatory Diseases, Pathology and Anatomy, Eastern Virginia Medical School, Norfolk, VA, United States
| | - Rong Ren
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Ye Zhang
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xiangdong Tang
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Xiangdong Tang,
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16
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Peripheral Biomarkers to Diagnose Obstructive Sleep Apnea in Adults: A Systematic Review and Meta-Analysis. Sleep Med Rev 2022; 64:101659. [DOI: 10.1016/j.smrv.2022.101659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 05/25/2022] [Accepted: 05/31/2022] [Indexed: 10/18/2022]
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Tan BKJ, Teo YH, Tan NKW, Yap DWT, Sundar R, Lee CH, See A, Toh ST. Association of obstructive sleep apnea and nocturnal hypoxemia with all-cancer incidence and mortality: a systematic review and meta-analysis. J Clin Sleep Med 2022; 18:1427-1440. [PMID: 34755597 PMCID: PMC9059590 DOI: 10.5664/jcsm.9772] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
STUDY OBJECTIVES Biological models suggest that obstructive sleep apnea (OSA) is potentially carcinogenic. We aimed to clarify the inconsistent epidemiological literature by considering various traditional and novel OSA severity indices. METHODS We systematically searched PubMed, Embase, Scopus, and the Cochrane Library for observational or randomized studies of associations of OSA, measured by diagnostic codes or any index, each with all-cancer incidence or mortality in adults, compared with participants with no/mild OSA. Two reviewers independently selected studies, extracted data, and evaluated study bias using the Newcastle-Ottawa scale and quality of evidence using GRADE (Grading of Recommendations Assessment, Development, and Evaluation). We performed inverse variance-weighted, random-effects meta-analyses and sensitivity analyses. RESULTS We included 20 observational studies (5,340,965 participants), all with moderate/low bias, from 1,698 records. Based on T90 (sleep duration with oxygen saturation < 90%), patients with OSA who had moderate (T90 > 1.2%, hazard ratio [HR] = 1.28, 95% confidence interval [CI] = 1.07-1.54) and severe nocturnal hypoxemia (T90 > 12%, HR = 1.43, 95% CI = 1.16-1.76) experienced 30%-40% higher pooled all-cancer risk than normoxemic patients, after multiple adjustment for covariates including obesity. Furthermore, severe nocturnal hypoxemia nearly tripled all-cancer mortality (HR = 2.66, 95% CI = 1.21-5.85). Patients with apnea-hypopnea index-defined severe OSA, but not moderate OSA, had higher all-cancer risk (HR = 1.18, 95% CI = 1.03-1.35) but similar all-cancer mortality as patients without OSA. An OSA diagnosis was not associated with all-cancer risk. Evidence quality ranged from low to moderate. Insufficient evidence was available on the oxygen desaturation index, lowest/median saturation, and arousal index. CONCLUSIONS In patients with OSA, nocturnal hypoxemia is independently associated with all-cancer risk and mortality. Future studies should explore if risk differs by cancer type, and whether cancer screening and OSA treatment are beneficial. SYSTEMATIC REVIEW REGISTRATION Registry: PROSPERO; URL: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=220836; Identifier: CRD42021220836. CITATION Tan BKJ, Teo YH, Tan NKW, et al. Association of obstructive sleep apnea and nocturnal hypoxemia with all-cancer incidence and mortality: a systematic review and meta-analysis. J Clin Sleep Med. 2022;18(5):1427-1440.
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Affiliation(s)
| | - Yao Hao Teo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Nicole Kye Wen Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Raghav Sundar
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore,Department of Hematology-Oncology, National University Cancer Institute, National University Hospital, Singapore,Cancer and Stem Cell Biology Program, Duke-National University of Singapore Medical School, Singapore,The N.1 Institute for Health, National University of Singapore, Singapore,Singapore Gastric Cancer Consortium
| | - Chi Hang Lee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore,Department of Cardiology, National University Health System, Singapore
| | - Anna See
- Department of Otorhinolaryngology–Head and Neck Surgery, Singapore General Hospital, Singapore,Surgery Academic Clinical Program, SingHealth, Singapore,Address correspondence to: Song Tar Toh, MBBS, MMed (ORL), MMed (Sleep Medicine), FAMS (ORL), Department of Otorhinolaryngology–Head and Neck Surgery, Singapore General Hospital, Outram Road, Singapore 169608; Tel: +65 6222 3322; ; and Anna See, MBBS, MMed (ORL), Department of Otorhinolaryngology–Head and Neck Surgery, Singapore General Hospital, Outram Road, Singapore 169608; Tel: +65 6222 3322;
| | - Song Tar Toh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore,Department of Otorhinolaryngology–Head and Neck Surgery, Singapore General Hospital, Singapore,Surgery Academic Clinical Program, SingHealth, Singapore,SingHealth Duke-NUS Sleep Centre, SingHealth, Singapore,Address correspondence to: Song Tar Toh, MBBS, MMed (ORL), MMed (Sleep Medicine), FAMS (ORL), Department of Otorhinolaryngology–Head and Neck Surgery, Singapore General Hospital, Outram Road, Singapore 169608; Tel: +65 6222 3322; ; and Anna See, MBBS, MMed (ORL), Department of Otorhinolaryngology–Head and Neck Surgery, Singapore General Hospital, Outram Road, Singapore 169608; Tel: +65 6222 3322;
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Monna F, Ben Messaoud R, Navarro N, Baillieul S, Sanchez L, Loiodice C, Tamisier R, Faure MJ, Pepin JL. Machine learning and geometric morphometrics to predict obstructive sleep apnea from 3D craniofacial scans. Sleep Med 2022; 95:76-83. [DOI: 10.1016/j.sleep.2022.04.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 03/23/2022] [Accepted: 04/23/2022] [Indexed: 12/21/2022]
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19
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Locke BW, Neill SE, Howe HE, Crotty MC, Kim J, Sundar KM. Electronic health record-derived outcomes in obstructive sleep apnea managed with positive airway pressure tracking systems. J Clin Sleep Med 2022; 18:885-894. [PMID: 34725036 PMCID: PMC8883092 DOI: 10.5664/jcsm.9750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 10/22/2021] [Accepted: 10/22/2021] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To assess the effectiveness of continuous positive airway pressure (CPAP) management guided by CPAP machine downloads in newly diagnosed patients with obstructive sleep apnea (OSA) using electronic health record-derived health care utilization, biometric variables, and laboratory data. METHODS Electronic health record data of patients seen at the University of Utah Sleep Program from 2012-2015 were reviewed to identify patients with new diagnosis of OSA in whom CPAP adherence and residual apnea-hypopnea index as measured by a positive airway pressure adherence tracking device data for ≥ 1 year were available. Biometric data, laboratory data, and system-wide charges were compared in the 1 year before and after CPAP therapy. Subgroups were divided by whether patients met tracking criteria, mean nightly usage, and OSA severity. RESULTS 976 consecutive, newly diagnosed participants with OSA (median age 55 years, 56.6% male) met inclusion criteria. There was a mean decrease of systolic blood pressure (BP) of 1.2 mm Hg and diastolic BP of 1.0 mm Hg within a year of initiation of CPAP therapy. BP improvements in the subgroup meeting CPAP tracking targets were 1.36 mmHg (systolic) and 1.37 mmHg (diastolic). No significant change was noted in body mass index, glycated hemoglobin, or serum creatinine values within a year of starting CPAP therapy, and health care utilization increased (mean acute care visits 0.22 per year to 0.53 per year; mean charges of $3,997 per year to $8,986 per year). CONCLUSIONS An improvement in BP was noted within a year of CPAP therapy in newly diagnosed patients with OSA, with no difference in the magnitude of improvement between those meeting tracking system adherence targets. CITATION Locke BW, Neill SE, Howe HE, Crotty MC, Kim J, Sundar KM. Electronic health record-derived outcomes in obstructive sleep apnea managed with positive airway pressure tracking systems. J Clin Sleep Med. 2022;18(3):885-894.
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Affiliation(s)
- Brian W. Locke
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Sarah E. Neill
- Pulmonary, Critical Care, and Sleep Medicine, Owensboro Health Medical Group, Owensboro, Kentucky
| | - Heather E. Howe
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Michael C. Crotty
- University of Utah Health, Enterprise Data Warehouse, Salt Lake City, Utah
| | - Jaewhan Kim
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, Utah
| | - Krishna M. Sundar
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
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20
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Boof ML, Ufer M, Fietze I, Pépin JL, Guern AS, Lemoine V, Dingemanse J. Assessment of the effect of the dual orexin receptor antagonist daridorexant on various indices of disease severity in patients with mild to moderate obstructive sleep apnea. Sleep Med 2022; 92:4-11. [DOI: 10.1016/j.sleep.2021.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 10/19/2021] [Accepted: 11/22/2021] [Indexed: 10/19/2022]
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21
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Liu J, Sheets V, Maerz R, Ni A, Magalang U, Ko CC, Firestone A. A multifactorial intervention to increase adherence to oral appliance therapy with a titratable mandibular advancement device for obstructive sleep apnea: a randomized controlled trial. Sleep Breath 2022; 26:1739-1745. [DOI: 10.1007/s11325-021-02548-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 11/09/2021] [Accepted: 12/01/2021] [Indexed: 10/19/2022]
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22
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Cade BE, Hassan SM, Dashti HS, Kiernan M, Pavlova MK, Redline S, Karlson EW. Sleep apnea phenotyping and relationship to disease in a large clinical biobank. JAMIA Open 2022; 5:ooab117. [PMID: 35156000 PMCID: PMC8826997 DOI: 10.1093/jamiaopen/ooab117] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 12/08/2021] [Accepted: 12/28/2021] [Indexed: 11/14/2022] Open
Abstract
Objective Sleep apnea is associated with a broad range of pathophysiology. While electronic health record (EHR) information has the potential for revealing relationships between sleep apnea and associated risk factors and outcomes, practical challenges hinder its use. Our objectives were to develop a sleep apnea phenotyping algorithm that improves the precision of EHR case/control information using natural language processing (NLP); identify novel associations between sleep apnea and comorbidities in a large clinical biobank; and investigate the relationship between polysomnography statistics and comorbid disease using NLP phenotyping. Materials and Methods We performed clinical chart reviews on 300 participants putatively diagnosed with sleep apnea and applied International Classification of Sleep Disorders criteria to classify true cases and noncases. We evaluated 2 NLP and diagnosis code-only methods for their abilities to maximize phenotyping precision. The lead algorithm was used to identify incident and cross-sectional associations between sleep apnea and common comorbidities using 4876 NLP-defined sleep apnea cases and 3× matched controls. Results The optimal NLP phenotyping strategy had improved model precision (≥0.943) compared to the use of one diagnosis code (≤0.733). Of the tested diseases, 170 disorders had significant incidence odds ratios (ORs) between cases and controls, 8 of which were confirmed using polysomnography (n = 4544), and 281 disorders had significant prevalence OR between sleep apnea cases versus controls, 41 of which were confirmed using polysomnography data. Discussion and Conclusion An NLP-informed algorithm can improve the accuracy of case-control sleep apnea ascertainment and thus improve the performance of phenome-wide, genetic, and other EHR analyses of a highly prevalent disorder. Sleep apnea is a common disease in which breathing partially or completely pauses during sleep, leading to less oxygen in the blood, repeated awakenings, and increased risk of developing multiple diseases. Current studies of sleep apnea often have relatively few participants due to the challenge of performing overnight sleep recordings. Electronic health record (EHR) billing code diagnoses of sleep apnea could be repurposed to increase the size of research studies, but the accuracy of the diagnoses is reduced. We developed a reusable algorithm that improves the accuracy of EHR sleep apnea diagnoses using natural language processing to extract information from clinical notes. As a proof of concept, we used the algorithm to identify hundreds of diseases that are increased among participants with sleep apnea compared to similar patients without sleep apnea. Many of these disease relationships with sleep apnea have not been previously recognized. This improved algorithm will help to accelerate future large-scale investigations of the causes and consequences of sleep apnea.
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Affiliation(s)
- Brian E Cade
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts, USA
| | - Syed Moin Hassan
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Division of Pulmonary Disease and Critical Care Medicine, University of Vermont, Burlington, Vermont, USA
| | - Hassan S Dashti
- Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts, USA
- Center for Genomic Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Anesthesia, Pain, and Critical Care Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Melissa Kiernan
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- NeuroCare Center for Sleep, Newton, Massachusetts, USA
| | - Milena K Pavlova
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Elizabeth W Karlson
- Center for Genomic Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Boston, Massachusetts, USA
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23
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Singh M, Ramachandran SK. Suspected obstructive sleep apnoea on pre-operative screening: going beyond a risk score. Anaesthesia 2021; 77:257-259. [PMID: 34636037 DOI: 10.1111/anae.15596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2021] [Indexed: 11/29/2022]
Affiliation(s)
- M Singh
- Department of Anesthesiology and Pain Management, Women's College Hospital, University Health Network, University of Toronto, Toronto, Canada
| | - S K Ramachandran
- Department of Anesthesiology, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
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Vecchiato M, Neunhaeuserer D, Quinto G, Bettini S, Gasperetti A, Battista F, Vianello A, Vettor R, Busetto L, Ermolao A. Cardiopulmonary exercise testing in patients with moderate-severe obesity: a clinical evaluation tool for OSA? Sleep Breath 2021; 26:1115-1123. [PMID: 34487305 PMCID: PMC9418285 DOI: 10.1007/s11325-021-02475-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/24/2021] [Accepted: 08/11/2021] [Indexed: 11/25/2022]
Abstract
Purpose Obstructive sleep apnea (OSA) is a widespread comorbidity of obesity. Nasal continuous positive airway pressure (CPAP) has been demonstrated very effective in treating patients with OSA. The aims of this study were to investigate whether or not cardiopulmonary exercise testing (CPET) can characterize patients with OSA and to evaluate the effect of nasal CPAP therapy. Methods An observational study was conducted on patients with moderate to severe obesity and suspected OSA. All patients underwent cardiorespiratory sleep study, spirometry, and functional evaluation with ECG-monitored, incremental, maximal CPET. Results Of the 147 patients, 94 presented with an apnea–hypopnea index (AHI) ≥ 15 events/h and were thus considered to have OSA (52 receiving nasal CPAP treatment; 42 untreated) while 53 formed a control group (AHI < 15 events/h). Patients with untreated OSA showed significantly lower oxygen uptake (VO2), heart rate, minute ventilation (VE), and end tidal carbon dioxide (PETCO2) at peak exercise compared to controls. Patients receiving nasal CPAP showed higher VE and VO2 at peak exercise compared to untreated patients. A difference in PETCO2 between the maximum value reached during test and peak exercise (ΔPETCO2 max-peak) of 1.71 mmHg was identified as a predictor of OSA. Conclusion Patients with moderate to severe obesity and untreated OSA presented a distinctive CPET-pattern characterized by lower aerobic and exercise capacity, higher PETCO2 at peak exercise associated with a lower ventilatory response. Nasal CPAP treatment was shown to positively affect these cardiorespiratory adaptations during exercise. ΔPETCO2 max-peak may be used to suggest OSA in patients with obesity.
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Affiliation(s)
- Marco Vecchiato
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
- Clinical Network of Sport and Exercise Medicine of the Veneto Region, Padova, Italy
| | - Daniel Neunhaeuserer
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padova, Italy.
- Clinical Network of Sport and Exercise Medicine of the Veneto Region, Padova, Italy.
| | - Giulia Quinto
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
- Clinical Network of Sport and Exercise Medicine of the Veneto Region, Padova, Italy
| | - Silvia Bettini
- Center for the Study and Integrated Treatment of Obesity (CeSTIO), Internal Medicine 3, Department of Medicine, University of Padova, Padova, Veneto Region, Italy
| | - Andrea Gasperetti
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
- Clinical Network of Sport and Exercise Medicine of the Veneto Region, Padova, Italy
| | - Francesca Battista
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
- Clinical Network of Sport and Exercise Medicine of the Veneto Region, Padova, Italy
| | - Andrea Vianello
- Respiratory Pathophysiology Unit, Department of Cardiological, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Roberto Vettor
- Center for the Study and Integrated Treatment of Obesity (CeSTIO), Internal Medicine 3, Department of Medicine, University of Padova, Padova, Veneto Region, Italy
| | - Luca Busetto
- Center for the Study and Integrated Treatment of Obesity (CeSTIO), Internal Medicine 3, Department of Medicine, University of Padova, Padova, Veneto Region, Italy
| | - Andrea Ermolao
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
- Clinical Network of Sport and Exercise Medicine of the Veneto Region, Padova, Italy
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25
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Bray R, Knapp H. Identifying Predictors of Airway Complications During Conscious Sedation Procedures. Gastroenterol Nurs 2021; 44:310-319. [PMID: 34319934 DOI: 10.1097/sga.0000000000000574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 09/29/2020] [Indexed: 11/27/2022] Open
Abstract
Conscious sedation procedures are complicated by unanticipated airway compromise and obstruction. The STOP-Bang questionnaire (University of Toronto, 2012) is a validated obstructive sleep apnea screening questionnaire used as a preprocedure evaluation tool to assess a patient's risk for obstructive sleep apnea. The purpose of this study was to determine whether risk factors for obstructive sleep apnea, using the STOP-Bang questionnaire, could predict procedural airway complications in 152 endoscopy patients following conscious sedation. Logistic regression analysis revealed that a STOP-Bang score of greater than 5 (high risk) predicted a 10% change in heart rate (p = .021), apnea (p = .038), and arousal-relieved airway obstruction (p = .023). Every point of increase in body mass index predicted a 10% change in heart rate (p = .046), a drop in oxygen saturation (p = .002), apnea (p = .003), and 1.212 times the odds of requiring arousal-relieved airway obstruction (p = .002). An intermediate-risk STOP-Bang score (3-4) positively correlated to abnormal carbon dioxide values during the procedure (p = .015). These findings concur with existing literature on the topic and translate to clinical considerations of procedural monitoring protocols for patients with a high probability for airway complications during conscious sedation.
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Affiliation(s)
- Rosemary Bray
- Rosemary Bray, DNP, RN, CCRN, CNML, is Senior Director of Nursing, Intensive Care Unit, Gastroenterology Services, Ambulatory Surgery and Nursing Administration, French Hospital Medical Center, San Luis Obispo, California
- Herschel Knapp, PhD, MSSW, is Director, Dignity Health Nursing Research Fellowship Program, Southern California Regional Office, Los Angeles
| | - Herschel Knapp
- Rosemary Bray, DNP, RN, CCRN, CNML, is Senior Director of Nursing, Intensive Care Unit, Gastroenterology Services, Ambulatory Surgery and Nursing Administration, French Hospital Medical Center, San Luis Obispo, California
- Herschel Knapp, PhD, MSSW, is Director, Dignity Health Nursing Research Fellowship Program, Southern California Regional Office, Los Angeles
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26
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Cade BE, Lee J, Sofer T, Wang H, Zhang M, Chen H, Gharib SA, Gottlieb DJ, Guo X, Lane JM, Liang J, Lin X, Mei H, Patel SR, Purcell SM, Saxena R, Shah NA, Evans DS, Hanis CL, Hillman DR, Mukherjee S, Palmer LJ, Stone KL, Tranah GJ, Abecasis GR, Boerwinkle EA, Correa A, Cupples LA, Kaplan RC, Nickerson DA, North KE, Psaty BM, Rotter JI, Rich SS, Tracy RP, Vasan RS, Wilson JG, Zhu X, Redline S. Whole-genome association analyses of sleep-disordered breathing phenotypes in the NHLBI TOPMed program. Genome Med 2021; 13:136. [PMID: 34446064 PMCID: PMC8394596 DOI: 10.1186/s13073-021-00917-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 05/28/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Sleep-disordered breathing is a common disorder associated with significant morbidity. The genetic architecture of sleep-disordered breathing remains poorly understood. Through the NHLBI Trans-Omics for Precision Medicine (TOPMed) program, we performed the first whole-genome sequence analysis of sleep-disordered breathing. METHODS The study sample was comprised of 7988 individuals of diverse ancestry. Common-variant and pathway analyses included an additional 13,257 individuals. We examined five complementary traits describing different aspects of sleep-disordered breathing: the apnea-hypopnea index, average oxyhemoglobin desaturation per event, average and minimum oxyhemoglobin saturation across the sleep episode, and the percentage of sleep with oxyhemoglobin saturation < 90%. We adjusted for age, sex, BMI, study, and family structure using MMSKAT and EMMAX mixed linear model approaches. Additional bioinformatics analyses were performed with MetaXcan, GIGSEA, and ReMap. RESULTS We identified a multi-ethnic set-based rare-variant association (p = 3.48 × 10-8) on chromosome X with ARMCX3. Additional rare-variant associations include ARMCX3-AS1, MRPS33, and C16orf90. Novel common-variant loci were identified in the NRG1 and SLC45A2 regions, and previously associated loci in the IL18RAP and ATP2B4 regions were associated with novel phenotypes. Transcription factor binding site enrichment identified associations with genes implicated with respiratory and craniofacial traits. Additional analyses identified significantly associated pathways. CONCLUSIONS We have identified the first gene-based rare-variant associations with objectively measured sleep-disordered breathing traits. Our results increase the understanding of the genetic architecture of sleep-disordered breathing and highlight associations in genes that modulate lung development, inflammation, respiratory rhythmogenesis, and HIF1A-mediated hypoxic response.
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Affiliation(s)
- Brian E. Cade
- grid.38142.3c000000041936754XDivision of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, MA 02115 USA ,grid.38142.3c000000041936754XDivision of Sleep Medicine, Harvard Medical School, Boston, MA 02115 USA ,grid.66859.34Program in Medical and Population Genetics, Broad Institute, Cambridge, MA 02142 USA
| | - Jiwon Lee
- grid.38142.3c000000041936754XDivision of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, MA 02115 USA
| | - Tamar Sofer
- grid.38142.3c000000041936754XDivision of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, MA 02115 USA ,grid.38142.3c000000041936754XDivision of Sleep Medicine, Harvard Medical School, Boston, MA 02115 USA
| | - Heming Wang
- grid.38142.3c000000041936754XDivision of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, MA 02115 USA ,grid.38142.3c000000041936754XDivision of Sleep Medicine, Harvard Medical School, Boston, MA 02115 USA ,grid.66859.34Program in Medical and Population Genetics, Broad Institute, Cambridge, MA 02142 USA
| | - Man Zhang
- grid.411024.20000 0001 2175 4264Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201 USA
| | - Han Chen
- grid.267308.80000 0000 9206 2401Human Genetics Center, Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX 77030 USA ,grid.267308.80000 0000 9206 2401Center for Precision Health, School of Public Health and School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX 77030 USA
| | - Sina A. Gharib
- grid.34477.330000000122986657Computational Medicine Core, Center for Lung Biology, UW Medicine Sleep Center, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA 98195 USA
| | - Daniel J. Gottlieb
- grid.38142.3c000000041936754XDivision of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, MA 02115 USA ,grid.38142.3c000000041936754XDivision of Sleep Medicine, Harvard Medical School, Boston, MA 02115 USA ,grid.410370.10000 0004 4657 1992VA Boston Healthcare System, Boston, MA 02132 USA
| | - Xiuqing Guo
- grid.239844.00000 0001 0157 6501The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA 90502 USA
| | - Jacqueline M. Lane
- grid.38142.3c000000041936754XDivision of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, MA 02115 USA ,grid.38142.3c000000041936754XDivision of Sleep Medicine, Harvard Medical School, Boston, MA 02115 USA ,grid.66859.34Program in Medical and Population Genetics, Broad Institute, Cambridge, MA 02142 USA ,grid.32224.350000 0004 0386 9924Center for Genomic Medicine and Department of Anesthesia, Pain, and Critical Care Medicine, Massachusetts General Hospital, Boston, MA 02114 USA
| | - Jingjing Liang
- grid.67105.350000 0001 2164 3847Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH 44106 USA
| | - Xihong Lin
- grid.38142.3c000000041936754XDepartment of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA 02115 USA
| | - Hao Mei
- grid.410721.10000 0004 1937 0407Department of Data Science, University of Mississippi Medical Center, Jackson, MS 29216 USA
| | - Sanjay R. Patel
- grid.21925.3d0000 0004 1936 9000Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA 15213 USA
| | - Shaun M. Purcell
- grid.38142.3c000000041936754XDivision of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, MA 02115 USA ,grid.38142.3c000000041936754XDivision of Sleep Medicine, Harvard Medical School, Boston, MA 02115 USA ,grid.66859.34Program in Medical and Population Genetics, Broad Institute, Cambridge, MA 02142 USA
| | - Richa Saxena
- grid.38142.3c000000041936754XDivision of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, MA 02115 USA ,grid.38142.3c000000041936754XDivision of Sleep Medicine, Harvard Medical School, Boston, MA 02115 USA ,grid.66859.34Program in Medical and Population Genetics, Broad Institute, Cambridge, MA 02142 USA ,grid.32224.350000 0004 0386 9924Center for Genomic Medicine and Department of Anesthesia, Pain, and Critical Care Medicine, Massachusetts General Hospital, Boston, MA 02114 USA
| | - Neomi A. Shah
- grid.59734.3c0000 0001 0670 2351Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA
| | - Daniel S. Evans
- grid.17866.3e0000000098234542California Pacific Medical Center Research Institute, San Francisco, CA 94107 USA
| | - Craig L. Hanis
- grid.267308.80000 0000 9206 2401Human Genetics Center, Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX 77030 USA
| | - David R. Hillman
- grid.3521.50000 0004 0437 5942Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia 6009 Australia
| | - Sutapa Mukherjee
- Sleep Health Service, Respiratory and Sleep Services, Southern Adelaide Local Health Network, Adelaide, South Australia Australia ,grid.1014.40000 0004 0367 2697Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia Australia
| | - Lyle J. Palmer
- grid.1010.00000 0004 1936 7304School of Public Health, University of Adelaide, Adelaide, South Australia 5000 Australia
| | - Katie L. Stone
- grid.17866.3e0000000098234542California Pacific Medical Center Research Institute, San Francisco, CA 94107 USA
| | - Gregory J. Tranah
- grid.17866.3e0000000098234542California Pacific Medical Center Research Institute, San Francisco, CA 94107 USA
| | | | - Gonçalo R. Abecasis
- grid.214458.e0000000086837370Department of Biostatistics and Center for Statistical Genetics, University of Michigan School of Public Health, Ann Arbor, MI 48109 USA
| | - Eric A. Boerwinkle
- grid.267308.80000 0000 9206 2401Human Genetics Center, Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX 77030 USA ,grid.39382.330000 0001 2160 926XHuman Genome Sequencing Center, Baylor College of Medicine, Houston, TX 77030 USA
| | - Adolfo Correa
- grid.410721.10000 0004 1937 0407Department of Medicine, University of Mississippi Medical Center, Jackson, MS 39216 USA ,Jackson Heart Study, Jackson, MS 39216 USA
| | - L. Adrienne Cupples
- grid.189504.10000 0004 1936 7558Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118 USA ,grid.510954.c0000 0004 0444 3861Framingham Heart Study, Framingham, MA 01702 USA
| | - Robert C. Kaplan
- grid.251993.50000000121791997Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, 10461 USA
| | - Deborah A. Nickerson
- grid.34477.330000000122986657Department of Genome Sciences, University of Washington, Seattle, WA 98195 USA ,grid.34477.330000000122986657Northwest Genomics Center, Seattle, WA 98105 USA
| | - Kari E. North
- grid.410711.20000 0001 1034 1720Department of Epidemiology and Carolina Center of Genome Sciences, University of North Carolina, Chapel Hill, NC 27514 USA
| | - Bruce M. Psaty
- grid.34477.330000000122986657Cardiovascular Health Study, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, WA 98101 USA ,grid.488833.c0000 0004 0615 7519Kaiser Permanente Washington Health Research Institute, Seattle, WA 98101 USA
| | - Jerome I. Rotter
- grid.239844.00000 0001 0157 6501The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA 90502 USA
| | - Stephen S. Rich
- grid.27755.320000 0000 9136 933XCenter for Public Health Genomics, University of Virginia, Charlottesville, VA 22908 USA
| | - Russell P. Tracy
- grid.59062.380000 0004 1936 7689Department of Pathology, University of Vermont, Colchester, VT 05405 USA
| | - Ramachandran S. Vasan
- grid.510954.c0000 0004 0444 3861Framingham Heart Study, Framingham, MA 01702 USA ,grid.189504.10000 0004 1936 7558Sections of Preventive Medicine and Epidemiology and Cardiology, Department of Medicine, Boston University School of Medicine, Boston, MA 02118 USA ,grid.189504.10000 0004 1936 7558Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118 USA
| | - James G. Wilson
- grid.410721.10000 0004 1937 0407Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, MS 39216 USA
| | - Xiaofeng Zhu
- grid.67105.350000 0001 2164 3847Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH 44106 USA
| | - Susan Redline
- grid.38142.3c000000041936754XDivision of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, MA 02115 USA ,grid.38142.3c000000041936754XDivision of Sleep Medicine, Harvard Medical School, Boston, MA 02115 USA ,grid.239395.70000 0000 9011 8547Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215 USA
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Lin CL, Su MC, Lin CP, Sun CA, Chung CH, Chien WC. Obstructive sleep apnea and injury events in Taiwanese adults: A retrospective cohort study. J Nurs Scholarsh 2021; 54:38-45. [PMID: 34396682 DOI: 10.1111/jnu.12697] [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: 08/30/2020] [Revised: 06/17/2021] [Accepted: 07/08/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of this study was to examine the association between obstructive sleep apnea (OSA) diagnosis and diverse types of injuries. DESIGN This population-based retrospective cohort study compared records from 2000 to 2013 in the Taiwan National Health Insurance Research Database. METHODS 3025 patients identified with OSA were compared against the control cohort consisting of 12,100 age- and sex-matched patients. Cox proportional hazards regression analysis was performed to estimate the effects of OSA on injury risk. FINDINGS Patients with OSA exhibited a significantly higher overall incidence of injury of 2599 per 100,000 person-years compared to the control cohort (2248 per 100,000 person-years). After the confounding factors were considered, subjects with OSA showed a higher risk of injury than subjects in the control group (adjusted hazard ratio [HR] = 1.78, 95% confidence interval [CI] = 1.64-1.93). The risk of unintentional injury (traffic, poisoning, falls) and intentional injury (suicide) in the group of patients with OSA was higher than that in the controls. CONCLUSIONS Our study strongly supports the conclusion that adults with OSA are at increased risk of injury. CLINICAL RELEVANCE The present results indicate the significance of OSA as a predictor of injury risk, which will provide valuable information for clinical practice and injury prevention.
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Affiliation(s)
- Chia-Ling Lin
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan, R.O.C
| | - Mei-Chen Su
- Department of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan, R.O.C
| | - Chun-Ping Lin
- Department of Nursing, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan, R.O.C
| | - Chien-An Sun
- Department of Public Health, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan, R.O.C.,Big Data Research Center, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan, R.O.C
| | - Chi-Hsiang Chung
- School of Public Health, National Defense Medical Center, Taipei, Taiwan, R.O.C.,Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan, R.O.C
| | - Wu-Chien Chien
- Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan, R.O.C.,Department of Medical Research, Tri-Service General Hospital, Taipei, Taiwan, R.O.C.,School of Public Health, Graduate Institute of Science, National Defense Medical Center, Taipei, Taiwan, R.O.C
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Singh M, Mejia JM, Auckley D, Abdallah F, Li C, Kumar V, Englesakis M, Brull R. [The impact of unilateral diaphragmatic paralysis on sleep-disordered breathing: a scoping review]. Can J Anaesth 2021; 68:1064-1076. [PMID: 33725316 DOI: 10.1007/s12630-021-01970-y] [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: 07/05/2020] [Revised: 01/16/2021] [Accepted: 01/18/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Unilateral diaphragm paralysis (UDP) may potentially worsen sleep-disordered breathing (SDB). Unilateral diaphragm paralysis has been associated with proximal brachial plexus blockade, such as interscalene and supraclavicular block. The impact of UDP in patients with SDB is not known in this context. The objectives of this scoping review were to explore the associations between UDP and worsening SDB severity, oxygenation, and pulmonary function. METHODS A systematic search was developed, peer-reviewed, and applied to Embase, Medline, CINAHL, and Cochrane databases to include studies involving adult patients (≥ 18 yr) with SDB, where the effects of UDP on SDB severity, oxygenation, and pulmonary function were examined. RESULTS Six studies (n = 100 patients) with UDP and SDB were included. The sample population was derived exclusively from respirology-sleep clinics, and none were surgical patients. Compared with control (no UDP), UDP was associated with an increased respiratory disturbance index, most pronounced during rapid eye movement (REM) sleep and supine sleep. Supine and REM sleep were associated with obstructive and mixed (both obstructive and central) events, respectively. Compared with control, UDP was associated with a lower mean and minimum oxygen saturation and arterial oxygen tension during all sleep stages and in all body positions. The majority of UDP patients were found to have clinically significant reductions in mean forced expiratory volume in one second and forced vital capacity values, consistent with restrictive ventilatory pattern. CONCLUSION We observed an association between UDP and increasing SDB severity, particularly during REM sleep and while sleeping in the supine position. Although we identified weaknesses in study design and lack of perioperative data, anesthesiologists should be aware of this association when considering proximal brachial plexus blockade in patients with SDB.
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Affiliation(s)
- Mandeep Singh
- Department of Anesthesiology and Pain Management, Women's College Hospital, Toronto, ON, Canada. .,Department of Anesthesiology and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, 399 Bathurst Street, McL 2-405, Toronto, ON, M5T 2S8, Canada.
| | - Jorge M Mejia
- Department of Anesthesiology and Pain Management, Women's College Hospital, Toronto, ON, Canada.,Department of Anesthesiology and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, 399 Bathurst Street, McL 2-405, Toronto, ON, M5T 2S8, Canada
| | - Dennis Auckley
- Division of Pulmonary, Critical Care and Sleep Medicine, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Faraj Abdallah
- Department of Anesthesia, University of Ottawa, Ottawa, ON, Canada
| | - Christopher Li
- Department of Respirology, St. Michael's Hospital, Unity Health, Toronto, ON, Canada
| | - Vivek Kumar
- Department of Anesthesiology and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, 399 Bathurst Street, McL 2-405, Toronto, ON, M5T 2S8, Canada
| | - Marina Englesakis
- Department of Anesthesiology and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, 399 Bathurst Street, McL 2-405, Toronto, ON, M5T 2S8, Canada
| | - Richard Brull
- Department of Anesthesiology and Pain Management, Women's College Hospital, Toronto, ON, Canada.,Department of Anesthesiology and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, 399 Bathurst Street, McL 2-405, Toronto, ON, M5T 2S8, Canada
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29
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Evaluation and Management of Adults with Obstructive Sleep Apnea Syndrome. Lung 2021; 199:87-101. [PMID: 33713177 DOI: 10.1007/s00408-021-00426-w] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 02/09/2021] [Indexed: 02/08/2023]
Abstract
Obstructive sleep apnea syndrome (OSAS) is a common and underdiagnosed medical condition characterized by recurrent sleep-dependent pauses and reductions in airflow. While a narrow, collapsible oropharynx plays a central role in the pathophysiology of OSAS, there are other equally important nonanatomic factors including sleep-stage dependent muscle tone, arousal threshold, and loop gain that drive obstructive apneas and hypopneas. Through mechanisms of intermittent hypoxemia, arousal-related sleep fragmentation, and intrathoracic pressure changes, OSAS impacts multiple organ systems. Risk factors for OSAS include obesity, male sex, age, specific craniofacial features, and ethnicity. The prevalence of OSAS is rising due to increasing obesity rates and improved sensitivity in the tools used for diagnosis. Validated questionnaires have an important but limited role in the identification of patients that would benefit from formal testing for OSA. While an in-laboratory polysomnography remains the gold standard for diagnosis, the widespread availability and accuracy of home sleep apnea testing modalities increase access and ease of OSAS diagnosis for many patients. In adults, the most common treatment involves the application of positive airway pressure (PAP), but compliance continues to be a challenge. Alternative treatments including mandibular advancement device, hypoglossal nerve stimulator, positional therapies, and surgical options coupled with weight loss and exercise offer possibilities of an individualized personal approach to OSAS. Treatment of symptomatic patients with OSAS has been found to be beneficial with regard to sleep-related quality of life, sleepiness, and motor vehicle accidents. The benefit of treating asymptomatic OSA patients, particularly with regard to cardiovascular outcomes, is controversial and more data are needed.
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30
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Gaspar LS, Sousa C, Álvaro AR, Cavadas C, Mendes AF. Common risk factors and therapeutic targets in obstructive sleep apnea and osteoarthritis: An unexpectable link? Pharmacol Res 2020; 164:105369. [PMID: 33352231 DOI: 10.1016/j.phrs.2020.105369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/11/2020] [Accepted: 12/09/2020] [Indexed: 10/22/2022]
Abstract
Osteoarthritis (OA) and Obstructive Sleep Apnea (OSA) are two highly prevalent chronic diseases for which effective therapies are urgently needed. Recent epidemiologic studies, although scarce, suggest that the concomitant occurrence of OA and OSA is associated with more severe manifestations of both diseases. Moreover, OA and OSA share risk factors, such as aging and metabolic disturbances, and co-morbidities, including cardiovascular and metabolic diseases, sleep deprivation and depression. Whether this coincidental occurrence is fortuitous or involves cause-effect relationships is unknown. This review aims at collating and integrating present knowledge on both diseases by providing a brief overview of their epidemiology and pathophysiology, analyzing current evidences relating OA and OSA and discussing potential common mechanisms by which they can aggravate each other. Such mechanisms constitute potential therapeutic targets whose pharmacological modulation may provide more efficient ways of reducing the consequences of OA and OSA and, thus, lessen the huge individual and social burden that they impose.
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Affiliation(s)
- Laetitia S Gaspar
- Centre for Neuroscience and Cell Biology (CNC), University of Coimbra, Coimbra, Portugal; Centre for Innovation in Biomedicine and Biotechnology (CIBB), University of Coimbra, Portugal; Institute for Interdisciplinary Research (IIIUC), University of Coimbra, Coimbra, Portugal; PhD Programme in Experimental Biology and Biomedicine (PDBEB), Institute for Interdisciplinary Research (IIIUC), University of Coimbra, Coimbra, Portugal
| | - Cátia Sousa
- Centre for Neuroscience and Cell Biology (CNC), University of Coimbra, Coimbra, Portugal; Centre for Innovation in Biomedicine and Biotechnology (CIBB), University of Coimbra, Portugal; Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal
| | - Ana Rita Álvaro
- Centre for Neuroscience and Cell Biology (CNC), University of Coimbra, Coimbra, Portugal; Centre for Innovation in Biomedicine and Biotechnology (CIBB), University of Coimbra, Portugal; Institute for Interdisciplinary Research (IIIUC), University of Coimbra, Coimbra, Portugal
| | - Cláudia Cavadas
- Centre for Neuroscience and Cell Biology (CNC), University of Coimbra, Coimbra, Portugal; Centre for Innovation in Biomedicine and Biotechnology (CIBB), University of Coimbra, Portugal; Institute for Interdisciplinary Research (IIIUC), University of Coimbra, Coimbra, Portugal; Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal.
| | - Alexandrina Ferreira Mendes
- Centre for Neuroscience and Cell Biology (CNC), University of Coimbra, Coimbra, Portugal; Centre for Innovation in Biomedicine and Biotechnology (CIBB), University of Coimbra, Portugal; Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal.
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31
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Cade BE, Dashti HS, Hassan SM, Redline S, Karlson EW. Sleep Apnea and COVID-19 Mortality and Hospitalization. Am J Respir Crit Care Med 2020; 202:1462-1464. [PMID: 32946275 PMCID: PMC7667903 DOI: 10.1164/rccm.202006-2252le] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Affiliation(s)
- Brian E. Cade
- Brigham and Women’s HospitalBoston, Massachusetts
- Harvard Medical SchoolBoston, Massachusetts
| | - Hassan S. Dashti
- Harvard Medical SchoolBoston, Massachusetts
- Massachusetts General HospitalBoston, Massachusetts
- Broad InstituteCambridge, Massachusettsand
| | - Syed M. Hassan
- Brigham and Women’s HospitalBoston, Massachusetts
- Harvard Medical SchoolBoston, Massachusetts
| | - Susan Redline
- Brigham and Women’s HospitalBoston, Massachusetts
- Harvard Medical SchoolBoston, Massachusetts
- Beth Israel Deaconess Medical CenterBoston, Massachusetts
| | - Elizabeth W. Karlson
- Brigham and Women’s HospitalBoston, Massachusetts
- Harvard Medical SchoolBoston, Massachusetts
- Massachusetts General HospitalBoston, Massachusetts
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32
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Khalyfa A, Castro-Grattoni AL, Gozal D. Cardiovascular morbidities of obstructive sleep apnea and the role of circulating extracellular vesicles. Ther Adv Respir Dis 2020; 13:1753466619895229. [PMID: 31852426 PMCID: PMC6923690 DOI: 10.1177/1753466619895229] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Obstructive sleep apnea (OSA) is characterized by recurrent upper airway collapse
during sleep resulting in impaired blood gas exchange, namely intermittent
hypoxia (IH) and hypercapnia, fragmented sleep (SF), increased oxidative stress
and systemic inflammation. Among a myriad of potential associated morbidities,
OSA has been particularly implicated as mechanistically contributing to the
prevalence and severity of cardiovascular diseases (CVD). However, the benefits
of continuous positive airway pressure (CPAP), which is generally employed in
OSA treatment, to either prevent or improve CVD outcomes remain unconvincing,
suggesting that the pathophysiological mechanisms underlying the incremental CVD
risk associated with OSA are not clearly understood. One of the challenges in
development of non-invasive diagnostic assays is the ability to identify
clinically and mechanistically relevant biomarkers. Circulating extracellular
vesicles (EVs) and their cargos reflect underlying changes in cellular
homeostasis and can provide insights into how cells and systems cope with
physiological perturbations by virtue of the identity and abundance of miRNAs,
mRNAs, proteins, and lipids that are packaged in the EVs under normal as well as
diseased states, such as OSA. EVs can not only provide unique insights into
coordinated cellular responses at the organ or systemic level, but can also
serve as reporters of the effects of OSA in CVD, either by their properties
enabling regeneration and repair of injured vascular cells or by damaging them.
Here, we highlight recent progress in the pathological CVD consequences of OSA,
and explore the putative roles of EVs in OSA-associated CVD, along with emerging
diagnostic and therapeutic opportunities. The reviews of this paper are available via the supplemental material
section.
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Affiliation(s)
- Abdelnaby Khalyfa
- Department of Child Health and the Child Health Research Institute, University of Missouri School of Medicine, Columbia, MO, USA
| | - Anabel L Castro-Grattoni
- Department of Child Health and the Child Health Research Institute, University of Missouri School of Medicine, Columbia, MO, USA
| | - David Gozal
- Department of Child Health and MU Women's and Children's Hospital, University of Missouri School of Medicine, 400 N. Keene Street, Suite 010, Columbia, MO 65201, USA
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Epidemiological characteristics of obstructive sleep apnea in a hospital-based historical cohort in Lebanon. PLoS One 2020; 15:e0231528. [PMID: 32413035 PMCID: PMC7228052 DOI: 10.1371/journal.pone.0231528] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 03/26/2020] [Indexed: 11/29/2022] Open
Abstract
The objective of our study was to characterize and analyze the associations between OSA (obstructive sleep apnea) and other clinical variables in adult patients referred for sleep evaluation by polysomnography at a referral center in Beirut, Lebanon, in terms of sociodemographic features, symptoms presentation and comorbidities, and evaluate the burden of comorbidities associated with this disease. All individuals with suspected Sleep Apnea referred (January 2010-September 2017) for a one-night polysomnography were included. Demographics, self-reported symptoms and comorbidities were documented. The relationship between OSA severity and the presence of symptoms and comorbidities were evaluated using multivariate logistic regression. Overall, 663 subjects were assessed. Of these, 57.3% were referred from chest physicians, and sleep test results were abnormal in 589 subjects (88.8%) of whom 526 patients (89.3%) fulfilled diagnostic criteria for OSA; 76.3% were men and women were on average older. OSA was severe in 43.2% and more severe in men. Almost all patients were symptomatic with ~2–4 symptoms per patient and women presented with symptoms that are more atypical. Comorbidities were significantly higher in women. In the multivariate analysis, age, male sex, obesity, symptoms of snoring, excessive daytime somnolence and witnessed apneas were associated with OSA severity. Only age and obesity were associated with self-reported diagnosis of hypertension and diabetes. This is the first study in Lebanon to explore the characteristics of patients with polysomnography-diagnosed OSA. High prevalence of severe OSA and low referral rates in the medical community support promoting awareness for an earlier diagnosis and more personalized approach in this country.
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Shimoura CG, Andrade MA, Toney GM. Central AT1 receptor signaling by circulating angiotensin II is permissive to acute intermittent hypoxia-induced sympathetic neuroplasticity. J Appl Physiol (1985) 2020; 128:1329-1337. [PMID: 32240022 DOI: 10.1152/japplphysiol.00094.2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Acute intermittent hypoxia (AIH) triggers sympathetic long-term facilitation (sLTF), a progressive increase in sympathetic nerve activity (SNA) linked to central AT1 receptor (AT1R) activation by circulating angiotensin II (ANG II). Here, we investigated AIH activation of the peripheral renin-angiotensin system (RAS) and the extent to which the magnitude of RAS activation predicts the magnitude of AIH-induced sLTF. In anesthetized male Sprague-Dawley rats, plasma renin activity (PRA) increased in a linear fashion in response to 5 (P = 0.0342) and 10 (P < 0.0001) cycles of AIH, with PRA remaining at the 10th cycle level 1 h later, a period over which SNA progressively increased. On average, SNA ramping began at the AIH cycle 4.6 ± 0.9 (n = 12) and was similar in magnitude 1 h later whether AIH consisted of 5 or 10 cycles (n = 6/group). Necessity of central AT1R in post-AIH sLTF was affirmed by intracerebroventricular (icv) losartan (40 nmol, 2 µL; n = 5), which strongly attenuated both splanchnic (P = 0.0469) and renal (P = 0.0018) sLTF compared with vehicle [artificial cerebrospinal fluid (aCSF), 2 µL; n = 5]. Bilateral nephrectomy largely prevented sLTF, affirming the necessity of peripheral RAS activation. Sufficiency of central ANG II signaling was assessed in nephrectomized rats. Whereas ICV ANG II (0.5 ng/0.5 µL, 30 min) in nephrectomized rats exposed to sham AIH (n = 4) failed to cause SNA ramping, it rescued sLTF in nephrectomized rats exposed to five cycles of AIH [splanchnic SNA (SSNA), P = 0.0227; renal SNA (RSNA), P = 0.0390; n = 5]. Findings indicate that AIH causes progressive peripheral RAS activation, which stimulates an apparent threshold level of central AT1R signaling that plays a permissive role in triggering sLTF.NEW & NOTEWORTHY Acute intermittent hypoxia (AIH) triggers sympathetic long-term facilitation (sLTF) that relies on peripheral renin-angiotensin system (RAS) activation. Here, increasing AIH cycles from 5 to 10 proportionally increased RAS activity, but not the magnitude of post-AIH sLTF. Brain angiotensin II (ANG II) receptor blockade and nephrectomy each largely prevented sLTF, whereas central ANG II rescued it following nephrectomy. Peripheral RAS activation by AIH induces time-dependent neuroplasticity at an apparent central ANG II signaling threshold, triggering a stereotyped sLTF response.
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Affiliation(s)
- Caroline G Shimoura
- Department of Cellular and Integrative Physiology, University of Texas Health San Antonio, San Antonio, Texas
| | - Mary Ann Andrade
- Department of Cellular and Integrative Physiology, University of Texas Health San Antonio, San Antonio, Texas
| | - Glenn M Toney
- Department of Cellular and Integrative Physiology, University of Texas Health San Antonio, San Antonio, Texas.,Center for Biomedical Neuroscience, University of Texas Health San Antonio, San Antonio, Texas
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Zhou Y, Shu D, Xu H, Qiu Y, Zhou P, Ruan W, Qin G, Jin J, Zhu H, Ying K, Zhang W, Chen E. Validation of novel automatic ultra-wideband radar for sleep apnea detection. J Thorac Dis 2020; 12:1286-1295. [PMID: 32395265 PMCID: PMC7212156 DOI: 10.21037/jtd.2020.02.59] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background To validate the accuracy of ultra-wideband (UWB) wireless radar for the screening diagnosis of sleep apnea. Methods One hundred and seventy-six qualified participants were successfully recruited. Apnea-hypopnea index (AHI) results from polysomnography (PSG) were reviewed by physicians, while the radar device automatically calculated AHI values with an embedded chip. All results were statistically analyzed. Results A UWB radar-based AHI algorithm was successfully developed according to respiratory movement and body motion signals. Of all 176 participants, 63 exhibited normal results (AHI <5/hr) and the remaining 113 were diagnosed with obstructive sleep apnea. Significant correlation was detected between radar AHI and PSG AHI (Intraclass correlation coefficient 0.98, P<0.001). Receiver operating characteristic curve (ROC) analysis revealed high sensitivity and specificity. High concordance in participants with varying gender, age, BMI, and PSG AHI was reached. Conclusions The UWB radar may be a portable, convenient, and reliable device for obstructive sleep apnea screening.
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Affiliation(s)
- Yong Zhou
- Respiratory and Critical Care Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310000, China.,Thoracic Oncology Program, Department of Surgery, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Degui Shu
- Respiratory and Critical Care Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310000, China
| | - Hangdi Xu
- Respiratory and Critical Care Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310000, China
| | - Yuanhua Qiu
- Respiratory and Critical Care Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310000, China
| | - Pan Zhou
- Respiratory and Critical Care Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310000, China
| | - Wenjing Ruan
- Respiratory and Critical Care Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310000, China
| | - Guangyue Qin
- Respiratory and Critical Care Medicine, Zhejiang Hospital, Hangzhou 310000, China
| | - Joy Jin
- Thoracic Oncology Program, Department of Surgery, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Hao Zhu
- Respiratory and Critical Care Medicine, Wuyi Campus, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310000, China
| | - Kejing Ying
- Respiratory and Critical Care Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310000, China
| | - Wenxia Zhang
- Respiratory and Critical Care Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310000, China
| | - Enguo Chen
- Respiratory and Critical Care Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310000, China
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Riba-Llena I, Álvarez-Sabin J, Romero O, Santamarina E, Sampol G, Maisterra O, Ferré Á, Montaner J, Quintana M, Delgado P. Nighttime hypoxia affects global cognition, memory, and executive function in community-dwelling individuals with hypertension. J Clin Sleep Med 2020; 16:243-250. [PMID: 31992414 DOI: 10.5664/jcsm.8174] [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] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The objective of this study was to determine which respiratory and architectural sleep parameters are related to cognitive function and cognitive status (mild cognitive impairment [MCI] versus normal cognitive aging [NCA]) in community-dwelling individuals with hypertension. Additionally, it aimed to determine whether the results changed in the presence or absence of vascular brain lesions (silent brain infarcts and extensive white matter hyperintensities [WMHs]). METHODS In a cohort of individuals with hypertension and without previous stroke or dementia, we conducted in-hospital polysomnography including electroencephalography, electro-oculography, electromyography, and magnetic resonance imaging to assess silent brain infarcts and WMHs. Cognitive testing was carried out with a screening test (Dementia Rating Scale version 2 [DRS-2]) and a complete cognitive visit. RESULTS This study included 158 participants with a median age of 65.0 years; 32.3% were females, and the median apnea-hypopnea index was 22.3 events/h. MCI was diagnosed in 24 study participants, and the rest had NCA. Regarding respiratory parameters, total DRS-2 scores (β; 95% CI) 0.121; 0.026, 0.215 were positively associated with mean O₂ saturation, whereas total (-0.022; -0.036, -0.009), executive function (-0.016; -0.026, -0.006) and memory (-0.017; -0.029, -0.004) DRS-2 scores were all negatively associated with the percent of time with oxygen saturation < 90% after correcting for education, vascular risk factors, and magnetic resonance imaging lesions. Regarding sleep architecture, Attention DRS-2 scores (0.0153; 0.001, 0.306) were independently associated with total sleep time. Similar results were obtained in the absence of silent brain infarcts or WMHs in the stratified analysis. None of the sleep parameters were associated with cognitive status. CONCLUSIONS Low oxygen saturation contributes to cognitive performance, and this effect appears even in the absence of vascular brain lesions in individuals with hypertension.
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Affiliation(s)
- Iolanda Riba-Llena
- Neurovascular Research Laboratory, Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.,Neurology Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - José Álvarez-Sabin
- Neurology Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Odile Romero
- Multidisciplinary Sleep Unit, Department of Neurophysiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.,CIBER Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Estevo Santamarina
- Neurology Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Gabriel Sampol
- CIBER Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.,Multidisciplinary Sleep Unit, Respiratory Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Olga Maisterra
- Neurology Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Álex Ferré
- Multidisciplinary Sleep Unit, Department of Neurophysiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joan Montaner
- Neurovascular Research Laboratory, Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manuel Quintana
- Neurology Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pilar Delgado
- Neurovascular Research Laboratory, Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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Poka-Mayap V, Balkissou Adamou D, Massongo M, Voufouo Sonwa S, Alime J, Moutlen BPM, Kongnyu Njamnshi A, Noseda A, Pefura-Yone EW. Obstructive sleep apnea and hypopnea syndrome in patients admitted in a tertiary hospital in Cameroon: Prevalence and associated factors. PLoS One 2020; 15:e0227778. [PMID: 31945127 PMCID: PMC6964861 DOI: 10.1371/journal.pone.0227778] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 12/27/2019] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Obstructive sleep apnea and hypopnea syndrome (OSAHS) is poorly documented in Sub-Saharan Africa, especially in the hospital setting. The aim of this study was to determine its prevalence and to investigate the associated factors in patients admitted in a tertiary referral hospital in Cameroon. METHODS In this cross-sectional study conducted in the Cardiology, Endocrinology and Neurology departments of the Yaounde Central Hospital; all patients aged 21 and older were included consecutively. A sample of randomly selected patients was recorded using a portable sleep monitoring device (PMD). OSAHS was defined as apnea-hypopnea index (AHI) ≥ 5/hour (with > 50% of events being obstructive) and moderate to severe OSAHS as an AHI > 15/hour. Logistic regression was used to identify factors associated to OSAHS. RESULTS Of the 359 patients included, 202 (56.3%) patients were women. The mean age (standard deviation) was 58 (16) years. The prevalence of OSAHS assessed by PMD (95% CI) was 57.7% (48.5-66.9%), 53.8% in men and 62.7% in women (p = 0.44). The median (25th-75th percentiles) AHI, body mass index and Epworth Sleepiness Scale score of OSAHS patients were 17 (10.6-26.9)/hour, 27.4 (24.7-31.6) kg/m2 and 7 (5-9) respectively. The only factor associated to moderate to severe OSAHS was hypertension [odds ratio (95% CI)]: 3.24 (1.08-9.72), p = 0.036. CONCLUSION OSAHS is a common condition in patients in this health care centre of Cameroon. In the hospital setting, screening for OSAHS in patients with hypertension is recommended.
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Affiliation(s)
| | | | | | - Steve Voufouo Sonwa
- Faculty of Medicine and Biomedical Sciences, The University of Yaounde I, Yaounde, Cameroon
| | - Jacqueline Alime
- Faculty of Medicine and Biomedical Sciences, The University of Yaounde I, Yaounde, Cameroon
| | | | - Alfred Kongnyu Njamnshi
- Department of Internal Medicine and Subspecialties, Faculty of Medicine and Biomedical Sciences, The University of Yaounde I, Yaounde, Cameroon
- Department of Neurology, Yaounde Central Hospital, Yaounde, Cameroon
- Brain Research Africa Initiative (BRAIN), Yaounde, Cameroon
| | - Andre Noseda
- Pulmonology Department, Brugmann University Hospital U.L.B., Brussels, Belgium
| | - Eric Walter Pefura-Yone
- Pulmonology Department, Yaounde Jamot Hospital, Yaounde, Cameroon
- Department of Internal Medicine and Subspecialties, Faculty of Medicine and Biomedical Sciences, The University of Yaounde I, Yaounde, Cameroon
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Pépin JL, Letesson C, Le-Dong NN, Dedave A, Denison S, Cuthbert V, Martinot JB, Gozal D. Assessment of Mandibular Movement Monitoring With Machine Learning Analysis for the Diagnosis of Obstructive Sleep Apnea. JAMA Netw Open 2020; 3:e1919657. [PMID: 31968116 PMCID: PMC6991283 DOI: 10.1001/jamanetworkopen.2019.19657] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
IMPORTANCE Given the high prevalence of obstructive sleep apnea (OSA), there is a need for simpler and automated diagnostic approaches. OBJECTIVE To evaluate whether mandibular movement (MM) monitoring during sleep coupled with an automated analysis by machine learning is appropriate for OSA diagnosis. DESIGN, SETTING, AND PARTICIPANTS Diagnostic study of adults undergoing overnight in-laboratory polysomnography (PSG) as the reference method compared with simultaneous MM monitoring at a sleep clinic in an academic institution (Sleep Laboratory, Centre Hospitalier Universitaire Université Catholique de Louvain Namur Site Sainte-Elisabeth, Namur, Belgium). Patients with suspected OSA were enrolled from July 5, 2017, to October 31, 2018. MAIN OUTCOMES AND MEASURES Obstructive sleep apnea diagnosis required either evoking signs or symptoms or related medical or psychiatric comorbidities coupled with a PSG-derived respiratory disturbance index (PSG-RDI) of at least 5 events/h. A PSG-RDI of at least 15 events/h satisfied the diagnosis criteria even in the absence of associated symptoms or comorbidities. Patients who did not meet these criteria were classified as not having OSA. Agreement analysis and diagnostic performance were assessed by Bland-Altman plot comparing PSG-RDI and the Sunrise system RDI (Sr-RDI) with diagnosis threshold optimization via receiver operating characteristic curves, allowing for evaluation of the device sensitivity and specificity in detecting OSA at 5 events/h and 15 events/h. RESULTS Among 376 consecutive adults with suspected OSA, the mean (SD) age was 49.7 (13.2) years, the mean (SD) body mass index was 31.0 (7.1), and 207 (55.1%) were men. Reliable agreement was found between PSG-RDI and Sr-RDI in patients without OSA (n = 46; mean difference, 1.31; 95% CI, -1.05 to 3.66 events/h) and in patients with OSA with a PSG-RDI of at least 5 events/h with symptoms (n = 107; mean difference, -0.69; 95% CI, -3.77 to 2.38 events/h). An Sr-RDI underestimation of -11.74 (95% CI, -20.83 to -2.67) events/h in patients with OSA with a PSG-RDI of at least 15 events/h was detected and corrected by optimization of the Sunrise system diagnostic threshold. The Sr-RDI showed diagnostic capability, with areas under the receiver operating characteristic curve of 0.95 (95% CI, 0.92-0.96) and 0.93 (95% CI, 0.90-0.93) for corresponding PSG-RDIs of 5 events/h and 15 events/h, respectively. At the 2 optimal cutoffs of 7.63 events/h and 12.65 events/h, Sr-RDI had accuracy of 0.92 (95% CI, 0.90-0.94) and 0.88 (95% CI, 0.86-0.90) as well as posttest probabilities of 0.99 (95% CI, 0.99-0.99) and 0.89 (95% CI, 0.88-0.91) at PSG-RDIs of at least 5 events/h and at least 15 events/h, respectively, corresponding to positive likelihood ratios of 14.86 (95% CI, 9.86-30.12) and 5.63 (95% CI, 4.92-7.27), respectively. CONCLUSIONS AND RELEVANCE Automatic analysis of MM patterns provided reliable performance in RDI calculation. The use of this index in OSA diagnosis appears to be promising.
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Affiliation(s)
- Jean-Louis Pépin
- Pôle Thorax et Vaisseaux, Centre Hospitalier Universitaire (CHU) de Grenoble-Alpes (CHUGA), Université Grenoble Alpes, Institut National de la Santé et de la Recherche Medicale, Grenoble, France
| | | | | | | | | | - Valérie Cuthbert
- Sleep Laboratory, CHU Université Catholique de Louvain (UCL) Namur Site Sainte-Elisabeth, Namur, Belgium
| | - Jean-Benoît Martinot
- Sleep Laboratory, CHU Université Catholique de Louvain (UCL) Namur Site Sainte-Elisabeth, Namur, Belgium
- Institute of Experimental and Clinical Research, UCL Bruxelles Woluwe, Brussels, Belgium
| | - David Gozal
- Department of Child Health, University of Missouri, Columbia
- Child Health Research Institute, University of Missouri, Columbia
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Brown DL, Shafie-Khorassani F, Kim S, Chervin RD, Case E, Yadollahi A, Lisabeth LD. Do apneas and hypopneas best reflect risk for poor outcomes after stroke? Sleep Med 2019; 63:14-17. [PMID: 31600656 PMCID: PMC6939631 DOI: 10.1016/j.sleep.2019.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 05/13/2019] [Accepted: 05/20/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE/BACKGROUND Sleep apnea (SA) is associated with poor outcomes after stroke. The best sleep apnea-related measure to capture this relationship is currently unknown. This measure or its underlying pathophysiology could serve as a treatment target. PATIENTS/METHODS Within the population-based Brain Attack Surveillance in Corpus Christi (BASIC) project, the ApneaLink Plus was used to perform sleep apnea tests shortly after ischemic stroke (2010-2015). Functional and cognitive outcomes were measured via in-person interviews 90-days post-stroke. Recurrent stroke was assessed longitudinally through active and passive surveillance procedures. After standardization to allow direct comparisons, adjusted models were built for each ApneaLink Plus measure and each outcome, to assess the effect of 1 standard deviation difference in the measure. RESULTS Among 995 subjects, median age was 67 years (interquartile range: 59, 78) and 52% were women. The respiratory event index had the strongest relationship with functional outcome (mean difference = 0.094, 95% confidence interval (CI): 0.040, 0.147). Desaturations ≤85% were associated with worse functional outcome (mean difference = 0.016, 95% CI: 0.002, 0.030), but desaturations ≤ 90% were not. Obstructive apnea index (OAI) showed the strongest association with cognitive outcome (mean difference = -0.079, 95% CI: -0.162, 0.005), but was not significant. Oxygen desaturation index (ODI) showed the strongest association with recurrent ischemic stroke (hazard ratio = 1.338, 95% CI: 1.016, 1.759). CONCLUSIONS Measurements easily obtained from a commonly used home sleep apnea test predicted outcomes differentially. This suggests the possibility of different SA-associated targets (perhaps using strategies more tolerable than standard treatment) based on the outcome of interest.
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Affiliation(s)
- Devin L Brown
- Stroke Program, University of Michigan Medical School, USA.
| | | | - Sehee Kim
- Department of Biostatistics, School of Public Health, University of Michigan, USA
| | - Ronald D Chervin
- Sleep Disorders Center and Department of Neurology, University of Michigan Medical School, USA
| | - Erin Case
- Stroke Program, University of Michigan Medical School, USA; Department of Epidemiology, School of Public Health, University of Michigan, USA
| | - Azadeh Yadollahi
- University Health Network-Toronto Rehabilitation Institute, Canada; Institute of Biomaterials & Biomedical Engineering, University of Toronto, Canada
| | - Lynda D Lisabeth
- Stroke Program, University of Michigan Medical School, USA; Department of Epidemiology, School of Public Health, University of Michigan, USA
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Holley AB, Phillips B. The Next 25 Years of Obstructive Sleep Apnea Epidemiology-Don't Keep Repeating Past Mistakes. Am J Respir Crit Care Med 2019; 198:410. [PMID: 29596752 DOI: 10.1164/rccm.201802-0315le] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Aaron B Holley
- 1 Walter Reed National Military Medical Center Bethesda, Maryland and
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Peppard PE, Hagen EW. Reply to Holley and Phillips: The Next 25 Years of Obstructive Sleep Apnea Epidemiology-Don't Keep Repeating Past Mistakes. Am J Respir Crit Care Med 2019; 198:410-411. [PMID: 29596753 DOI: 10.1164/rccm.201803-0467le] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Erika W Hagen
- 1 University of Wisconsin-Madison Madison, Wisconsin
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Abstract
PURPOSE OF REVIEW Obstructive sleep apnea (OSA) is increasing in prevalence. The intermittent hypoxia of OSA has wide-ranging effects on a patient's general health outcomes. However, gold-standard investigations and treatment are expensive and a significant burden on patients. Therefore, OSA research remains focused on improving the means of diagnosing and treating OSA, in high-risk-associated conditions. This review is to provide an update on the advances in the field of OSA. RECENT FINDINGS There has been recent debate about the best practice for diagnosis and treatment of OSA. Further work has been done on conditions associated with OSA including hypertension, atherosclerosis, various types of dementia and intracranial aneurysms. Inflammatory and vascular risk factors associated with OSA increase stroke risk and alter outcomes for recovery. OSA should definitely be considered in patients presenting with nonarteritic anterior ischemic optic neuropathy, and perhaps those with intracranial hypertension. SUMMARY Newer home-based sleep-apnea testing can be implemented via physician clinics, with oversight by a certified sleep physician. Although continuous positive airway pressure (CPAP) is the gold-standard, management should include diet and exercise. It is important to test for, and treat OSA in patients with a range of neurological diseases. However, further studies into the long-term impact of CPAP on health outcomes are still needed.
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Andrade AG, Bubu OM, Varga AW, Osorio RS. The Relationship between Obstructive Sleep Apnea and Alzheimer's Disease. J Alzheimers Dis 2019; 64:S255-S270. [PMID: 29782319 DOI: 10.3233/jad-179936] [Citation(s) in RCA: 123] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Obstructive sleep apnea (OSA) and Alzheimer's disease (AD) are highly prevalent conditions with growing impact on our aging society. While the causes of OSA are now better characterized, the mechanisms underlying AD are still largely unknown, challenging the development of effective treatments. Cognitive impairment, especially affecting attention and executive functions, is a recognized clinical consequence of OSA. A deeper contribution of OSA to AD pathogenesis is now gaining support from several lines of research. OSA is intrinsically associated with disruptions of sleep architecture, intermittent hypoxia and oxidative stress, intrathoracic and hemodynamic changes as well as cardiovascular comorbidities. All of these could increase the risk for AD, rendering OSA as a potential modifiable target for AD prevention. Evidence supporting the relevance of each of these mechanisms for AD risk, as well as a possible effect of AD in OSA expression, will be explored in this review.
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Affiliation(s)
- Andreia G Andrade
- Department of Neurology, Alzheimer's Disease Center, NYU Langone Medical Center, New York, NY, USA.,Department of Psychiatry, Center for Brain Health, NYU Langone Medical Center, New York, NY, USA
| | - Omonigho M Bubu
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL, USA
| | - Andrew W Varga
- Division of Pulmonary, Critical Care and Sleep Medicine at the Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ricardo S Osorio
- Department of Psychiatry, Center for Brain Health, NYU Langone Medical Center, New York, NY, USA.,Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York, NY, USA
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OSA, Short Sleep Duration, and Their Interactions With Sleepiness and Cardiometabolic Risk Factors in Adults. Chest 2019; 155:1190-1198. [DOI: 10.1016/j.chest.2018.12.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 10/26/2018] [Accepted: 12/03/2018] [Indexed: 02/06/2023] Open
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Comorbidities associated with obstructive sleep apnea: a retrospective Egyptian study on 244 patients. Sleep Breath 2019; 23:1079-1085. [PMID: 30685854 DOI: 10.1007/s11325-019-01783-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 01/09/2019] [Accepted: 01/12/2019] [Indexed: 01/09/2023]
Abstract
PURPOSE The aim of the present study was to assess prevalence of associated comorbidities in a group of patients diagnosed with obstructive sleep apnea syndrome (OSAS). METHODS This retrospective study enrolled 244 consecutive patients diagnosed by polysomnogram with OSAS between October 2010 and January 2015 after being referred to our Sleep-Related Breathing Disorders Unit, Chest Diseases Department, in the Alexandria Main University Hospital. RESULTS Of 244 patients, 47% were men, mean age was 56.9 years, and mean apnea-hypopnea index was 43.6 events per hour. Patients were categorized into two groups: group 1 (38%), mild and moderate OSAS, and group 2 (62%), severe, very severe, and extreme OSAS. Comorbidities were present in 91% of patients. The most common comorbidities were obesity, hypertension (HTN), and diabetes mellitus (DM). Prevalence of obesity, HTN, DM, congestive heart failure, deep vein thrombosis, pulmonary embolism (PE), and hypothyroidism was significantly higher in severity group 2. PE, bronchial asthma, and chronic obstructive pulmonary disease were significantly higher among men, whereas hypothyroidism was significantly higher among women. During this period of over 4 years, mortality rate was 8%. The majority of deaths occurred at night. Most of the studied patients (60%) either received no treatment or were not adherent to positive airway pressure (PAP) therapy. None of the patients received surgicaltreatment. The majority (50%) gained access to PAP therapy through donations. Associated hypoventilation was the only significant predictor of PAP adherence. Quality of life was significantly better among PAP adherent patients. CONCLUSIONS Patients suffering from OSAS have very high prevalence of comorbidities indicating a great burden on the healthcare system. Despite this fact, over 50% of the patients studied did not receive any treatment. Charities were the main portal fortreatment.
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Brooks AT, Tuason RT, Chakravorty S, Raju S, Ritterband LM, Thorndike FP, Wallen GR. Online cognitive behavioral therapy for insomnia (CBT-I) for the treatment of insomnia among individuals with alcohol use disorder: study protocol for a randomized controlled trial. Pilot Feasibility Stud 2018; 4:183. [PMID: 30555713 PMCID: PMC6287341 DOI: 10.1186/s40814-018-0376-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 11/25/2018] [Indexed: 12/16/2022] Open
Abstract
Abstract Alcohol use disorder (AUD) is characterized by problematic drinking that becomes severe. Individuals with AUD often experience insomnia and other sleep disturbances at various phases of recovery. Cognitive behavioral therapy for insomnia (CBT-I) is an efficacious non-pharmacological treatment for insomnia and is recommended as a first-line treatment for adults with chronic insomnia. Internet-based CBT-I could play a key role in the dissemination of this behavioral sleep intervention, given the paucity of trained clinicians able to provide CBT-I in person and other logistical/cost concerns. SHUTi (Sleep Healthy Using The Internet) is the most tested and empirically-sound Internet intervention for insomnia. Despite the promise of Internet-based CBT-I interventions, to date, no randomized controlled trials (RCTs) exist examining the feasibility/efficacy of an Internet-based CBT-I program among treatment-seeking individuals recovering from AUD. This is a two-phase RCT assessing feasibility/acceptability and efficacy of the SHUTi program among individuals with AUD in recovery with insomnia. Phase I will focus on assessing the feasibility and acceptability of program delivery and data collection (n = 10). Phase II will be an RCT powered to examine preliminary intervention efficacy (n = 30 per group). Participants for this study must meet criteria for “moderate to severe” insomnia. Individuals randomized to the intervention group will receive the SHUTi intervention (initiated while inpatient and completed while outpatient), and individuals randomized to the control group will receive an educational web-based program. The goals of the study are as follows: (1) assess the feasibility and acceptability of Internet-based CBT-I among individuals with AUD in recovery with insomnia (phase I), (2) compare the preliminary efficacy of CBT-I versus control group with respect to primary and secondary outcome variables (phase II), and (3) explore specific domains associated with improved outcomes, e.g., demographic, psychiatric, and drinking-related factors (phase II). Primary outcome measures include changes in insomnia severity over time and changes in actigraphy-recorded sleep efficiency over time. Trial registration NCT#03493958; registered 1 June 2018. Electronic supplementary material The online version of this article (10.1186/s40814-018-0376-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alyssa T Brooks
- 1National Institutes of Health Clinical Center, Bethesda, USA
| | - Ralph T Tuason
- 1National Institutes of Health Clinical Center, Bethesda, USA
| | - Subhajit Chakravorty
- 2Perelman School of Medicine, Department of Psychiatry, University of Pennsylvania, Philadelphia, USA
| | - Shravya Raju
- 1National Institutes of Health Clinical Center, Bethesda, USA
| | - Lee M Ritterband
- Department of Psychiatry and Neurobehavioral Sciences, Center for Behavioral Health and Technology, PO Box 801075, Charlottesville, VA 22908 USA
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Khalyfa A, Gozal D. Connexins and Atrial Fibrillation in Obstructive Sleep Apnea. CURRENT SLEEP MEDICINE REPORTS 2018; 4:300-311. [PMID: 31106116 PMCID: PMC6516763 DOI: 10.1007/s40675-018-0130-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF THE REVIEW To summarize the potential interactions between obstructive sleep apnea (OSA), atrial fibrillation (AF), and connexins. RECENT FINDINGS OSA is highly prevalent in patients with cardiovascular disease, and is associated with increased risk for end-organ substantial morbidities linked to autonomic nervous system imbalance, increased oxidative stress and inflammation, ultimately leading to reduced life expectancy. Epidemiological studies indicate that OSA is associated with increased incidence and progression of coronary heart disease, heart failure, stroke, as well as arrhythmias, particularly AF. Conversely, AF is very common among subjects referred for suspected OSA, and the prevalence of AF increases with OSA severity. The interrelationships between AF and OSA along with the well-known epidemiological links between these two conditions and obesity may reflect shared pathophysiological pathways, which may depend on the intercellular diffusion of signaling molecules into either the extracellular space or require cell-to-cell contact. Connexin signaling is accomplished via direct exchanges of cytosolic molecules between adjacent cells at gap membrane junctions for cell-to-cell coupling. The role of connexins in AF is now quite well established, but the impact of OSA on cardiac connexins has only recently begun to be investigated. Understanding the biology and regulatory mechanisms of connexins in OSA at the transcriptional, translational, and post-translational levels will undoubtedly require major efforts to decipher the breadth and complexity of connexin functions in OSA-induced AF. SUMMARY The risk of end-organ morbidities has initiated the search for circulating mechanistic biomarker signatures and the implementation of biomarker-based algorithms for precision-based diagnosis and risk assessment. Here we summarize recent findings in OSA as they relate to AF risk, and also review potential mechanisms linking OSA, AF and connexins.
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Affiliation(s)
- Abdelnaby Khalyfa
- Department of Pediatrics, Biological Sciences Division, Pritzker School of Medicine, The University of Chicago, Chicago IL 60637, USA
| | - David Gozal
- Department of Child Health, University of Missouri School of Medicine, Columbia, MO 65201, USA
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Johnson KG, Johnson DC, Thomas RJ, Feldmann E, Lindenauer PK, Visintainer P, Kryger MH. Flow limitation/obstruction with recovery breath (FLOW) event for improved scoring of mild obstructive sleep apnea without electroencephalography. Sleep Med 2018; 67:249-255. [PMID: 30583916 DOI: 10.1016/j.sleep.2018.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 11/06/2018] [Accepted: 11/21/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Apnea/hypopnea index (AHI), especially without arousal criteria, does not adequately risk stratify patients with mild obstructive sleep apnea (OSA). We describe and test scoring reliability of an event, Flow Limitation/Obstruction With recovery breath (FLOW), representing obstructive airflow disruptions using only pressure transducer and snore signals available without electroencephalography. METHODS The following process was used (i) Development of FLOW event definition, (ii) Training period and definition refinement, and (iii) Reliability testing on 10 100-epoch polysomnography (PSG) samples and two 100-sample tests. Twenty full-night in-laboratory baseline PSGs in OSA patients with AHI with ≥4% desaturations <15 were rescored for FLOW events, traditional hypopneas with desaturations, respiratory-related arousal (RRA) events (hypopneas with arousals and respiratory-effort related arousals) and non-respiratory arousals (NRA). RESULTS Scoring of FLOW events in 100-epoch samples had good reliability with intraclass correlation (ICC) of 0.91. The overall kappa for presence of events on two sets of 100 sample events was 0.84 and 0.87 demonstrating good agreement. Moreover, 80% of RRA and 8% of NRA were concurrent with FLOW events. Furthermore, 56% of FLOW events were independent of RRA events. FLOW stratifies patients in traditional AHI categories with 50%/8% of AHI with ≥3% desaturations (AHI3) <5 and 12%/63% of AHI3 >5 in lowest/highest tertiles of AHI3 plus FLOW index. CONCLUSIONS Scoring of FLOW after training is reliable. FLOW scores a high proportion of RRA and many currently unrepresented obstructive airflow disruptions. FLOW allows for stratification within the current normal-mild OSA category, which may better identify patients who will benefit from treatment.
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Affiliation(s)
- Karin Gardner Johnson
- Department of Neurology, Baystate Medical Center, University of Massachusetts Medical School-Baystate, 759 Chestnut St, Springfield, MA, 01199, USA; Institute for Healthcare Delivery and Population Science and Department of Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA, USA.
| | - Douglas Clark Johnson
- Department of Medicine, Baystate Medical Center, University of Massachusetts Medical School-Baystate, 759 Chestnut St, Springfield, MA, 01199, USA
| | - Robert Joseph Thomas
- Division of Pulmonary, Critical Care & Sleep, Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA.
| | - Edward Feldmann
- Department of Neurology, Baystate Medical Center, University of Massachusetts Medical School-Baystate, 759 Chestnut St, Springfield, MA, 01199, USA
| | - Peter K Lindenauer
- Institute for Healthcare Delivery and Population Science and Department of Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA, USA; Department of Medicine, Baystate Medical Center, University of Massachusetts Medical School-Baystate, 759 Chestnut St, Springfield, MA, 01199, USA; Department of Quantitative Health Sciences University of Massachusetts Medical School, Worcester, MA, USA
| | - Paul Visintainer
- Institute for Healthcare Delivery and Population Science and Department of Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA, USA
| | - Meir H Kryger
- Division of Pulmonary, Critical Care and Sleep Medicine, Yale New Haven Medical Center, Yale School of Medicine, 20 York Street New Haven, CT, 06510, USA.
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Accuracy of portable devices in sleep apnea using oximetry-derived heart rate increases as a surrogate arousal marker. Sleep Breath 2018; 23:483-492. [PMID: 30112633 DOI: 10.1007/s11325-018-1708-5] [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: 05/14/2018] [Revised: 07/06/2018] [Accepted: 08/05/2018] [Indexed: 01/09/2023]
Abstract
PURPOSE Type 3 home study (HS) monitors do not detect cortical arousal-related hypopneas and may therefore underestimate the polysomnography (PSG)-based apnea-hypopnea index (AHI). Our aim was to test the hypothesis that scoring hypopneas using heart rate accelerations as a surrogate marker for cortical arousal (autonomic hypopnea; AnH) improves the accuracy of HS for OSA diagnosis, using PSG AHI as the diagnostic gold standard. METHODS We retrospectively identified patients referred for OSA who underwent complete PSG following an initial inconclusive HS. Respiratory events were scored using AASM research (Chicago) criteria with additional HS scoring for AnH, defined as hypopneas based on flow criteria associated with an increase in pulse oximetry-derived heart rate ≥ 6 beats/min. RESULTS A total of 178 patients met inclusion criteria, with mean (±SD) HS AHI = 4.4 ± 4.2/h, which increased to 8.5 ± 5.3/h with AnH scoring. The hypopnea arousal index on subsequent PSG was 7.6 ± 7.7/h, with total AHI 15.6 ± 11.9/h. Bland-Altman analysis showed improved agreement between HS and PSG AHI (mean difference 11.2/h (95%CI 33.6, - 11.1) without vs. 7.2/h (95%CI 29.6, - 15.4) with AnH scoring). Overall diagnostic accuracy was improved with AnH scoring as reflected by an increased area under the receiver-operating characteristic curve for AHI thresholds of 10 and 15 events/h. CONCLUSIONS In this retrospective analysis, the diagnostic accuracy of type 3 HS was improved by the inclusion of hypopnea-associated heart rate increases as a surrogate marker of arousal. Prospective studies are warranted to evaluate the impact of AnH scoring on clinical decision-making and patient outcomes.
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