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Hajipour M, Hirsch Allen AJ, Beaudin AE, Raneri JK, Jen R, Foster GE, Fogel S, Kendzerska T, Series F, Skomro RP, Robillard R, Kimoff RJ, Hanly PJ, Fels S, Singh A, Azarbarzin A, Ayas NT. All Obstructive Sleep Apnea Events Are Not Created Equal: The Relationship between Event-related Hypoxemia and Physiologic Response. Ann Am Thorac Soc 2024; 21:794-802. [PMID: 38252424 PMCID: PMC11109914 DOI: 10.1513/annalsats.202309-777oc] [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: 09/07/2023] [Accepted: 01/22/2024] [Indexed: 01/23/2024] Open
Abstract
Rationale: Obstructive sleep apnea (OSA) severity is typically assessed by the apnea-hypopnea index (AHI), a frequency-based metric that allocates equal weight to all respiratory events. However, more severe events may have a greater physiologic impact. Objectives: The purpose of this study was to determine whether the degree of event-related hypoxemia would be associated with the postevent physiologic response. Methods: Patients with OSA (AHI, ⩾5/h) from the multicenter Canadian Sleep and Circadian Network cohort were studied. Using mixed-effect linear regression, we examined associations between event-related hypoxic burden (HBev) assessed by the area under the event-related oxygen saturation recording with heart rate changes (ΔHRev), vasoconstriction (vasoconstriction burden [VCBev] assessed with photoplethysmography), and electroencephalographic responses (power ratio before and after events). Results: Polysomnographic recordings from 658 patients (median [interquartile range] age, 55.00 [45.00, 64.00] yr; AHI, 27.15 [14.90, 64.05] events/h; 42% female) were included in the analyses. HBev was associated with an increase in all physiologic responses after controlling for age, sex, body mass index, sleep stage, total sleep time, and study centers; for example, 1 standard deviation increase in HBev was associated with 0.21 [95% confidence interval, 0.2, 0.22], 0.08 [0.08, 0.09], and 0.22 [0.21, 0.23] standard deviation increases in ΔHRev, VCBev, and β-power ratio, respectively. Conclusions: Increased event-related hypoxic burden was associated with greater responses across a broad range of physiologic signals. Future metrics that incorporate information about the variability of these physiologic responses may have promise in providing a more nuanced assessment of OSA severity.
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Affiliation(s)
| | | | | | - Jill K. Raneri
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Sleep Centre, Foothills Medical Centre, Calgary, Alberta, Canada
| | | | - Glen E. Foster
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
| | | | - Tetyana Kendzerska
- Department of Medicine, Faculty of Medicine, The Ottawa Hospital Research Institute, and
| | - Fréderic Series
- Department of Medicine, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
| | - Robert P. Skomro
- Department of Medicine, Faculty of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Rebecca Robillard
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - R. John Kimoff
- Respiratory Division and Sleep Laboratory, McGill University Health Centre, Montreal, Quebec, Canada; and
| | - Patrick J. Hanly
- Hotchkiss Brain Institute, and
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Sleep Centre, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Sidney Fels
- Department of Electrical and Computer Engineering, Faculty of Applied Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - Amrit Singh
- Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine, and
| | - Ali Azarbarzin
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Najib T. Ayas
- Department of Experimental Medicine
- Department of Medicine
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Luukinen M, Pitkänen H, Leppänen T, Töyräs J, Islind AS, Kainulainen S, Korkalainen H. Variation in the Photoplethysmogram Response to Arousal From Sleep Depending on the Cause of Arousal and the Presence of Desaturation. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE 2024; 12:328-339. [PMID: 38444399 PMCID: PMC10914203 DOI: 10.1109/jtehm.2024.3349916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 12/07/2023] [Accepted: 12/22/2023] [Indexed: 03/07/2024]
Abstract
OBJECTIVE The aim of this study was to assess how the photoplethysmogram frequency and amplitude responses to arousals from sleep differ between arousals caused by apneas and hypopneas with and without blood oxygen desaturations, and spontaneous arousals. Stronger arousal causes were hypothesized to lead to larger and faster responses. METHODS AND PROCEDURES Photoplethysmogram signal segments during and around respiratory and spontaneous arousals of 876 suspected obstructive sleep apnea patients were analyzed. Logistic functions were fit to the mean instantaneous frequency and instantaneous amplitude of the signal to detect the responses. Response intensities and timings were compared between arousals of different causes. RESULTS The majority of the studied arousals induced photoplethysmogram responses. The frequency response was more intense ([Formula: see text]) after respiratory than spontaneous arousals, and after arousals caused by apneas compared to those caused by hypopneas. The amplitude response was stronger ([Formula: see text]) following hypopneas associated with blood oxygen desaturations compared to those that were not. The delays of these responses relative to the electroencephalogram arousal start times were the longest ([Formula: see text]) after arousals caused by apneas and the shortest after spontaneous arousals and arousals caused by hypopneas without blood oxygen desaturations. CONCLUSION The presence and type of an airway obstruction and the presence of a blood oxygen desaturation affect the intensity and the timing of photoplethysmogram responses to arousals from sleep. CLINICAL IMPACT The photoplethysmogram responses could be used for detecting arousals and assessing their intensity, and the individual variation in the response intensity and timing may hold diagnostically significant information.
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Affiliation(s)
- Mieli Luukinen
- Department of Technical PhysicsUniversity of Eastern Finland70211KuopioFinland
- Diagnostic Imaging CenterKuopio University Hospital70210KuopioFinland
| | - Henna Pitkänen
- Department of Technical PhysicsUniversity of Eastern Finland70211KuopioFinland
- Diagnostic Imaging CenterKuopio University Hospital70210KuopioFinland
| | - Timo Leppänen
- Department of Technical PhysicsUniversity of Eastern Finland70211KuopioFinland
- Diagnostic Imaging CenterKuopio University Hospital70210KuopioFinland
- School of Electrical Engineering and Computer ScienceThe University of QueenslandBrisbaneQLD4072Australia
| | - Juha Töyräs
- Department of Technical PhysicsUniversity of Eastern Finland70211KuopioFinland
- School of Electrical Engineering and Computer ScienceThe University of QueenslandBrisbaneQLD4072Australia
- Science Service CenterKuopio University Hospital70210KuopioFinland
| | | | - Samu Kainulainen
- Department of Technical PhysicsUniversity of Eastern Finland70211KuopioFinland
- Diagnostic Imaging CenterKuopio University Hospital70210KuopioFinland
| | - Henri Korkalainen
- Department of Technical PhysicsUniversity of Eastern Finland70211KuopioFinland
- Diagnostic Imaging CenterKuopio University Hospital70210KuopioFinland
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3
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Abu K, Khraiche ML, Amatoury J. Obstructive sleep apnea diagnosis and beyond using portable monitors. Sleep Med 2024; 113:260-274. [PMID: 38070375 DOI: 10.1016/j.sleep.2023.11.034] [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: 07/03/2023] [Revised: 08/03/2023] [Accepted: 11/21/2023] [Indexed: 01/07/2024]
Abstract
Obstructive sleep apnea (OSA) is a chronic sleep and breathing disorder with significant health complications, including cardiovascular disease and neurocognitive impairments. To ensure timely treatment, there is a need for a portable, accurate and rapid method of diagnosing OSA. This review examines the use of various physiological signals used in the detection of respiratory events and evaluates their effectiveness in portable monitors (PM) relative to gold standard polysomnography. The primary objective is to explore the relationship between these physiological parameters and OSA, their application in calculating the apnea hypopnea index (AHI), the standard metric for OSA diagnosis, and the derivation of non-AHI metrics that offer additional diagnostic value. It is found that increasing the number of parameters in PMs does not necessarily improve OSA detection. Several factors can cause performance variations among different PMs, even if they extract similar signals. The review also highlights the potential of PMs to be used beyond OSA diagnosis. These devices possess parameters that can be utilized to obtain endotypic and other non-AHI metrics, enabling improved characterization of the disorder and personalized treatment strategies. Advancements in PM technology, coupled with thorough evaluation and validation of these devices, have the potential to revolutionize OSA diagnosis, personalized treatment, and ultimately improve health outcomes for patients with OSA. By identifying the key factors influencing performance and exploring the application of PMs beyond OSA diagnosis, this review aims to contribute to the ongoing development and utilization of portable, efficient, and effective diagnostic tools for OSA.
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Affiliation(s)
- Kareem Abu
- Biomedical Engineering Program, Maroun Semaan Faculty of Engineering and Architecture (MSFEA), American University of Beirut, Beirut, Lebanon; Neural Engineering and Nanobiosensors Group, American University of Beirut, Beirut, Lebanon; Sleep and Upper Airway Research Group (SUARG), American University of Beirut, Beirut, Lebanon
| | - Massoud L Khraiche
- Biomedical Engineering Program, Maroun Semaan Faculty of Engineering and Architecture (MSFEA), American University of Beirut, Beirut, Lebanon; Neural Engineering and Nanobiosensors Group, American University of Beirut, Beirut, Lebanon
| | - Jason Amatoury
- Biomedical Engineering Program, Maroun Semaan Faculty of Engineering and Architecture (MSFEA), American University of Beirut, Beirut, Lebanon; Sleep and Upper Airway Research Group (SUARG), American University of Beirut, Beirut, Lebanon.
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4
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Chang JL, Goldberg AN, Alt JA, Alzoubaidi M, Ashbrook L, Auckley D, Ayappa I, Bakhtiar H, Barrera JE, Bartley BL, Billings ME, Boon MS, Bosschieter P, Braverman I, Brodie K, Cabrera-Muffly C, Caesar R, Cahali MB, Cai Y, Cao M, Capasso R, Caples SM, Chahine LM, Chang CP, Chang KW, Chaudhary N, Cheong CSJ, Chowdhuri S, Cistulli PA, Claman D, Collen J, Coughlin KC, Creamer J, Davis EM, Dupuy-McCauley KL, Durr ML, Dutt M, Ali ME, Elkassabany NM, Epstein LJ, Fiala JA, Freedman N, Gill K, Boyd Gillespie M, Golisch L, Gooneratne N, Gottlieb DJ, Green KK, Gulati A, Gurubhagavatula I, Hayward N, Hoff PT, Hoffmann OM, Holfinger SJ, Hsia J, Huntley C, Huoh KC, Huyett P, Inala S, Ishman SL, Jella TK, Jobanputra AM, Johnson AP, Junna MR, Kado JT, Kaffenberger TM, Kapur VK, Kezirian EJ, Khan M, Kirsch DB, Kominsky A, Kryger M, Krystal AD, Kushida CA, Kuzniar TJ, Lam DJ, Lettieri CJ, Lim DC, Lin HC, Liu SY, MacKay SG, Magalang UJ, Malhotra A, Mansukhani MP, Maurer JT, May AM, Mitchell RB, Mokhlesi B, Mullins AE, Nada EM, Naik S, Nokes B, Olson MD, Pack AI, Pang EB, Pang KP, Patil SP, Van de Perck E, Piccirillo JF, Pien GW, Piper AJ, Plawecki A, Quigg M, Ravesloot MJ, Redline S, Rotenberg BW, Ryden A, Sarmiento KF, Sbeih F, Schell AE, Schmickl CN, Schotland HM, Schwab RJ, Seo J, Shah N, Shelgikar AV, Shochat I, Soose RJ, Steele TO, Stephens E, Stepnowsky C, Strohl KP, Sutherland K, Suurna MV, Thaler E, Thapa S, Vanderveken OM, de Vries N, Weaver EM, Weir ID, Wolfe LF, Tucker Woodson B, Won CH, Xu J, Yalamanchi P, Yaremchuk K, Yeghiazarians Y, Yu JL, Zeidler M, Rosen IM. International Consensus Statement on Obstructive Sleep Apnea. Int Forum Allergy Rhinol 2023; 13:1061-1482. [PMID: 36068685 PMCID: PMC10359192 DOI: 10.1002/alr.23079] [Citation(s) in RCA: 53] [Impact Index Per Article: 53.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 08/12/2022] [Accepted: 08/18/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Evaluation and interpretation of the literature on obstructive sleep apnea (OSA) allows for consolidation and determination of the key factors important for clinical management of the adult OSA patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International Consensus statement on Obstructive Sleep Apnea (ICS:OSA). METHODS Using previously defined methodology, focal topics in OSA were assigned as literature review (LR), evidence-based review (EBR), or evidence-based review with recommendations (EBR-R) formats. Each topic incorporated the available and relevant evidence which was summarized and graded on study quality. Each topic and section underwent iterative review and the ICS:OSA was created and reviewed by all authors for consensus. RESULTS The ICS:OSA addresses OSA syndrome definitions, pathophysiology, epidemiology, risk factors for disease, screening methods, diagnostic testing types, multiple treatment modalities, and effects of OSA treatment on multiple OSA-associated comorbidities. Specific focus on outcomes with positive airway pressure (PAP) and surgical treatments were evaluated. CONCLUSION This review of the literature consolidates the available knowledge and identifies the limitations of the current evidence on OSA. This effort aims to create a resource for OSA evidence-based practice and identify future research needs. Knowledge gaps and research opportunities include improving the metrics of OSA disease, determining the optimal OSA screening paradigms, developing strategies for PAP adherence and longitudinal care, enhancing selection of PAP alternatives and surgery, understanding health risk outcomes, and translating evidence into individualized approaches to therapy.
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Affiliation(s)
- Jolie L. Chang
- University of California, San Francisco, California, USA
| | | | | | | | - Liza Ashbrook
- University of California, San Francisco, California, USA
| | | | - Indu Ayappa
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | - Maurits S. Boon
- Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Pien Bosschieter
- Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | - Itzhak Braverman
- Hillel Yaffe Medical Center, Hadera Technion, Faculty of Medicine, Hadera, Israel
| | - Kara Brodie
- University of California, San Francisco, California, USA
| | | | - Ray Caesar
- Stone Oak Orthodontics, San Antonio, Texas, USA
| | | | - Yi Cai
- University of California, San Francisco, California, USA
| | | | | | | | | | | | | | | | | | - Susmita Chowdhuri
- Wayne State University and John D. Dingell VA Medical Center, Detroit, Michigan, USA
| | - Peter A. Cistulli
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - David Claman
- University of California, San Francisco, California, USA
| | - Jacob Collen
- Uniformed Services University, Bethesda, Maryland, USA
| | | | | | - Eric M. Davis
- University of Virginia, Charlottesville, Virginia, USA
| | | | | | - Mohan Dutt
- University of Michigan, Ann Arbor, Michigan, USA
| | - Mazen El Ali
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | | | | | | | - Kirat Gill
- Stanford University, Palo Alto, California, USA
| | | | - Lea Golisch
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | | | | | - Arushi Gulati
- University of California, San Francisco, California, USA
| | | | | | - Paul T. Hoff
- University of Michigan, Ann Arbor, Michigan, USA
| | - Oliver M.G. Hoffmann
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | - Jennifer Hsia
- University of Minnesota, Minneapolis, Minnesota, USA
| | - Colin Huntley
- Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | | | - Sanjana Inala
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | | | | | | | | | | | - Meena Khan
- Ohio State University, Columbus, Ohio, USA
| | | | - Alan Kominsky
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | - Meir Kryger
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Derek J. Lam
- Oregon Health and Science University, Portland, Oregon, USA
| | | | | | | | | | | | | | - Atul Malhotra
- University of California, San Diego, California, USA
| | | | - Joachim T. Maurer
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Anna M. May
- Case Western Reserve University, Cleveland, Ohio, USA
| | - Ron B. Mitchell
- University of Texas, Southwestern and Children’s Medical Center Dallas, Texas, USA
| | | | | | | | | | - Brandon Nokes
- University of California, San Diego, California, USA
| | | | - Allan I. Pack
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | | | | | | | | | | | | | - Mark Quigg
- University of Virginia, Charlottesville, Virginia, USA
| | | | - Susan Redline
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Armand Ryden
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | | | - Firas Sbeih
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | | | | | | | | | - Jiyeon Seo
- University of California, Los Angeles, California, USA
| | - Neomi Shah
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | - Ryan J. Soose
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Erika Stephens
- University of California, San Francisco, California, USA
| | | | | | | | | | - Erica Thaler
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sritika Thapa
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Nico de Vries
- Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | | | - Ian D. Weir
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Josie Xu
- University of Toronto, Ontario, Canada
| | | | | | | | | | | | - Ilene M. Rosen
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
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5
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Hinder D, Schams SC, Knaus C, Tschopp K. Home sleep apnea testing with peripheral arterial tonometry to assess outcome in upper airway stimulation. J Clin Sleep Med 2022; 18:2197-2205. [PMID: 35689596 PMCID: PMC9435336 DOI: 10.5664/jcsm.10082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 04/19/2022] [Accepted: 04/19/2022] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To determine whether home sleep apnea testing with peripheral arterial tonometry (HSAT-PAT) can be used in upper airway stimulation to evaluate therapy success. METHODS Data analysis from 50 consecutive patients receiving upper airway stimulation was performed. Baseline values were measured by polysomnography and HSAT-PAT. Follow-up was performed during and after titration (3-6 months) by polysomnography and HSAT-PAT and after 1 year by HSAT-PAT only. Primary outcome measures were reduction in the apnea-hypopnea index and oxygen desaturation index. In addition, an analysis of night-to-night variability for HSAT-PAT was performed. RESULTS All 50 patients completed their posttitration visit (3-6 months) and 41 patients completed the 1-year follow-up. In HSAT-PAT after 1 year, the mean apnea-hypopnea index (desaturation 3%) was reduced from 29.5 ± 17.1 events/h to 19.9 ± 13.1 events/h (P < .01) and the oxygen desaturation index (desaturation 4%) was reduced from 17.8 ± 12.6 events/h to 10.2 ± 8.3 events/h (P < .01). Therapy adherence after 1 year was high (6.6 ± 1.9 hours per night) and led to improvement in daytime sleepiness, meaning a reduction in the Epworth Sleepiness Scale score from 12.8 ± 5.4 to 5.9 ± 4.0 (P < .01). Analysis of night-to-night variability showed similar apnea-hypopnea index values between the 2 nights. CONCLUSIONS Upper airway stimulation was able to reduce the apnea-hypopnea index and oxygen desaturation index after 1 year, as assessed by full-night efficacy studies with HSAT-PAT. In addition, improvements in self-reported outcome parameters were observed. The importance of publishing the scoring criteria is highlighted and whether data are based on full-night efficacy studies or a selected period of time from a sleep study. This is a prerequisite for comparing data with other trials in the emerging field of upper airway stimulation. CITATION Hinder D, Schams SC, Knaus C, Tschopp K. Home sleep apnea testing with peripheral arterial tonometry to assess outcome in upper airway stimulation. J Clin Sleep Med. 2022;18(9):2197-2205.
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Affiliation(s)
- Dominik Hinder
- Address correspondence to: Dominik Hinder, MD, Department of Otorhinolaryngology, Head and Neck Surgery, Cantonal Hospital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland;
| | | | - Christoph Knaus
- Department of Otorhinolaryngology, Head and Neck Surgery, Cantonal Hospital Baselland, Liestal, Switzerland
| | - Kurt Tschopp
- Department of Otorhinolaryngology, Head and Neck Surgery, Cantonal Hospital Baselland, Liestal, Switzerland
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6
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O’Reilly BM, Wang Q, Collen J, Matsangas P, Colombo CJ, Mysliwiec V. Performance comparison of peripheral arterial tonometry-based testing and polysomnography to diagnose obstructive sleep apnea in military personnel. J Clin Sleep Med 2022; 18:1523-1530. [DOI: 10.5664/jcsm.9894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
| | - Qing Wang
- Madigan Army Medical Center, Tacoma, Washington
| | - Jacob Collen
- Walter Reed National Military Medical Center, Bethesda, Maryland
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7
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Schnall RP, Sheffy JK, Penzel T. Peripheral arterial tonometry-PAT technology. Sleep Med Rev 2021; 61:101566. [PMID: 34920273 DOI: 10.1016/j.smrv.2021.101566] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 10/09/2021] [Accepted: 10/31/2021] [Indexed: 10/19/2022]
Abstract
PAT Technology is a plethysmographic based measurement method which facilitates the accurate recording of the pulsatile volume changes of the arteries of peripheral vascular beds at the distal end of the fingers over sustained periods of time. It represents a departure from previously available plethysmographic methods, in so far as it applies a uniform pressure field which completely envelopes the measured part of a digit, including its distal-most tip. Applying near diastolic blood pressure levels of pressure within the PAT probe optimizes the dynamic range of the signal, prevents confounding veno-arteriolar reflex vasoconstriction at the measurement site, reduces respiratory and movement artifacts and thus facilitates accurate long term measurement. The vascular bed of the distal phalanx of the finger is a major site of sympathetic nervous system mediated vasoconstrictor activity, and the PAT response to sympathetic changes provides a platform for accurate and robust measurement in a number of sleep and sleep related clinical areas, foremost as a patient friendly and extensively validated home sleep testing device.
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Affiliation(s)
| | | | - Thomas Penzel
- Interdisciplinary Sleep Medicine Center, Charite Universitätsmedizin Berlin, Berlin, Germany.
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Abstract
Sleep studies have typically followed criteria established many decades ago, but emerging technologies allow signal analyses that go far beyond the scoring rules for manual analysis of sleep recordings. These technologies may apply to the analysis of signals obtained in standard polysomnography in addition to novel signals more recently developed that provide both direct and indirect measures of sleep and breathing in the ambulatory setting. Automated analysis of signals such as electroencephalogram and oxygen saturation, in addition to heart rate and rhythm, provides a wealth of additional information on sleep and breathing disturbances and their potential for comorbidity.
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Affiliation(s)
- Walter T McNicholas
- Department of Respiratory and Sleep Medicine, School of Medicine, University College Dublin, St. Vincent's Hospital Group, Elm Park, Dublin 4, Ireland.
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Hirotsu C, Betta M, Bernardi G, Marques-Vidal P, Vollenweider P, Waeber G, Pichot V, Roche F, Siclari F, Haba-Rubio J, Heinzer R. Pulse wave amplitude drops during sleep: clinical significance and characteristics in a general population sample. Sleep 2021; 43:5715731. [PMID: 31978212 PMCID: PMC7355400 DOI: 10.1093/sleep/zsz322] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 12/06/2019] [Indexed: 11/13/2022] Open
Abstract
Study Objectives To explore the clinical significance of pulse wave amplitude (PWA)-drops during sleep as a biomarker for cardiometabolic disorders and describe their main characteristics in a general population sample. Methods Cross-sectional study of HypnoLaus cohort, in which 2162 individuals underwent clinical assessment and in-home full polysomnography. PWA-drops were derived from photoplethysmography and processed using a validated automated algorithm. Associations between PWA-drop features (index, mean duration, and mean area under the curve [AUC]) with hypertension, diabetes, and previous cardiovascular (CV) event were analyzed using multivariable-adjusted logistic regression. Results Two thousand one hundred forty-nine participants (59 ± 11 years, 51% women, 9.9% diabetes, 41.3% hypertension, 4.4% CV event) were included. Mean ± standard deviation (SD) of PWA-drop index, duration, and AUC during sleep were 51.0 ± 20.3 events/hour, 14.0 ± 2.7 seconds, and 527±115 %seconds, respectively. PWA-drop index was lower in women and decreased with age, while its mean duration and AUC increased in men and elderly. Overall, lower PWA-drop index, longer duration and greater AUC were associated with increased odds of hypertension, diabetes, or CV event after adjustment for confounders. Participants in the lowest quartile of mean duration-normalized PWA-drop index had a significantly higher odds ratio (OR) of hypertension (OR = 1.60 [1.19–2.16]), CV event (OR = 3.26 [1.33–8.03]), and diabetes (OR = 1.71 [1.06–2.76]) compared to those in the highest quartile. Similar results were observed for mean AUC-normalized PWA-drop index regarding hypertension (OR = 1.59 [1.19–2.13]), CV event (OR = 2.45 [1.14–5.26]) and diabetes (OR = 1.76 [1.10–2.83]). Conclusions PWA-drop features during sleep seem to be an interesting biomarker independently associated with cardiometabolic outcomes in the general population.
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Affiliation(s)
- Camila Hirotsu
- Center for Investigation and Research in Sleep (CIRS), Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland (Institution where the work was performed)
| | - Monica Betta
- IMT School for Advanced Studies Lucca, Lucca, Italy
| | | | - Pedro Marques-Vidal
- Department of Medicine, Internal Medicine, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Peter Vollenweider
- Department of Medicine, Internal Medicine, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Gérard Waeber
- Department of Medicine, Internal Medicine, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Vincent Pichot
- University Hospital of Saint-Étienne, Clinical and Exercise Physiology, Saint-Étienne, France
| | - Frederic Roche
- University Hospital of Saint-Étienne, Clinical and Exercise Physiology, Saint-Étienne, France
| | - Francesca Siclari
- Center for Investigation and Research in Sleep (CIRS), Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland (Institution where the work was performed)
| | - Jose Haba-Rubio
- Center for Investigation and Research in Sleep (CIRS), Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland (Institution where the work was performed)
| | - Raphael Heinzer
- Center for Investigation and Research in Sleep (CIRS), Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland (Institution where the work was performed).,Pulmonary Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland
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10
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Kontos A, Willoughby S, Lushington K, Martin J, Wabnitz D, Dorrian J, Kennedy D. Increased Platelet Aggregation in Children and Adolescents with Sleep-disordered Breathing. Am J Respir Crit Care Med 2020; 202:1560-1566. [PMID: 32628860 DOI: 10.1164/rccm.201911-2229oc] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Rationale: Sleep-disordered breathing (SDB) is associated with increased vascular resistance in children and adults. Persistent increased vascular resistance damages vascular endothelial cells-a marker of which is increased platelet activation.Objectives: This study compared whole-blood impedance platelet aggregation in children with clinically diagnosed SDB warranting adenotonsillectomy and healthy control subjects.Methods: Thirty children who had SDB warranting intervention clinically diagnosed by experienced pediatric otolaryngologists were recruited from adenotonsillectomy waitlists, and 20 healthy children from the community underwent overnight polysomnography to determine SDB severity (obstructive apnea-hypopnea index). Snoring frequency was collected from parents. In the morning, a fasting blood sample was taken, and whole-blood platelet aggregation was measured.Measurements and Main Results: Children with SDB exhibited increased platelet aggregation to TRAP (thrombin receptor-activating peptide) (children with SDB = 114.8 aggregation units [AU] vs. control subjects = 98.0 AU; P < 0.05) and COL antibody (96.7 vs. 82.2 AU; P < 0.05) and an increased trend in ADP antibody (82.3 vs. 69.2 AU; P < 0.07) but not aspirin dialuminate (82.1 vs. 79.5 AU; P > 0.05). No significant association was observed between either the obstructive apnea-hypopnea index and any aggregation parameter, but parental report of snoring was positively associated with TRAP aggregation (Kendall's τ-c = 0.23; P < 0.05).Conclusions: The finding of increased platelet aggregation is consistent with endothelial damage. This suggests that the profile of cardiovascular changes noted in adults with SDB may also occur in children with SDB.
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Affiliation(s)
- Anna Kontos
- Department of Respiratory and Sleep Medicine and.,Robinson Research Institute.,Discipline of Paediatrics, School of Medicine, and
| | - Scott Willoughby
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia; and
| | - Kurt Lushington
- Robinson Research Institute.,Centre for Behaviour, Brain and Body, Justice and Society Unit, University of South Australia, Adelaide, South Australia, Australia
| | - James Martin
- Department of Respiratory and Sleep Medicine and.,Robinson Research Institute.,Discipline of Paediatrics, School of Medicine, and
| | - David Wabnitz
- Department of Otolaryngology, Head and Neck Surgery, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Jill Dorrian
- Centre for Behaviour, Brain and Body, Justice and Society Unit, University of South Australia, Adelaide, South Australia, Australia
| | - Declan Kennedy
- Department of Respiratory and Sleep Medicine and.,Robinson Research Institute.,Discipline of Paediatrics, School of Medicine, and
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11
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O'Mahony AM, Garvey JF, McNicholas WT. Technologic advances in the assessment and management of obstructive sleep apnoea beyond the apnoea-hypopnoea index: a narrative review. J Thorac Dis 2020; 12:5020-5038. [PMID: 33145074 PMCID: PMC7578472 DOI: 10.21037/jtd-sleep-2020-003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Obstructive sleep apnoea (OSA) is a growing and serious worldwide health problem with significant health and socioeconomic consequences. Current diagnostic testing strategies are limited by cost, access to resources and over reliance on one measure, namely the apnoea-hypopnoea frequency per hour (AHI). Recent evidence supports moving away from the AHI as the principle measure of OSA severity towards a more personalised approach to OSA diagnosis and treatment that includes phenotypic and biological traits. Novel advances in technology include the use of signals such as heart rate variability (HRV), oximetry and peripheral arterial tonometry (PAT) as alternative or additional measures. Ubiquitous use of smartphones and developments in wearable technology have also led to increased availability of applications and devices to facilitate home screening of at-risk populations, although current evidence indicates relatively poor accuracy in comparison with the traditional gold standard polysomnography (PSG). In this review, we evaluate the current strategies for diagnosing OSA in the context of their limitations, potential physiological targets as alternatives to AHI and the role of novel technology in OSA. We also evaluate the current evidence for using newer technologies in OSA diagnosis, the physiological targets such as smartphone applications and wearable technology. Future developments in OSA diagnosis and assessment will likely focus increasingly on systemic effects of sleep disordered breathing (SDB) such as changes in nocturnal oxygen and blood pressure (BP); and may also include other factors such as circulating biomarkers. These developments will likely require a re-evaluation of the diagnostic and grading criteria for clinically significant OSA.
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Affiliation(s)
- Anne M O'Mahony
- School of Medicine, University College Dublin, Dublin, Ireland
| | - John F Garvey
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Walter T McNicholas
- School of Medicine, University College Dublin, Dublin, Ireland.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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12
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Lazazzera R, Deviaene M, Varon C, Buyse B, Testelmans D, Laguna P, Gil E, Carrault G. Detection and Classification of Sleep Apnea and Hypopnea Using PPG and SpO 2 Signals. IEEE Trans Biomed Eng 2020; 68:1496-1506. [PMID: 32997622 DOI: 10.1109/tbme.2020.3028041] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
In this work, a detection and classification method for sleep apnea and hypopnea, using photopletysmography (PPG) and peripheral oxygen saturation (SpO 2) signals, is proposed. The detector consists of two parts: one that detects reductions in amplitude fluctuation of PPG (DAP)and one that detects oxygen desaturations. To further differentiate among sleep disordered breathing events (SDBE), the pulse rate variability (PRV) was extracted from the PPG signal, and then used to extract features that enhance the sympatho-vagal arousals during apneas and hypopneas. A classification was performed to discriminate between central and obstructive events, apneas and hypopneas. The algorithms were tested on 96 overnight signals recorded at the UZ Leuven hospital, annotated by clinical experts, and from patients without any kind of co-morbidity. An accuracy of 75.1% for the detection of apneas and hypopneas, in one-minute segments,was reached. The classification of the detected events showed 92.6% accuracy in separating central from obstructive apnea, 83.7% for central apnea and central hypopnea and 82.7% for obstructive apnea and obstructive hypopnea. The low implementation cost showed a potential for the proposed method of being used as screening device, in ambulatory scenarios.
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13
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Cai Y, Sun GS, Zhao L, Han F, Zhao MW, Shi X. Quantitative evaluation of retinal microvascular circulation in patients with obstructive sleep apnea-hypopnea using optical coherence tomography angiography. Int Ophthalmol 2020; 40:3309-3321. [PMID: 32743760 DOI: 10.1007/s10792-020-01518-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 07/17/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE To compare capillaries perfusion in macular areas at different layers and peripapillary region in radial peripapillary capillaries (RPC) between healthy subjects and subjects with obstructive sleep apnea-hypopnea (OSA) using spectral-domain optical coherence tomography angiography (OCTA). METHODS Totally 16 eyes with mild-to-moderate OSA, 14 eyes with severe OSA and 22 control eyes were enrolled in this study. Every subject filled out the Berlin questionnaire and received a comprehensive ocular and physical examination. The clinical characteristics were collected, OCT and OCTA scans using OCTA RT XR Avanti (AngioVue software, Optovue Inc., Fremont, CA, USA) were performed and analyzed. RESULTS Compared to the control group, the severe group had significantly higher VD in parafovea and perifoveal regions (p = 0.031; p = 0.029) at the level of deep capillary plexus (DCP), whereas the mild-to-moderate group had a significantly lower VD in the peripapillary region on RPC network in disc areas (p = 0.013). CONCLUSIONS Blood flow changes in macular areas might first appear at the DCP layer in OSA patients. Reduced VD in the peripapillary region at the RPC layer might be associated with OSA and cause subsequent RNFL changes.
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Affiliation(s)
- Yi Cai
- Department of Ophthalmology & Clinical Centre of Optometry, Peking University People's Hospital, Beijing, China.,Eye Diseases and Optometry Institute, Beijing, China.,Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China.,College of Optometry, Peking University Health Science Center, Beijing, China
| | - Guo-Sheng Sun
- Department of Ophthalmology & Clinical Centre of Optometry, Peking University People's Hospital, Beijing, China.,Eye Diseases and Optometry Institute, Beijing, China.,Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China.,College of Optometry, Peking University Health Science Center, Beijing, China
| | - Long Zhao
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing, 100044, China
| | - Fang Han
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing, 100044, China
| | - Ming-Wei Zhao
- Department of Ophthalmology & Clinical Centre of Optometry, Peking University People's Hospital, Beijing, China.,Eye Diseases and Optometry Institute, Beijing, China.,Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China.,College of Optometry, Peking University Health Science Center, Beijing, China
| | - Xuan Shi
- Department of Ophthalmology & Clinical Centre of Optometry, Peking University People's Hospital, Beijing, China. .,Eye Diseases and Optometry Institute, Beijing, China. .,Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China. .,College of Optometry, Peking University Health Science Center, Beijing, China.
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14
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Jen R, Orr JE, Li Y, DeYoung P, Smales E, Malhotra A, Owens RL. Accuracy of WatchPAT for the Diagnosis of Obstructive Sleep Apnea in Patients with Chronic Obstructive Pulmonary Disease. COPD 2020; 17:34-39. [PMID: 31965862 DOI: 10.1080/15412555.2019.1707789] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The co-existence of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA), termed the overlap syndrome (OVS), is associated with adverse outcomes that may be reversed with treatment. However, diagnosis is limited by the apparent need for in-laboratory polysomnography (PSG). WatchPAT is a portable diagnostic device that is validated for the diagnosis of OSA that might represent an attractive tool for the diagnosis of OVS.Subjects with established COPD were recruited from a general population. Subjects underwent PSG and simultaneous recording with WatchPAT. Pulmonary function testing and questionnaires were also performed.A total of 36 subjects were recruited and valid data was obtained on 33 (age 63 ± 7, BMI 28 ± 7, 61% male, FEV1 56 ± 20% predicted). There was no significant difference in the apnea-hypopnea index (AHI) between PSG and WatchPAT (19 ± 20 versus 20 ± 15 events/h; mean difference 2(-2, 5) events/h; p = 0.381). The AHI was not significantly different in rapid eye movement (REM) and non-rapid eye movement (NREM) determined by PSG versus REM and NREM determined by WatchPAT. WatchPAT slightly overestimated total and REM sleep time, and sleep efficiency. The sensitivity of WatchPAT at an AHI cut-off of ≥5, ≥15, and ≥30 events/h for corresponding PSG AHI cut-offs was 95.8, 92.3, and 88.9, respectively; specificity was 55, 65.0, and 95.8, respectively.WatchPAT is able to determine OSA reliably in patients with COPD. The availability of this additional diagnostic modality may lead to improved detection of OVS, which may in turn lead to improved outcomes for a group of COPD patients at high risk of poor outcomes.
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Affiliation(s)
- R Jen
- Division of Respiratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, La Jolla, California, USA
| | - J E Orr
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, La Jolla, California, USA
| | - Y Li
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, La Jolla, California, USA.,Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology, Head and Neck Surgery (Ministry of Education of China), Beijing, China
| | - P DeYoung
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, La Jolla, California, USA
| | - E Smales
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, La Jolla, California, USA
| | - A Malhotra
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, La Jolla, California, USA
| | - R L Owens
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, La Jolla, California, USA
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15
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Fricke K, Schneider H, Biselli P, Hansel NN, Zhang ZG, Sowho MO, Grote L. Nasal high flow, but not supplemental O 2, reduces peripheral vascular sympathetic activity during sleep in COPD patients. Int J Chron Obstruct Pulmon Dis 2018; 13:3635-3643. [PMID: 30464446 PMCID: PMC6220426 DOI: 10.2147/copd.s166093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Introduction Patients with COPD have increased respiratory loads and altered blood gases, both of which affect vascular function and sympathetic activity. Sleep, particularly rapid eye movement (REM) sleep, is known to exacerbate hypoxia and respiratory loads. Therefore, we hypothesize that nasal high flow (NHF), which lowers ventilatory loads, reduces sympathetic activity during sleep and that this effect depends on COPD severity. Methods We performed full polysomnography in COPD patients (n=17; FEV1, 1.6±0.6 L) and in matched controls (n=8). Participants received room air (RA) at baseline and single night treatment with O2 (2 L/min) and NHF (20 L/min) in a random order. Finger pulse wave amplitude (PWA), a measure of vascular sympathetic tone, was assessed by photoplethysmography. Autonomic activation (AA) events were defined as PWA attenuation ≥30% and indexed per hour for sleep stages (AA index [AAI]) at RA, NHF, and O2). Results In COPD, sleep apnea improved following O2 (REM-apnea hypopnea index [AHI] with RA, O2, and NHF: 18.6±20.9, 12.7±18.1, and 14.4±19.8, respectively; P=0.04 for O2 and P=0.06 for NHF). REM-AAI was reduced only following NHF in COPD patients (AAI-RA, 21.5±18.4 n/h and AAI-NHF, 9.9±6.8 n/h, P=0.02) without changes following O2 (NHF-O2 difference, P=0.01). REM-AAI reduction was associated with lung function expressed as FEV1 and FVC (FEV1: r=−0.59, P=0.001; FEV1/FVC: r=−0.52 and P=0.007). Conclusion NHF but not elevated oxygenation reduces peripheral vascular sympathetic activity in COPD patients during REM sleep. Sympathetic off-loading by NHF, possibly related to improved breathing mechanics, showed a strong association with COPD severity.
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Affiliation(s)
- K Fricke
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA, .,Department for Pulmonary, Sleep, and Intensive Care Medicine, Helios Klinikum, Wuppertal, Germany
| | - H Schneider
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA,
| | - P Biselli
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA, .,Intensive Care Unit, Medical Division, University Hospital, University of Sao Paolo, Sao Paolo, Brazil
| | - N N Hansel
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA,
| | - Z G Zhang
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA, .,Department for Geriatrics, Peking University First Hospital, Beijing, China
| | - M O Sowho
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA,
| | - L Grote
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA, .,Sleep Disorders Center, Department for Pulmonary Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.,Center for Sleep and Wake Disorders, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
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16
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Ikeda AK, Li Q, Quyuumi AA, Dedhia RC. Hypoglossal nerve stimulation therapy on peripheral arterial tonometry in obstructive sleep apnea: a pilot study. Sleep Breath 2018; 23:153-160. [PMID: 29926395 DOI: 10.1007/s11325-018-1676-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 05/18/2018] [Accepted: 05/29/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE Hypoglossal nerve stimulation (HGNS) is being increasingly utilized in the setting of moderate-severe obstructive sleep apnea (OSA). While moderate-severe OSA confers excess cardiovascular risk, the impact of HGNS on cardiovascular requires further investigation. With the advent of peripheral arterial tonometry (PAT), one can non-invasively study real-time changes to the autonomic nervous system. This study evaluates the effect of HGNS therapy on autonomic output, using PAT-integrated polysomnography. METHODS Subjects included adult patients undergoing 2-month post-operative HGNS titration studies with PAT-integrated polysomnography. Apneic and hypopneic events with arousal during stage 2 sleep were identified at increasing levels of stimulation. With each event, PAT signal attenuations were recorded, processed, and analyzed. RESULTS Nine subjects were enrolled, and eight met inclusion criteria (mean age 67.8 ± 12.4 years; 50% female). The PAT signal did not significantly change before and during stimulation (mean pre-stimulation 43.4 ± 1.7, mean intra-stimulation 41.1 ± 22.5, p = 0.53) in any patient. The ratio of the PAT signal maximum and minimum amplitudes during sleep breathing events largely demonstrated very weak correlation (R2 = <0.12). Across all subjects, poor linear correlation was present between HGNS and PAT signal attenuation (R2 = 0.028) in both adjusted and unadjusted analyses. CONCLUSIONS Using PAT-integrated polysomnography, PAT output does not appear to be affected by HGNS stimulation at clinical thresholds. These findings support the absence of autonomic system alterations by twelfth nerve stimulation and support the clinical use of PAT-based devices for post-HGNS monitoring. Larger studies examining hard cardiovascular endpoints with HGNS are needed.
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Affiliation(s)
- Allison K Ikeda
- Emory University School of Medicine, Medical Office Tower, Suite 1135 550 Peachtree Street NE, Atlanta, GA, 30308, USA
| | - Qiao Li
- Department of Biomedical Informatics, Emory University, Atlanta, GA, USA
| | - Arshed A Quyuumi
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Raj C Dedhia
- Department of Otolaryngology, Emory University School of Medicine, Atlanta, GA, USA. .,Emory Sleep Center, Emory Healthcare, Atlanta, GA, USA.
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17
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Zhang Z, Bolz N, Laures M, Oremek M, Schmidt C, Qi M, Khatami R. Cerebral blood volume and oxygen supply uniformly increase following various intrathoracic pressure strains. Sci Rep 2017; 7:8344. [PMID: 28827669 PMCID: PMC5566207 DOI: 10.1038/s41598-017-08698-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 07/17/2017] [Indexed: 01/11/2023] Open
Abstract
Intrathoracic pressure (ITP) swings challenge many physiological systems. The responses of cerebral hemodynamics to different ITP swings are still less well-known due to the complexity of cerebral circulation and methodological limitation. Using frequency-domain near-infrared spectroscopy and echocardiography, we measured changes in cerebral, muscular and cardiac hemodynamics in five graded respiratory maneuvers (RM), breath holding, moderate and strong Valsalva maneuvers (mVM/sVM) with 20 and 40 cmH2O increments in ITP, moderate and strong Mueller maneuvers (mMM/sMM) with 20 and 40 cmH2O decrements in ITP controlled by esophageal manometry. We found cerebral blood volume (CBV) maintains relative constant during the strains while it increases during the recoveries together with increased oxygen supply. By contrast changes in muscular blood volume (MBV) are mainly controlled by systemic changes. The graded changes of ITP during the maneuvers predict the changes of MBV but not CBV. Changes in left ventricular stroke volume and heart rate correlate to MBV but not to CBV. These results suggest the increased CBV after the ITP strains is brain specific, suggesting cerebral vasodilatation. Within the strains, cerebral oxygen saturation only decreases in sVM, indicating strong increment rather than decrement in ITP may be more challenging for the brain.
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Affiliation(s)
- Zhongxing Zhang
- Center for Sleep Medicine and Sleep Research, Clinic Barmelweid AG, Barmelweid, Switzerland.
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Nina Bolz
- Center for Sleep Medicine and Sleep Research, Clinic Barmelweid AG, Barmelweid, Switzerland
| | - Marco Laures
- Center for Sleep Medicine and Sleep Research, Clinic Barmelweid AG, Barmelweid, Switzerland
| | - Margit Oremek
- Cardiac Rehabilitation Clinic, Clinic Barmelweid AG, Barmelweid, Switzerland
| | - Christoph Schmidt
- Cardiac Rehabilitation Clinic, Clinic Barmelweid AG, Barmelweid, Switzerland
| | - Ming Qi
- Center for Sleep Medicine and Sleep Research, Clinic Barmelweid AG, Barmelweid, Switzerland
| | - Ramin Khatami
- Center for Sleep Medicine and Sleep Research, Clinic Barmelweid AG, Barmelweid, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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18
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Shokoueinejad M, Fernandez C, Carroll E, Wang F, Levin J, Rusk S, Glattard N, Mulchrone A, Zhang X, Xie A, Teodorescu M, Dempsey J, Webster J. Sleep apnea: a review of diagnostic sensors, algorithms, and therapies. Physiol Meas 2017; 38:R204-R252. [PMID: 28820743 DOI: 10.1088/1361-6579/aa6ec6] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
While public awareness of sleep related disorders is growing, sleep apnea syndrome (SAS) remains a public health and economic challenge. Over the last two decades, extensive controlled epidemiologic research has clarified the incidence, risk factors including the obesity epidemic, and global prevalence of obstructive sleep apnea (OSA), as well as establishing a growing body of literature linking OSA with cardiovascular morbidity, mortality, metabolic dysregulation, and neurocognitive impairment. The US Institute of Medicine Committee on Sleep Medicine estimates that 50-70 million US adults have sleep or wakefulness disorders. Furthermore, the American Academy of Sleep Medicine (AASM) estimates that more than 29 million US adults suffer from moderate to severe OSA, with an estimated 80% of those individuals living unaware and undiagnosed, contributing to more than $149.6 billion in healthcare and other costs in 2015. Although various devices have been used to measure physiological signals, detect apneic events, and help treat sleep apnea, significant opportunities remain to improve the quality, efficiency, and affordability of sleep apnea care. As our understanding of respiratory and neurophysiological signals and sleep apnea physiological mechanisms continues to grow, and our ability to detect and process biomedical signals improves, novel diagnostic and treatment modalities emerge. OBJECTIVE This article reviews the current engineering approaches for the detection and treatment of sleep apnea. APPROACH It discusses signal acquisition and processing, highlights the current nonsurgical and nonpharmacological treatments, and discusses potential new therapeutic approaches. MAIN RESULTS This work has led to an array of validated signal and sensor modalities for acquiring, storing and viewing sleep data; a broad class of computational and signal processing approaches to detect and classify SAS disease patterns; and a set of distinctive therapeutic technologies whose use cases span the continuum of disease severity. SIGNIFICANCE This review provides a current perspective of the classes of tools at hand, along with a sense of their relative strengths and areas for further improvement.
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Affiliation(s)
- Mehdi Shokoueinejad
- Department of Biomedical Engineering, University of Wisconsin-Madison, 1550 Engineering Drive, Madison, WI 53706-1609, United States of America. Department of Population Health Sciences, University of Wisconsin-Madison, 610 Walnut St 707, Madison, WI 53726, United States of America. EnsoData Research, EnsoData Inc., 111 N Fairchild St, Suite 240, Madison, WI 53703, United States of America
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19
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Gan YJ, Lim L, Chong YK. Validation study of WatchPat 200 for diagnosis of OSA in an Asian cohort. Eur Arch Otorhinolaryngol 2016; 274:1741-1745. [DOI: 10.1007/s00405-016-4351-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 10/17/2016] [Indexed: 11/25/2022]
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20
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Model-Derived Markers of Autonomic Cardiovascular Dysfunction in Sleep-Disordered Breathing. Sleep Med Clin 2016; 11:489-501. [PMID: 28118872 DOI: 10.1016/j.jsmc.2016.07.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Evidence indicates that sleep-disordered breathing leads to elevated sympathetic tone and impaired vagal activity, promoting hypertension and cardiometabolic disease. Low-cost but accurate monitoring of autonomic function is useful for the aggressive management of sleep apnea. This article reviews the development and application of multivariate dynamic biophysical models that enable the causal dependencies among respiration, blood pressure, heart rate variability, and peripheral vascular resistance to be quantified. The markers derived from these models can be used in conjunction with heart rate variability to increase the sensitivity with which abnormalities in autonomic cardiovascular control are detected in subjects with sleep-disordered breathing.
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21
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Randerath WJ, Treml M, Priegnitz C, Hedner J, Sommermeyer D, Zou D, Ficker JH, Fietze I, Penzel T, Sanner B, Grote L. Parameters of Overnight Pulse Wave under Treatment in Obstructive Sleep Apnea. Respiration 2016; 92:136-43. [DOI: 10.1159/000448248] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 07/08/2016] [Indexed: 11/19/2022] Open
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22
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Gunduz C, Basoglu OK, Tasbakan MS. Prevalence of overlap syndrome in chronic obstructive pulmonary disease patients without sleep apnea symptoms. CLINICAL RESPIRATORY JOURNAL 2016; 12:105-112. [DOI: 10.1111/crj.12493] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 04/04/2016] [Accepted: 04/28/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Canan Gunduz
- Department of Chest Diseases; Ege University Faculty of Medicine; Izmir Turkey
| | - Ozen K. Basoglu
- Department of Chest Diseases; Ege University Faculty of Medicine; Izmir Turkey
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23
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Cooksey JA, Balachandran JS. Portable Monitoring for the Diagnosis of OSA. Chest 2016; 149:1074-81. [PMID: 26539918 DOI: 10.1378/chest.15-1076] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 10/05/2015] [Accepted: 10/14/2015] [Indexed: 11/01/2022] Open
Abstract
In-laboratory, attended polysomnography has long been the gold standard for the diagnosis of sleep-disordered breathing (SDB). In recent years, economic pressures and long wait times have driven interest in home sleep testing, which has, in turn, led to the development of algorithms that bypass the sleep laboratory in favor of portable monitoring studies and in-home initiation of positive airway pressure therapy. For appropriately selected outpatients, evidence is accumulating that portable monitors are a reasonable substitute for in-laboratory polysomnography. In the inpatient setting, in which SDB is both highly prevalent and associated with adverse outcomes in certain populations, the literature is evolving on the use of portable monitors to expedite diagnosis and treatment of SDB. This review discusses society guidelines and recent research in the growing field of portable monitoring.
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Affiliation(s)
- Jessica A Cooksey
- Section of Pulmonary and Critical Care, University of Chicago, Chicago, IL
| | - Jay S Balachandran
- Section of Pulmonary and Critical Care, University of Chicago, Chicago, IL.
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Pinto JA, Godoy LBMD, Ribeiro RC, Mizoguchi EI, Hirsch LAM, Gomes LM. Accuracy of peripheral arterial tonometry in the diagnosis of obstructive sleep apnea. Braz J Otorhinolaryngol 2015; 81:473-8. [PMID: 26277832 PMCID: PMC9449073 DOI: 10.1016/j.bjorl.2015.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 10/08/2014] [Indexed: 11/09/2022] Open
Abstract
Introduction The use of handheld devices that assess peripheral arterial tonometry has emerged as an auxiliary method for assessment and diagnosis of obstructive sleep apnea syndrome. Objective To evaluate the accuracy of peripheral arterial tonometry in the diagnosis of obstructive sleep apnea. Methods Contemporary cohort cross-sectional study. Thirty patients with suspected obstructive sleep apnea underwent peripheral arterial tonometry and assisted nocturnal polysomnography concomitantly. Results The mean apnea/hypopnea index by peripheral arterial tonometry was significantly higher than that by polysomnography (p < 0.001), but the values of both sleep studies were significantly correlated (r = 0.762). There was a high correlation between variables: minimum oxygen saturation (r = 0.842, p < 0.001), oxygen saturation < 90% (r = 0.799, p < 0.001), and mean heart rate (r = 0.951, p < 0.001). Sensitivity and specificity were 60% and 96.2% (AUC: 0.727; p = 0.113), respectively, when at a threshold value of 5 events/h. In severe cases (≥30 events/h), the result was a sensitivity of 77.8% and a specificity of 86.4% (AUC: 0.846, p = 0.003). Conclusion Peripheral arterial tonometry is a useful portable device for the diagnosis of obstructive sleep apnea; its accuracy is higher in moderate and severe cases.
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Affiliation(s)
- José Antonio Pinto
- Department of Otorhinolaryngology, Hospital São Camilo, Pompéia, São Paulo, SP, Brazil; Otorhinolaryngology and Head and Neck Surgery and Sleep Medicine Center of São Paulo (NOSP), São Paulo, SP, Brazil.
| | - Luciana Balester Mello de Godoy
- Department of Otorhinolaryngology, Hospital São Camilo, Pompéia, São Paulo, SP, Brazil; Otorhinolaryngology and Head and Neck Surgery and Sleep Medicine Center of São Paulo (NOSP), São Paulo, SP, Brazil
| | | | - Elcio Izumi Mizoguchi
- Department of Otorhinolaryngology, Hospital São Camilo, Pompéia, São Paulo, SP, Brazil
| | - Lina Ana Medeiros Hirsch
- Department of Otorhinolaryngology, Hospital São Camilo, Pompéia, São Paulo, SP, Brazil; Otorhinolaryngology and Head and Neck Surgery and Sleep Medicine Center of São Paulo (NOSP), São Paulo, SP, Brazil
| | - Leonardo Marques Gomes
- Department of Otorhinolaryngology, Hospital São Camilo, Pompéia, São Paulo, SP, Brazil; Otorhinolaryngology and Head and Neck Surgery and Sleep Medicine Center of São Paulo (NOSP), São Paulo, SP, Brazil
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The efficacy of Watch PAT in obstructive sleep apnea syndrome diagnosis. Eur Arch Otorhinolaryngol 2014; 272:111-6. [PMID: 24838359 DOI: 10.1007/s00405-014-3097-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 05/08/2014] [Indexed: 10/25/2022]
Abstract
Polysomnography is currently considered as the gold standard for the diagnosis of obstructive sleep apnea syndrome (OSAS). But high expense and the backlog of the sleep centers have resulted in a search for an alternative method of diagnosis. The aim of this study is to assess the efficacy and reliability of Watch PAT as an alternate option in OSAS diagnosis. The patients have worn a Watch PAT(®) 200 device in the sleep laboratory during a standard polysomnography. The correlation in REM and Non-REM AHI scores, sleep periods and the mean O2 saturation percentage between Watch PAT and PSG sleep studies were assessed. There was a statistically significant very strong correlation between PSG and Watch PAT AHI scores (Spearman's rho = 0.802 p < 0.001). The mean recording time with PSG and Watch PAT was 463.06 ± 37.08 and 469.33 ± 72.81 min, respectively, and there was no statistically significant difference (p = 0.068). However, there was a statistically significant difference between two methods regarding the average sleep time and REM sleep period. No statistically significant difference was revealed in the mean O2 saturation percentage (p < 0.001). Watch PAT is an efficient device and is considered to be an adjunctive diagnostic method for PSG in diagnosis of OSAS.
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Park CY, Hong JH, Lee JH, Lee KE, Cho HS, Lim SJ, Kwak JW, Kim KS, Kim HJ. Clinical usefulness of watch-PAT for assessing the surgical results of obstructive sleep apnea syndrome. J Clin Sleep Med 2014; 10:43-7. [PMID: 24426819 DOI: 10.5664/jcsm.3356] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This study aimed to assess the accuracy and clinical efficacy of a wrist-worn device that is based on peripheral arterial tonometry (watch-PAT) to evaluate the surgical results of obstructive sleep apnea (OSA) syndrome subjects. STUDY DESIGN AND METHOD Thirty-five subjects who were diagnosed with OSA and underwent sleep surgeries such as septoplasty, tonsillectomy, or uvuloplasty to correct their airway collapse, participated in this study; the watch-PAT-derived respiratory disturbance index (RDI), apnea and hypopnea index (AHI), lowest oxygen saturation, and valid sleep time were measured after the sleep surgery. RESULTS The present study showed that RDI (32.8 ± 10.7 vs. 14.8 ± 7.5), AHI (30.3 ± 8.6 vs. 13.4 ± 8.2 events/h), lowest oxygen saturation (78.2% ± 8.4% vs. 90.5% ± 7.1%), and valid sleep time (329.1 ± 47.2 min and a postoperative value of 389.1 ± 50.1 min) recovered to within a normal range after surgery in 28 subjects. In addition, good agreement was found between watch-PAT-derived factors and visual analogue scales for changes in subjective symptoms, such as snoring, apnea, and daytime somnolence. Seven of the 35 subjects showed no improvement for their subjective symptoms and complained of snoring and apnea after surgery. We found that the RDI and AHI of those 7 subjects were not reduced, and the changes between pre- and postoperative values which were measured with watch-PAT were minimal. Their postoperative lowest oxygen saturation and valid sleep time were not elevated per the watch-PAT. The results support a strong correlation between the findings from watch-PAT and improved symptoms after surgical correction of an airway collapse. CONCLUSIONS Our study provides evidence that the factors measured by the watch-PAT might be reliable indicators of symptomatic changes in OSA subjects after sleep surgery and also shows that the watch-PAT is a highly sensitive portable device for estimating treatment results in OSA.
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Affiliation(s)
- Chong Yoon Park
- Department of Otorhinolaryngology and Head & Neck Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Joon Hyeong Hong
- Department of Otorhinolaryngology and Head & Neck Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jae Heon Lee
- Department of Otorhinolaryngology and Head & Neck Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Kyu Eun Lee
- Department of Otorhinolaryngology and Head & Neck Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hyun Sang Cho
- Department of Otorhinolaryngology and Head & Neck Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Su Jin Lim
- Department of Otorhinolaryngology and Head & Neck Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jin Wook Kwak
- Department of Otorhinolaryngology and Head & Neck Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Kyung Soo Kim
- Department of Otorhinolaryngology and Head & Neck Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hyun Jik Kim
- Department of Otorhinolaryngology and Head & Neck Surgery, Chung-Ang University College of Medicine, Seoul, Korea
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Adler D, Bridevaux PO, Contal O, Georges M, Dupuis-Lozeron E, Claudel E, Pépin JL, Janssens JP. Pulse wave amplitude reduction: A surrogate marker of micro-arousals associated with respiratory events occurring under non-invasive ventilation? Respir Med 2013; 107:2053-60. [DOI: 10.1016/j.rmed.2013.10.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 09/30/2013] [Accepted: 10/07/2013] [Indexed: 11/29/2022]
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A critical review of peripheral arterial tone and pulse transit time as indirect diagnostic methods for detecting sleep disordered breathing and characterizing sleep structure. Curr Opin Pulm Med 2012; 15:550-8. [PMID: 19724229 DOI: 10.1097/mcp.0b013e3283318585] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Sympathetic activity varies continuously across sleep stages. During rapid eye movement sleep, sympathetic tone increases substantially but is highly variable. Microarousals are associated with momentary bursts of sympathetic activity. Abnormal respiratory events progressively elevate sympathetic activity in proportion to the severity of oxyhemoglobin desaturation. These phenomena imply that cardiovascular markers of sympathetic activity such as peripheral arterial tone (PAT) and pulse transit time could be indirect tools for diagnosing sleep disordered breathing and characterizing sleep structure and fragmentation. RECENT FINDINGS Measurement of variations in PAT coupled with pulse rate accelerations and desaturations in oximetry can be used to diagnose sleep apnea. Good agreement between both manually and automatically analyzed PAT recordings and polysomnography has been demonstrated during in-laboratory or at-home studies. Numerous validation studies against esophageal pressure have demonstrated that pulse transit time is the best noninvasive method for measurement of respiratory effort. Pulse transit time and PAT are sensitive techniques for arousal recognition, particularly in children and infants. There are specific sleep stage-dependent PAT patterns that allow for the recognition of rapid eye movement sleep and, in the case of nonrapid eye movement sleep, the separation of lighter stages from deeper, slow wave sleep. Elevated nocturnal sympathetic activity as documented by PAT attenuations is linked with chronically elevated blood pressure in humans. SUMMARY Cardiovascular markers of autonomic control during sleep permit not only the diagnosis of obstructive sleep apnea and estimation of sleep structure but are also linked with the prevalence of daytime hypertension.
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GOFF ELIZABETHA, NICHOLAS CHRISTIANL, KLEIMAN JAN, SPEAR OWEN, MORRELL MARYJ, TRINDER JOHN. The effect of flow limitation on the cardiorespiratory response to arousal from sleep under controlled conditions of chemostimulation in healthy older adults. J Sleep Res 2012; 21:718-23. [DOI: 10.1111/j.1365-2869.2012.01019.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Onder NS, Akpinar ME, Yigit O, Gor AP. Watch peripheral arterial tonometry in the diagnosis of obstructive sleep apnea: influence of aging. Laryngoscope 2012; 122:1409-14. [PMID: 22522750 DOI: 10.1002/lary.23233] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Revised: 01/05/2012] [Accepted: 01/10/2012] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS To investigate the consequences of aging and associated peripheral vascular tone impairment on peripheral arterial tonometry (Watch PAT)-based sleep and respiratory disturbance analysis in obstructive sleep apnea (OSA) diagnosis. STUDY DESIGN Prospective, nonrandomized, clinical trial. METHODS A total of 56 subjects with age ranges of 20 to 35 years (group I, n = 27) and 50 to 65 years (group II, n = 29) referred to the sleep laboratory for overnight polysomnography (PSG) with suspected OSA were enrolled. All patients underwent simultaneous overnight PSG and Watch PAT monitoring. The data derived from PSG and Watch PAT records, including apnea-hypopnea index (AHI), rapid eye movement (REM) AHI, non-rapid eye movement (NREM) AHI, oxygen desaturation index (ODI), mean O(2) saturation (mean O(2) sat), minimum O(2) saturation (min O(2) sat), sleep duration, and the percentages of NREM sleep stages 1-2 and 3 and of REM sleep were used for comparisons. The calculated ΔPSG-Watch PAT of the two groups were compared statistically. The correlations between the PSG-Watch PAT measurements in each group were assessed. RESULTS The comparison of AHI, REM AHI, NREM AHI, ODI, mean O(2) sat, min O(2) sat, NREM sleep stage 1-2, and REM sleep ΔPSG-Watch PAT between the two groups did not reveal statistical significance. The difference between the two groups in terms of ΔPSG-Watch PAT of sleep duration and sleep stage 3 was statistically significant. CONCLUSIONS In addition to the good agreement confirmed between PSG and Watch PAT data in each group, aging did not negatively impact Watch PAT recorded data in terms of included parameters, except the difference in ΔPSG-Watch PAT of sleep stage 3, which may be attributable to aging and impaired vascular tone.
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Affiliation(s)
- Nilgun Surmen Onder
- Second Clinic of Otolaryngology-Head and Neck Surgery, Istanbul Training and Research Hospital, Istanbul, Turkey
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Shah P, Gurubhagavatula I. Portable Monitoring: Practical Aspects and Case Examples. Sleep Med Clin 2011. [DOI: 10.1016/j.jsmc.2011.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hesselbacher S, Mattewal A, Hirshkowitz M, Sharafkhaneh A. Classification, Technical Specifications, and Types of Home Sleep Testing Devices for Sleep-Disordered Breathing. Sleep Med Clin 2011. [DOI: 10.1016/j.jsmc.2011.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Maurer JT. Early diagnosis of sleep related breathing disorders. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2010; 7:Doc03. [PMID: 22073090 PMCID: PMC3199834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Obstructive sleep apnea (OSA) being the most frequent sleep related breathing disorder results in non-restorative sleep, an increased cardiovascular morbidity and mortality as well as an elevated number of accidents. In Germany at least two million people have to be expected. If obstructive sleep apnea is diagnosed early enough then sleep may regain its restorative function, daytime performance may be improved and accident risk as well as cardiovascular risk may be normalised. This review critically evaluates anamnestic parameters, questionnaires, clinical findings and unattended recordings during sleep regarding their diagnostic accurracy in recognising OSA. There are numerous tools with insufficient results or too few data disqualifying them for screening for OSA. Promising preliminary results are published concerning neural network analysis of a high number of clinical parameters and non-linear analysis of oximetry itself or in combination with heart rate. Nasal pressure recordings can be used for risk estimation even without expertise in sleep medicine. More data is needed. Unattended portable monitoring used by qualified physicians is the gold standard procedure when screening methods for OSA are compared. It has a very high sensitivity and specificity well documented by several meta-analyses.
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Affiliation(s)
- Joachim T. Maurer
- Sleep Disorders Centre, University Dept. of Otorhinolaryngology, Head and Neck Surgery Mannheim, Medical Faculty Mannheim of the Ruprecht-Karls-University Heidelberg, Mannheim, Germany,*To whom correspondence should be addressed: Joachim T. Maurer, Sleep Disorders Centre, University Dept. of Otorhinolaryngology, Head and Neck Surgery Mannheim, Medical Faculty Mannheim of the Ruprecht-Karls-University Heidelberg, 68135 Mannheim, Germany, Telephone: +49 (0)621 383 1600, Telefax: +49 (0)621 383 1972, E-mail:
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Ramar K, Guilleminault C. Cardiovascular complications of obstructive sleep apnea. Expert Rev Respir Med 2010; 2:63-74. [PMID: 20477223 DOI: 10.1586/17476348.2.1.63] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Obstructive sleep apnea (OSA) is a common disorder with an increasing public health burden. It is characterized by repeated upper airway narrowing and closure, leading to apneas, hypopneas and increased respiratory effort-related arousals. Continuous positive airway pressure is an effective modality of treatment for OSA. Apart from being responsible for daytime sleepiness and cognitive impairment, OSA has been implicated in various systemic diseases, particularly of the cardiovascular system. This article reviews some of the extensive literature implicating OSA in the development of cardiovascular diseases and describes the intermediary pathophysiologic mechanisms involved. Repetitive nocturnal oxygen desaturation and reoxygenation and increased intrathoracic pressure changes related to OSA result in the intermediary pathophysiologic mechanisms that affect the neural, humoral, thrombotic, inflammatory and metabolic pathways responsible for the development of cardiovascular disorders. This review also examines evidence that suggests that OSA may be a specific cause of certain cardiovascular disorders.
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Affiliation(s)
- Kannan Ramar
- Mayo Clinic, Center for Sleep Medicine, Division of Pulmonary, Sleep and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
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Abstract
Current evidence suggests a role for obstructive sleep apnea (OSA) in the development of cardiovascular disorders. However, obesity is an active confounder in this relationship. OSA and obesity share similar pathophysiologic mechanisms potentially leading to cardiovascular disorders. Presence of OSA in obese patients may further contribute to adverse cardiovascular outcomes when compared with each condition in isolation. In this review the authors explore the complex relationship between OSA and obesity (and nonobese subjects) in the development of cardiovascular disorders.
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Karasulu L, Epöztürk PÖ, Sökücü SN, Dalar L, Altın S. Improving Heart Rate Variability in Sleep Apnea Patients: Differences in Treatment with Auto-titrating Positive Airway Pressure (APAP) Versus Conventional CPAP. Lung 2010; 188:315-20. [DOI: 10.1007/s00408-010-9237-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2009] [Accepted: 03/16/2010] [Indexed: 10/19/2022]
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Gil E, Bailón R, Vergara JM, Laguna P. PTT variability for discrimination of sleep apnea related decreases in the amplitude fluctuations of PPG signal in children. IEEE Trans Biomed Eng 2010; 57:1079-88. [PMID: 20142152 DOI: 10.1109/tbme.2009.2037734] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In this paper, an analysis of pulse transit time variability (PTTV) during decreases in the amplitude fluctuations of pulse photoplethysmography signal (PPG) (DAP) events for obstructive sleep apnea syndrome (OSAS) screening is presented. The temporal evolution of time-frequency PTTV parameters during DAP was analyzed. The results show an increase in the sympathetic activity index low-frequency component (LF) during DAP for PTTV (85%) significantly higher than for heart rate variability (HRV) (33%), (p < 10(-13)). However, decreases in parasympathetic activity produce lower decrements in high-frequency component (HF) indexes for PTTV (18%) than for HRV (22%). Thus, PTTV reflects sympathetic changes more clearly than HRV. A clinical study was carried out. DAP events were classified as apneic or nonapneic using a linear discriminant analysis from the PTTV indexes. The ratio of DAP events per hour r (DAP), the ratio after filtering based on HRV indexes r (HRV) (DAP), or on PTTV indexes r (PTTV) (DAP), were computed. The results show an accuracy of 75% for r (PTTV) (DAP) (14% increase with respect to r (DAP) and 5% increase with respect to r (HRV) (DAP)), a sensitivity of 81.8%, and a specificity of 73.9% when classifying 1-h polysomnographic excerpts as OSAS or normal. These results suggest that the combination of DAP and PTTV could be better alternative for sleep apnea screening using PPG with the added benefit of its low cost and simplicity.
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Affiliation(s)
- Eduardo Gil
- Communications Technology Group, Aragón Institute of Engineering Research, and CIBER de Bioingeniería, Biomateriales y Nanomedicina (CIBER_BBN), University of Zaragoza, Zaragoza, Spain.
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Abstract
Sleep-induced apnea and disordered breathing refers to intermittent, cyclical cessations or reductions of airflow, with or without obstructions of the upper airway (OSA). In the presence of an anatomically compromised, collapsible airway, the sleep-induced loss of compensatory tonic input to the upper airway dilator muscle motor neurons leads to collapse of the pharyngeal airway. In turn, the ability of the sleeping subject to compensate for this airway obstruction will determine the degree of cycling of these events. Several of the classic neurotransmitters and a growing list of neuromodulators have now been identified that contribute to neurochemical regulation of pharyngeal motor neuron activity and airway patency. Limited progress has been made in developing pharmacotherapies with acceptable specificity for the treatment of sleep-induced airway obstruction. We review three types of major long-term sequelae to severe OSA that have been assessed in humans through use of continuous positive airway pressure (CPAP) treatment and in animal models via long-term intermittent hypoxemia (IH): 1) cardiovascular. The evidence is strongest to support daytime systemic hypertension as a consequence of severe OSA, with less conclusive effects on pulmonary hypertension, stroke, coronary artery disease, and cardiac arrhythmias. The underlying mechanisms mediating hypertension include enhanced chemoreceptor sensitivity causing excessive daytime sympathetic vasoconstrictor activity, combined with overproduction of superoxide ion and inflammatory effects on resistance vessels. 2) Insulin sensitivity and homeostasis of glucose regulation are negatively impacted by both intermittent hypoxemia and sleep disruption, but whether these influences of OSA are sufficient, independent of obesity, to contribute significantly to the "metabolic syndrome" remains unsettled. 3) Neurocognitive effects include daytime sleepiness and impaired memory and concentration. These effects reflect hypoxic-induced "neural injury." We discuss future research into understanding the pathophysiology of sleep apnea as a basis for uncovering newer forms of treatment of both the ventilatory disorder and its multiple sequelae.
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Affiliation(s)
- Jerome A Dempsey
- The John Rankin Laboratory of Pulmonary Medicine, Departments of Population Health Sciences and of Orthopedics and Rehabilitation, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin 53706, USA.
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Uloza V, Balsevičius T, Sakalauskas R, Miliauskas S, Žemaitienė N. Changes in emotional state of bed partners of snoring and obstructive sleep apnea patients following radiofrequency tissue ablation: a pilot study. Sleep Breath 2009; 14:125-30. [DOI: 10.1007/s11325-009-0293-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2009] [Accepted: 08/12/2009] [Indexed: 10/20/2022]
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Basner RC. Nocturnal sympathetic activity and hypertension: Riding the wave of the peripheral pulse. Sleep Med 2009; 10:818-9. [DOI: 10.1016/j.sleep.2008.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Accepted: 11/25/2008] [Indexed: 10/21/2022]
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Gil E, María Vergara J, Laguna P. Detection of decreases in the amplitude fluctuation of pulse photoplethysmography signal as indication of obstructive sleep apnea syndrome in children. Biomed Signal Process Control 2008. [DOI: 10.1016/j.bspc.2007.12.002] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bangash MF, Xie A, Skatrud JB, Reichmuth KJ, Barczi SR, Morgan BJ. Cerebrovascular response to arousal from NREM and REM sleep. Sleep 2008; 31:321-7. [PMID: 18363307 PMCID: PMC2276740 DOI: 10.1093/sleep/31.3.321] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
STUDY OBJECTIVE To determine the effect of arousal from sleep on cerebral blood flow velocity (CBFV) in relation to associated ventilatory and systemic hemodynamic changes. PARTICIPANTS Eleven healthy individuals (6 men, 5 women). MEASUREMENTS Pulsed Doppler ultrasonography was used to measure CBFV in the middle cerebral artery with simultaneous measurements of sleep state (EEG, EOG, and EMG), ventilation (inductance plethysmography), heart rate (ECG), and arterial pressure (finger plethysmography). Arousals were induced by auditory tones (range: 40-80 dB; duration: 0.5 sec). Cardiovascular responses were examined beat-by-beat for 30 sec before and 30 sec after auditory tones. RESULTS During NREM sleep, CBFV declined following arousals (-15% +/- 2%; group mean +/- SEM) with a nadir at 9 sec after the auditory tone, followed by a gradual return to baseline. Mean arterial pressure (MAP; +20% +/- 1%) and heart rate (HR; +17% +/- 2%) increased with peaks at 5 and 3 sec after the auditory tone, respectively. Minute ventilation (VE) was increased (+35% +/- 10%) for 2 breaths after the auditory tone. In contrast, during REM sleep, CBFV increased following arousals (+15% +/- 3%) with a peak at 3 sec. MAP (+17% +/- 2%) and HR (+15% +/- 2%) increased during arousals from REM sleep with peaks at 5 and 3 sec post tone. VE increased (+16% +/- 7%) in a smaller, more sustained manner during arousals from REM sleep. CONCLUSIONS Arousals from NREM sleep transiently reduce CBFV, whereas arousals from REM sleep transiently increase CBFV, despite qualitatively and quantitatively similar increases in MAP, HR, and VE in the two sleep states.
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Affiliation(s)
| | | | | | | | | | - Barbara J. Morgan
- Orthopedics and Rehabilitation, University of Wisconsin-Madison and the Middleton Veterans Administration Hospital, Madison, WI
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Pang KP, Gourin CG, Terris DJ. A comparison of polysomnography and the WatchPAT in the diagnosis of obstructive sleep apnea. Otolaryngol Head Neck Surg 2007; 137:665-8. [PMID: 17903588 DOI: 10.1016/j.otohns.2007.03.015] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2006] [Accepted: 03/08/2007] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Our goal was to validate the WatchPAT in the diagnosis of obstructive sleep apnea. STUDY DESIGN We conducted a prospective, blinded, nonrandomized clinical trial. METHODS Patients with suspected obstructive sleep apnea scheduled for an overnight level I polysomnogram were offered enrollment in a study to compare the WatchPAT (Itamar Ltd, Israel) device with polysomnography. Patients wore the WatchPAT device simultaneously while undergoing polysomnography during evaluation in the sleep lab. RESULTS Thirty-seven patients participated in the study. They had a mean age of 50.1 years (range, 31-73 years) and mean body mass index of 34.6 kg/m(2) (range, 21.2-46.8 kg/m(2)). There was high correlation between the polysomnogram and WatchPAT apnea-hypopnea index (r = 0.9288; 95% confidence interval = 0.8579-0.9650, P < 0.0001). The lowest oxygen saturation also showed high correlation (r = 0.989; 95% confidence interval = 0.9773-0.9947, P < 0.0001). The overall polysomnogram and WatchPAT sleep times revealed a correlation of r = 0.5815 (P = 0.005). CONCLUSION The WatchPAT showed a high correlation with the polysomnogram in apnea-hypopnea index, lowest oxygen saturation, and sleep time. SIGNIFICANCE It's use as a reliable tool in the diagnosis of Obstructive Sleep Apnea.
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Affiliation(s)
- Kenny P Pang
- Pacific Sleep Centre, Singapore, Republic of Singapore.
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Madani M, Frank M, Lloyd R, Dimitrova DI, Madani F. Polysomnography versus home sleep study: overview and clinical application. Atlas Oral Maxillofac Surg Clin North Am 2007; 15:101-9. [PMID: 17823071 DOI: 10.1016/j.cxom.2007.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Mansoor Madani
- Department of Oral and Maxillofacial Surgery, Capital Health System, 750 Brungswick Avenue, Trenton, NJ, USA.
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Abdelghani A, Roisman G, Escourrou P. [Evaluation of a home respiratory polygraphy system in the diagnosis of the obstructive sleep apnea syndrome]. Rev Mal Respir 2007; 24:331-8. [PMID: 17417171 DOI: 10.1016/s0761-8425(07)91065-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Recent recommendations advise against the use of portable home respiratory polygraphy systems for the diagnosis of the obstructive sleep apnoea syndrome (OSAS). Nevertheless such systems are widely used, particularly in France. Our aim was to assess the diagnostic value of one of these systems in the diagnosis of OSAS. METHODS 65 consecutive patients were assessed prospectively, on account of suspicion of OSAS, by home respiratory polygraphy (HRP, Medcare Embletta). HRP confirmed severe OSAS [apnoea/hypopnoea index (AHI)>30/hr] in 8 patients. Those having AHI<30 hr or a failure of HRP (5 patients) were studied by full polysomnography in the sleep laboratory (PSG). RESULTS In 52 patients the AHI obtained by HRP and analysed manually correlated weakly with that obtained by PSG (n=52; p<0.001; r=0.36). The AHI-PSG was 27.1+/-2.8/hr and the AHI-HRP was 12+/-0.9/hr. The mean difference (HRP-PSG) was 15.1+/-37.5/hr with poor concordance. A better cut off value in terms of efficacy of HRP was an AHI of 10/hr, with sensitivity of 61.4% and a specificity of 100%. CONCLUSION A negative result by HRP does not exclude OSAS and full PSG is required in patients suspected of having this condition.
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Affiliation(s)
- A Abdelghani
- Service de Pneumologie, centre hospitalo-universitaire Farhat Hached de Sousse, Tunisia
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Pittman SD, Pillar G, Berry RB, Malhotra A, MacDonald MM, White DP. Follow-up assessment of CPAP efficacy in patients with obstructive sleep apnea using an ambulatory device based on peripheral arterial tonometry. Sleep Breath 2007; 10:123-31. [PMID: 16586136 DOI: 10.1007/s11325-006-0058-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study aimed to assess the accuracy of a wrist-worn device based on peripheral arterial tonometry (Watch_PAT 100) to detect residual episodes of respiratory disturbance during continuous positive airway pressure (CPAP) therapy. Concurrent polysomnography was used as the reference standard to identify sleep disordered breathing (SDB) events. The study was conducted in three sleep laboratories affiliated with tertiary care academic medical centers. Seventy patients using CPAP to treat obstructive sleep apnea for at least 3 months, following an in-laboratory titration to determine the optimal therapeutic positive airway pressure, participated in this study. Symptoms indicating suboptimal therapy were not required for participation, but self-reported adherence to CPAP therapy was necessary for inclusion. Interventions are not applicable in this study. The accuracy of the PAT-derived respiratory disturbance index (PAT RDI scored by automated algorithm) to detect residual SDB on CPAP was assessed against polysomnography (PSG) using Bland-Altman analysis, receiver-operator characteristic (ROC) curves, and likelihood ratios for increasing (LR+) and decreasing (LR-) the probability of moderate-severe SDB in the study population. Respiratory events on the PSG were quantified using standard criteria for research investigations ("Chicago criteria") to yield a PSG RDI.C. Based on the PSG results, 19% of the participants had moderate-severe SDB (PSG RDI.C>15 events per hour) on their prescribed pressure. For PAT RDI >15 events per hour, the area under the ROC curve was 0.95 (SE 0.03, p < 0.0001, 95% CI 0.89 to 1.00), the LR+ was 8.04 (95% CI 3.64-17.7), and the LR- was 0.17 (95% CI 0.05-0.62). The mean difference between the PAT RDI and PSG RDI.C was three (2SD 14.5) events per hour. Therefore, residual moderate-severe SDB on CPAP was not uncommon in a multicenter population self-reporting adherence to CPAP therapy to treat obstructive sleep apnea. The Watch_PAT device accurately identified participants with moderate-severe SDB while using CPAP in the attended setting of a sleep laboratory.
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Affiliation(s)
- Stephen D Pittman
- Division of Sleep Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115-5817, USA.
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See CQ, Mensah E, Olopade CO. Obesity, ethnicity, and sleep-disordered breathing: medical and health policy implications. Clin Chest Med 2006; 27:521-33, viii. [PMID: 16880061 DOI: 10.1016/j.ccm.2006.04.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The obesity epidemic in the United States is a major health problem, which poses im-mediate and long-term health risks with potential for significant reduction in life expectancy if not curtailed. Despite affecting all segments of the population, minorities carry a relatively larger burden of the obesity threat. Obesity is a major risk factor for develop-ing obstructive sleep apnea and the metabolic syndrome, which are associated with increased cardiovascular and cerebrovascular morbidity and mortality. This article discusses the implications of the obesity trend on the prevalence of obstructive sleep ap-nea and health, highlights ethnic differences, reviews the resultant economic implications, and suggests public health and health policy initiatives that may be beneficial in stemming the obesity scourge.
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Affiliation(s)
- Carolina Q See
- Section of Respiratory and Critical Care Medicine, Department of Medicine, M/C 719, University of Illinois at Chicago, 840 South Wood Street, Chicago, IL 60612, USA
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Pang KP, Terris DJ. Screening for obstructive sleep apnea: an evidence-based analysis. Am J Otolaryngol 2006; 27:112-8. [PMID: 16500475 DOI: 10.1016/j.amjoto.2005.09.002] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2005] [Indexed: 11/22/2022]
Abstract
Sleep disordered breathing is a spectrum of diseases that includes snoring, upper airway resistance syndrome, and obstructive sleep apnea (OSA). Obstructive sleep apnea is a common sleep disorder and is estimated to have an incidence of 24% in men and 9% in women. However, many authors believe that up to 93% of women and 82% of men with moderate to severe OSA remain undiagnosed. There is a strong link between sleep disordered breathing and hypertension, believed to be due to sleep fragmentation, intermittent hypoxemia, and increased sympathetic tone, which results in a higher mortality and morbidity rate among these patients. It is therefore desirable to attempt to diagnose all patients with OSA, to institute early treatment intervention, and to prevent development of cardiovascular complications. The gold standard for diagnosing OSA remains the attended overnight level I polysomnogram. However, in view of the limited resources, including limited number of recording beds, high cost, long waiting lists, and labor requirements, many authors have explored the use of clinical predictors or questionnaires that may help to identify higher-risk patients. Screening devices in the form of single or multiple channel monitoring systems have also been introduced and may represent an alternative method to diagnose OSA. The ideal screening device should be cheap, readily accessible, easily used with minimal instructions, have no risk or side effects to the patient, and be safe and accurate. We review a variety of clinical predictive formulae and several screening devices available for the diagnosis of OSA.
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Affiliation(s)
- Kenny P Pang
- Department of Otolaryngology-Head and Neck Surgery, Medical College of Georgia, Augusta, GA, USA.
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O'Driscoll DM, Kostikas K, Simonds AK, Morrell MJ. Occlusion of the upper airway does not augment the cardiovascular response to arousal from sleep in humans. J Appl Physiol (1985) 2005; 98:1349-55. [PMID: 15579578 DOI: 10.1152/japplphysiol.00706.2004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The cardiovascular response to an arousal from sleep at the termination of an obstructive apnea is more than double that to a spontaneous arousal. We investigated the hypothesis that stimulation of respiratory mechanoreceptors, by inspiring against an occluded airway during an arousal from sleep, augments the accompanying cardiovascular response. Arousals (>10 s) from stage 2 sleep were induced by a 1-s auditory tone (85 dB) during a concomitant 1-s inspiratory occlusion (O) and without an occlusion [i.e., control arousal (C)] in 15 healthy men (mean ± SE: age, 25 ± 1 yr). Arousals were associated with a significant increase in mean arterial blood pressure (MAP) at 4 s ( P < 0.001) and a significant decrease in R-R interval at 3 s ( P < 0.001). However, the magnitude of the cardiovascular response was not different during C compared with O (MAP: C, 86 ± 3 to 104 ± 3 mmHg; O, 86 ± 3 to 105 ± 3 mmHg; P = 0.99. R-R interval: C, 1.12 ± 0.03 to 0.89 ± 0.04 s; O, 1.11 ± 0.02 to 0.87 ± 0.02 s, P = 0.99). Ventilation significantly increased during arousals under both conditions at the second breath ( P < 0.001); this increase was not different between the two conditions (C: 4.40 ± 0.29 to 6.76 ± 0.61 l/min, O: 4.35 ± 0.34 to 7.65 ± 0.73 l/min; P = 0.31). We conclude that stimulation of the respiratory mechanoreceptors by transient upper airway occlusion is unlikely to interact with the arousal-related autonomic outflow to augment the cardiovascular response in healthy young men.
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Affiliation(s)
- Denise M O'Driscoll
- Clinical and Academic Unit of Sleep and Breathing, Royal Brompton Hospital, Sydney St., London SW3 6NP, UK.
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Abstract
PURPOSE OF REVIEW In recent years, understanding of the mechanisms by which sleep is maintained and the consequences of abnormal arousal from sleep has improved rapidly. This review describes the recent insights into the nature of sleep and arousal and the particular insights gained in common disease states such as sleep-disordered breathing. RECENT FINDINGS Expansion of the definitions of the classic stages of non-REM and REM sleep to include consideration of the role of cyclic alternating pattern sleep as a gating mechanism for arousal and maintenance of stable sleep has led to a significant advancement in understanding the nature of normal and pathologic arousals from sleep. In addition, the effect of arousals from sleep on cerebral cortical electrophysiology and autonomic activation has been further defined, with a potential effect on clinical practice. SUMMARY Arousal from sleep is dependent on wake-promoting influences overwhelming forces promoting sleep. Autonomic activation and cortical arousal can significantly affect and destabilize sleep homeostasis. The understanding of sleep-respiration interactions continues to evolve. The definition of the minimal arousal event is an important research goal. It will be important in clinical practice and research to consider sleep stability domains as a complement to sleep depth staging to allow better understanding of the relative stability and instability of the system and to consider all components of the consequences of arousal.
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Affiliation(s)
- Geoffrey S Gilmartin
- Beth Israel Deaconess Medical Center, Division of Pulmonary, Critical Care and Sleep Medicine, Boston, Massachusetts 02115, USA
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