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Hamada E, Yamauchi M, Fujita Y, Nishijima T, Ikegami A, Takaoka T, Shirahama R, Strohl KP, Muro S. Multidimensional prediction of continuous positive airway pressure adherence. Sleep Med 2024; 122:177-184. [PMID: 39182274 DOI: 10.1016/j.sleep.2024.08.018] [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: 02/04/2024] [Revised: 08/01/2024] [Accepted: 08/16/2024] [Indexed: 08/27/2024]
Abstract
OBJECTIVE Continuous positive airway pressure (CPAP) is the standard treatment for obstructive sleep apnea (OSA). Unsatisfactory adherence to CPAP is an important clinical issue to resolve. Cluster analysis is a powerful tool to distinguish subgroups in a multidimensional fashion. This study aimed to investigate the use of cluster analysis for predicting CPAP adherence using clinical polysomnographic (PSG) parameters and patient characteristics. PATIENTS/METHODS Participants of this multicenter observational study were 1133 patients with OSA who were newly diagnosed and implemented CPAP. Ward's method of cluster analysis was applied to in-laboratory diagnostic PSG parameters and patient characteristics. CPAP adherence was assessed during 90- and 365-day periods after CPAP initiation in each cluster. We adopted the Centers for Medicare and Medicaid Services criterion for CPAP adherence, i.e., CPAP use ≥4 h per night for 70 % or more of the observation period. Logistic regression analysis was performed to stratify clusters according to CPAP adherence. RESULTS Five clusters were identified through cluster analysis. Clustering was significantly associated with CPAP adherence at 90- and 365-day periods after CPAP initiation. Logistic regression revealed that the cluster with features including apnea predominant sleep-disordered breathing, high apnea-hypopnea index, and relatively older age demonstrated the highest CPAP adherence. CONCLUSION Cluster analysis revealed hidden connections using patient characteristics and PSG parameters to successfully identify patients more likely to adhere to CPAP for 90 days and up to 365 days. When prescribing CPAP, it is possible to identify patients with OSA who are more likely to be non-adherent.
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Affiliation(s)
- Eriko Hamada
- Department of Respiratory Medicine, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8521, Japan
| | - Motoo Yamauchi
- Department of Respiratory Medicine, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8521, Japan; Department of Clinical Pathophysiology of Nursing, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8521, Japan.
| | - Yukio Fujita
- Department of Respiratory Medicine, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8521, Japan
| | - Tsuguo Nishijima
- Division of Behavioral Sleep Medicine, Iwate Medical University School of Medicine, 1-1-1 Idaidori, Yahaba, Shiwa, Iwate, 028-3694, Japan
| | - Azusa Ikegami
- Sleep Center, Kuwamizu Hospital, 1-14-41 Kuwamizu, Chuo-ku, Kumamoto, 862-0954, Japan
| | - Toshio Takaoka
- Department of Internal Medicine, Kagoshima Takaoka Hospital, 14-12 Nishisengokucho, Kagoshima, 892-0847, Japan
| | - Ryutaro Shirahama
- RESM Shin Yokohama Sleep and Respiratory Medical-care Clinic, 4th floor, Maruhachishinyokohama building, 3-8-12, Shinyokohama, Kita-ku, Kanagawa, Japan; Faculty of Science and Technology, Keio University, 3-14-1 Hiyoshi, Kohoku-ku, Yokohama, Kanagawa, 223-0061, Japan
| | - Kingman P Strohl
- Division of Pulmonary, Critical Care and Sleep Medicine, University Hospital Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Shigeo Muro
- Department of Respiratory Medicine, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8521, Japan
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Bonsignore MR, Mazzuca E, Baiamonte P, Bouckaert B, Verbeke W, Pevernagie DA. REM sleep obstructive sleep apnoea. Eur Respir Rev 2024; 33:230166. [PMID: 38355150 PMCID: PMC10865098 DOI: 10.1183/16000617.0166-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 12/18/2023] [Indexed: 02/16/2024] Open
Abstract
Obstructive sleep apnoea (OSA) can occur in both rapid eye movement (REM) and non-REM sleep or be limited to REM sleep, when the upper airway is most prone to collapse due to REM sleep atonia. Respiratory events are usually longer and more desaturating in REM than in NREM sleep. The prevalence of REM OSA is higher in women than in men and REM OSA usually occurs in the context of mild-moderate OSA based on the apnoea-hypopnoea index calculated for the entire sleep study. Studies have highlighted some detrimental consequences of REM OSA; for example, its frequent association with systemic hypertension and a degree of excessive daytime sleepiness similar to that found in nonsleep-stage-dependent OSA. Moreover, REM OSA could increase cardiometabolic risk. Continuous positive airway pressure (CPAP) treatment aimed at preventing REM OSA should be longer than the 4 h usually considered as good compliance, since REM sleep occurs mostly during the second half of the night. Unfortunately, patients with REM OSA show poor adherence to CPAP. Alternative non-CPAP treatments might be a good choice for REM OSA, but data are lacking. This review summarises the available data on REM OSA and critically examines the weaknesses and strengths of existing literature.
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Affiliation(s)
- Maria R Bonsignore
- PROMISE Department, University of Palermo, Institute for Biomedical Research and Innovation (IRIB), National Research Council (CNR), Palermo, Italy
| | - Emilia Mazzuca
- Department of Respiratory Diseases, Cervello Hospital, AO Villa Sofia-Cervello, Palermo, Italy
| | - Pierpaolo Baiamonte
- Department of Respiratory Diseases, Cervello Hospital, AO Villa Sofia-Cervello, Palermo, Italy
| | - Bernard Bouckaert
- Department of Respiratory Diseases and Sleep Disorders Centre, AZ Delta, Rumbeke, Belgium
| | - Wim Verbeke
- Department of Respiratory Diseases and Sleep Disorders Centre, AZ Delta, Rumbeke, Belgium
| | - Dirk A Pevernagie
- Department of Respiratory Diseases and Sleep Disorders Centre, AZ Delta, Rumbeke, Belgium
- Department Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Gent, Belgium
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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: 62] [Impact Index Per Article: 62.0] [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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Patients with Obstructive Sleep Apnea and Cardiovascular Diseases: What, When, and Why Is Mandibular Advancement Device Treatment Required? A Short Review. J Clin Med 2022; 11:jcm11226845. [PMID: 36431322 PMCID: PMC9696671 DOI: 10.3390/jcm11226845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/07/2022] [Accepted: 11/17/2022] [Indexed: 11/22/2022] Open
Abstract
Obstructive sleep apnea is a potentially dangerous condition with significant risks of comorbidities if left untreated. It represents a cardiovascular risk factor in the general population, and a higher prevalence is observed in patients already suffering from cardiovascular diseases. The gold standard treatment, continuous positive airway pressure, is not always accepted or tolerated. The mandibular advancement device represents an alternative treatment that we propose to implement in our study. The objective here is to first present a brief review of the topic. Due to poor evidence in the field, we propose a pilot study to evaluate the effect of a mandibular advancement device in patients with cardiovascular disease who are not treated for their sleep pathology in order to improve their therapeutic management.
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Mano M, Nomura A, Hori R, Sasanabe R. Association between Rapid Eye Movement Obstructive Sleep Apnea and Metabolic Syndrome in a Japanese Population. Intern Med 2022. [PMID: 36384898 PMCID: PMC10372281 DOI: 10.2169/internalmedicine.0336-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective Rapid eye movement (REM) obstructive sleep apnea (OSA) is characterized by apnea and hypopnea events due to airway collapse occurring predominantly or exclusively during REM sleep. OSA is a potential risk factor for metabolic dysfunction. However, the association between REM OSA and risk of adverse health outcomes remains unclear. The present study investigated the association between REM OSA and metabolic syndrome (MetS), including the MetS components of hypertension, dyslipidemia, and hyperglycemia, in the Japanese population. Methods In total, 836 Japanese patients with mild to moderate OSA were enrolled in this study. We compared the prevalence of MetS, including hypertension, dyslipidemia, and hyperglycemia, between REM OSA and non-REM OSA via univariate analyses of descriptive statistics and logistic regression analyses. Results The prevalence of hypertension was 68.3% in the REM OSA group and 56.6% in the non-REM OSA group (p<0.05). In addition, the prevalence of metabolic syndrome was significantly higher (37.0%) in the REM OSA group than in the non-REM-OSA group (25.2%). Logistic regression analyses showed that the prevalence of hypertension and Mets was significantly greater in the REM OSA group than in the non-REM-OSA group. Conclusion Our findings suggest that patients with REM OSA, regardless of age, sex, and body mass index, are at a higher risk of developing hypertension and MetS than patients with non-REM OSA.
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Affiliation(s)
- Mamiko Mano
- Department of Sleep Medicine and Sleep Disorders Center, Aichi Medical University Hospital, Japan
| | - Atsuhiko Nomura
- Department of Sleep Medicine and Sleep Disorders Center, Aichi Medical University Hospital, Japan
| | - Reiko Hori
- Department of Sleep Medicine and Sleep Disorders Center, Aichi Medical University Hospital, Japan
| | - Ryujiro Sasanabe
- Department of Sleep Medicine and Sleep Disorders Center, Aichi Medical University Hospital, Japan
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Chamnanpet S, Tovichien P, Tanphaichitr A, Chotinaiwattarakul W. Prevalence and Risk Factors for Rapid Eye Movement-Related Obstructive Sleep Apnea in Children. Front Pediatr 2022; 10:869986. [PMID: 35573955 PMCID: PMC9097965 DOI: 10.3389/fped.2022.869986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 03/22/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Different pathophysiological mechanisms and the distribution of respiratory events among rapid eye movement (REM) and non-rapid eye movement (NREM) sleep modulate the effect of obstructive sleep apnea (OSA). We aimed to study the prevalence and risk factors for REM-related OSA in children. STUDY DESIGN Retrospective, cross-sectional study. METHODS We recruited 366 children with OSA confirmed by polysomnography (PSG) over a 5-year period. REM-related OSA is defined by an obstructive apnea-hypopnea index (OAHI) in the REM sleep ≥2× than during NREM sleep. RESULTS The prevalence of REM-related OSA in children was 50.3%. Children with REM-related OSA were more likely to be female (P = 0.042), and had lower prevalence of adenotonsillar hypertrophy (P = 0.043) compared with children with other OSA subtypes. Children with REM-related OSA slept longer in the supine position (P = 0.003), had shorter duration of NREM1 sleep (P = 0.018), lower nadir SpO2 (P = 0.005), and a higher oxygen desaturation index 3% (ODI3%) (P = 0.014), and lower arousal index (P = 0.034) compared with other OSA subtypes. Female gender and supine sleep was the independent risk factors for REM-related OSA. CONCLUSION The prevalence of REM-related OSA was 50.3%. OAHIREM should be considered as an important parameter in future clinical research studies done in children with OSA.
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Affiliation(s)
- Surisa Chamnanpet
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Prakarn Tovichien
- Division of Pulmonology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Archwin Tanphaichitr
- Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Wattanachai Chotinaiwattarakul
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.,Siriraj Sleep Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Rapid eye movement predominant obstructive sleep apnoea: prognostic relevance and clinical approach. Curr Opin Pulm Med 2021; 27:514-522. [PMID: 34620787 DOI: 10.1097/mcp.0000000000000817] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE OF REVIEW Rapid eye movement (REM) obstructive sleep apnoea (OSA) is a stage-specific OSA, in which obstructive events occur primarily during REM sleep. This review discusses REM-OSA definitions, its cardiometabolic correlates, associated comorbidities and treatment, and addresses diagnostic ambiguities and therapeutic pitfalls. RECENT FINDINGS Current evidence indicates that REM-OSA is prevalent among younger age groups and women and is independently associated with cardiometabolic complications, particularly hypertension, metabolic complications such as insulin resistance and metabolic syndrome. However, currently, there is no consensus on the accepted diagnostic criteria for REM-OSA. Available data suggest that adherence to positive airway pressure (PAP) therapy in patients with REM-OSA is suboptimal. Moreover, the currently accepted criteria for good adherence to PAP therapy of 4 h/night, 70% of the days may not be suitable for REM-OSA, as it will not cover most of the REM sleep periods. In addition, further research is needed to assess the impact of REM-OSA treatment on cardiometabolic outcomes. SUMMARY Patients with REM-OSA are at an increased risk of cardiometabolic complications. A high index of suspicion is needed to diagnose this disorder, and close follow-up is required to enhance adherence to therapy.
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Saito K, Okada Y, Torimoto K, Takamatsu Y, Tanaka Y. Blood glucose dynamics during sleep in patients with obstructive sleep apnea and normal glucose tolerance: effects of CPAP therapy. Sleep Breath 2021; 26:771-781. [PMID: 34382134 PMCID: PMC9130196 DOI: 10.1007/s11325-021-02442-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/18/2021] [Accepted: 07/13/2021] [Indexed: 11/26/2022]
Abstract
Purpose Glycemic variability (GV) and hypoglycemia during nighttime are presumed to be associated with fatal bradycardia. The aim of this prospective study was to evaluate blood glucose dynamics during sleep in patients with obstructive sleep apnea syndrome (OSA) and normal glucose tolerance. Methods Patients with OSA and no diabetes who underwent type 1 overnight polysomnography from December 2018 to May 2020 participated in this study. GV was evaluated in all participants for 14 days using a flash glucose monitoring device. Correlations were examined between GV indexes and indexes related to sleep breathing disorders, the effects of treatment with continuous positive airway pressure (CPAP) on these GV indexes, and the characteristics of glucose dynamics in different OSA subtypes classified by sleep stage. Results Among 42 patients with OSA and no diabetes, the standard deviation of GV during sleep correlated significantly with sleep time spent with oxygen saturation <90% (r=0.591, p=0.008). High blood glucose index during sleep correlated significantly with stage N1% (r=0.491, p=0.032) and negatively with stage N2% (r=−0.479, p=0.038). High blood glucose index correlated significantly with sleep time spent with oxygen saturation <90% (r=0.640, p=0.003). The rapid eye movement–related OSA group had a higher incidence of hypoglycemia. One-week with CPAP treatment significantly improved GV during sleep, standard deviation of GV (from 12.1 to 9.0 mg/dL, p<0.001), and high blood glucose index (from 0.7 to 0.4, p=0.006). Conclusions To evaluate GV during sleep in patients with OSA may be useful for clinical risk management. CPAP treatment for 1 week may have an improving GV and high blood glucose index. Clinical trial registration UMIN000038489 2019/11/04, UMIN 000025433 2016/12/27 Supplementary Information The online version contains supplementary material available at 10.1007/s11325-021-02442-9.
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Affiliation(s)
- Kimimasa Saito
- Saito Naika Kokyukika, Mie Sleep Clinic, 446 Sogo, Obata-chyo, Ise-shi, Mie, 519-0502, Japan.
| | - Yosuke Okada
- First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushyu-shi, 807-8555, Japan
| | - Keiichi Torimoto
- First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushyu-shi, 807-8555, Japan
| | - Yoko Takamatsu
- Saito Naika Kokyukika, Mie Sleep Clinic, 446 Sogo, Obata-chyo, Ise-shi, Mie, 519-0502, Japan
| | - Yoshiya Tanaka
- First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushyu-shi, 807-8555, Japan
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Chen PY, Chen TY, Chao PZ, Liu WT, Bai CH, Tsao ST, Lin YC. REM-related obstructive sleep apnea and vertigo: A retrospective case-control study. PLoS One 2021; 16:e0252844. [PMID: 34115792 PMCID: PMC8195434 DOI: 10.1371/journal.pone.0252844] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/23/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND In recent population-based case-control studies, sleep apnea was significantly associated with a higher incidence (hazard ratio, 1.71) of vertigo and the risk of tinnitus was found to increase 1.36 times in patients with sleep apnea. The possibility that obstructive sleep apnea (OSA) might affect neurotological consequences was not noticed, until studies using polysomnography (PSG) for these patients. OBJECTIVES The purpose of this study was to investigate the relationship between vertigo and OSA. METHODS The collected data among patients from May 1st, 2018 to October 31th, 2018 at Shuang Ho Hospital. Eligibility criteria included an age older than 20 years, a diagnosis of obstructive sleep apnea. The diagnosis of OSA was defined as an oxygen desaturation index of at least 5, was established with the use of polysomnographic examination at hospital. Patients were excluded from the study if they had head injury, brain tumour, headache history and hearing loss. Patients who had vertigo were labeled as Vertigo group. In the other hand, patients who had no dizziness were labeled as control group. 58 patients were in the Vertigo group, and 113 were in the control group. RESULTS After PSG examination, 58 patients who had vertigo, were diagnosed OSA (29 males, average age = 57.07 years old, BMI = 26.64, RDI = 24.69, ESS = 8.65), and 24 patients of them (41.3%) were REM-related OSA. Meanwhile, in the control group, 113 patients had OSA (92male, average age = 49.66 years old, BMI = 26.06, RDI = 35.19, ESS = 11.43), and 18 patients of them (15.9%) were REM-related OSA (Table 1). Therefore, patient who had vertigo, would have higher proportion of REM OSA (P<0.001). CONCLUSIONS The vertigo patients have a higher rate of REM-related OSA, and the acceptance rate to CPAP use is low. Further research is needed to explore novel therapeutic approaches, or combination of currently available non-CPAP therapies, in patients with REM OSA.
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Affiliation(s)
- Po-Yueh Chen
- Department of Otolaryngology, Taipei Municipal Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Sleep Centre, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Tzu-Ying Chen
- Department of Otolaryngology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Pin-Zhir Chao
- Sleep Centre, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Department of Otolaryngology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Wen-Te Liu
- Sleep Centre, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Department of Chest, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Chyi-Huey Bai
- Department of Public Health, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Sheng-Teng Tsao
- Department of Public Health, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yi-Chih Lin
- Sleep Centre, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Department of Otolaryngology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Department of Public Health, College of Medicine, Taipei Medical University, Taipei, Taiwan
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10
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Hoshino T, Sasanabe R, Murotani K, Hori R, Mano M, Nomura A, Konishi N, Baku M, Nishio Y, Kato C, Kuczynski W, Shiomi T. Estimated respiratory arousal threshold in patients with rapid eye movement obstructive sleep apnea. Sleep Breath 2021; 26:347-353. [PMID: 33999361 PMCID: PMC8857081 DOI: 10.1007/s11325-021-02399-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 05/04/2021] [Accepted: 05/05/2021] [Indexed: 12/20/2022]
Abstract
Purpose Rapid eye movement (REM) obstructive sleep apnea (OSA) is a prevalent clinical phenotype. However, the literature focusing on the pathophysiology of REM OSA is limited. This study compared the proportion of individuals with a low respiratory arousal threshold between patients with REM and non-REM OSA. Methods REM OSA was defined as having an apnea–hypopnea index (AHI) ≥ 5 and AHI during REM (AHI-REM)/AHI during NREM (AHI-NREM) ≥ 2. REM OSA was sub-divided into REM-predominant OSA and REM-isolated OSA. REM-predominant OSA was defined as satisfying the definition of REM OSA and having an AHI-NREM ≥ 5. REM-isolated OSA was defined as satisfying the definition of REM OSA and having an AHI-NREM < 5. Patients with an AHI-REM/AHI-NREM < 2 were defined as having non-REM OSA. A low respiratory arousal threshold was defined as having 2 or more of the following conditions: AHI < 30 events/h, proportion of hypopnea > 58.3%, and nadir SpO2 > 82.5%. Results The proportions of individuals with low respiratory arousal thresholds among individuals with REM-predominant OSA and REM-isolated OSA were significantly higher (77.2% and 93.7%, respectively) than that of patients with non-REM OSA (48.6%). This was also true when the analysis was performed according to sex. Conclusion These results indicate that a low respiratory arousal threshold might be an important endotype that contributes to the pathogenesis of REM OSA, especially in REM-isolated OSA.
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Affiliation(s)
- Tetsuro Hoshino
- Department of Sleep Medicine and Sleep Disorder Center, Aichi Medical University Hospital, 1-1 Nagakute, Aichi, 4801195, Japan.
| | - Ryujiro Sasanabe
- Department of Sleep Medicine and Sleep Disorder Center, Aichi Medical University Hospital, 1-1 Nagakute, Aichi, 4801195, Japan
| | - Kenta Murotani
- Biostatistics Center, Graduate School of Medicine, Kurume University, 67 Asahimachi, Kurume, Fukuoka, 8300011, Japan
| | - Reiko Hori
- Department of Sleep Medicine and Sleep Disorder Center, Aichi Medical University Hospital, 1-1 Nagakute, Aichi, 4801195, Japan
| | - Mamiko Mano
- Department of Sleep Medicine and Sleep Disorder Center, Aichi Medical University Hospital, 1-1 Nagakute, Aichi, 4801195, Japan
| | - Atsuhiko Nomura
- Department of Sleep Medicine and Sleep Disorder Center, Aichi Medical University Hospital, 1-1 Nagakute, Aichi, 4801195, Japan
| | - Noriyuki Konishi
- Department of Sleep Medicine and Sleep Disorder Center, Aichi Medical University Hospital, 1-1 Nagakute, Aichi, 4801195, Japan
| | - Masayo Baku
- Department of Sleep Medicine and Sleep Disorder Center, Aichi Medical University Hospital, 1-1 Nagakute, Aichi, 4801195, Japan
| | - Yoshitomo Nishio
- Department of Oral and Maxillofacial Surgery, Aichi Medical University Hospital, 1-1 Nagakute, Aichi, 4801195, Japan
| | - Chihiro Kato
- Department of Sleep Medicine and Sleep Disorder Center, Aichi Medical University Hospital, 1-1 Nagakute, Aichi, 4801195, Japan
| | - Wojciech Kuczynski
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, 90-001, Lodz, Poland
| | - Toshiaki Shiomi
- Department of Sleep Medicine and Sleep Disorder Center, Aichi Medical University Hospital, 1-1 Nagakute, Aichi, 4801195, Japan
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11
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Chan KC, Au CT, Yu MW, Wing YK, Li AM. Natural History of REM-OSA in Children and Its Associations with Adverse Blood Pressure Outcomes: A Longitudinal Follow-Up Study. Nat Sci Sleep 2021; 13:1967-1984. [PMID: 34764712 PMCID: PMC8575368 DOI: 10.2147/nss.s331389] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 10/08/2021] [Indexed: 01/10/2023] Open
Abstract
PURPOSE Most respiratory events in childhood obstructive sleep apnea (OSA) take place during rapid-eye-movement (REM) sleep. This study aimed to describe the characteristics and natural history of childhood REM-OSA and to evaluate the associations between OSA subtypes and blood pressure (BP) outcomes. PARTICIPANTS AND METHODS This was a prospective 10-year follow-up study of a cohort established for a childhood OSA epidemiologic study. All subjects from the original cohort were invited to undergo a polysomnography (PSG) and 24-hour ambulatory blood pressure (ABP) monitoring. REM-OSA was defined with a ratio of obstructive apnea hypopnea index (OAHI) during REM sleep (OAHIREM) to OAHI during non-REM sleep (OAHINREM) ≥ 2. Natural history was observed and linear mixed models were used to assess the associations between OSA subtypes and BP outcomes. RESULTS A total of 610 participants from baseline were included to study the epidemiology of REM-OSA in childhood. Among children with OSA, 65% had REM-OSA. At 10-year follow-up, 234 were included in the analysis. REM-OSA was more common at both baseline (58/92, 63%) and 10-year follow-up (34/58, 59%). For those with REM-OSA at baseline and persistent OSA at follow-up, the majority (72%) remained to have REM-OSA. Compared to those without OSA, subjects with REM-OSA had significantly higher nocturnal SBP (mean difference 2.19 mmHg, 95% confidence interval (CI): 0.12, 4.26; p = 0.039) and DBP (mean difference 1.58 mmHg, 95% confidence interval (CI): 0.11, 3.04; p = 0.035), and less nocturnal SBP dipping (mean difference -1.84%, 95% CI: -3.25, -0.43; p = 0.011), after adjusting for potential confounders. This significant association between REM-OSA and nocturnal SBP dipping was observed at baseline visit only. CONCLUSION REM-OSA was found to be a stable phenotype through childhood to young adulthood, and REM-OSA was associated with higher nocturnal BP and a lesser degree of nocturnal SBP dipping in children.
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Affiliation(s)
- Kate C Chan
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Chun T Au
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Michelle W Yu
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yun K Wing
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Albert M Li
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
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12
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Insomnia as a Symptom of Rapid Eye Movement-Related Obstructive Sleep Apnea. J Clin Med 2020; 9:jcm9061821. [PMID: 32545253 PMCID: PMC7356215 DOI: 10.3390/jcm9061821] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 06/09/2020] [Accepted: 06/10/2020] [Indexed: 12/26/2022] Open
Abstract
Rapid eye movement (REM)-related obstructive sleep apnea (OSA), a polysomnographic phenotype that affects 12–36% of OSA patients, is defined by apnea and hypopnea events that predominantly or exclusively occur during REM sleep. Recent studies indicated that REM-related OSA was associated with the development of nocturnal non-dipping of systolic and diastolic blood pressure, metabolic syndrome, diabetes, and depressive symptoms. However, to date, the association between REM-related OSA and insomnia still remains unclear. We investigated whether there was a difference between REM- and non-REM-related OSA in terms of insomnia-related sleep disturbance as measured by the Pittsburgh Sleep Quality Index (PSQI) in 1736 patients with OSA. REM-related OSA showed a significant association with increased PSQI in all adjusted models. In the subgroup analysis, the coefficients of all models were higher in female than in male patients with REM-related OSA. Insomnia should be considered an important complaint in patients with REM-related OSA, and its indicators, such as the PSQI, should be included in routine diagnostic testing.
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13
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Treatment outcome of oral appliance in patients with REM-related obstructive sleep apnea. Sleep Breath 2019; 24:1339-1347. [PMID: 31768931 PMCID: PMC7679325 DOI: 10.1007/s11325-019-01966-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 10/04/2019] [Accepted: 10/22/2019] [Indexed: 02/04/2023]
Abstract
Purpose Oral appliances (OA) are used to treat patients with obstructive sleep apnea (OSA). The purpose of this study is to evaluate the efficacy of OA treatment in patients with rapid eye movement (REM)–related OSA. Methods Forty-six patients with REM-related OSA and 107 with non-stage-specific OSA were prescribed OA treatment after diagnosis by polysomnography (PSG) and a follow-up sleep test by PSG was conducted. Efficacy and treatment outcome predictors were evaluated according to the following criteria for treatment success: #1, reduction of the apnea-hypopnea index (AHI) to less than 5 and > 50% compared with baseline; #2, AHI reduction to less than 10 and > 50% compared with baseline; and #3, > 50% AHI reduction compared with baseline. Results Success rates according to criteria #1, #2, and #3 were 45.7%, 50.0%, and 50.0% in REM-related OSA and 36.4%, 52.3%, and 63.6% in non-stage-specific OSA, respectively. No significant differences in success rate were found between the two groups. In multivariate logistic regression analysis with each criterion as the response variable, only BMI was extracted as a significant predictor. The BMI cutoff values defined based on the maximum Youden index according to the three criteria were 26.2 kg/m2, 25.6 kg/m2, and 26.2 kg/m2, respectively. Conclusions No significant differences in success rate of OA treatment were found between REM-related OSA and non-stage-specific OSA. BMI has greater impact on treatment outcome of OA in patients with REM-related OSA.
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14
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Hoshino T, Sasanabe R, Mano M, Nomura A, Kato C, Sato M, Imai M, Murotani K, Guilleminault C, Shiomi T. Prevalence of Rapid Eye Movement-related Obstructive Sleep Apnea in Adult Narcolepsy. Intern Med 2019; 58:2151-2157. [PMID: 30996185 PMCID: PMC6709340 DOI: 10.2169/internalmedicine.2601-18] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective The association between narcolepsy and rapid eye movement (REM)-related obstructive sleep apnea (OSA) has not been reported. This study aimed to examine the prevalence of REM-related OSA in narcolepsy patients. Methods From January 2013 to April 2018, 141 adult patients were diagnosed with narcolepsy using nocturnal polysomnography and the multiple sleep latency test. The prevalence of REM-related OSA in narcolepsy patients was retrospectively reviewed. Three criteria were used to determine REM-related OSA: Definition #1, an overall apnea-hypopnea index (AHI) ≥5 and AHI during REM (AHIREM)/AHI during non-rapid eye movement (NREM) (AHINREM) ≥2; Definition #2, an overall AHI ≥5 and AHIREM/AHINREM≥2 and AHINREM <15; and Definition #3, an overall AHI ≥5 and AHIREM/AHINREM≥2 and AHINREM <8 plus an REM sleep duration >10.5 minutes. Results Of the 141 narcolepsy patients, 26 were diagnosed with narcolepsy with cataplexy (NA-CA) and 115 with narcolepsy without cataplexy (NA w/o CA). Seventeen patients with NA-CA and 39 with NA w/o CA had OSA. According to Definition #1, the prevalence of REM-related OSA was 47.1% and 41.0%, respectively, in OSA patients with NA-CA and NA w/o CA; according to Definition #2, the respective prevalence was 47.1% and 38.5%, while that according to Definition #3 was 41.2% and 25.6%. No significant differences were found in the prevalence of REM-related OSA for each definition. Conclusion A high prevalence of REM-related OSA was confirmed in adult narcolepsy patients with OSA. Compared to previous reports, we noted a high frequency of REM-related OSA satisfying the relatively strict Definition #3. These results might reflect the pathophysiological characteristics of narcolepsy.
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Affiliation(s)
- Tetsuro Hoshino
- Department of Sleep Medicine and Sleep Disorders Center, Aichi Medical University Hospital, Japan
| | - Ryujiro Sasanabe
- Department of Sleep Medicine and Sleep Disorders Center, Aichi Medical University Hospital, Japan
| | - Mamiko Mano
- Department of Sleep Medicine and Sleep Disorders Center, Aichi Medical University Hospital, Japan
| | - Atsuhiko Nomura
- Department of Sleep Medicine and Sleep Disorders Center, Aichi Medical University Hospital, Japan
| | - Chihiro Kato
- Department of Sleep Medicine and Sleep Disorders Center, Aichi Medical University Hospital, Japan
| | - Masako Sato
- Department of Sleep Medicine and Sleep Disorders Center, Aichi Medical University Hospital, Japan
| | - Masato Imai
- Department of Sleep Medicine and Sleep Disorders Center, Aichi Medical University Hospital, Japan
| | - Kenta Murotani
- Center for Clinical Research, Aichi Medical University Hospital, Japan
| | | | - Toshiaki Shiomi
- Department of Sleep Medicine and Sleep Disorders Center, Aichi Medical University Hospital, Japan
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15
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Sunwoo BY, Light M, Malhotra A. Strategies to augment adherence in the management of sleep-disordered breathing. Respirology 2019; 25:363-371. [PMID: 31270925 DOI: 10.1111/resp.13589] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 02/05/2019] [Accepted: 05/02/2019] [Indexed: 01/05/2023]
Abstract
Continuous positive airway pressure (CPAP) is highly effective in treating sleep-disordered breathing (SDB). However, unlike surgical interventions, this treatment modality relies heavily on patient acceptance and adherence. The current definition of adherence is largely arbitrary and is mainly used by third-party payers to determine CPAP reimbursement but CPAP adherence remains sub-optimal. Strategies to augment adherence, especially early in the course of a CPAP trial, are needed in the management of SDB. An understanding of the basis for observed differences in CPAP and oral appliance (OA) use is necessary in developing these strategies, but to date no single factor has been consistently identified. Consequently, a multidimensional approach using educational, behavioural, technological and potentially pharmacological strategies to target (i) disease characteristics, (ii) patient characteristics including psychosocial factors, (iii) treatment protocols and (iv) technological devices and side effects that may influence adherence, is likely required to augment the complex behaviour of CPAP and OA use. In the near future, we envision a personalized medicine approach to determine the risk of non-adherence and set individualized adherence goals aimed at treating specific symptoms (e.g. excessive daytime sleepiness) and reducing the risk of patient-specific SDB consequences (e.g. atherosclerosis). Resources for interventions to improve adherence such as educational programmes and telemedicine encounters could then be more efficiently allocated.
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Affiliation(s)
- Bernie Y Sunwoo
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego, CA, USA
| | - Matthew Light
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego, CA, USA
| | - Atul Malhotra
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego, CA, USA
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16
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Mano M, Hoshino T, Sasanabe R, Murotani K, Nomura A, Hori R, Konishi N, Baku M, Shiomi T. Impact of Gender and Age on Rapid Eye Movement-Related Obstructive Sleep Apnea: A Clinical Study of 3234 Japanese OSA Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16061068. [PMID: 30934646 PMCID: PMC6466410 DOI: 10.3390/ijerph16061068] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 03/20/2019] [Accepted: 03/21/2019] [Indexed: 12/12/2022]
Abstract
Rapid eye movement (REM)-related obstructive sleep apnea (OSA) is characterized by apnea and hypopnea events due to airway collapse occurring predominantly or exclusively during REM sleep. Previous studies have reported that REM-related OSA occurs more commonly in women and younger individuals. However, external validity of this tendency has not been confirmed in a large clinical sample. The objective of this study was to evaluate the effect of gender and age on REM-related OSA after adjustment for several covariates based on their established clinical relationships to gender difference in OSA. A total of 3234 Japanese patients with OSA were enrolled in this study. We confirmed that female sex is an important risk factor for REM-related OSA, as reported by previous studies. Moreover, we showed that women aged over 50 years were at a greater risk than those aged under 50 years. These results suggest that hormonal changes in women might play an important role in REM-related OSA and might reflect its unknown pathophysiological characteristics.
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Affiliation(s)
- Mamiko Mano
- Department of Sleep Medicine and Sleep Disorders Center, Aichi Medical University Hospital, 1-1 Nagakute, Aichi 4801195, Japan.
| | - Tetsuro Hoshino
- Department of Sleep Medicine and Sleep Disorders Center, Aichi Medical University Hospital, 1-1 Nagakute, Aichi 4801195, Japan.
| | - Ryujiro Sasanabe
- Department of Sleep Medicine and Sleep Disorders Center, Aichi Medical University Hospital, 1-1 Nagakute, Aichi 4801195, Japan.
| | - Kenta Murotani
- Biostatistics Center, Graduate School of Medicine, Kurume University, 67 Asahimachi, Kurume, Fukuoka 8300011, Japan.
| | - Atsuhiko Nomura
- Department of Sleep Medicine and Sleep Disorders Center, Aichi Medical University Hospital, 1-1 Nagakute, Aichi 4801195, Japan.
| | - Reiko Hori
- Department of Sleep Medicine and Sleep Disorders Center, Aichi Medical University Hospital, 1-1 Nagakute, Aichi 4801195, Japan.
| | - Noriyuki Konishi
- Department of Sleep Medicine and Sleep Disorders Center, Aichi Medical University Hospital, 1-1 Nagakute, Aichi 4801195, Japan.
| | - Masayo Baku
- Department of Sleep Medicine and Sleep Disorders Center, Aichi Medical University Hospital, 1-1 Nagakute, Aichi 4801195, Japan.
| | - Toshiaki Shiomi
- Department of Sleep Medicine and Sleep Disorders Center, Aichi Medical University Hospital, 1-1 Nagakute, Aichi 4801195, Japan.
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