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Hajak G, Vetter C, Wehling M. Neurexan Prescription Is Associated with Lower Risk of Sleep Disorder Recurrence and Depression Prevalence as Compared to Z-Drugs and Benzodiazepines: A Retrospective Database Analysis in Germany. Healthcare (Basel) 2024; 12:1413. [PMID: 39057556 PMCID: PMC11276089 DOI: 10.3390/healthcare12141413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 07/10/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024] Open
Abstract
Real-world evidence on the association between natural medicinal products and the recurrence of sleep disorders is currently limited, particularly when compared to the evidence reported for prescription hypnotics. In a retrospective cohort analysis, we investigated patients with sleep disorders prescribed either the natural medicinal product Neurexan (Nx4), benzodiazepines, or nonbenzodiazepines (Z-drugs) using the IQVIA Disease Analyzer database, which encompasses electronic medical records nationwide in Germany. A 1:1 matching procedure based on age, sex, prevalent depression, anxiety or adjustment disorder, and the number of medical consultations in the past 12 months resulted in four cohorts: patients prescribed Nx4 were matched with those prescribed Z-drugs (two cohorts with 8594 matched patients each), and another cohort of patients prescribed Nx4 were matched with those prescribed benzodiazepines (7779 matched pairs). Results from multivariable-adjusted Cox regression models demonstrated that Nx4 was associated with a significantly lower risk of recurrent sleep disorder diagnosis within 30-365 days after prescription compared to both Z-drugs (HR = 0.65, 95%CI = 0.60-0.70, p < 0.001) and benzodiazepines (HR = 0.85, 95%CI = 0.79-0.93, p < 0.001). Additionally, Nx4 was associated with a lower prevalence of depression compared to Z-drugs (HR = 0.90, 95%CI = 0.83-0.98, p = 0.020) and benzodiazepines (HR = 0.89, 95%CI = 0.82-0.97, p = 0.009). These findings suggest an association between Nx4 and improved sleep and mental health outcomes. However, due to inherent limitations in the study design, the causality of this relationship cannot be stated.
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Affiliation(s)
- Göran Hajak
- Clinic for Psychiatry, Psychosomatic Medicine and Psychotherapy, Sozialstiftung Social Foundation Bamberg, Teaching Hospital of the University of Erlangen, 96049 Bamberg, Germany
| | - Céline Vetter
- IQVIA Commercial GmbH & Co. KG, 60549 Frankfurt am Main, Germany
| | - Martin Wehling
- Medical Faculty Mannheim, University of Heidelberg, 68167 Mannheim, Germany
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Malhotra A, Grunstein RR, Fietze I, Weaver TE, Redline S, Azarbarzin A, Sands SA, Schwab RJ, Dunn JP, Chakladar S, Bunck MC, Bednarik J. Tirzepatide for the Treatment of Obstructive Sleep Apnea and Obesity. N Engl J Med 2024. [PMID: 38912654 DOI: 10.1056/nejmoa2404881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
Abstract
BACKGROUND Obstructive sleep apnea is characterized by disordered breathing during sleep and is associated with major cardiovascular complications; excess adiposity is an etiologic risk factor. Tirzepatide may be a potential treatment. METHODS We conducted two phase 3, double-blind, randomized, controlled trials involving adults with moderate-to-severe obstructive sleep apnea and obesity. Participants who were not receiving treatment with positive airway pressure (PAP) at baseline were enrolled in trial 1, and those who were receiving PAP therapy at baseline were enrolled in trial 2. The participants were assigned in a 1:1 ratio to receive either the maximum tolerated dose of tirzepatide (10 mg or 15 mg) or placebo for 52 weeks. The primary end point was the change in the apnea-hypopnea index (AHI, the number of apneas and hypopneas during an hour of sleep) from baseline. Key multiplicity-controlled secondary end points included the percent change in AHI and body weight and changes in hypoxic burden, patient-reported sleep impairment and disturbance, high-sensitivity C-reactive protein (hsCRP) concentration, and systolic blood pressure. RESULTS At baseline, the mean AHI was 51.5 events per hour in trial 1 and 49.5 events per hour in trial 2, and the mean body-mass index (BMI, the weight in kilograms divided by the square of the height in meters) was 39.1 and 38.7, respectively. In trial 1, the mean change in AHI at week 52 was -25.3 events per hour (95% confidence interval [CI], -29.3 to -21.2) with tirzepatide and -5.3 events per hour (95% CI, -9.4 to -1.1) with placebo, for an estimated treatment difference of -20.0 events per hour (95% CI, -25.8 to -14.2) (P<0.001). In trial 2, the mean change in AHI at week 52 was -29.3 events per hour (95% CI, -33.2 to -25.4) with tirzepatide and -5.5 events per hour (95% CI, -9.9 to -1.2) with placebo, for an estimated treatment difference of -23.8 events per hour (95% CI, -29.6 to -17.9) (P<0.001). Significant improvements in the measurements for all prespecified key secondary end points were observed with tirzepatide as compared with placebo. The most frequently reported adverse events with tirzepatide were gastrointestinal in nature and mostly mild to moderate in severity. CONCLUSIONS Among persons with moderate-to-severe obstructive sleep apnea and obesity, tirzepatide reduced the AHI, body weight, hypoxic burden, hsCRP concentration, and systolic blood pressure and improved sleep-related patient-reported outcomes. (Funded by Eli Lilly; SURMOUNT-OSA ClinicalTrials.gov number, NCT05412004.).
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Affiliation(s)
- Atul Malhotra
- From the University of California, San Diego, La Jolla (A.M.); Woolcock Institute of Medical Research, Macquarie University, Royal Prince Alfred Hospital, and the University of Sydney - all in Sydney (R.R.G.); the Center of Sleep Medicine, Charité University Hospital Berlin, Berlin (I.F.); the College of Nursing, University of Illinois Chicago, Chicago (T.E.W.); the School of Nursing (T.E.W.) and Perelman School of Medicine (R.J.S.), University of Pennsylvania, Philadelphia; the Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (S.R., A.A., S.A.S.); and Eli Lilly, Indianapolis (J.P.D., S.C., M.C.B., J.B.)
| | - Ronald R Grunstein
- From the University of California, San Diego, La Jolla (A.M.); Woolcock Institute of Medical Research, Macquarie University, Royal Prince Alfred Hospital, and the University of Sydney - all in Sydney (R.R.G.); the Center of Sleep Medicine, Charité University Hospital Berlin, Berlin (I.F.); the College of Nursing, University of Illinois Chicago, Chicago (T.E.W.); the School of Nursing (T.E.W.) and Perelman School of Medicine (R.J.S.), University of Pennsylvania, Philadelphia; the Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (S.R., A.A., S.A.S.); and Eli Lilly, Indianapolis (J.P.D., S.C., M.C.B., J.B.)
| | - Ingo Fietze
- From the University of California, San Diego, La Jolla (A.M.); Woolcock Institute of Medical Research, Macquarie University, Royal Prince Alfred Hospital, and the University of Sydney - all in Sydney (R.R.G.); the Center of Sleep Medicine, Charité University Hospital Berlin, Berlin (I.F.); the College of Nursing, University of Illinois Chicago, Chicago (T.E.W.); the School of Nursing (T.E.W.) and Perelman School of Medicine (R.J.S.), University of Pennsylvania, Philadelphia; the Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (S.R., A.A., S.A.S.); and Eli Lilly, Indianapolis (J.P.D., S.C., M.C.B., J.B.)
| | - Terri E Weaver
- From the University of California, San Diego, La Jolla (A.M.); Woolcock Institute of Medical Research, Macquarie University, Royal Prince Alfred Hospital, and the University of Sydney - all in Sydney (R.R.G.); the Center of Sleep Medicine, Charité University Hospital Berlin, Berlin (I.F.); the College of Nursing, University of Illinois Chicago, Chicago (T.E.W.); the School of Nursing (T.E.W.) and Perelman School of Medicine (R.J.S.), University of Pennsylvania, Philadelphia; the Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (S.R., A.A., S.A.S.); and Eli Lilly, Indianapolis (J.P.D., S.C., M.C.B., J.B.)
| | - Susan Redline
- From the University of California, San Diego, La Jolla (A.M.); Woolcock Institute of Medical Research, Macquarie University, Royal Prince Alfred Hospital, and the University of Sydney - all in Sydney (R.R.G.); the Center of Sleep Medicine, Charité University Hospital Berlin, Berlin (I.F.); the College of Nursing, University of Illinois Chicago, Chicago (T.E.W.); the School of Nursing (T.E.W.) and Perelman School of Medicine (R.J.S.), University of Pennsylvania, Philadelphia; the Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (S.R., A.A., S.A.S.); and Eli Lilly, Indianapolis (J.P.D., S.C., M.C.B., J.B.)
| | - Ali Azarbarzin
- From the University of California, San Diego, La Jolla (A.M.); Woolcock Institute of Medical Research, Macquarie University, Royal Prince Alfred Hospital, and the University of Sydney - all in Sydney (R.R.G.); the Center of Sleep Medicine, Charité University Hospital Berlin, Berlin (I.F.); the College of Nursing, University of Illinois Chicago, Chicago (T.E.W.); the School of Nursing (T.E.W.) and Perelman School of Medicine (R.J.S.), University of Pennsylvania, Philadelphia; the Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (S.R., A.A., S.A.S.); and Eli Lilly, Indianapolis (J.P.D., S.C., M.C.B., J.B.)
| | - Scott A Sands
- From the University of California, San Diego, La Jolla (A.M.); Woolcock Institute of Medical Research, Macquarie University, Royal Prince Alfred Hospital, and the University of Sydney - all in Sydney (R.R.G.); the Center of Sleep Medicine, Charité University Hospital Berlin, Berlin (I.F.); the College of Nursing, University of Illinois Chicago, Chicago (T.E.W.); the School of Nursing (T.E.W.) and Perelman School of Medicine (R.J.S.), University of Pennsylvania, Philadelphia; the Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (S.R., A.A., S.A.S.); and Eli Lilly, Indianapolis (J.P.D., S.C., M.C.B., J.B.)
| | - Richard J Schwab
- From the University of California, San Diego, La Jolla (A.M.); Woolcock Institute of Medical Research, Macquarie University, Royal Prince Alfred Hospital, and the University of Sydney - all in Sydney (R.R.G.); the Center of Sleep Medicine, Charité University Hospital Berlin, Berlin (I.F.); the College of Nursing, University of Illinois Chicago, Chicago (T.E.W.); the School of Nursing (T.E.W.) and Perelman School of Medicine (R.J.S.), University of Pennsylvania, Philadelphia; the Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (S.R., A.A., S.A.S.); and Eli Lilly, Indianapolis (J.P.D., S.C., M.C.B., J.B.)
| | - Julia P Dunn
- From the University of California, San Diego, La Jolla (A.M.); Woolcock Institute of Medical Research, Macquarie University, Royal Prince Alfred Hospital, and the University of Sydney - all in Sydney (R.R.G.); the Center of Sleep Medicine, Charité University Hospital Berlin, Berlin (I.F.); the College of Nursing, University of Illinois Chicago, Chicago (T.E.W.); the School of Nursing (T.E.W.) and Perelman School of Medicine (R.J.S.), University of Pennsylvania, Philadelphia; the Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (S.R., A.A., S.A.S.); and Eli Lilly, Indianapolis (J.P.D., S.C., M.C.B., J.B.)
| | - Sujatro Chakladar
- From the University of California, San Diego, La Jolla (A.M.); Woolcock Institute of Medical Research, Macquarie University, Royal Prince Alfred Hospital, and the University of Sydney - all in Sydney (R.R.G.); the Center of Sleep Medicine, Charité University Hospital Berlin, Berlin (I.F.); the College of Nursing, University of Illinois Chicago, Chicago (T.E.W.); the School of Nursing (T.E.W.) and Perelman School of Medicine (R.J.S.), University of Pennsylvania, Philadelphia; the Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (S.R., A.A., S.A.S.); and Eli Lilly, Indianapolis (J.P.D., S.C., M.C.B., J.B.)
| | - Mathijs C Bunck
- From the University of California, San Diego, La Jolla (A.M.); Woolcock Institute of Medical Research, Macquarie University, Royal Prince Alfred Hospital, and the University of Sydney - all in Sydney (R.R.G.); the Center of Sleep Medicine, Charité University Hospital Berlin, Berlin (I.F.); the College of Nursing, University of Illinois Chicago, Chicago (T.E.W.); the School of Nursing (T.E.W.) and Perelman School of Medicine (R.J.S.), University of Pennsylvania, Philadelphia; the Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (S.R., A.A., S.A.S.); and Eli Lilly, Indianapolis (J.P.D., S.C., M.C.B., J.B.)
| | - Josef Bednarik
- From the University of California, San Diego, La Jolla (A.M.); Woolcock Institute of Medical Research, Macquarie University, Royal Prince Alfred Hospital, and the University of Sydney - all in Sydney (R.R.G.); the Center of Sleep Medicine, Charité University Hospital Berlin, Berlin (I.F.); the College of Nursing, University of Illinois Chicago, Chicago (T.E.W.); the School of Nursing (T.E.W.) and Perelman School of Medicine (R.J.S.), University of Pennsylvania, Philadelphia; the Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (S.R., A.A., S.A.S.); and Eli Lilly, Indianapolis (J.P.D., S.C., M.C.B., J.B.)
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Arzt M, Munt O, Pépin JL, Heinzer R, Kübeck R, von Hehn U, Ehrsam-Tosi D, Benjafield AV, Woehrle H. Effects of Adaptive Servo-Ventilation on Quality of Life: The READ-ASV Registry. Ann Am Thorac Soc 2024; 21:651-657. [PMID: 38241012 DOI: 10.1513/annalsats.202310-908oc] [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: 10/25/2023] [Accepted: 01/18/2024] [Indexed: 04/04/2024] Open
Abstract
Rationale: Adaptive servo-ventilation (ASV) effectively treats sleep-disordered breathing, including central sleep apnea (CSA) and coexisting obstructive sleep apnea (OSA).Objectives: The prospective, multicenter European READ-ASV (Registry on the Treatment of Central and Complex Sleep-Disordered Breathing with Adaptive Servo-Ventilation) registry investigated the effects of first-time ASV therapy on disease-specific quality of life (QoL).Methods: The registry enrolled adults with CSA with or without OSA who had ASV therapy prescribed between September 2017 and March 2021. The primary endpoint was change in disease-specific QoL (Functional Outcomes of Sleep Questionnaire [FOSQ]) score between baseline and 12-month follow-up. Sleepiness determined using the Epworth Sleepiness Scale (ESS) score was a key secondary outcome. For subgroup analysis, participants were classified as symptomatic (FOSQ score < 17.9 and/or ESS score > 10) or asymptomatic (FOSQ score ⩾ 17.9 and/or ESS score ⩽ 10).Results: A total of 801 individuals (age, 67 ± 12 yr; 14% female; body mass index, 31 ± 5 kg/m2; apnea-hypopnea index, 48 ± 22/h) were enrolled; analyses include those with paired baseline and follow-up data. After 12 ± 3 months on ASV, median (interquartile range) FOSQ score had increased significantly from baseline (+0.8 [-0.2 to 2.2]; P < 0.001; n = 499). This was due to a significantly increased FOSQ score in symptomatic participants (+1.69 [0.38 to 3.05]), with little change in asymptomatic individuals (+0.11 [-0.39 to 0.54]). The median ESS score also improved significantly from baseline during ASV (-2.0 [-5.0 to 0.0]; P < 0.001).Conclusions: ASV treatment of CSA with or without coexisting OSA was associated with improvements in disease-specific QoL and daytime sleepiness, especially in individuals with sleep-disordered breathing symptoms before therapy initiation. These improvements in patient-reported outcomes support the use of ASV in this population.
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Affiliation(s)
- Michael Arzt
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | | | - Jean-Louis Pépin
- University Grenoble Alpes, Laboratoire HP2, U1300 Inserm, CHU Grenoble Alpes, Grenoble, France
| | - Raphael Heinzer
- Centre d'Investigation et de Recherche sur le Sommeil, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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Staykov E, Mann DL, Duce B, Kainulainen S, Leppänen T, Töyräs J, Azarbarzin A, Georgeson T, Sands SA, Terrill PI. Increased Flow Limitation During Sleep Is Associated With Increased Psychomotor Vigilance Task Lapses in Individuals With Suspected OSA. Chest 2024; 165:990-1003. [PMID: 38048938 DOI: 10.1016/j.chest.2023.11.031] [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: 04/18/2023] [Revised: 09/03/2023] [Accepted: 11/16/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Impaired daytime vigilance is an important consequence of OSA, but several studies have reported no association between objective measurements of vigilance and the apnea-hypopnea index (AHI). Notably, the AHI does not quantify the degree of flow limitation, that is, the extent to which ventilation fails to meet intended ventilation (ventilatory drive). RESEARCH QUESTION Is flow limitation during sleep associated with daytime vigilance in OSA? STUDY DESIGN AND METHODS Nine hundred ninety-eight participants with suspected OSA completed a 10-min psychomotor vigilance task (PVT) before same-night in-laboratory polysomnography. Flow limitation frequency (percent of flow-limited breaths) during sleep was quantified using airflow shapes (eg, fluttering and scooping) from nasal pressure airflow. Multivariable regression assessed the association between flow limitation frequency and the number of lapses (response times > 500 ms, primary outcome), adjusting for age, sex, BMI, total sleep time, depression, and smoking status. RESULTS Increased flow limitation frequency was associated with decreased vigilance: a 1-SD (35.3%) increase was associated with 2.1 additional PVT lapses (95% CI, 0.7-3.7; P = .003). This magnitude was similar to that for age, where a 1-SD increase (13.5 years) was associated with 1.9 additional lapses. Results were similar after adjusting for AHI, hypoxemia severity, and arousal severity. The AHI was not associated with PVT lapses (P = .20). In secondary exploratory analysis, flow limitation frequency was associated with mean response speed (P = .012), median response time (P = .029), fastest 10% response time (P = .041), slowest 10% response time (P = .018), and slowest 10% response speed (P = .005). INTERPRETATION Increased flow limitation during sleep was associated with decreased daytime vigilance in individuals with suspected OSA, independent of the AHI. Flow limitation may complement standard clinical metrics in identifying individuals whose vigilance impairment most likely is explained by OSA.
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Affiliation(s)
- Eric Staykov
- School of Electrical Engineering and Computer Science, The University of Queensland, Brisbane, QLD, Australia.
| | - Dwayne L Mann
- School of Electrical Engineering and Computer Science, The University of Queensland, Brisbane, QLD, Australia; Institute for Social Science Research, The University of Queensland, Brisbane, QLD, Australia
| | - Brett Duce
- Department of Respiratory & Sleep Medicine, Princess Alexandra Hospital, Brisbane, QLD, Australia; Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Samu Kainulainen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland; Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Timo Leppänen
- School of Electrical Engineering and Computer Science, The University of Queensland, Brisbane, QLD, Australia; Department of Technical Physics, University of Eastern Finland, Kuopio, Finland; Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Juha Töyräs
- School of Electrical Engineering and Computer Science, The University of Queensland, Brisbane, QLD, Australia; Department of Technical Physics, University of Eastern Finland, Kuopio, Finland; Science Service Center, Kuopio University Hospital, Kuopio, Finland
| | - Ali Azarbarzin
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, MA
| | - Thomas Georgeson
- School of Electrical Engineering and Computer Science, The University of Queensland, Brisbane, QLD, Australia; Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Scott A Sands
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, MA
| | - Philip I Terrill
- School of Electrical Engineering and Computer Science, The University of Queensland, Brisbane, QLD, Australia
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Sawatari H, Kumagai H, Kawaguchi K, Kiyohara Y, Konishi N, Arita A, Hayashi M, Shiomi T. Risk factors for collisions attributed to microsleep-related behaviors while driving in professional truck drivers. Sci Rep 2024; 14:6378. [PMID: 38493230 PMCID: PMC10944504 DOI: 10.1038/s41598-024-57021-1] [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: 08/17/2023] [Accepted: 03/13/2024] [Indexed: 03/18/2024] Open
Abstract
Sleep-disordered breathing (SDB) is prevalent among professional drivers. Although SDB is a known risk factor for truck collisions attributed to microsleep-related behaviors at the wheel (TC-MRBs), the usefulness of overnight pulse oximetry for predicting TC-MRBs is debatable. This retrospective study assessed the association between overnight pulse oximetry parameters, the Epworth Sleepiness Scale (ESS), and TC-MRBs, confirmed by dashcam footage. This study included 108 matched professional truck drivers (TC-MRBs: N = 54; non-TC-MRBs: N = 54), with a mean age and body mass index of 41.9 ± 11.3 years and 23.0 ± 3.7 kg/m2, respectively. Night-time drivers, 4% oxygen desaturation index (ODI), and nadir oxygen saturation (SpO2) were associated with TC-MRBs (odds ratio [95% confidence interval]: 25.63 [5.88-111.77], p < 0.0001; 2.74 [1.02-7.33], p = 0.045; and 3.87 [1.04-14.39], p = 0.04, respectively). The area under the curve of 4% ODI and nadir SpO2 for TC-MRBs were 0.50 and 0.57, respectively. In conclusion, night-time driving, 4% ODI, and nadir SpO2 were significantly associated with TC-MRBs in professional truck drivers. However, the sensitivity of overnight pulse oximetry parameters to predict TC-MRBs in a real-world application was poor. Therefore, combining subjective and objective assessments such as dashcam video footage may be needed to achieve high accuracy for predicting TC-MRBs among professional truck drivers.
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Affiliation(s)
- Hiroyuki Sawatari
- Department of Perioperative and Critical Care Management, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hajime Kumagai
- Department of Sleep Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 7348533, Japan.
- Sleep Disorders Center, Hiroshima University Hospital, Hiroshima, Japan.
| | - Kengo Kawaguchi
- Department of Sleep Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 7348533, Japan
| | - Yuka Kiyohara
- Department of Sleep Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 7348533, Japan
- Sleep Disorders Center, Hiroshima University Hospital, Hiroshima, Japan
| | - Noriyuki Konishi
- Department of Sleep Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 7348533, Japan
| | - Aki Arita
- Department of Sleep Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 7348533, Japan
| | - Mitsuo Hayashi
- Graduate School of Integrated Arts and Sciences, Hiroshima University, Hiroshima, Japan
| | - Toshiaki Shiomi
- Department of Sleep Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 7348533, Japan
- Sleep Disorders Center, Hiroshima University Hospital, Hiroshima, Japan
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Wada H, Nakano H, Sakurai S, Tanigawa T. Self-reported sleep tendency poorly predicts the presence of obstructive sleep apnea in commercial truck drivers. Sleep Med 2024; 115:109-113. [PMID: 38354681 DOI: 10.1016/j.sleep.2024.02.014] [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: 11/15/2023] [Revised: 01/19/2024] [Accepted: 02/05/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND AND OBJECTIVES Drowsy driving increases the risk of motor vehicle crashes in those with untreated obstructive sleep apnea (OSA). Although previous studies indicated that excessive daytime sleepiness (EDS) might not predict OSA, they were not conclusive due to their small study sizes or restricted participants to sleep clinic patients. The overall objective was to determine whether self-reported EDS can be used for case identification of OSA among commercial truck drivers. METHODS Commercial truck drivers (N = 19,699) were screened for OSA-related symptoms. EDS was determined using the Epworth Sleepiness Scale (ESS) ≥ 11 and all participants completed the home sleep apnea test using a type 4 portable monitor to derive the respiratory event index (REI). Regression analyses were used to characterize the association between EDS and REI. RESULTS EDS was associated with OSA severity (p for trend <0.001). The sensitivity and specificity values of EDS for identifying moderate-to-severe OSA (REI ≥15 events/hour) were 0.10 and 0.93, respectively, and 0.48 and 0.71 if BMI ≥25 kg/m2 was added. Those using BMI ≥25 kg/m2 with OSA-related signs yielded the best sensitivity and specificity of 0.77 and 0.50, which were not improved by the addition of EDS. CONCLUSIONS Despite the associations between EDS and OSA severity and between OSA and lethal crash, case-identification of OSA using the ESS in commercial truck drivers is poor. Thus, OSA screening strategy may need a special approach, including a hierarchical combination of screening tools (Swiss Cheese Model approach), and incorporation of home sleep apnea testing.
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Affiliation(s)
- Hiroo Wada
- Department of Public Health, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo, Tokyo, 113-8421, Japan
| | - Hiroshi Nakano
- Sleep Disorders Centre, National Hospital Organization Fukuoka National Hospital, 4-39-1 Yakatabaru, Minami-ku, Fukuoka, 811-1394, Japan
| | - Susumu Sakurai
- Department of Clinical Laboratory Science, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo, 204-8588, Japan
| | - Takeshi Tanigawa
- Department of Public Health, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo, Tokyo, 113-8421, Japan.
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Alqurashi YD, Alqarni AS, Albukhamsin FM, Alfaris AA, Alhassan BI, Ghazwani WK, Altammar AA, Aleid ME, Almutary H, Aldhahir AM, Alessy SA, Almusally R, Alsaid A, Mahmoud MI, Qutub HO, Sebastian T, Alghnam S, Polkey MI. Gender Differences in Prevalence of Sleepy Driving Among Young Drivers in Saudi Arabia. Nat Sci Sleep 2024; 16:53-62. [PMID: 38322016 PMCID: PMC10844006 DOI: 10.2147/nss.s439161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/05/2024] [Indexed: 02/08/2024] Open
Abstract
Introduction Sleepy driving is associated with Motor Vehicles Accidents (MVAs). In Saudi Arabia, previous studies have addressed this association among men only. Therefore, the aim of this study was to compare the prevalence of sleepy driving and associated factors between genders. Methods In a cross-sectional study design, we offered a self-administered online questionnaire to 3272 participants from different regions of Saudi Arabia. The questionnaire included 46 questions covering sociodemographics, driving habits, sleeping habits, Epworth Sleepiness Scale, and Berlin questionnaire to assess the risk of sleep apnea. Univariable and multivariable logistic regression analyses were used to determine the significant factors associated with self-reported sleepy driving, defined as operating a motor vehicle while feeling sleepy in the preceding six months. Results Of the 3272 invitees, 2958 (90%) completed the questionnaire, of which 1414 (48%) were women. The prevalence of sleepy driving in the preceding six months was 42% (men: 50% and women 32%, p<0.001). Specifically, participants reported the following: 12% had had to stop their vehicle due to sleepiness (men: 16.2% and women 7%, p<0.001), 12.4% reported near-miss accidents (men: 16.2% and women: 8.2%, p<0.001) and 4.2% reported an accident due to sleepiness (men: 4.3% and women: 4%, p=0.645). In multivariable analysis, being male, younger age, use of any type of medications, shift working, working more than 12 hours per day, driving duration of 3-5 hours per day, driving experience of more than 2 years, excessive daytime sleepiness and risk of having obstructive sleep apnea were all associated with increased likelihood of falling asleep while driving in the preceding 6 months. Conclusion Sleepy driving and MVA are prevalent in both gender but was higher in men. Future public health initiatives should particularly focus on men, since men reported a greater likelihood of both sleep-related MVA and "near miss" events.
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Affiliation(s)
- Yousef D Alqurashi
- Respiratory Care Department, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Abdullah S Alqarni
- Respiratory Care Department, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Faisal Maher Albukhamsin
- Respiratory Care Department, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Abdullah Abdulaziz Alfaris
- Respiratory Care Department, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Bader Ibrahim Alhassan
- Respiratory Care Department, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Waleed Khalid Ghazwani
- Respiratory Care Department, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Abdulaziz Abdulrahman Altammar
- Respiratory Care Department, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mutlaq Eid Aleid
- Respiratory Care Department, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Hayfa Almutary
- Medical Surgical Nursing Department, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abdulelah M Aldhahir
- Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Saleh A Alessy
- Department of Public Health, College of Health Sciences, Saudi Electronic University, Jeddah, Saudi Arabia
| | - Rayyan Almusally
- Internal Medicine Department, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Abir Alsaid
- Internal Medicine Department, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Mahmoud Ibrahim Mahmoud
- Internal Medicine Department, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Hatem Othman Qutub
- Internal Medicine Department, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Tunny Sebastian
- Clinical Nutrition Department, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Suliman Alghnam
- Population Health Section-King Abdullah International Medical Research Center (KAIMRC), King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia
| | - Michael I Polkey
- Royal Brompton Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
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8
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Holtstrand Hjälm H, Thunström E, Glantz H, Karlsson M, Celik Y, Peker Y. Obstructive sleep apnea severity and prevalent atrial fibrillation in a sleep clinic cohort with versus without excessive daytime sleepiness. Sleep Med 2023; 112:63-69. [PMID: 37806037 DOI: 10.1016/j.sleep.2023.09.012] [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: 07/14/2023] [Revised: 09/11/2023] [Accepted: 09/12/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is associated with atrial fibrillation (AF) in cardiac cohorts. Less is known regarding the magnitude of this association in a sleep clinic cohort with vs. without excessive daytime sleepiness (EDS). OBJECTIVES To explore the association of OSA severity with AF in a sleep clinic cohort stratified by EDS. PATIENTS AND METHODS All consecutive adults (n = 3814) admitted to the Skaraborg Hospital, Sweden between Jan 2005 and December 2011 were registered in a local database, and the follow-up ended in December 2018. OSA was defined as an apnea-hypopnea index (AHI) ≥5 events/h. Mild OSA was defined as AHI ≥5 & AHI<15 events/h; moderate OSA as AHI ≥15 & AHI<30 events/h; and severe OSA as AHI ≥30 events/h. EDS was defined as an Epworth Sleepiness Scale score ≥11. We conducted cross-sectional analyzes of the prevalent AF across the OSA severity categories and logistic regression analyzes stratified by EDS. RESULTS In all, 202 patients (5.3%) had AF at baseline, 1.6% in no-OSA, 3.9% in mild OSA, 5.2% in moderate OSA, and 7.6% in severe OSA, respectively (p < 0.001). The stratified analyzes revealed that patients with severe OSA without EDS had an increased risk for prevalent AF (OR 2.54, 95% CI 1.05-6.16; p = 0.039) independent of the confounding factors. CONCLUSIONS There was an independent dose-response relationship between OSA and prevalent AF among the non-sleepy phenotype in this sleep clinic cohort. Since adherence to OSA treatment is challenging in the absence of EDS, these patients may have increased risk for adverse cardiovascular outcomes.
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Affiliation(s)
- Henrik Holtstrand Hjälm
- Department of Molecular and Clinical Medicine/Cardiology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Erik Thunström
- Department of Molecular and Clinical Medicine/Cardiology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Helena Glantz
- Department of Internal Medicine, Skaraborg Hospital, Lidköping, Sweden
| | - Martin Karlsson
- Department of Internal Medicine, Skaraborg Hospital, Lidköping, Sweden
| | - Yeliz Celik
- Department of Pulmonary Medicine, Koc University School of Medicine & Koc University Research Center for Translational Medicine (KUTTAM), Istanbul, Turkey
| | - Yüksel Peker
- Department of Molecular and Clinical Medicine/Cardiology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Pulmonary Medicine, Koc University School of Medicine & Koc University Research Center for Translational Medicine (KUTTAM), Istanbul, Turkey; Division of Sleep and Circadian Disorders, Brigham and Women's Hospital & Harvard Medical School, Boston, MA, USA; Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Department of Clinical Sciences, Respiratory Medicine and Allergology, Faculty of Medicine, Lund University, Lund, Sweden
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9
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Bonsignore MR. Adaptive responses to chronic intermittent hypoxia: contributions from the European Sleep Apnoea Database (ESADA) Cohort. J Physiol 2023; 601:5467-5480. [PMID: 37218069 DOI: 10.1113/jp284108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/18/2023] [Indexed: 05/24/2023] Open
Abstract
Obstructive sleep apnoea (OSA) is a common disease in the general population, and is associated with increased cardiovascular risk and several comorbidities. Obesity favours upper airway collapsibility, but other pathophysiological traits have been identified, i.e. upper airway muscle activity, modulation of the respiratory drive, and the arousal threshold. OSA causes chronic intermittent hypoxia, inflammatory activation and autonomic imbalance with diurnal and nocturnal sympathetic hyperactivity. Disentangling so many components to investigate the pathogenesis of OSA's consequences is very hard clinically. However, albeit imperfect, clinical medicine constitutes a major source of inspiration for basic research, and a mutual exchange of information is essential between clinicians and physiologists to improve our understanding of disease states. OSA is no exception, and this narrative review will summarize the results of clinical studies performed over the years by the European Sleep Apnoea Database (ESADA) Study Group, to explore the variables linked to markers of intermittent hypoxia as opposed to the traditional assessment of OSA severity based on the frequency of respiratory events during sleep (the Apnoea Hypopnoea Index). The results of the clinical studies indicate that intermittent hypoxia variables are associated with several comorbidities, although evidence of a cause-effect relationship is still missing in many cases. It is also possible that adaptive rather than maladaptive responses could be evoked by intermittent hypoxia. The intensity, duration and frequency of intermittent hypoxia episodes causing adaptive rather than maladaptive responses, and their clinical implications, deserve further investigation.
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Affiliation(s)
- Maria R Bonsignore
- PROMISE Department, University of Palermo, Palermo, Italy
- Sleep Disordered Breathing Clinic, Division of Pneumology, V. Cervello Hospital, Palermo, Italy
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10
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Alakörkkö I, Törmälehto S, Leppänen T, McNicholas WT, Arnardottir ES, Sund R. The economic cost of obstructive sleep apnea: A systematic review. Sleep Med Rev 2023; 72:101854. [PMID: 37939650 DOI: 10.1016/j.smrv.2023.101854] [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: 02/28/2023] [Revised: 09/15/2023] [Accepted: 09/18/2023] [Indexed: 11/10/2023]
Abstract
Obstructive sleep apnea (OSA) is a common disease associated with a high prevalence of costly comorbidities and accidents that add to the disease's economic impact. Although more attention has been focused on OSA in recent years, no previous systematic reviews have synthesized findings from existing studies that provide estimates of the economic cost of OSA. This study aims to summarize the findings of existing studies that provide estimates of the cost of OSA. Two bibliographic databases, PubMed and Scopus, were used to identify articles on the costs of OSA. The systematic literature review identified 5,938 publications, of which 31 met the inclusion criteria. According to the results, adjusted for inflation and converted to euros, the annual cost per patient ranged from €236 (the incremental cost of OSA) for New Zealand to €28,267 for the United States. The total annual cost per patient in Europe ranged from €1,669 to €5,186. OSA causes a significant burden on society, and OSA-related costs increase many years before the diagnosis and remain elevated for a long time after the diagnosis. Despite some well-conducted studies, the cost estimates for OSA are uncertain and specific to the context in which the study was conducted.
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Affiliation(s)
- Ida Alakörkkö
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
| | - Soili Törmälehto
- School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland
| | - Timo Leppänen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland; Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland; School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
| | - Walter T McNicholas
- Department of Respiratory and Sleep Medicine, St. Vincent's Hospital Group, School of Medicine, University College Dublin, Dublin, Ireland
| | - Erna S Arnardottir
- Reykjavik University Sleep Institute, School of Technology, Reykjavik University, Reykjavik, Iceland
| | - Reijo Sund
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
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11
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Kumagai H, Tsuda H, Kawaguchi K, Sawatari H, Kiyohara Y, Konishi N, Taniyama Y, Takaoka T, Shiomi T. Truck collisions attributed to falling asleep at the wheel in two commercial drivers prescribed oral appliance therapy for obstructive sleep apnea. J Clin Sleep Med 2023; 19:2117-2122. [PMID: 37551827 PMCID: PMC10692933 DOI: 10.5664/jcsm.10758] [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: 05/18/2023] [Revised: 08/03/2023] [Accepted: 08/03/2023] [Indexed: 08/09/2023]
Abstract
Falling asleep at the wheel is attributed to sleepiness, and obstructive sleep apnea is a significant cause of sleepiness that increases the risk of motor vehicle collisions due to falling asleep at the wheel. Although continuous positive airway pressure therapy for obstructive sleep apnea reduces the risk of motor vehicle collisions, similar evidence for alternatives such as oral appliance therapy is lacking. We discuss two truck collisions attributed to microsleep confirmed with dashcam video footage of commercial drivers with obstructive sleep apnea. Our results highlight the current situation where there is insufficient evidence for the prevention and reduction of the risk of motor vehicle collisions by oral appliance therapy, objective adherence monitoring of oral appliance therapy, and effectiveness confirmation tests. Therefore, it is suggested that for commercial truck drivers who require a high level of driving safety, careful selection for oral appliance therapy, systematic follow-up, and monitoring of the driver and truck status with dashcam video footage are crucial. CITATION Kumagai H, Tsuda H, Kawaguchi K, et al. Truck collisions attributed to falling asleep at the wheel in two commercial drivers prescribed oral appliance therapy for obstructive sleep apnea. J Clin Sleep Med. 2023;19(12):2117-2122.
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Affiliation(s)
- Hajime Kumagai
- Department of Sleep Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
- Sleep Disorders Center, Hiroshima University Hospital, Hiroshima, Japan
| | - Hiroko Tsuda
- Department of Sleep Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
- General Dentistry, Kyushu University Hospital, Fukuoka, Japan
| | - Kengo Kawaguchi
- Department of Sleep Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hiroyuki Sawatari
- Department of Perioperative and Critical Care Management, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yuka Kiyohara
- Department of Sleep Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
- Sleep Disorders Center, Hiroshima University Hospital, Hiroshima, Japan
| | - Noriyuki Konishi
- Department of Sleep Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yukari Taniyama
- Department of Internal Medicine, Kagoshima Takaoka Hospital, Kagoshima, Japan
| | - Toshio Takaoka
- Department of Internal Medicine, Kagoshima Takaoka Hospital, Kagoshima, Japan
| | - Toshiaki Shiomi
- Department of Sleep Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
- Sleep Disorders Center, Hiroshima University Hospital, Hiroshima, Japan
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12
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Vu HM, Tran TH, Dang AK, Hoang TN, Nguyen CT, Nguyen HLT, Latkin CA, Ho CSH, Ho RCM. Sleep disorders among patients suffering from road traffic injuries in an urban setting of Vietnam: an exploratory study. Sci Rep 2023; 13:11496. [PMID: 37460778 PMCID: PMC10352290 DOI: 10.1038/s41598-023-38693-7] [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: 07/05/2022] [Accepted: 07/12/2023] [Indexed: 07/20/2023] Open
Abstract
Sleep quality is an important indicator of treatment outcome for patients with traffic accident injuries. In Vietnam, the impacts of injury on sleep status are usually amplified in urban areas due to disproportionate distribution of mental care services between the city and less developed settings. Our study investigated deterioration in sleep quality and identified associated demographic factors among traffic injury patients in an small urban setting of Vietnam. A cross-sectional study was conducted among 408 patients in one provincial hospital and five district hospitals in Thai Binh, Vietnam from October to December 2018. A structured questionnaire was designed based on 3 standardized scales: Health-related Quality of Life, the Pittsburgh Sleep Quality Index and the Kessler Scale. Face-to-face interviews and medical records were conducted by trained health professionals on patients hospitalized in the Trauma-Orthopedic/Burn Department and Surgery and General Department. About 16.9% of respondents had sleep disturbances, and there was a statistically significant difference between age group (p < 0.01), education level (p < 0.01), and monthly household income (p < 0.01) between participants who with and without sleep disturbances. Furthermore, more than half (50.7%) of respondents sleep less than 5 h per day, while 18.7% of the sampled also reported that the habitual sleep efficiency was below 85%. Current results indicated that people being female, suffering from traumatic brain injury, being comatose at hospitalization, and having higher psychological distress scores were more likely to suffer from sleep problems. Our study is one of the first evidence in Vietnam to assess sleep disturbances in road traffic injury patients and their correlated factors. It is important to identify patients who are at risk of sleep disturbances based on socio-demographic and clinical characteristics, as well as psychological distress status. Therefore, a holistic approach should be taken to include sleep quality and psychological state in the treatment process and outcome assessment for road traffic injury patients.
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Affiliation(s)
- Hai Minh Vu
- Department of Trauma, Thai Binh University of Medicine and Pharmacy, Thai Binh, 410000, Vietnam
| | - Tung Hoang Tran
- Institute of Orthopaedic and Trauma Surgery, Vietnam-Germany Hospital, Hanoi, 100000, Vietnam
| | - Anh Kim Dang
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, 100000, Vietnam
| | - Trong Nang Hoang
- Department of Ophthalmology, Thai Binh University of Medicine and Pharmacy, Thai Binh, 410000, Vietnam
| | - Cuong Tat Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang, 550000, Vietnam.
- Faculty of Medicine, Duy Tan University, Da Nang, 550000, Vietnam.
| | - Huong Lan Thi Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang, 550000, Vietnam
- Faculty of Medicine, Duy Tan University, Da Nang, 550000, Vietnam
| | - Carl A Latkin
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Cyrus S H Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119228, Singapore
| | - Roger C M Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119228, Singapore
- Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore, 119077, Singapore
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13
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McNicholas WT, Arnardottir ES, Leppänen T, Schiza S, Randerath W. CPAP therapy for obstructive sleep apnoea: persisting challenges in outcome assessment. Eur Respir J 2023; 62:2300182. [PMID: 37474148 DOI: 10.1183/13993003.00182-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/27/2023] [Indexed: 07/22/2023]
Affiliation(s)
- Walter T McNicholas
- School of Medicine, University College Dublin, Dublin, Ireland
- Department of Respiratory and Sleep Medicine, St Vincent's Hospital Group, Dublin, Ireland
| | - Erna Sif Arnardottir
- The Reykjavik University Sleep Institute, Reykjavik University, Reykjavik, Iceland
- Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - Timo Leppänen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
| | - Sophia Schiza
- Sleep Disorders Center, Dept of Respiratory Medicine, Medical School, University of Crete, Heraklion, Greece
| | - Winfried Randerath
- Bethanien Hospital, Clinic of Pneumology and Allergology, Center for Sleep Medicine and Respiratory Care, Institute of Pneumology at the University of Cologne, Solingen, Germany
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14
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Howarth TP, Karhu T, Kainulainen S, Chen X, Mahamid A, Töyräs J, Leppänen T. Oxygen resaturation rate is significantly associated with objectively assessed excessive daytime sleepiness in suspected obstructive sleep apnoea patients. Sleep Med 2023; 107:171-178. [PMID: 37187080 DOI: 10.1016/j.sleep.2023.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/22/2023] [Accepted: 04/27/2023] [Indexed: 05/17/2023]
Abstract
INTRODUCTION Commonly utilised metrics such as the apnoea-hypopnoea index show limited correlation to excessive daytime sleepiness (EDS). Oxygen desaturation parameters show better predictive power, however oxygen resaturation parameters have not yet been investigated. Oxygen resaturation may represent increased cardiovascular fitness and thus we hypothesized that a higher resaturation rate would be protective against EDS. METHODS Oxygen saturation parameters were computed via ABOSA software for adult patients referred for polysomnography and multiple sleep latency test in Israel Loewenstein hospital 2001-2011. EDS was defined as a mean sleep latency (MSL) below 8 min. RESULTS 1629 patients (75% male, 53% obese, median age of 54 years) were included for analysis. The average desaturation event nadir was 90.4% and resaturation rate 0.59%/second. Median MSL was 9.6 min, and 606 patients met criteria for EDS. Patients who were younger, female, and with larger desaturations had significantly higher resaturation rates (p < 0.001). In multivariate models, adjusted for age, sex, body mass index, and average desaturation depth, resaturation rate showed a significant negative correlation with MSL (z-score standardised beta, -1 (95%CI -0.49, -1.52)), and significantly increased odds ratio (OR) of EDS (OR, 1.28 (95%CI 1.07, 1.53)). The beta associated with resaturation rate was larger, though non-significantly, than that of desaturation depth (difference 0.36 (95% CI -1.34, 0.62), p = 0.470). CONCLUSION Oxygen resaturation parameters show significant associations with objectively assessed EDS independent of desaturation parameters. Thus, resaturation and desaturation parameters may reflect differing underlying mechanistic pathways and both be considered novel and appropriate markers for assessing sleep-disordered breathing and associated outcomes.
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Affiliation(s)
- Timothy P Howarth
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland; Darwin Respiratory and Sleep Health, Darwin Private Hospital, Darwin, Australia; College of Health and Human Sciences, Charles Darwin University, Darwin, Australia.
| | - Tuomas Karhu
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland; Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Samu Kainulainen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland; Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Xin Chen
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
| | - Alaa Mahamid
- Sleep Disorders Unit, Loewenstein Hospital-Rehabilitation Center, Raanana, Israel
| | - Juha Töyräs
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland; School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia; Science Service Center, Kuopio University Hospital, Kuopio, Finland
| | - Timo Leppänen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland; Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland; School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
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Tsoutsi V, Papadakaki M, Yannis G, Pavlou D, Basta M, Chliaoutakis J, Dikeos D. Driving Behaviour in Depression Based on Subjective Evaluation and Data from a Driving Simulator. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20085609. [PMID: 37107891 PMCID: PMC10138476 DOI: 10.3390/ijerph20085609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/23/2023] [Accepted: 04/13/2023] [Indexed: 05/10/2023]
Abstract
Road traffic collisions are a major issue for public health. Depression is characterized by mental, emotional and executive dysfunction, which may have an impact on driving behaviour. Patients with depression (N = 39) and healthy controls (N = 30) were asked to complete questionnaires and to drive on a driving simulator in different scenarios. Driving simulator data included speed, safety distance from the preceding vehicle and lateral position. Demographic and medical information, insomnia (Athens Insomnia Scale, AIS), sleepiness (Epworth Sleepiness Scale, ESS), fatigue (Fatigue Severity Scale, FSS), symptoms of sleep apnoea (StopBang Questionnaire) and driving (Driver Stress Inventory, DSI and Driver Behaviour Questionnaire, DBQ) were assessed. Gender and age influenced almost all variables. The group of patients with depression did not differ from controls regarding driving behaviour as assessed through questionnaires; on the driving simulator, patients kept a longer safety distance. Subjective fatigue was positively associated with aggression, dislike of driving, hazard monitoring and violations as assessed by questionnaires. ESS and AIS scores were positively associated with keeping a longer safety distance and with Lateral Position Standard Deviation (LPSD), denoting lower ability to keep a stable position. It seems that, although certain symptoms of depression (insomnia, fatigue and somnolence) may affect driving performance, patients drive more carefully eliminating, thus, their impact.
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Affiliation(s)
- Vagioula Tsoutsi
- First Department of Psychiatry, Medical School, National & Kapodistrian University of Athens, Eginition Hospital, 11528 Athens, Greece;
- Laboratory of Health and Road Safety, Department of Social Work, School of Health Sciences, Hellenic Mediterranean University, 71410 Crete, Greece; (M.P.); (J.C.)
- Correspondence:
| | - Maria Papadakaki
- Laboratory of Health and Road Safety, Department of Social Work, School of Health Sciences, Hellenic Mediterranean University, 71410 Crete, Greece; (M.P.); (J.C.)
| | - George Yannis
- Department of Transportation Planning and Engineering, School of Civil Engineering, National Technical University of Athens, 15773 Athens, Greece; (G.Y.); (D.P.)
| | - Dimosthenis Pavlou
- Department of Transportation Planning and Engineering, School of Civil Engineering, National Technical University of Athens, 15773 Athens, Greece; (G.Y.); (D.P.)
| | - Maria Basta
- Department of Psychiatry, University Hospital of Heraklion, 71500 Crete, Greece;
| | - Joannes Chliaoutakis
- Laboratory of Health and Road Safety, Department of Social Work, School of Health Sciences, Hellenic Mediterranean University, 71410 Crete, Greece; (M.P.); (J.C.)
| | - Dimitris Dikeos
- First Department of Psychiatry, Medical School, National & Kapodistrian University of Athens, Eginition Hospital, 11528 Athens, Greece;
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McNicholas WT, Philip P. CPAP therapy for excessive daytime sleepiness and accident risk in obstructive sleep apnoea. THE LANCET. RESPIRATORY MEDICINE 2023; 11:222-224. [PMID: 36863784 DOI: 10.1016/s2213-2600(22)00503-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 12/09/2022] [Indexed: 03/04/2023]
Affiliation(s)
- Walter T McNicholas
- School of Medicine, University College Dublin, Dublin, Ireland; Department of Respiratory and Sleep Medicine, St Vincent's Hospital Group, Dublin, Ireland.
| | - Pierre Philip
- University of Bordeaux, SANPSY, Bordeaux, France; Centre National de la Recherche Scientifique, SANPSY, UMR 6033, Bordeaux, France; Centre Hospitalier Universitaire Bordeaux, Service Universitaire de Médecine du sommeil, Bordeaux, France
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Maierean AD, Vulturar DM, Chetan IM, Crivii CB, Bala C, Vesa SC, Todea DA. The Management of Obstructive Sleep Apnea Patients during the COVID-19 Pandemic as a Public Health Problem-Interactions with Sleep Efficacy and Mental Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4313. [PMID: 36901329 PMCID: PMC10002103 DOI: 10.3390/ijerph20054313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 02/15/2023] [Accepted: 02/25/2023] [Indexed: 06/18/2023]
Abstract
With the onset of the COVID-19 outbreak, it was stipulated that patients with obstructive sleep apnea (OSA) may have a greater risk of morbidity and mortality and may even experience changes in their mental health. The aim of the current study is to evaluate how patients managed their disease (sleep apnea) during the COVID-19 pandemic, to determine if continuous positive airway pressure (CPAP) usage changed after the beginning of the pandemic, to compare the stress level with the baseline, and to observe if any modifications are related to their individual characteristics. The present studies highlight the level of anxiety, which was high among patients with OSA during the COVID-19 pandemic (p < 0.05), with its influence on weight control (62.5% of patients with high levels of stress gained weight) and sleep schedule (82.6% reported a change in sleep schedule). Patients with severe OSA and high levels of stress increased their CPAP usage (354.5 min/night vs. 399.5 min/night during the pandemic, p < 0.05). To conclude, in OSA patients, the presence of the pandemic led to a greater level of anxiety, changes in sleep schedule and weight gain because of job loss, isolation, and emotional changes, influencing mental health. A possible solution, telemedicine, could become a cornerstone in the management of these patients.
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Affiliation(s)
- Anca Diana Maierean
- Department of Pneumology, Iuliu Hatieganu University of Medicine and Pharmacy, 400332 Cluj-Napoca, Romania
| | - Damiana Maria Vulturar
- Department of Pneumology, Iuliu Hatieganu University of Medicine and Pharmacy, 400332 Cluj-Napoca, Romania
| | - Ioana Maria Chetan
- Department of Pneumology, Iuliu Hatieganu University of Medicine and Pharmacy, 400332 Cluj-Napoca, Romania
| | - Carmen-Bianca Crivii
- Morphological Sciences Department, Iuliu Hațieganu University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania
| | - Cornelia Bala
- Department of Diabetes and Nutrition, Iuliu Hațieganu University of Medicine and Pharmacy, 400332 Cluj-Napoca, Romania
| | - Stefan Cristian Vesa
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Iuliu Hatieganu University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania
| | - Doina Adina Todea
- Department of Pneumology, Iuliu Hatieganu University of Medicine and Pharmacy, 400332 Cluj-Napoca, Romania
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18
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Riha RL, Celmina M, Cooper B, Hamutcu-Ersu R, Kaditis A, Morley A, Pataka A, Penzel T, Roberti L, Ruehland W, Testelmans D, van Eyck A, Grundström G, Verbraecken J, Randerath W. ERS technical standards for using type III devices (limited channel studies) in the diagnosis of sleep disordered breathing in adults and children. Eur Respir J 2023; 61:13993003.00422-2022. [PMID: 36609518 DOI: 10.1183/13993003.00422-2022] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 07/27/2022] [Indexed: 02/01/2023]
Abstract
For more than three decades, type III devices have been used in the diagnosis of sleep disordered breathing in supervised as well as unsupervised settings. They have satisfactory positive and negative predictive values for detecting obstructive and central sleep apnoea in populations with moderately high pre-test probability of symptoms associated with these events. However, standardisation of commercially available type III devices has never been undertaken and the technical specifications can vary widely. None have been subjected to the same rigorous processes as most other diagnostic modalities in the medical field. Although type III devices do not include acquisition of electroencephalographic signals overnight, the minimum number of physical sensors required to allow for respiratory event scoring using standards outlined by the American Academy of Sleep Medicine remains debatable. This technical standard summarises data on type III studies published since 2007 from multiple perspectives in both adult and paediatric sleep practice. Most importantly, it aims to provide a framework for considering current type III device limitations in the diagnosis of sleep disordered breathing while raising research- and practice-related questions aimed at improving our use of these devices in the present and future.
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Affiliation(s)
- Renata L Riha
- Department of Sleep Medicine, The Royal Infirmary Edinburgh, Edinburgh, UK
| | - Marta Celmina
- Epilepsy and Sleep Medicine Centre, Children's Clinical University Hospital, Riga, Latvia
| | - Brendan Cooper
- Lung Function and Sleep, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, UK
| | | | - Athanasios Kaditis
- Division of Paediatric Pulmonology and Sleep Disorders Laboratory, First Department of Pediatrics, National and Kapodistrian University of Athens School of Medicine and Agia Sofia Children's Hospital, Athens, Greece
| | | | - Athanasia Pataka
- Respiratory Failure Unit, G. Papanikolaou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Thomas Penzel
- Department of Cardiology and Angiology, Interdisciplinary Center of Sleep Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Warren Ruehland
- Institute for Breathing and Sleep, Austin Health, Melbourne, Australia
| | - Dries Testelmans
- Department of Pneumology, University Hospitals Leuven, Leuven, Belgium
| | - Annelies van Eyck
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp (Edegem), Belgium
- Department of Pediatrics, Antwerp University Hospital, Antwerp (Edegem), Belgium
| | | | - Johan Verbraecken
- Antwerp University Hospital and University of Antwerp, Edegem (Antwerp), Belgium
| | - Winfried Randerath
- Bethanien Hospital, Clinic of Pneumology and Allergology, Center for Sleep Medicine and Respiratory Care, Institute of Pneumology at the University of Cologne, Solingen, Germany
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19
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Farré R, Almendros I, Martínez-García MÁ, Gozal D. Experimental Models to Study End-Organ Morbidity in Sleep Apnea: Lessons Learned and Future Directions. Int J Mol Sci 2022; 23:ijms232214430. [PMID: 36430904 PMCID: PMC9696027 DOI: 10.3390/ijms232214430] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/17/2022] [Accepted: 11/18/2022] [Indexed: 11/22/2022] Open
Abstract
Sleep apnea (SA) is a very prevalent sleep breathing disorder mainly characterized by intermittent hypoxemia and sleep fragmentation, with ensuing systemic inflammation, oxidative stress, and immune deregulation. These perturbations promote the risk of end-organ morbidity, such that SA patients are at increased risk of cardiovascular, neurocognitive, metabolic and malignant disorders. Investigating the potential mechanisms underlying SA-induced end-organ dysfunction requires the use of comprehensive experimental models at the cell, animal and human levels. This review is primarily focused on the experimental models employed to date in the study of the consequences of SA and tackles 3 different approaches. First, cell culture systems whereby controlled patterns of intermittent hypoxia cycling fast enough to mimic the rates of episodic hypoxemia experienced by patients with SA. Second, animal models consisting of implementing realistic upper airway obstruction patterns, intermittent hypoxia, or sleep fragmentation such as to reproduce the noxious events characterizing SA. Finally, human SA models, which consist either in subjecting healthy volunteers to intermittent hypoxia or sleep fragmentation, or alternatively applying oxygen supplementation or temporary nasal pressure therapy withdrawal to SA patients. The advantages, limitations, and potential improvements of these models along with some of their pertinent findings are reviewed.
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Affiliation(s)
- Ramon Farré
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, 08036 Barcelona, Spain
- CIBER de Enfermedades Respiratorias, 1964603 Madrid, Spain
- Institut Investigacions Biomediques August Pi Sunyer, 08036 Barcelona, Spain
- Correspondence: (R.F.); (D.G.)
| | - Isaac Almendros
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, 08036 Barcelona, Spain
- CIBER de Enfermedades Respiratorias, 1964603 Madrid, Spain
- Institut Investigacions Biomediques August Pi Sunyer, 08036 Barcelona, Spain
| | - Miguel-Ángel Martínez-García
- CIBER de Enfermedades Respiratorias, 1964603 Madrid, Spain
- Pneumology Department, University and Polytechnic La Fe Hospital, 46026 Valencia, Spain
| | - David Gozal
- Department of Child Health and Child Health Research Institute, School of Medicine, The University of Missouri, Columbia, MO 65201, USA
- Correspondence: (R.F.); (D.G.)
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20
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Craig S, Pépin JL, Randerath W, Caussé C, Verbraecken J, Asin J, Barbé F, Bonsignore MR. Investigation and management of residual sleepiness in CPAP-treated patients with obstructive sleep apnoea: the European view. Eur Respir Rev 2022; 31:31/164/210230. [PMID: 35613742 DOI: 10.1183/16000617.0230-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 03/28/2022] [Indexed: 02/06/2023] Open
Abstract
Excessive daytime sleepiness (EDS) is a major symptom of obstructive sleep apnoea (OSA), defined as the inability to stay awake during the day. Its clinical descriptors remain elusive, and the pathogenesis is complex, with disorders such as insufficient sleep and depression commonly associated. Subjective EDS can be evaluated using the Epworth Sleepiness Scale, in which the patient reports the probability of dozing in certain situations; however, its reliability has been challenged. Objective tests such as the multiple sleep latency test or the maintenance of wakefulness test are not commonly used in patients with OSA, since they require nocturnal polysomnography, daytime testing and are expensive. Drugs for EDS are available in the United States but were discontinued in Europe some time ago. For European respiratory physicians, treatment of EDS with medication is new and they may lack experience in pharmacological treatment of EDS, while novel wake-promoting drugs have been recently developed and approved for clinical use in OSA patients in the USA and Europe. This review will discuss 1) the potential prognostic significance of EDS in OSA patients at diagnosis, 2) the prevalence and predictors of residual EDS in treated OSA patients, and 3) the evolution of therapy for EDS specifically for Europe.
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Affiliation(s)
- Sonya Craig
- Liverpool Sleep and Ventilation Centre, University Hospital Aintree, Liverpool University Foundation Trust, Liverpool, UK
| | - Jean-Louis Pépin
- University Grenoble Alpes, HP2 Laboratory INSERM U1042, Grenoble, France
| | - Winfried Randerath
- Bethanien Hospital, Institute of Pneumonology, University of Cologne, Solingen, Germany
| | | | - Johan Verbraecken
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital and University of Antwerp, Edegem-Antwerp, Belgium
| | - Jerryll Asin
- Amphia Ziekenlius, AFD, Longziekten, Breda, The Netherlands
| | - Ferran Barbé
- Respiratory Dept, Institut Ricerca Biomedica de Vilanova, Lleida, Spain
| | - Maria R Bonsignore
- PROMISE Dept, University of Palermo; Institute for Biomedical Research and Innovation (IRIB), National Research Council (CNR), Palermo, Italy
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21
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Bonsignore MR, Lombardi C, Lombardo S, Fanfulla F. Epidemiology, Physiology and Clinical Approach to Sleepiness at the Wheel in OSA Patients: A Narrative Review. J Clin Med 2022; 11:jcm11133691. [PMID: 35806976 PMCID: PMC9267880 DOI: 10.3390/jcm11133691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/22/2022] [Accepted: 06/24/2022] [Indexed: 11/16/2022] Open
Abstract
Sleepiness at the wheel (SW) is recognized as an important factor contributing to road traffic accidents, since up to 30 percent of fatal accidents have been attributed to SW. Sleepiness-related motor vehicle accidents may occur both from falling asleep while driving and from behavior impairment attributable to sleepiness. SW can be caused by various sleep disorders but also by behavioral factors such as sleep deprivation, shift work and non-restorative sleep, as well as chronic disease or the treatment with drugs that negatively affect the level of vigilance. An association between obstructive sleep apnea (OSA) and motor vehicle accidents has been found, with an increasing risk in OSA patients up to sevenfold in comparison to the general population. Regular treatment with continuous positive airway pressure (CPAP) relieves excessive daytime sleepiness and reduces the crash risk. Open questions still remain about the physiological and clinical determinants of SW in OSA patients: the severity of OSA in terms of the frequency of respiratory events (apnea hypopnea index, AHI) or hypoxic load, the severity of daytime sleepiness, concomitant chronic sleep deprivation, comorbidities, the presence of depressive symptoms or chronic fatigue. Herein, we provide a review addressing the epidemiological, physiological and clinical aspects of SW, with a particular focus on the methods to recognize those patients at risk of SW.
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Affiliation(s)
- Maria R. Bonsignore
- PROMISE Department, University of Palermo, 90127 Palermo, Italy
- Sleep Clinic, Division of Respiratory Medicine, Ospedali Riuniti Villa Sofia-Cervello, 90146 Palermo, Italy;
- Institute for Biomedical Research and Innovation (IRIB), National Research Council (CNR), 90146 Palermo, Italy
- Correspondence:
| | - Carolina Lombardi
- Sleep Disorders Center, Department of Cardiology, San Luca Hospital, Istituto Auxologico Italiano, IRCCS, 20145 Milan, Italy;
- Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Simone Lombardo
- Sleep Clinic, Division of Respiratory Medicine, Ospedali Riuniti Villa Sofia-Cervello, 90146 Palermo, Italy;
| | - Francesco Fanfulla
- Respiratory Function and Sleep Unit, Maugeri Clinical and Scientific Institute of Pavia and Montescano, 27100 Pavia, Italy;
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22
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Randerath W, de Lange J, Hedner J, Ho JPT, Marklund M, Schiza S, Steier J, Verbraecken J. Current and Novel Treatment Options for OSA. ERJ Open Res 2022; 8:00126-2022. [PMID: 35769417 PMCID: PMC9234427 DOI: 10.1183/23120541.00126-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 04/24/2022] [Indexed: 12/03/2022] Open
Abstract
Obstructive sleep apnoea is a challenging medical problem due to its prevalence, its impact on quality of life and performance in school and professionally, the implications for risk of accidents, and comorbidities and mortality. Current research has carved out a broad spectrum of clinical phenotypes and defined major pathophysiological components. These findings point to the concept of personalised therapy, oriented on both the distinct clinical presentation and the most relevant pathophysiology in the individual patient. This leads to questions of whether sufficient therapeutic options other than positive airway pressure (PAP) alone are available, for which patients they may be useful, if there are specific indications for single or combined treatment, and whether there is solid scientific evidence for recommendations. This review describes our knowledge on PAP and non-PAP therapies to address upper airway collapsibility, muscle responsiveness, arousability and respiratory drive. The spectrum is broad and heterogeneous, including technical and pharmaceutical options already in clinical use or at an advanced experimental stage. Although there is an obvious need for more research on single or combined therapies, the available data demonstrate the variety of effective options, which should replace the unidirectional focus on PAP therapy. The analysis of individual pathophysiological composition opens new directions towards personalised treatment of OSA, focusing not only on pharyngeal dilation, but also on technical or pharmaceutical interventions on muscle function or breathing regulationhttps://bit.ly/3sayhkd
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23
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Deboer T, Arnardóttir ES, Landolt H, Luppi PH, McNicholas WT, Pevernagie D, Plazzi G. The European Sleep Research Society – past, present and future. J Sleep Res 2022; 31:e13601. [PMID: 35430759 PMCID: PMC9539836 DOI: 10.1111/jsr.13601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 03/18/2022] [Indexed: 01/20/2023]
Abstract
It is 50 years ago, in 1972, that the founding conference of the European Sleep Research Society (ESRS) was organised in Basel. Since then the Society has had 13 presidents and a multitude of board members and has organised, among other things, another 24 congresses. At this 50th anniversary, as the 26th ESRS congress is approaching, we have summarised the history of the ESRS. In this review, we provide a background to show why the foundation of a European society was a logical step, and show how, in the course of the past 50 years, the Society changed and grew. We give special attention to some developments that occurred over the years and discuss where the ESRS stands now, and how we foresee its future.
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Affiliation(s)
- Tom Deboer
- Laboratory for Neurophysiology, Department of Cell and Chemical Biology Leiden University Medical Center Leiden the Netherlands
| | - Erna Sif Arnardóttir
- Reykjavik University Sleep Institute School of Technology Reykjavik University Reykjavik Iceland
| | - Hans‐Peter Landolt
- Institute of Pharmacology and Toxicology, University of Zürich Zürich Switzerland
- Sleep & Health Zürich University Center of Competence, University of Zürich Zürich Switzerland
| | - Pierre Hervé Luppi
- Team “SLEEP” Centre de Recherche en Neurosciences de Lyon (CRNL) UMR 5292 CNRS/U1028 INSERM and Université de Lyon Bron France
| | - Walter T. McNicholas
- School of Medicine University College Dublin, and Department of Respiratory and Sleep Medicine, St. Vincent's Hospital Group Dublin Ireland
| | - Dirk Pevernagie
- Department of Respiratory Medicine Ghent University Hospital Ghent Belgium
- Dept of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences Ghent University Ghent Belgium
| | - Giuseppe Plazzi
- Department of Biomedical Metabolic and Neural Sciences, University of Modena and Reggio Emilia Modena Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna Bologna Italy
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24
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Obstructive Sleep Apnea and Road Traffic Accidents: A Danish Nationwide Cohort Study. Sleep Med 2022; 96:64-69. [DOI: 10.1016/j.sleep.2022.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/13/2022] [Accepted: 04/06/2022] [Indexed: 01/01/2023]
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25
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Hedner J, Stenlöf K, Zou D, Hoff E, Hansen C, Kuhn K, Lennartz P, Grote L. A Randomized Controlled Trial Exploring Safety and Tolerability of Sulthiame in Sleep Apnea. Am J Respir Crit Care Med 2022; 205:1461-1469. [PMID: 35202553 DOI: 10.1164/rccm.202109-2043oc] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONAL Current therapies in obstructive sleep apnea (OSA) are limited by insufficient efficacy, compliance or tolerability. An effective pharmacological treatment in OSA is warranted. Carbonic anhydrase (CA) inhibition has been shown to ameliorate OSA. OBJECTIVE To explore safety and tolerability of the CA inhibitor sulthiame (STM) in OSA. METHODS A four week double-blind, randomized, placebo-controlled dose guiding trial in patients with moderate/severe OSA not tolerating positive airway pressure treatment. MEASUREMENTS AND RESULTS Intermittent paresthesia was reported by 79, 67 and 18% of patients receiving 400 mg STM (N=34), 200 mg STM (N=12) or placebo (N=22), respectively. Dyspnea was reported only after 400 mg STM (18%). Six patients in the higher dose group withdrew due to an adverse event. There were no serious adverse events. STM reduced the apnea-hypopnea index (AHI) from 55.3 to 33.1 events/h ( 41.0%) in the 400 mg group and from 61.2 to 40.7 events/h ( 32.1%) after 200 mg (p<0.001, respectively). Corresponding placebo values were 53.9 and 50.9 events/h ( 5.4 %). The AHI reduction threshold of ≥50% was reached in 40% after 400 mg, 25% after 200 mg and 5% following placebo. Mean overnight oxygen saturation improved by 1.1% after 400 mg and 200 mg (p<0.001 and p=0.034, respectively). Patient related outcomes were unchanged. CONCLUSIONS STM showed a satisfactory safety profile in moderate/severe OSA. STM reduced OSA by more than 20 events/h, one of the strongest reductions reported in a drug trial in OSA. Larger scale clinical studies of STM in OSA are justified. Clinical trial registration available at https://www.clinicaltrialsregister.eu/https://www.clinicaltrialsregister.eu/, ID: 2017-004767-13.
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Affiliation(s)
- Jan Hedner
- University of Gothenburg Sahlgrenska Academy, 70712, Internal Medicine, Center for Sleep and Wake Disorders, Goteborg, Sweden;
| | - Kaj Stenlöf
- University of Gothenburg Sahlgrenska Academy, 70712, Internal Medicine, Center for Sleep and Wake Disorders, Goteborg, Sweden
| | - Ding Zou
- University of Gothenburg Sahlgrenska Academy, 70712, Internal Medicine, Center for Sleep and Wake Disorders, Goteborg, Sweden
| | - Erik Hoff
- University of Gothenburg Sahlgrenska Academy, 70712, Internal Medicine, Center for Sleep and Wake Disorders, Goteborg, Sweden
| | | | - Katrin Kuhn
- Desitin Arzneimittel GmbH, 60840, Hamburg, Germany
| | | | - Ludger Grote
- University of Gothenburg Sahlgrenska Academy, 70712, Internal Medicine, Center for Sleep and Wake Disorders, Goteborg, Sweden.,Sahlgrenska University Hospital, 56749, Sleep Laboratory, Pulmonary Medicine, Goteborg, Sweden
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26
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Chalmers JD, Kolb M. The evolution of the European Respiratory Journal: adapting in an era of change. Eur Respir J 2022; 59:59/1/2200037. [PMID: 35086842 DOI: 10.1183/13993003.00037-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 01/08/2022] [Indexed: 11/05/2022]
Affiliation(s)
- James D Chalmers
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Martin Kolb
- Dept of Respiratory Medicine, Pathology and Molecular Medicine, McMaster University and St Joseph's Healthcare, Hamilton, ON, Canada
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27
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Riha RL. Defining obstructive sleep apnoea syndrome: a failure of semantic rules. Breathe (Sheff) 2022; 17:210082. [PMID: 35035552 PMCID: PMC8753646 DOI: 10.1183/20734735.0082-2021] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 07/27/2021] [Indexed: 12/14/2022] Open
Abstract
Obstructive sleep apnoea syndrome (OSAS) is one of the most ubiquitous medical conditions in industrialised society. Since the recognition that symptoms of excessive daytime somnolence, problems with concentration, mood and cognitive impairment, as well as cardiometabolic abnormalities can arise as a consequence of obstructed breathing during sleep, it has been subject to variation in its definition. Over the past five decades, attempts have been made to standardise the definitions and scoring criteria used for apnoeas and hypopnoea, which are the hallmarks of obstructive sleep apnoea (OSA). However, applying these definitions in clinical and research practice has resulted in over- and under-estimation of the severity and prevalence of OSAS. Furthermore, the definitions may eventually become redundant in the context of rapid technological advances in breathing measurement and other signal acquisition. Increased efforts towards precision medicine have led to a focus on the pathophysiology of obstructed breathing during sleep. However, the same degree of effort has not been focused on how and why the latter does or does not result in diurnal symptoms, integral to the definition of OSAS. This review focuses on OSAS in adults and discusses some of the difficulties with current definitions and the possible reasons behind them. The definition of obstructive sleep apnoea syndrome appears to be in constant flux dependent on the definitions attributed to its diagnostic componentshttps://bit.ly/3zXrWKg
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Affiliation(s)
- Renata L Riha
- Dept of Sleep Medicine, Royal Infirmary Edinburgh, Edinburgh, UK.,Sleep Research Unit, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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28
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Maghsoudipour M, Moradi R, Moghimi S, Ancoli-Israel S, DeYoung PN, Malhotra A. Time of day, time of sleep, and time on task effects on sleepiness and cognitive performance of bus drivers. Sleep Breath 2022; 26:1759-1769. [DOI: 10.1007/s11325-021-02526-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 10/08/2021] [Accepted: 11/05/2021] [Indexed: 10/19/2022]
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29
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Lehert P. Efficacy of Pitolisant 20 mg in Reducing Excessive Daytime Sleepiness and Fatigue in Patients with Obstructive Sleep Apnoea Syndrome: An Individual Patient Data Meta-analysis. Clin Drug Investig 2021; 42:65-74. [PMID: 34859394 PMCID: PMC8755655 DOI: 10.1007/s40261-021-01104-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2021] [Indexed: 11/26/2022]
Abstract
Background and objective Excessive daytime sleepiness (EDS) and fatigue are major complaints in patients with obstructive sleep apnoea (OSA) syndrome. Pitolisant is an orally active selective histamine H3 receptor (H3R) antagonist/inverse agonist, which enhances histaminergic transmissions in the brain and thereby elicits strong wake-promoting effects. This article assesses the efficacy and safety of pitolisant 20 mg in patients with OSA, based on existing randomised controlled studies. Methods An individual patient data (IPD) meta-analytical two-level (study-patient) hierarchical model was used assuming a random treatment effect. The Epworth Sleepiness Scale (ESS) and Oxford Sleep Resistance (OSleR) tests were co-primary endpoints. Results A total of 512 patients, including 384 treated with pitolisant and 128 with placebo, were included in the analysis.
Compared with placebo, pitolisant reduced mean ESS by − 3.1 (95% CI [− 4.1; − 2.1]; p < 0.001) and improved OSleR by 1.18 (1.02; 1.35, p = 0.022); 30% more patients had reduced fatigue (risk ratio [RR] = 1.3, [1.11; 1.53]), p = 0.001) and 46% more patients had improved Clinical Global Impression (CGI) (RR = 1.46 [1.12; 1.89], p = 0.005). No significant differences in safety endpoints were found. These results proved homogeneous across studies and subgroups of the population. Conclusion The results provide evidence of a significant benefit of pitolisant in improving EDS and fatigue, irrespective of baseline conditions. Supplementary Information The online version contains supplementary material available at 10.1007/s40261-021-01104-8.
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Affiliation(s)
- Philippe Lehert
- Faculty of Medicine, The University of Melbourne, Parkville, VIC, Australia.
- Louvain School of Management, Louvain University, Chaussee de Binche 151/M1.01.01, 7000, Mons, Belgium.
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30
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Ji Y, Wang H, Liu M, Partridge MR. Use of the pictorial Sleepiness and Sleep Apnoea Scale in Chinese patients with suspected obstructive sleep apnoea syndrome. J Thorac Dis 2021; 13:6071-6081. [PMID: 34795953 PMCID: PMC8575826 DOI: 10.21037/jtd-20-2152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 08/19/2021] [Indexed: 11/28/2022]
Abstract
Background Sleep related breathing disorders represent a significant health burden. Being able to stratify patients according to their need for differing types of investigation and predicting the likelihood of obstructive sleep apnoea syndrome (OSAS) is helpful. This study attempts to assess the value of a pictorial Sleepiness and Sleep Apnoea Scale (pSSAS) in this process. Methods A total of 126 sequential patients attending a sleep service with suspected OSAS completed the pSSAS, the Epworth Sleepiness Score (ESS), and the Berlin Questionnaire (BQ) prior to full polysomnography. Results With Apnoea-hypopnea index (AHI) >15 as the positive diagnostic criterion, the area under the receiver operating characteristic curve (AUC) of the BQ was the highest (0.683), followed by pSSAS and ESS (AUC 0.648 and 0.516, respectively). With AHI >30 as the positive diagnostic criterion, the AUC of pSSAS was the highest (0.696), followed by BQ and ESS (AUC 0.653 and 0.510, respectively). With MiniSO2 <80% as the positive diagnostic criterion, the AUC of pSSAS was the highest (0.736), followed by BQ and ESS (AUC 0.634 and 0.516, respectively). Conclusions This study shows that the pSSAS which was first tested in a European population performs equally well amongst a Chinese population. The pSSAS performed in a similar fashion to the BQ in predicting those likely to have OSAS and was superior at predicting those who have severe OSAS. Because it is a pictorial questionnaire, it has advantages for those who may have reduced health literacy, a problem which is under-recognized in most healthcare systems.
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Affiliation(s)
- Yang Ji
- Division of Respiratory Medicine, University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Hongxia Wang
- Division of Respiratory Medicine, University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Min Liu
- Division of Respiratory Medicine, University of Hong Kong-Shenzhen Hospital, Shenzhen, China
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Bonsignore MR, Pepin JL, Cibella F, Barbera CD, Marrone O, Verbraecken J, Saaresranta T, Basoglu OK, Trakada G, Bouloukaki I, McNicholas WT, Bailly S, Pataka A, Kvamme JA, Hein H, Mihaicuta S, Grote L, Fanfulla F. Excessive Daytime Sleepiness in Obstructive Sleep Apnea Patients Treated With Continuous Positive Airway Pressure: Data From the European Sleep Apnea Database. Front Neurol 2021; 12:690008. [PMID: 34434158 PMCID: PMC8381644 DOI: 10.3389/fneur.2021.690008] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 05/31/2021] [Indexed: 12/17/2022] Open
Abstract
Excessive daytime sleepiness (EDS) is a symptom of obstructive sleep apnea (OSA) that resolves under treatment with continuous positive airway pressure (CPAP). In some patients, sleepiness persists despite CPAP treatment. We retrospectively analyzed data on subjective residual EDS, assessed as an Epworth Sleepiness Scale score (ESS) >10, in patients from the European Sleep Apnea Database (n = 4,853, mean age ± SD 54.8 ± 11.8 years, 26.1% females), at baseline and at the first visit (median follow-up: 5 months, interquartile range 3–13). An ESS > 10 occurred in 56% of patients at baseline and in 28.2% of patients at follow-up. Residual EDS was analyzed in 2,190 patients (age: 55.1 ± 12.0 years, 26.1% females) with sleep monitoring data (median follow-up: 3 months, interquartile range 1–15). Sleep studies during CPAP use were obtained in 58% of these patients; EDS was reported by 47.2% of patients at baseline and by 30.3% at follow-up. Residual OSA, defined as an apnea–hypopnea index >10/h, and insufficient CPAP adherence, defined as nightly use <4 h, occurred with similar frequency in patients with and without EDS at follow-up. Prevalence of residual EDS was highest (40%) in patients with a first follow-up visit at 0–3 months, then it was 13–19% in patients with a first follow-up visit after 4 months to 2 years. The change in ESS (n = 2,190) was weakly correlated with CPAP use (R2 = 0.023, p < 0.0001). Logistic regression showed that an ESS score >10 at the first follow-up visit was associated directly with ESS at baseline and inversely with duration of follow-up, and CPAP use (R2 of the model: 0.417). EDS showed heterogeneity in different European countries both at baseline and at the first follow-up visit, suggesting modulation by cultural and lifestyle factors. In conclusion, residual EDS in CPAP-treated OSA occurred in approximately one in four patients at follow-up; its prevalence was highest (40%) in the first 3 months of treatment and subsequently decreased. The finding of residual EDS in a significant percentage of optimally treated OSA patients suggests that wake-promoting agents may be useful, but their indication should be evaluated after at least 3 months of treatment.
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Affiliation(s)
- Maria R Bonsignore
- Sleep Disordered Breathing Clinic, Pulmonary Division, PROMISE Department, University of Palermo, Palermo, Italy.,National Research Council (CNR), Institute for Biomedical Research and Innovation (IRIB), Palermo, Italy
| | - Jean L Pepin
- HP2 Laboratory, U1042, INSERM, Grenoble Alpes University, Grenoble, France
| | - Fabio Cibella
- National Research Council (CNR), Institute for Biomedical Research and Innovation (IRIB), Palermo, Italy
| | - Calogero D Barbera
- Sleep Disordered Breathing Clinic, Pulmonary Division, PROMISE Department, University of Palermo, Palermo, Italy
| | - Oreste Marrone
- National Research Council (CNR), Institute for Biomedical Research and Innovation (IRIB), Palermo, Italy
| | - Johan Verbraecken
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital and University Hospital Antwerp, Antwerp, Belgium
| | - Tarja Saaresranta
- Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, Turku, Finland.,Department of Pulmonary Diseases and Clinical Allergology, Sleep Research Centre, University of Turku, Turku, Finland
| | - Ozen K Basoglu
- Department of Chest Diseases, Ege University Faculty of Medicine, Izmir, Turkey
| | - Georgia Trakada
- Division of Pulmonology, Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Izolde Bouloukaki
- Sleep Disorders Unit, Department of Respiratory Medicine, Medical School, University of Crete, Crete, Greece
| | - Walter T McNicholas
- Department of Respiratory and Sleep Medicine, School of Medicine, St. Vincent's Hospital Group, University College Dublin, Dublin, Ireland
| | - Sébastien Bailly
- HP2 Laboratory, U1042, INSERM, Grenoble Alpes University, Grenoble, France
| | - Athanasia Pataka
- Respiratory Failure Unit, G Papanikolaou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - John A Kvamme
- Ear, Nose and Throat-Department, Foerde Central Hospital, Foerde, Norway
| | - Holger Hein
- Private Practice and Sleep Lab for Internal Medicine, Pulmonary Medicine and Sleep Medicine, Geesthacht, Germany
| | - Stefan Mihaicuta
- Victor Babes University of Medicine and Pharmacy, CardioPrevent Foundation, Timisoara, Romania
| | - Ludger Grote
- Sleep Disorders Centre, Respiratory Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.,Centre for Sleep and Wake Disorders, Institute for Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Francesco Fanfulla
- Respiratory Function and Sleep Medicine Unit, Scientific Institutes of Pavia and Montescano, Istituti Clinici Scientifici Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Pavia, Italy
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Obstructive sleep apnea and risk of motor vehicle accident. Sleep Med 2021; 85:196-203. [PMID: 34348205 DOI: 10.1016/j.sleep.2021.07.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 07/01/2021] [Accepted: 07/10/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate the association between obstructive sleep apnea (OSA) and risk of motor vehicle accident (MVA). METHODS We conducted a cohort study at Kaiser Permanente Washington using electronic health plan data and linked Washington State Department of Transportation MVA records. We included persons 18-79 years of age during 2005-2014. OSA was ascertained via diagnosis codes. The primary outcome, first MVA during cohort follow-up, was ascertained from state MVA records. Risk factors for MVAs, including medical conditions and medication use, were ascertained from health plan data. Multivariable Cox proportional hazards models were used to estimate the adjusted hazard ratio (HR) and 95% confidence interval (CI) for the association between OSA and study outcomes. RESULTS Among the 879,547 eligible persons, the unadjusted rate of MVA in those with and without OSA was 238 and 229 per 10,000 person-years, respectively. A diagnosis of OSA was associated with a 17% increased risk of MVA (adjusted HR = 1.17; 95% CI: 1.13 to 1.20). CONCLUSION In this large population-based study, a diagnosis of OSA was associated with a modestly increased risk of MVA.
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Sleepiness Behind the Wheel and the Implementation of European Driving Regulations. Sleep Med Clin 2021; 16:533-543. [PMID: 34325829 DOI: 10.1016/j.jsmc.2021.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Sleep disturbance and sleepiness are established risk factors for driving accidents and obstructive sleep apnea (OSA) is the most prevalent medical disorder associated with excessive daytime sleepiness. Because effective treatment of OSA reduces accident risk, several jurisdictions have implemented regulations concerning the ability of patients with OSA to drive, unless effectively treated. This review provides a practical guide for clinicians who may be requested to certify a patient with OSA as fit to drive regarding the scope of the problem, the role of questionnaires and driving simulators to evaluate sleepiness, and the benefit of treatment on accident risk.
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Sabil A, Bignard R, Gervès-Pinquié C, Philip P, Le Vaillant M, Trzepizur W, Meslier N, Gagnadoux F. Risk Factors for Sleepiness at the Wheel and Sleep-Related Car Accidents Among Patients with Obstructive Sleep Apnea: Data from the French Pays de la Loire Sleep Cohort. Nat Sci Sleep 2021; 13:1737-1746. [PMID: 34675722 PMCID: PMC8502051 DOI: 10.2147/nss.s328774] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 09/24/2021] [Indexed: 01/28/2023] Open
Abstract
PURPOSE We aimed to determine the risk factors of sleepiness at the wheel among patients with obstructive sleep apnea (OSA) and to determine factors that were independently associated with reported sleep-related near-miss accidents or car accidents. PATIENTS AND METHODS This retrospective study was conducted on 843 OSA patients from the French Pays de la Loire sleep cohort database. Each patient completed surveys including anthropometric data, medical history, professional status, and data on alcohol and tobacco use. Epworth sleepiness scale (ESS) and sleep quality questionnaires were administered. Regarding driving, data were collected on occurrence of sleepiness-related near-misses or car accidents, and on distance driven per year. The primary dependent variable of interest was reported sleepiness at the wheel. RESULTS On multivariable regression analysis, reported sleepiness at the wheel (n=298) was independently associated with younger age (p=0.02), male gender (p=0.009), marked nocturnal hypoxemia (p=0.006), lower BMI (p=0.03), absence of cardiovascular disease (p=0.022), executives or high degree jobs (p=0.003) and reported difficulty-maintaining sleep (p=0.03). Only past experience of sleepiness at the wheel (OR 12.18, [6.38-23.25]) and an ESS ≥11 (OR 4.75 [2.73-8.27]) were independently associated with reported car accidents (n=30) or near-miss accidents (n=137). CONCLUSION In patients newly diagnosed with OSA, the risk of car accident seems multifactorial, and its evaluation should include multiple parameters such as patient self-reported sleepiness at the wheel, occurrence of sleepiness-related accidents, anthropometry, professional status, and insomnia complaints. Thus, it is possible to evaluate this risk and advise patients as early as the first visit at the sleep medicine clinic without waiting for the results of the sleep study.
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Affiliation(s)
| | - Remi Bignard
- Department of Respiratory and Sleep Medicine, University Hospital of Angers, Angers, France
| | - Chloé Gervès-Pinquié
- Biostatistics Department, Pays de la Loire Respiratory Health Research Institute, Beaucouzé, France
| | - Pierre Philip
- Sleep, Attention and Neuropsychiatry Unit, University of Bordeaux, CNRS, SANPSY USR 3413, and CHU Pellegrin, Bordeaux, France
| | - Marc Le Vaillant
- Biostatistics Department, Pays de la Loire Respiratory Health Research Institute, Beaucouzé, France
| | - Wojciech Trzepizur
- Department of Respiratory and Sleep Medicine, University Hospital of Angers, Angers, France
| | - Nicole Meslier
- Department of Respiratory and Sleep Medicine, University Hospital of Angers, Angers, France
| | - Frédéric Gagnadoux
- Department of Respiratory and Sleep Medicine, University Hospital of Angers, Angers, France
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