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Stewart GM, Tong BK, Cistulli PA. Precision medicine approaches in obstructive sleep apnoea: The role of dentist-sleep physician partnerships. Aust Dent J 2024. [PMID: 39354705 DOI: 10.1111/adj.13039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2024] [Indexed: 10/03/2024]
Abstract
Obstructive Sleep Apnoea (OSA) is a common heterogenous sleep disorder that is associated with a wide range of comorbidities and consequences, including the development of neurocognitive and cardiometabolic disorders. The heterogeneity of OSA necessitates a precision medicine approach to accurately diagnose this condition and to effectively manage patients. One of the primary models of precision medicine is described by the P4 approach of predicting those who are susceptible to disease, preventing the occurrence of disease, personalizing treatment, and encouraging patients to participate in their individual healthcare journey. Recent advances in oral appliance therapy and OSA monitoring techniques have fostered an exciting opportunity for enhanced collaboration between dentists and sleep physicians to optimize OSA precision medicine care. This review aims to discuss the sources of heterogeneity among OSA patients, provide an overview of the growing applications of oral appliance therapy and tailored monitoring programs for OSA that are shifting treatment to a more personalized and participatory model of care, and outline the pivotal role of dentists in managing patients with OSA.
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Affiliation(s)
- G M Stewart
- Charles Perkins Centre and Sydney Medical School, University of Sydney, Camperdown, Sydney, Australia
- Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, St Leonards, Sydney, Australia
| | - B K Tong
- Charles Perkins Centre and Sydney Medical School, University of Sydney, Camperdown, Sydney, Australia
- Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, St Leonards, Sydney, Australia
| | - P A Cistulli
- Charles Perkins Centre and Sydney Medical School, University of Sydney, Camperdown, Sydney, Australia
- Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, St Leonards, Sydney, Australia
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2
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Wang L, Ou Q, Shan G, Zhan W, Huang J, Lin Q, Li J, Liu Y, Xu Y, Chen C, Chen W. Community-based intervention for obstructive sleep apnea in the general population: a randomized controlled trial. Sleep 2024; 47:zsae132. [PMID: 38902934 DOI: 10.1093/sleep/zsae132] [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: 02/08/2024] [Revised: 05/04/2024] [Indexed: 06/22/2024] Open
Abstract
STUDY OBJECTIVES To investigate the engagement and health outcomes of community-based intervention for obstructive sleep apnea (OSA) in the general population. METHODS We conducted a 3-month randomized controlled trial in two communities in southern China. We initially screened the general population for high-risk OSA and further diagnosis using home sleep testing. Eligible participants were randomly (1:1) assigned to either a control or continuous positive airway pressure-based integrated intervention group. The primary outcomes were multimodal indicators reflecting health outcomes, including health-related quality of life (Short Form-36 [SF-36]), sleep-related symptoms, and cardiometabolic risk. RESULTS Of the 2484 participants screened, 1423 identified as having high-risk OSA were considered for telephone invitations to participate in the trial. Of these, 401 participants responded positively (28.2%), 279 were diagnosed with OSA, and 212 were randomized. The intervention significantly improved several domains of SF-36, including physical functioning (intergroup difference, 2.8; p = .003), vitality (2.3; p = .031), and reported health transition (6.8; p = .005). Sleep-related symptoms, including Epworth Sleepiness Scale (-0.7; p = .017), Fatigue Severity Scale (-3.0; p = .022), Insomnia Severity Index (-1.8; p < .001), and Pittsburgh Sleep Quality Index (-0.7; p = .032), also showed significant improvements. Although the intervention did not significantly alter glycolipid metabolism, ventricular function, or cardiac structural remodeling, it achieved a significant reduction in systolic (-4.5 mmHg; p = .004) and diastolic blood pressure (BP; -3.7 mmHg; p < .001). CONCLUSIONS Community-based intervention for previously undiagnosed OSA in the general population yielded improvements in health-related quality of life, sleep-related symptoms, and BP. However, engagement in the intervention program was low. CLINICAL TRIAL REGISTRATION "Community Intervention Trial for OSA";URL: https://www.chictr.org.cn/showprojEN.html?proj=144927;Trial identification number: ChiCTR2100054800.
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Affiliation(s)
- Longlong Wang
- Sleep Center, Division I, Department of Geriatric Respiratory, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University; Guangdong Provincial Geriatrics Institute, Guangzhou, China
| | - Qiong Ou
- Sleep Center, Division I, Department of Geriatric Respiratory, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University; Guangdong Provincial Geriatrics Institute, Guangzhou, China
| | - Guangliang Shan
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, School of Basic Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Weixin Zhan
- Sleep Center, Division I, Department of Geriatric Respiratory, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University; Guangdong Provincial Geriatrics Institute, Guangzhou, China
| | - Jinhuan Huang
- Department of Pulmonary and Critical Care Medicine, People's Hospital of Chenghai, Shantou, China
| | - Qiuqiang Lin
- Department of Pulmonary and Critical Care Medicine, People's Hospital of Chenghai, Shantou, China
| | - Jianfei Li
- Special Wards and Geriatrics Department, Shantou Central Hospital, Shantou, China
| | - Yibin Liu
- Health Management Center, Shantou Central Hospital, Shantou, China
| | - Yuejun Xu
- Health Management Center, Shantou Central Hospital, Shantou, China
| | - Chunyan Chen
- Health Management Center, Shantou Central Hospital, Shantou, China
| | - Weili Chen
- Health Management Center, Shantou Central Hospital, Shantou, China
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Shiina K. Obstructive sleep apnea -related hypertension: a review of the literature and clinical management strategy. Hypertens Res 2024:10.1038/s41440-024-01852-y. [PMID: 39210083 DOI: 10.1038/s41440-024-01852-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 07/24/2024] [Accepted: 07/30/2024] [Indexed: 09/04/2024]
Abstract
Obstructive Sleep Apnea (OSA) and hypertension have a high rate of co-occurrence, with OSA being a causative factor for hypertension. Sympathetic activity due to intermittent hypoxia and/or fragmented sleep is the most important mechanisms triggering the elevation in blood pressure in OSA. OSA-related hypertension is characterized by resistant hypertension, nocturnal hypertension, abnormal blood pressure variability, and vascular remodeling. In particular, the prevalence of OSA is high in patients with resistant hypertension, and the mechanism proposed includes vascular remodeling due to the exacerbation of arterial stiffness by OSA. Continuous positive airway pressure therapy is effective at lowering blood pressure, however, the magnitude of the decrease in blood pressure is relatively modest, therefore, patients often need to also take antihypertensive medications to achieve optimal blood pressure control. Antihypertensive medications targeting sympathetic pathways or the renin-angiotensin-aldosterone system have theoretical potential in OSA-related hypertension, Therefore, beta-blockers and renin-angiotensin system inhibitors may be effective in the management of OSA-related hypertension, but current evidence is limited. The characteristics of OSA-related hypertension, such as nocturnal hypertension and obesity-related hypertension, suggests potential for angiotensin receptor-neprilysin inhibitor (ARNI), sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucose-dependent insulinotropic polypeptide receptor/ glucagon-like peptide-1 receptor agonist (GIP/GLP-1 RA). Recently, OSA has been considered to be caused not only by upper airway anatomy but also by several non-anatomic mechanisms, such as responsiveness of the upper airway response, ventilatory control instability, and reduced sleep arousal threshold. Elucidating the phenotypic mechanisms of OSA may potentially advance more personalized hypertension treatment strategies in the future. Clinical characteristics and management strategy of OSA-related hypertension. OSA obstructive sleep apnea, BP blood pressure, ABPM ambulatory blood pressure monitoring, CPAP continuous positive airway pressure, LVH left ventricular hypertrophy, ARB: angiotensin II receptor blocker, SGLT2i Sodium-glucose cotransporter 2 inhibitors, ARNI angiotensin receptor-neprilysin inhibitor, CCB calcium channel blocker, GIP/GLP-1 RA glucose-dependent insulinotropic polypeptide receptor and glucagon-like peptide-1 receptor agonist.
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Affiliation(s)
- Kazuki Shiina
- Department of Cardiology, Tokyo Medical University, Tokyo, Japan.
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4
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Nagai M, Noda A, Dasari TW. Obstructive sleep apnea without obesity: the beginning of a journey to "NOOSA"? Hypertens Res 2024; 47:1970-1972. [PMID: 38609552 DOI: 10.1038/s41440-024-01669-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 03/13/2024] [Indexed: 04/14/2024]
Affiliation(s)
- Michiaki Nagai
- Cardiovascular Section, Department of Medicine, University of Oklahoma Health Science Center, Oklahoma City, OK, USA.
| | - Akiko Noda
- Department of Biomedical Sciences, Chubu University Collage of Life and Health Sciences, Kasugai, Aichi, Japan
| | - Tarun W Dasari
- Cardiovascular Section, Department of Medicine, University of Oklahoma Health Science Center, Oklahoma City, OK, USA.
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He J, Zhou H, Xiong J, Huang Y, Huang N, Jiang J. Association between elevated homocysteine levels and obstructive sleep apnea hypopnea syndrome: a systematic review and updated meta-analysis. Front Endocrinol (Lausanne) 2024; 15:1378293. [PMID: 38887264 PMCID: PMC11180825 DOI: 10.3389/fendo.2024.1378293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 05/14/2024] [Indexed: 06/20/2024] Open
Abstract
Objective This study aimed to distinguish between healthy controls and patients with OSAHS regarding homocysteine (HCY) levels and investigate how individuals with OSAHS respond to continuous positive airway pressure ventilation (CPAP) in terms of serum and plasma HCY levels. Methods To ascertain published articles about OSAHS, an exhaustive search was performed across medical databases, encompassing PubMed, Web of Science, EMBASE, CNKI, and Cochrane Library, until January 2, 2024. This study reviewed the literature regarding HCY levels in individuals with OSAHS and control groups, HCY levels under pre- and post-CPAP treatment, the Pearson/Spearman correlation coefficients between HCY levels and apnea-hypopnea index (AHI), and the hazard ratio (HR) of HCY levels concerning the occurrence of major adverse cerebrocardiovascular events (MACCEs) in patients with OSAHS. Meta-analyses were performed using weighted mean difference (WMD), correlation coefficients, and HR as effect variables. The statistical analysis was conducted using the R 4.1.2 and STATA 11.0 software packages. Results In total, 33 articles were selected for the final analysis. The OSAHS group exhibited significantly higher serum/plasma HCY levels than the control group (WMD = 4.25 μmol/L, 95% CI: 2.60-5.91, P< 0.001), particularly among individuals with moderate and severe OSAHS. Additionally, subgroup analysis using mean age, ethnicity, mean body mass index, and study design type unveiled significantly elevated levels of HCY in the serum/plasma of the OSAHS group compared to the control group. CPAP treatment can significantly decrease serum/plasma HCY levels in patients with OSAHS. Moreover, elevated HCY levels in individuals with OSAHS could be one of the risk factors for MACCEs (adjusted HR = 1.68, 95% CI = 1.10-2.58, P = 0.017). AHI scores show a positive correlation with serum/plasma HCY levels. Conclusion Patients with OSAHS had elevated serum/plasma HCY levels compared to healthy controls; however, CPAP therapy dramatically decreased HCY levels in patients with OSAHS. In patients with OSAHS, elevated HCY levels were linked with an increased risk of MACCEs, and HCY was positively connected with AHI values. HCY levels may serve as a useful clinical indicator for determining the severity and efficacy of OSAHS treatments. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier CRD42024498806.
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Affiliation(s)
- Jie He
- Clinical Medical College of Chengdu Medical College, Chengdu, Sichuan, China
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Haiying Zhou
- Clinical Medical College of Chengdu Medical College, Chengdu, Sichuan, China
- Department of Rehabilitation, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Juan Xiong
- Clinical Medical College of Chengdu Medical College, Chengdu, Sichuan, China
- Emergency department, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Yuanyuan Huang
- Clinical Medical College of Chengdu Medical College, Chengdu, Sichuan, China
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Na Huang
- Clinical Medical College of Chengdu Medical College, Chengdu, Sichuan, China
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Jiaqing Jiang
- Clinical Medical College of Chengdu Medical College, Chengdu, Sichuan, China
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Pengo MF, Gozal D, Martinez-Garcia MA. Should we treat with continuous positive airway pressure severe non-sleepy obstructive sleep apnea individuals without underlying cardiovascular disease? Sleep 2022; 45:6677982. [PMID: 36029295 DOI: 10.1093/sleep/zsac208] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/12/2022] [Indexed: 12/14/2022] Open
Abstract
The majority of the current international obstructive sleep apnea (OSA) guidelines base the recommendation to treat OSA with continuous positive airway pressure (CPAP) on the presence of symptoms (principally, albeit not exclusively on daytime hypersomnolence). In nonsleepy patients, even with severe OSA, controversies remain, as clear evidence supporting CPAP treatment of this subgroup of OSA patients is lacking. However, given the nonnegligible proportion of non-sleepy OSA patients, clinicians often face a serious dilemma since CPAP treatment in these patients may prove to be not cost-effective. Here, we propose a simple three-step-based algorithm that attempts to better phenotype non-sleepy OSA patients prior to reaching a CPAP treatment decision while also considering a series of clinically relevant elements in the process that may improve with CPAP therapy. Such algorithm focuses on the presence of several OSA symptoms that are susceptible to benefit from treatment and also relies on OSA phenotypes that need to be considered in an effort to achieve optimal cardiovascular prevention. Here, we attempt to establish a framework for clinicians who are evaluating severe nonsleepy OSA patients in their practices. However, the algorithm proposal needs to be extensively validated before being systematically implemented in clinical settings.
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Affiliation(s)
| | - David Gozal
- Department of Child Health and Child Health Research Institute, University of Missouri School of Medicine, Columbia, MO, USA.,Department of Medical Pharmacology and Physiology, University of Missouri School of Medicine, Columbia, MO, USA
| | - Miguel Angel Martinez-Garcia
- Respiratory Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain.,Centro de Investigación Biomédica en Red (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
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Singh P, Chopra M, Vardhan V. Detection of obstructive sleep apnea in young patients suffering from coronary artery disease by performing portable polysomnography studies. Med J Armed Forces India 2022; 78:394-399. [PMID: 36267506 PMCID: PMC9577263 DOI: 10.1016/j.mjafi.2020.06.005] [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: 04/04/2020] [Accepted: 06/17/2020] [Indexed: 11/26/2022] Open
Abstract
Background Obstructive sleep apnea (OSA) is known to be an important contributory factor of coronary artery disease (CAD), but the extent of contribution of OSA in young patients suffering from CAD is not known. Thus, with an aim to detect OSA in young patients suffering from CAD by performing portable polysomnography (PSG), the present study was carried out at a tertiary care chest center. Methods A prospective study was carried out from June 2015 to June 2018, wherein 100 consecutive young (age less than 40 years), non-smoking patients with angiographically confirmed CAD, with no identifiable risk factors for cardiovascular diseases except obesity, were subjected to level 3 portable PSG studies. Results Of 100 patients with CAD, 80% had OSA (24% with mild OSA, 28% with moderate OSA, and 28% with severe OSA). Body weight and severity of OSA showed a significant correlation with a P-value of 0.033. SPSS software was used for statistical analysis. The categorical variables were compared using Fischer's exact test. Conclusion The study detected a significant number of young patients with angiographically confirmed CAD having OSA. A significant correlation was also observed between weight and severity of OSA, suggesting that overweight patients and patients with obesity have higher grades of OSA.
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Affiliation(s)
- Priyanka Singh
- Pulmonologist (Pulmonary Medicine), Army Hospital (Research & Referral), New Delhi, India
| | - Manu Chopra
- Pulmonologist (Pulmonary Medicine), Army Hospital (Research & Referral), New Delhi, India
| | - V. Vardhan
- Consultant & Head (Pulmonary Medicine), Army Hospital (Research & Referral), New Delhi, India
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8
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Mansfield DR. Sleep medicine is more than just obstructive sleep apnoea. Respirology 2022; 27:812-814. [PMID: 36068023 DOI: 10.1111/resp.14364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 08/26/2022] [Indexed: 11/28/2022]
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Wang L, Ou Q, Shan G, Lao M, Pei G, Xu Y, Huang J, Tan J, Chen W, Lu B. Independent Association Between Oxygen Desaturation Index and Cardiovascular Disease in Non-Sleepy Sleep-Disordered Breathing Subtype: A Chinese Community-Based Study. Nat Sci Sleep 2022; 14:1397-1406. [PMID: 35979084 PMCID: PMC9377398 DOI: 10.2147/nss.s370471] [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: 04/27/2022] [Accepted: 07/29/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Non-sleepy sleep-disordered breathing (SDB) is increasingly recognized as an important clinical subtype. The association between non-sleepy SDB and cardiovascular disease (CVD) is not well understood. Our objectives were to investigate the relationship between non-sleepy SDB and CVD and determine which nocturnal hypoxia parameter most strongly reflects this association in a large community population. PATIENTS AND METHODS Cross-sectional data from 3626 randomly-selected Chinese community-dwelling participants who underwent overnight type IV sleep monitoring were analyzed. Parameters of nocturnal hypoxemia were extracted from sleep monitoring devices, including mean nocturnal oxygen saturation, lowest oxygen saturation, oxygen desaturation index (ODI), and time with oxygen saturation <90%. An ODI ≥7.0 events/h was considered to signify SDB. An Epworth Sleepiness Scale score of 10 or less indicated no sleepiness. RESULTS The SDB rate was 30.7% (1114/3626), of which 96.5% (1075/1114) were considered the non-sleepy SDB subtype. ODI, typical nocturnal intermittent hypoxia indicator for SDB, was independently related to CVD, regardless of whether excessive daytime sleepiness was present. After adjusting for confounders, ODI most strongly reflected the association between non-sleepy SDB and CVD (OR:1.023; 95% CI:1.003-1.043). We observed a nonlinear association between ODI and the prevalence of CVD, where the likelihood of CVD increased with ODI≥10 events/h and a markedly increasing trend was observed with ODI ≥20 events/h (reference ODI = 7.0 events/h). Metabolic parameters, Pittsburgh Sleep Quality Index, and inflammatory marker did not mediate the association between ODI and CVD in the non-sleepy SDB subtype. CONCLUSION In the Chinese community-dwelling population, non-sleepy SDB was highly prevalent. ODI, an easily extracted indicator from a type IV sleep monitor, most strongly reflected the association between non-sleepy SDB and CVD.
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Affiliation(s)
- Longlong Wang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, People's Republic of China.,Sleep Center, Department of Pulmonary and Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, People's Republic of China
| | - Qiong Ou
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, People's Republic of China.,Sleep Center, Department of Pulmonary and Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, People's Republic of China
| | - Guangliang Shan
- Department of Epidemiology & Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences/School of Basic Medicine, Peking Union Medical College, Beijing, People's Republic of China
| | - Miaochan Lao
- Sleep Center, Department of Pulmonary and Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, People's Republic of China
| | - Guo Pei
- Sleep Center, Department of Pulmonary and Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, People's Republic of China
| | - Yanxia Xu
- Sleep Center, Department of Pulmonary and Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, People's Republic of China
| | - Jinhuan Huang
- Department of Pulmonary and Critical Care Medicine, People's Hospital of Chenghai, Shantou, People's Republic of China
| | - Jiaoying Tan
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, People's Republic of China.,Sleep Center, Department of Pulmonary and Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, People's Republic of China
| | - Weiping Chen
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, People's Republic of China.,Sleep Center, Department of Pulmonary and Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, People's Republic of China
| | - Bing Lu
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, People's Republic of China.,Sleep Center, Department of Pulmonary and Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, People's Republic of China
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10
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Jeon B, Luyster FS, Sereika SM, DiNardo MM, Callan JA, Chasens ER. Comorbid obstructive sleep apnea and insomnia and its associations with mood and diabetes-related distress in type 2 diabetes mellitus. J Clin Sleep Med 2021; 18:1103-1111. [PMID: 34879902 DOI: 10.5664/jcsm.9812] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Previous research suggests that obstructive sleep apnea (OSA) and insomnia frequently co-exist and are prevalent in persons with type 2 diabetes mellitus (T2DM). This study compared mood and diabetes-related distress among OSA, insomnia, and comorbid OSA and insomnia (OSA+I) groups in persons with T2DM. METHODS A secondary analysis was conducted with baseline data from two independent randomized controlled trials evaluating the efficacy of OSA and insomnia treatment. The pooled sample (N=224) included participants with OSA only (n=68 [30.4%]), insomnia only (n=107 [47.8%]), and OSA and insomnia (OSA+I; n=49 [21.9%]). OSA was defined as an apnea-hypopnea index ≥ 15 events per hour; insomnia defined as an Insomnia Severity Index score ≥ 15. Mood was measured by the Profile of Mood States total and subscale scores; diabetes-related distress was assessed by the Problem Areas in Diabetes. One-way analysis of covariance and multivariate analysis of covariance were conducted, controlling for demographic characteristics and restless leg syndrome. RESULTS The insomnia group had on average significantly higher scores for total mood disturbance (insomnia vs. OSA= 45.32 vs. 32.15, p=.049), tension-anxiety (insomnia vs. OSA= 12.64 vs. 9.47, p=.008), and confusion-bewilderment (insomnia vs. OSA= 9.45 vs. 7.46, p=.036) than OSA group. The OSA+I group had on average significantly greater diabetes-related distress than OSA group (OSA+I vs. OSA= 40.61 vs. 30.97, p=.036). CONCLUSIONS Insomnia may have greater impact on mood disturbance and diabetes-related distress than OSA in persons with T2DM. In particular, comorbid insomnia may contribute to greater diabetes-related distress in persons with T2DM and OSA.
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Affiliation(s)
- Bomin Jeon
- University of Pittsburgh School of Nursing, Pittsburgh, PA
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11
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Osorio RS, Martínez-García MÁ, Rapoport DM. Sleep apnoea in the elderly: a great challenge for the future. Eur Respir J 2021; 59:13993003.01649-2021. [PMID: 34561285 DOI: 10.1183/13993003.01649-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/25/2021] [Indexed: 11/05/2022]
Abstract
Due in part to overall improvements in health, the population of elderly individuals is increasing rapidly. Similarly, obstructive sleep apnoea (OSA) is both gaining increased recognition and also increasing due to the worldwide obesity epidemic. The overlap of OSA and aging is large, but there is strong plausibility for causation in both directions: OSA is associated with pathological processes that may accelerate aging and aging related processes; aging may cause physical and neurological changes that predispose to obstructive (and central) apnoea. In addition, the common symptoms (e.g. excessive daytime somnolence, defects in memory and cognition), possible physiological consequences of OSA (e.g. accelerated cardiovascular and cerebrovascular atherosclerosis), and changes in metabolic and inflammatory markers overlap with the symptoms and associated conditions seen in aging. There is also the possibility of synergy in the effects of these symptoms and conditions on quality of life, as well as a need to separate treatable consequences of OSA from age-related complaints. Taken together, the above make it essential to review the interaction of OSA and aging, both proven and suspected. The present review examines some aspects of what is known and points to the need for further investigation of the relationships, given the large number of potentially affected subjects.
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Affiliation(s)
- Ricardo S Osorio
- Department of Psychiatry, New York University (NYU) Grossman School of Medicine, New York, New York, USA.,Clinical Research Division, Nathan Kline Institute (NKI), Orangeburg, New York, USA
| | - Miguel Ángel Martínez-García
- Respirology Department, University and Politechnic la Fe Hospital, Valencia, Valencian Community, Spain .,CIBERES de Enfermedades Respiratorias, Madrid, Spain
| | - David M Rapoport
- Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Hill EA, Fairley DM, Williams LJ, Spanò G, Cooper SA, Riha RL. Prospective Trial of CPAP in Community-Dwelling Adults with Down Syndrome and Obstructive Sleep Apnea Syndrome. Brain Sci 2020; 10:E844. [PMID: 33198148 PMCID: PMC7696635 DOI: 10.3390/brainsci10110844] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 10/31/2020] [Accepted: 11/05/2020] [Indexed: 11/30/2022] Open
Abstract
Adults with Down syndrome (DS) are predisposed to obstructive sleep apnoea (OSA), but the effectiveness and acceptability of continuous positive airway pressure treatment (CPAP) in this group has rarely been formally assessed. This study was designed as a pilot randomised, parallel controlled trial for one month, continuing as an uncontrolled cohort study whereby the control group also received the intervention. Symptomatic, community-dwelling DS individuals exhibiting ≥10 apnoeas/hypopneas per hour in bed on a Type 3 home sleep study were invited to participate in this study, with follow-up at 1, 3, 6, and 12 months from baseline. Measurements of sleepiness, behaviour, cognitive function and general health were undertaken; the primary outcome was a change in the pictorial Epworth Sleepiness Scale (pESS) score. Twenty-eight participants (19 male) were enrolled: age 28 ± 9 year; body mass index 31.5 ± 7.9 kg/m2; 39.6 ± 32.2 apnoeas/hypopneas per hour in bed; pESS 11 ± 6/24. The pilot randomised controlled trial at one month demonstrated no change between the groups. At 12 months, participant (p = 0.001) pESS and Disruptive (p < 0.0001), Anxiety/Antisocial (p = 0.024), and Depressive (p = 0.008) behaviour scores were reduced compared to baseline. Improvement was noted in verbal (p = 0.001) and nonverbal intelligence scores (p = 0.011). General health scores also improved (p = 0.02). At the end of the trial, 19 participants continued on treatment. Use of CPAP in adults with DS and OSA led to a number of significant, sustained improvements in sleepiness and behavioural/emotional outcomes at 12 months.
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Affiliation(s)
- Elizabeth A Hill
- Sleep Research Unit, Centre for Clinical Brain Sciences, University of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK; (E.A.H.); (D.M.F.)
| | - Donna M Fairley
- Sleep Research Unit, Centre for Clinical Brain Sciences, University of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK; (E.A.H.); (D.M.F.)
| | - Linda J Williams
- Centre for Population Health Sciences, Usher Institute, Old Medical School, University of Edinburgh, Teviot Place, Edinburgh EH8 9AG, UK;
| | - Goffredina Spanò
- Down Syndrome Research Group, Department of Psychology, University of Arizona, Tucson, AZ 85721, USA;
| | - Sally-Ann Cooper
- Mental Health and Wellbeing Research Group, Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 0XH, UK;
| | - Renata L Riha
- Sleep Research Unit, Centre for Clinical Brain Sciences, University of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK; (E.A.H.); (D.M.F.)
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Sunwoo BY, Schmickl CN, Malhotra A. Contemporary Concise Review 2019: Sleep and ventilation. Respirology 2020; 25:552-558. [PMID: 32048407 PMCID: PMC7162714 DOI: 10.1111/resp.13781] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 01/29/2020] [Indexed: 12/30/2022]
Affiliation(s)
- Bernie Y Sunwoo
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego (UCSD), La Jolla, CA, USA
| | - Christopher N Schmickl
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego (UCSD), La Jolla, CA, USA
| | - Atul Malhotra
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego (UCSD), La Jolla, CA, USA
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