Associations of sleep-disordered breathing with excessive daytime sleepiness and blood pressure in Japanese women

Lip Seal Strength and Tongue Pressure among Japanese Male Workers: Comparison of Different Age Groups

Lip seal strength and tongue pressure are related to sarcopenia in older adults and are directly linked to the quality of life of workers after retirement. This study examined lip seal strength and tongue pressure among Japanese male workers by age. A self-administered questionnaire survey including alcohol consumption and smoking was conducted on 454 male workers. Height, weight, lip seal strength, and tongue pressure were also measured and then stratified by age (20s, 30s, 40s, 50s, and 60s and over). The mean (25th, 75th percentiles) lip seal strength and tongue pressure for all workers were 13.7 N (11.6, 16.4) and 41.7 kPa (35.2, 48.2), respectively. Both lip seal strength and tongue pressure were lowest in the 20s, at 12.1 N (9.6, 14.0) and 40.6 kPa (33.4, 47.6), respectively. The multiple regression analysis adjusted for smoking showed a significant positive association between lip seal strength and BMI for the 20s, 50s, and 60s and over, and a significant positive association between tongue pressure and BMI for the 30s, 40s, 50s, and 60s and over. To maintain oral health in older adults, it may be useful to measure workers' lip seal strength and tongue pressure and intervene at an earlier stage.

The comparison of two different mandibular positions for oral appliance therapy in patients with obstructive sleep apnea

BACKGROUND

An oral appliance (OA) can alleviate upper airway obstruction by pulling the mandible forward during sleep. While a large mandibular advancement with an OA decreases the number of apnea and hypopnea events, long-term use may cause side effects, such as toothache, stiffness, and pain in the temporomandibular joint.

OBJETIVES

This study aimed to evaluate the effectiveness of different mandibular positions for obstructive sleep apnea (OSA) and determine the optimal therapeutic mandibular position.

METHODS

Thirty-two patients (17 males and 15 females) with mild to moderate OSA participated in this prospective study. All patients were randomly allocated to receive a 50% mandibular advancement or a 75% mandibular advancement with an OA. The pre- and posttreatment apnea-hypopnea index (AHI), apnea index (AI), and Epworth Sleepiness Scale (ESS) were compared. Treatment effectiveness and treatment success were compared between groups.

RESULTS

AHI improved significantly in both groups, and AI improved significantly in the group with 50% mandibular advancement. No significant improvements in the ESS were observed in either group. There was no significant difference in treatment effectiveness between groups. In the proportion of females and males whose treatment was effective in the two groups, females were significantly greater than males.

CONCLUSIONS

For patients with mild to moderate OSA, 50% mandibular advancement is recommended as the initial therapeutic mandibular position. It was suggested that gender differences also affect treatment effectiveness.

Predicting the presence and severity of obstructive sleep apnea based on mandibular measurements using quantitative analysis of facial profiles via three-dimensional photogrammetry

BACKGROUND

In obstructive sleep apnea (OSA), the upper airway is obstructed during sleep due to obesity and/or posterior collapse of the tongue root. Maxillofacial morphological abnormalities increase the risk of OSA in the Asian population. This study sought to elucidate whether three-dimensional (3D) photogrammetry measurements correlate with the severity of OSA irrespective of sex and degree of obesity.

METHODS

A prospective pilot study was performed, in which 37 consecutive adult patients (M/F = 28/9) underwent polysomnography and 3D photogrammetry in the supine position for the diagnosis of OSA. Measurements obtained from 3D photogrammetry included mandibular width (Mw), mandibular length (Ml), mandibular depth (Md), mandibular width-length angle (Mwla), and mandibular area (Ma). The effects of sex and body mass index (BMI) on the measurements and their association with the apnea-hypopnea index (AHI) were statistically analyzed. The inter-rater reliability of the measurements was evaluated using intraclass correlation coefficients (ICC).

RESULTS

Mwla (R = 0.73, p < 0.01), Mw (R = 0.39, p < 0.05), and Md (R = -0.34, p < 0.05) were significantly correlated with the severity of OSA. On multivariate analysis, Mwla (p < 0.01) and Md (p < 0.05) remained independent factors for AHI after adjusting for sex, age, BMI, and neck circumference. In addition, diagnosability analysis revealed that Mwla was useful for identifying the presence of OSA (AHI ≥5) (cutoff: 78.6°, sensitivity: 0.938, specificity: 0.800, area under the curve: 0.931). The ICC was >0.9, showing high reliability.

CONCLUSIONS

This study suggests that Mwla measured using 3D photogrammetry can predict the presence of OSA and correlates with the severity of OSA, independent of obesity and sex.

Assessment of thrombocytopenia, sleep apnea, and cardiac involvement in GNE myopathy patients

INTRODUCTION

We previously identified UDP-N-acetylglucosamine 2-epimerase (GNE) myopathy patients with sleep apnea and a past history of thrombocytopenia, but without disease-specific cardiac involvement. This study aimed to clarify the occurrence, severity, and serial changes of these complications.

METHODS

Thirty-three genetically confirmed GNE myopathy patients who participated in a 5-y longitudinal observational history study underwent platelet count and platelet-associated immunoglobulin G (PA-IgG) measurements, a sleep study, and electrocardiography (ECG), Holter ECG, and echocardiogram examinations.

RESULTS

Among the 33 patients, three had low platelet counts and 17 out of 26 were PA-IgG positive. No patient exhibited bleeding tendencies, and 3 out of 28 had low platelet counts. Muscle weakness was more pronounced, and summed MMT and grip power significantly lower, in PA-IgG-positive patients than in PA-IgG-negative patients. Of 19 patients, 7, 4, and 3 who underwent a sleep study had mild, moderate, and severe sleep apnea, respectively, and three started continuous positive airway pressure (CPAP). The respiratory disturbance index was not significantly correlated with physical evaluation items or forced vital capacity. All patients underwent ECG, 32 underwent cardiac ultrasound, and 25 underwent Holter ECG. No disease-specific cardiac involvement was noted, no serial changes during the follow-up period were observed for ECG and echocardiography, and none of the patients required therapy for cardiac abnormalities.

DISCUSSION

PA-IgG is a potential disease biomarker in GNE myopathy patients, although its significance needs to be clarified. While none of the patients in this study experienced cardiomyopathy or arrythmia due to myopathy, sleep apnea was identified as a frequent complication.

Mild obstructive sleep apnea increases hypertension risk, challenging traditional severity classification

STUDY OBJECTIVES

The association of mild obstructive sleep apnea (OSA) with important clinical outcomes remains unclear. We aimed to investigate the association between mild OSA and systemic arterial hypertension (SAH) in the European Sleep Apnea Database cohort.

METHODS

In a multicenter sample of 4,732 participants, we analyzed the risk of mild OSA (subclassified into 2 groups: mild_{AHI 5-<11/h} (apnea-hypopnea index [AHI], 5 to <11 events/h) and mild_{AHI 11-<15/h} (AHI, ≥11 to <15 events/h) compared with nonapneic snorers for prevalent SAH after adjustment for relevant confounding factors including sex, age, smoking, obesity, daytime sleepiness, dyslipidemia, chronic obstructive pulmonary disease, type 2 diabetes, and sleep test methodology (polygraphy or polysomnography).

RESULTS

SAH prevalence was higher in the mild_{AHI 11-<15/h} OSA group compared with the mild_{AHI 5-<11/h} group and nonapneic snorers (52% vs 45% vs 30%; P < .001). Corresponding adjusted odds ratios for SAH were 1.789 (mild_{AHI 11-<15/h}; 95% confidence interval [CI], 1.49-2.15) and 1.558 (mild_{AHI 5-<11/h}; 95%, CI, 1.34-1.82), respectively (P < .001). In sensitivity analysis, mild_{AHI 11-<15/h} OSA remained a significant predictor for SAH both in the polygraphy (odds ratio, 1.779; 95% CI, 1.403-2.256; P < .001) and polysomnography groups (odds ratio, 1.424; 95% CI, 1.047-1.939; P = .025).

CONCLUSIONS

Our data suggest a dose-response relationship between mild OSA and SAH risk, starting from 5 events/h in polygraphy recordings and continuing with a further risk increase in the 11- to <150-events/h range. These findings potentially introduce a challenge to traditional thresholds of OSA severity and may help to stratify participants with OSA according to cardiovascular risk.

Primary aldosteronism and obstructive sleep apnea: A single-center cross-sectional study of the Japanese population

A recent report demonstrated that the prevalence of obstructive sleep apnea (OSA) is 67.6% among Caucasian and Chinese patients with primary aldosteronism (PA). Moreover, the report showed a significant association between plasma aldosterone concentration (PAC) and the severity of OSA in Caucasian patients. However, no studies have examined the prevalence of OSA with PA or the association of its severity with PAC in the Japanese population. We retrospectively evaluated the prevalence and severity of OSA in 71 newly diagnosed Japanese patients with PA. Thirty-nine (55%) of the 71 patients were diagnosed with OSA, and 69% of PA patients with OSA reported snoring. No correlation was found between the respiratory event index (REI), snoring index, and PAC and plasma renin activity (PRA). In contrast, REI correlated significantly with body mass index (BMI), which was significantly correlated with PRA. In conclusion, although the severity of OSA did not correlate with PAC and PRA, there was a high prevalence of OSA among Japanese patients with PA. Moreover, the severity of OSA was strongly affected by BMI. Thus, the examination of OSA in patients with PA and the proper management of OSA might be important for the Japanese population.

Nocturnal Hypoxemia and High Circulating TNF-α Levels in Chronic Thromboembolic Pulmonary Hypertension

Objective Chronic thromboembolic pulmonary hypertension (CTEPH) is a form of pulmonary hypertension caused by persistent thromboemboli of the pulmonary arteries, and one of its etiological factors may be inflammation. Sleep disordered breathing (SDB) is reportedly an important complication of pulmonary hypertension. However, the association between SDB and inflammation in CTEPH has been undefined. This prospective observational study analyzed the association between the severity of SDB, pulmonary hemodynamic parameters and the systemic inflammation level in patients with CTEPH. Methods CTEPH patients admitted for a right heart catheter (RHC) examination were consecutively enrolled from November 2017 to June 2019 at the pulmonary hypertension center in Chiba University Hospital. Patients with idiopathic pulmonary arterial hypertension (IPAH) were also enrolled as a control group. All patients underwent a sleep study using a WatchPAT 200 during admission. Results The CTEPH patients showed worse nocturnal hypoxemia, oxygen desaturation index (ODI), and apnea-hypopnea index than the IPAH patients. Among these factors, only the nocturnal mean percutaneous oxygen saturation (SpO₂) was negatively correlated with the pulmonary hemodynamic parameters. The circulating tumor necrosis factor-alpha (TNF-α) level was also high in the CTEPH group, and a multivariate analysis showed that the nocturnal mean SpO₂ was the most important predictive factor for a high TNF-α level. Conclusion We showed that CTEPH patients had high serum TNF-α levels and that the nocturnal mean SpO₂ was a predictive factor for serum TNF-α levels. Further investigations focused on nocturnal hypoxemia and the TNF-α level may provide novel insight into the etiology and new therapeutic strategies for CTEPH.

Associations of snoring frequency with blood pressure among the lean Japanese population: the Toon Health Study

To date, there are few studies in Asian populations on the association between snoring (a major clinical symptom of sleep apnea) and hypertension. This study aims to examine whether snoring frequency is associated with blood pressure and hypertension in the general Japanese population, after adjustment for major confounding factors. A cross-sectional study of 2021 middle-aged Japanese men and women enrolled in the Toon Health Study between 2009-2012 was conducted. Snoring frequency was assessed using a self-reported questionnaire, and was classified into four categories: never, ≤2 times/week, ≥3 times/week, and unknown. Multivariable regression coefficients for each snoring category were calculated for systolic and diastolic blood pressure, and their odds ratios (ORs) and 95% confidence intervals (95% CIs) for hypertension were calculated after adjusting for major confounding factors. The same analyses were also conducted after stratification by several major confounding factors. Multivariable-adjusted means of systolic and diastolic blood pressure among individuals who snored ≥3 times/week were 4.57 mmHg and 2.58 mmHg higher, respectively, than in individuals who never snored (p < 0.05). The multivariable-adjusted OR (95% CI) for hypertension in the group that snored ≥3 times/week was 1.79 (1.29-2.48), compared with the group that never snored. We also found a significant positive association between snoring frequency and hypertension not only in normal and overweight individuals, but also in lean individuals (body mass index ≤22.8 kg/m²). Higher snoring frequency was associated with higher blood pressure and hypertension among both lean and non-lean Japanese.

An Official American Thoracic Society Research Statement: Impact of Mild Obstructive Sleep Apnea in Adults

BACKGROUND

Mild obstructive sleep apnea (OSA) is a highly prevalent disorder in adults; however, whether mild OSA has significant neurocognitive and cardiovascular complications is uncertain.

OBJECTIVES

The specific goals of this Research Statement are to appraise the evidence regarding whether long-term adverse neurocognitive and cardiovascular outcomes are attributable to mild OSA in adults, evaluate whether or not treatment of mild OSA is effective at preventing or reducing these adverse neurocognitive and cardiovascular outcomes, delineate the key research gaps, and provide direction for future research agendas.

METHODS

Literature searches from multiple reference databases were performed using medical subject headings and text words for OSA in adults as well as by hand searches. Pragmatic systematic reviews of the relevant body of evidence were performed.

RESULTS

Studies were incongruent in their definitions of "mild" OSA. Data were inconsistent regarding the relationship between mild OSA and daytime sleepiness. However, treatment of mild OSA may improve sleepiness in patients who are sleepy at baseline and improve quality of life. There is limited or inconsistent evidence pertaining to the impact of therapy of mild OSA on neurocognition, mood, vehicle accidents, cardiovascular events, stroke, and arrhythmias.

CONCLUSIONS

There is evidence that treatment of mild OSA in individuals who demonstrate subjective sleepiness may be beneficial. Treatment may also improve quality of life. Future research agendas should focus on clarifying the effect of mild OSA and impact of effective treatment on other neurocognitive and cardiovascular endpoints as detailed in the document.

Prevalence of Sleep Disordered Breathing among Patients with Nocturia at a Urology Clinic

OBJECTIVE

We assessed the prevalence of sleep disordered breathing (SDB) and characteristics among patients who visited a urology clinic complaining of nocturia (URO group) and those who visited a sleep apnea (SA) clinic complaining of excessive daytime sleepiness (EDS) (SA group). Additionally, we evaluated the effects of continuous positive airway pressure (CPAP) therapy in the URO group patients with nocturia and SDB resistant to conventional therapy for nocturia.

METHODS

Questionnaires were used to assess EDS, nocturia and lower urinary tract symptoms in 34 URO group patients and 49 age-matched SA group patients. We also compared these factors in the male patients in both groups and the male and female patients in the SA group. Significant SDB was diagnosed as a 3% oxygen desaturation index (3%ODI) on pulse oximeter of >5/h. The treatment response was analyzed in six URO group patients treated with CPAP after not responding to the conventional medical treatment.

RESULTS

SDB was found in 91.8% of the SA group patients and 70.6% of the URO group patients. The level of EDS and lower urinary tract symptoms were similar in both groups. The SA group showed higher 3%ODI values, while the frequency of urination during bedtime was higher in the URO group. The frequency of nocturnal urination was reduced after CPAP in the subjects resistant to conventional therapy.

CONCLUSION

SDB is as prevalent in patients who visit a urology clinic complaining of nocturia as in those who visit a sleep apnea clinic. Patients who complains of nocturia must be assessed for SDB before starting therapy for nocturia.

Lack of Impact of Mild Obstructive Sleep Apnea on Sleepiness, Mood and Quality of Life

BACKGROUND AND OBJECTIVES

Obstructive sleep apnea (OSA) is associated with sleepiness, depression and reduced quality of life. However, it is unclear whether mild OSA has these negative impacts. Using data from the Apnea Positive Pressure Long-term Efficacy Study (APPLES), this study determined whether participants with mild OSA had greater sleepiness, more depressive symptoms and poorer quality of life in comparison to those without OSA.

METHODS

239 individuals evaluated for participation in APPLES with a baseline apnea hypopnea index (AHI) < 15 /hour were assigned to 1 of 2 groups: No OSA (N=40, AHI < 5 /hour) or Mild OSA (N=199, 5 to <15 /hour) based on their screening polysomnogram. Scores on their Epworth Sleepiness Scale (ESS), Stanford Sleepiness Scale (SSS), Hamilton Rating Scale for Depression (HAM-D), Profile of Mood States (POMS) and Sleep Apnea Quality of Life Index (SAQLI) were compared between groups.

RESULTS

There were no significant differences between the No OSA and Mild OSA groups on any of the 5 measures: ESS (No OSA, 9.8 ± 3.5 vs Mild OSA, 10.6 ± 4.3, p=0.26), SSS,(2.8 ± 0.9 vs. 2.9 ± 1.0, p=0.52), HAM-D (4.6 ± 3.0 vs. 4.9 ± 4.7, p=0.27), POMS (33.5 ± 22.3 vs. 28.7 ± 22.0, p=0.70), SAQLI (4.5 ± 0.8 vs. 4.7 ± 0.7, p=0.39).

CONCLUSION

Individuals with mild OSA in this cohort do not have worse sleepiness, mood or quality of life in comparison to those without OSA.

Obstructive sleep apnea syndrome (OSAS) and hypertension: pathogenic mechanisms and possible therapeutic approaches

Obstructive sleep apnea syndrome (OSAS), a chronic condition characterized by collapse of the pharynx during sleep, has been increasingly recognized as a health issue of growing importance over the last decade. Recently emerging evidence suggests that there is a causal link between OSAS and hypertension, and hypertension represents an independent risk factor in OSAS patients. However, the pathophysiological basis for patients with OSAS having an increased risk for hypertension remains to be elucidated. The main acute physiological outcomes of OSAS are intermittent hypoxia, intrapleural pressure changes, and arousal from sleep, which might induce endothelial dysfunction, sympathetic activation, renin-angiotensin-aldosterone system activation, lipid metabolism dysfunction, and increased oxidative stress. This brief review focuses on the current understanding of the complex association between OSAS and hypertension.

Self-reported snoring frequency and incidence of cardiovascular disease: the Circulatory Risk in Communities Study (CIRCS)

Background

Although associations between snoring and cardiovascular disease have been reported in several prospective studies, there is limited evidence from Asian populations. The objective of this study was to determine if there is an association between self-reported snoring frequency and the incidence of cardiovascular disease in Japanese.

Methods

The subjects were 2350 men and 4163 women aged 40 to 69 years who lived in 3 communities in Japan. All subjects were participants in the Circulatory Risk in Communities Study (CIRCS) and were followed for 6 years. Incidence of cardiovascular disease during the follow-up period comprised events of myocardial infarction, angina pectoris, sudden cardiac death and stroke.

Results

During the 6-year follow-up period, 97 participants (56 men and 41 women) had cardiovascular events. After adjustment for potential confounding factors, self-reported snoring frequency was associated with an increased risk of cardiovascular events among women but not men. The hazard ratios (95% CI) for cardiovascular events were 0.9 (0.4–2.0) for sometimes snoring and 2.5 (1.0–6.1) for everyday snoring in women and 0.7 (0.3–1.3) and 1.0 (0.5–2.1), respectively, in men. Further adjustment for body mass index attenuated the association in women; the respective hazard ratios for cardiovascular events were 0.9 (0.4–1.9) and 2.1 (0.9–5.4).

Conclusions

Self-reported habitual snoring was associated with increased risk of cardiovascular events among Japanese women. Overweight may partly mediate this association.

Risk factors for snoring among Japanese men and women: a community-based cross-sectional study

PURPOSE

This study seeks to examine risk factors for snoring, a major symptom of sleep-disordered breathing (SDB) because the evidence is limited in Asian populations.

METHODS

Subjects for the present cross-sectional study were 3,138 men and 5,345 women aged 35–79 years from three communities in Japan who participated in the Circulatory Risk in Communities Study. The data on snoring frequency and cardiovascular health were obtained during annual cardiovascular surveys between 2000 and 2005. The logistic regression model was used to estimate the odds ratios (ORs) for snoring associated with body mass index (BMI), alcohol consumption, and other cardiovascular risk factors.

RESULTS

The prevalence of almost everyday snoring was 24% among men and 10% among women. After adjustments for age, community, cigarette smoking, alcohol consumption, and for women, menopausal status, the multivariable-adjusted ORs for everyday snoring in the highest versus lowest quartiles of BMI categories were 3.4 (95% confidence interval (CI): 2.6–4.4) for men and 3.9 (2.8–5.4) for women. The respective ORs in ≥23 g ethanol per day versus never-drinkers categories were 1.4 (1.1–1.8) and 3.1 (1.8–5.3) and those in ≥20 cigarettes versus never-smokers categories were 1.4 (1.0–1.8) and 1.9 (0.9–3.7). The associations of alcohol consumption and cigarette smoking with everyday snoring were stronger for BMI<25 kg/m2 than BMI≥25 kg/m2 in both sexes.

CONCLUSION

BMI, alcohol consumption, and cigarette smoking were positively associated with habitual snoring for both men and women, especially in nonoverweight persons.

Obstructive sleep apnea: its prevention and screening may contribute to the prevention of hypertension, diabetes and cardiovascular diseases

Relationships between obstructive sleep apnea and cardiovascular diseases have been reported by both clinical and epidemiological studies. To investigate whether nocturnal intermittent hypoxia (NIH), a surrogate marker for obstructive sleep apnea in the general population, is associated with cardiovascular risk factors, we have conducted epidemiological studies in Japan. The Circulatory Risk in Communities Study (CIRCS) is a cohort study conducted across Japan to examine the risk factors for cardiovascular diseases. In CIRCS participants, NIH was estimated by the hourly occurrences of oxygen desaturation ≥3% (3% oxygen desaturation index [3% ODI]) measured during sleep using a pulse-oximeter. Our studies showed that among middle-aged Japanese, 3% ODI levels were associated with hypertension, elevated serum CRP levels, accumulation of metabolic risk factors, and increased risk of developing type 2 diabetes. Screening for obstructive sleep apnea in the general population is a promising and widely broadly applicable strategy for predictive, preventive and personalized medicine.

Associations between alcohol consumption and sleep-disordered breathing among Japanese women

BACKGROUND

The associations between alcohol consumption and sleep-disordered breathing in women are uncertain.

METHODS

We conducted a cross-sectional study of 3113 women aged 30-69 years. The 3% oxygen desaturation index (3% ODI), based on overnight pulse oximetry findings, was selected as an indicator of sleep-disordered breathing.

RESULTS

3% ODI frequencies of ≥5 were higher for drinking women with ethanol intakes of ≥23.0 g/d than for never drinkers: the respective multivariable odds ratios and 95% confidence intervals was 1.8(1.0-3.4). The corresponding odds ratio was 3.0(1.6-5.8) for habitual snoring. The associations of ethanol intakes of ≥23.0 g/d with 3% ODI ≥ 5 was more evident among women with BMI <23.0 kg/m(2) (median) than those with higher BMI but did not vary by habitual snoring. The multivariable odds ratios of 3%ODI ≥ 5 for women with ethanol intakes of ≥23.0 g/d versus never drinkers were 2.7(1.0-6.7) for lower BMI and 1.5(0.6-3.3) for higher BMI and the corresponding odds ratio were 2.8(1.6-7.2) and 3.2(1.3-7.9) for habitual snoring, respectively.

CONCLUSION

Alcohol consumption was associated with higher prevalence of sleep-disordered breathing among Japanese women.