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Bertoni DG, Garvey E, Garg N, Amin D, Tekumalla S, Mann D, Naimi B, Zhan T, Hunt P, Boon M, Huntley C. Safety of Ambulatory Surgery For Obstructive Sleep Apnea: A Retrospective Review. Otolaryngol Head Neck Surg 2024; 171:277-285. [PMID: 38426630 DOI: 10.1002/ohn.691] [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: 08/26/2023] [Revised: 01/08/2024] [Accepted: 01/21/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVE Assess the safety of ambulatory surgery performed for obstructive sleep apnea. STUDY DESIGN Retrospective chart review. SETTING Tertiary care hospital. METHODS Demographic data including age, gender, race, body mass index, insurance status, socioeconomic status, and distance traveled for surgery was collected, as well as comorbidities, and apnea-hypopnea index (AHI). Outcome variables included continuous positive airway pressure reinitiation, planned/unplanned postoperative admission, emergency department (ED) presentation, or readmission within 7 and 14 days of surgery. RESULTS A total of 601 patients were included, who underwent sleep surgery between 2017 and 2022. The median age was 55 years [interquartile range: 19]. A total of 437 patients (73%) were male, 502 (84%) were Caucasian, and the median distance traveled was 20 miles [27]. The median AHI was 27.1 [26]. A total of 286 hypoglossal nerve stimulators, 12 tonsillectomies, 160 expansion sphincteroplasties (ESP), and 201 nasal procedures were performed. There were 9 (1%) planned and 23 (4%) total admissions postoperatively. Sixteen patients (2%) presented to ED within 7 days, and 22 (3%) within 14 days. Nine (1%) were readmitted within 7 days, and 12 (2%) within 14 days. There were significantly more planned admissions, unplanned admissions, ED presentations, and readmissions for ESP. There were no significant differences in demographic or clinical data between patients who underwent single versus multiple surgeries. CONCLUSION Outpatient sleep surgery is generally safe. Close postoperative monitoring is necessary and overnight observation should be considered in those with very severe sleep apnea and/or significant comorbidities. The distance a patient travels should also be considered for overnight admission.
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Affiliation(s)
- Dylan Gregory Bertoni
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Emily Garvey
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Neha Garg
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Dev Amin
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Sruti Tekumalla
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Derek Mann
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Bita Naimi
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Tingting Zhan
- Department of Biostatistics, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Patrick Hunt
- Department of Anesthesiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Maurits Boon
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Colin Huntley
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
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Blaszczyk B, Wichniak A, Wieckiewicz M, Brzecka A, Nowacki D, Michalek-Zrabkowska M, Lachowicz G, Mazur G, Martynowicz H. The clinical characteristic of catathrenia: a new look at an old issue-a systematic review of existing literature. Sleep Breath 2024:10.1007/s11325-024-03033-0. [PMID: 38755507 DOI: 10.1007/s11325-024-03033-0] [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: 01/24/2024] [Revised: 03/25/2024] [Accepted: 04/08/2024] [Indexed: 05/18/2024]
Abstract
STUDY OBJECTIVES The International Classification of Sleep Disorders categorized catathrenia as a respiratory disorder, but there are doubts whether episodes appear during rapid eye movement (REM) sleep or the non-rapid eye movement (NREM), their duration, and symptoms. The main objectives were to identify the most common features and relations of catathrenia. METHODS PubMed, Embase, and Web of Science were searched according to the PRISMA 2020 guidelines. The Joanna Briggs Institute and the ROBINS-I tools were chosen to assess the risk of bias. RESULTS A total of 288 records were identified, 31 articles were included. The majority of the studies had a moderate risk of bias. 49.57% of episodes occurred during the NREM sleep, while 46% took place during REM. In 60.34% females, catathrenia was more common in the NREM, while in 59.26% of males was in REM sleep (p < 0.05). Females and obese individuals were found to have shorter episodes (p < 0.05). Age was inversely correlated with minimal episodes duration (r = - 0.34). The continuous positive airway pressure (CPAP) therapy was inversely correlated with the maximal episode duration (r = - 0.48). CONCLUSIONS Catathrenia occurs with similar frequency in both genders. The most frequent symptoms embraced groaning, awareness of disturbing bedpartners, and daytime somnolence-not confirmed by the Epworth Sleepiness Scale. The episodes occur more frequently in NREM than in REM sleep. Catathrenia may be considered as a sex-specific condition. The effects of CPAP treatment leading to shortening episodes duration, which may indicate the respiratory origin of catathrenia.
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Affiliation(s)
- Bartlomiej Blaszczyk
- Student Research Club No K133, Faculty of Medicine, Wroclaw Medical University, 50-556, Wroclaw, Poland.
| | - Adam Wichniak
- Third Department of Psychiatry and Sleep Medicine Centre, Institute of Psychiatry and Neurology, 02-957, Warsaw, Poland
| | - Mieszko Wieckiewicz
- Department of Experimental Dentistry, Wroclaw Medical University, 50-425, Wroclaw, Poland
| | - Anna Brzecka
- Department of Pulmonology and Lung Cancer, Wroclaw Medical University, 53-439, Wroclaw, Poland
| | - Dorian Nowacki
- Department of Human Nutrition, Wroclaw University of Environmental and Life Sciences, 51-630, Wroclaw, Poland
| | - Monika Michalek-Zrabkowska
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 50-556, Wroclaw, Poland
| | - Gabriella Lachowicz
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 50-556, Wroclaw, Poland
| | - Grzegorz Mazur
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 50-556, Wroclaw, Poland
| | - Helena Martynowicz
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 50-556, Wroclaw, Poland
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Eshera YM, Gavrilova L, Hughes JW. Sleep is Essential for Cardiovascular Health: An Analytic Review of the Relationship Between Sleep and Cardiovascular Mortality. Am J Lifestyle Med 2024; 18:340-350. [PMID: 38737888 PMCID: PMC11082862 DOI: 10.1177/15598276231211846] [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: 05/14/2024] Open
Abstract
The American Heart Association recently included sleep health as one of eight factors that define cardiovascular health. Restorative sleep is a pillar of lifestyle medicine influenced by sleep duration, quality, and disorders. Short and long sleep duration are associated with greater risk of cardiovascular disease. Short sleep appears causally related to cardiovascular risk. Long sleep is more strongly predictive of cardiovascular risk, which may be due to comorbidities and other risk factors. Good-quality sleep appears to protect against the increased risk and is independently associated with risk of cardiovascular disease (CVD). Insomnia, particularly difficulty falling asleep and non-restorative sleep, is associated with an increase in cardiac events. Obstructive sleep apnea (OSA) is associated with cardiac risk and outcomes, which is typically observed in the context of contributing comorbidities. However, treating OSA with continuous positive airway pressure (CPAP) may not improve prognosis. Further research is needed to understand the causal mechanisms connecting sleep health with CVD and whether modifying sleep can improve outcomes. Sleep health should be considered as part of a holistic approach to improving cardiovascular health, as reflected in the scoring of LE8 and as one of the interrelated components of lifestyle medicine.
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Affiliation(s)
- Yasmine M. Eshera
- Department of Psychological Sciences, Kent State University, Kent, OH, USA
| | - Lyubov Gavrilova
- Department of Psychological Sciences, Kent State University, Kent, OH, USA
| | - Joel W. Hughes
- Department of Psychological Sciences, Kent State University, Kent, OH, USA
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4
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Khan S, Walters RK, Walker AM, Nguyen SA, Liu SY, Tremont TJ, Abdelwahab MA. The readability of online patient education materials on maxillomandibular advancement surgery. Sleep Breath 2024; 28:745-751. [PMID: 38062224 DOI: 10.1007/s11325-023-02952-8] [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: 06/17/2023] [Revised: 10/05/2023] [Accepted: 11/20/2023] [Indexed: 05/31/2024]
Abstract
STUDY OBJECTIVES Maxillomandibular advancement (MMA) is an effective surgical option for patients suffering from obstructive sleep apnea (OSA). As a relatively new treatment option, patients may turn to the Internet to learn more. However, online patient education materials (OPEMs) on MMA may be written at a higher literacy level than recommended for patients. The aim of this study was to analyze the readability of OPEMs on MMA. METHODS A Google search of "maxillomandibular advancement" was performed, and the first 100 results were screened. Websites that met eligibility criteria were analyzed for their readability using the Automated Readability Index (ARI), Coleman-Liau Index (CLI), Flesch-Kincaid Grade Level (FKGL), Gunning Fog (GF), and Simple Measure of Gobbledygook (SMOG) and compared to the recommended sixth-grade reading level using one-tailed t tests. Readability scores were compared based on the type of website, including hospitals/universities or physician clinics, using ANOVA tests. RESULTS The mean (SD) for ARI, CLI, FKGL, GF, and SMOG was 11.91 (2.43), 13.42 (1.81), 11.91 (2.06), 14.32 (2.34), and 13.99 (1.56), respectively. All readability scores were significantly higher than a sixth-grade reading level (p < 0.001). After comparing readability scores between different website types (university/hospital, clinic, and other), there was no statistical difference found. CONCLUSIONS The available OPEMs on MMA surgery for OSA are above the recommended sixth-grade reading level. Identifying and reducing the gap between the reading levels of OPEMs and the reading level of the patient are needed to encourage a more active role, informed decisions, and better patient satisfaction.
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Affiliation(s)
- Sofia Khan
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, MSC 500, Charleston, SC, 29425, USA.
| | - Rameen K Walters
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, MSC 500, Charleston, SC, 29425, USA
| | - Angelica M Walker
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, MSC 500, Charleston, SC, 29425, USA
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, MSC 500, Charleston, SC, 29425, USA
| | - Stanley Y Liu
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, CA, 94305, USA
| | - Timothy J Tremont
- Department of Orthodontics, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Mohamed A Abdelwahab
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, MSC 500, Charleston, SC, 29425, USA
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5
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Varol Y, Uçar ZZ, Oktay Arslan B, Karasu I. Apnea-hypopnea index and the polysomnographic risk factors for predicting 5- to 8-year mortality in patients with OSA. Sleep Breath 2024; 28:103-112. [PMID: 37422579 DOI: 10.1007/s11325-023-02868-3] [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: 06/13/2022] [Revised: 05/22/2023] [Accepted: 06/02/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND The purpose of this study was to investigate the long-term mortality rates of patients with obstructive sleep apnea (OSA) who received an overnight polysomnogram (PSG) for obtaining the diagnosis and to determine the relationship between PSG parameters and overall mortality. METHODS Between 2007 and 2013, patients who had overnight PSG and were diagnosed with OSA were included in the study. Factors which are thought to influence mortality were assessed for 5-year and overall survival using the log rank test and Kaplan-Meier survival curves. Using multivariable Cox regression analysis, a model was constructed for factors influencing 5-year and overall survival. RESULTS A total of 762 patients with a mean age of 52.7 (±10.8) and a dominance of men (74.7%) were studied. Gender, OSA severity subgroups, and apnea hypopnea index (AHI) were not statistically significantly associated with either 5-year or overall mortality (p<0.05 for both). Age, having a cardiovascular comorbidity, proportion of rapid eye movement (%REM), and total sleep time with an oxyhemoglobin saturation of less than 90% (T90) all showed a significant correlation with overall all-cause mortality in the model. For 5-year mortality and overall mortality, the hazard ration (HR) for T90 was 3.6 (95% CI (1.6-8.0) p=0.001) and 3 (95% CI (1.6-5.7) p=0.001), respectively. CONCLUSION The study findings suggest that not AHI but PSG parameters of hypoxia, mainly T90, having cardiovascular comorbidity, and %REM sleep were significant risk factors for all-cause mortality in patients with OSA. The association of OSA, hypoxia, and mortality is an area that deserves further study.
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Affiliation(s)
- Yelda Varol
- Department of Pulmonology, Dr. Suat Seren Chest Diseases and Surgery Education and Training Hospital, University of Health Sciences, Izmir Faculty of Medicine, Izmir, Turkey.
| | - Zeynep Zeren Uçar
- Department of Pulmonology, Dr. Suat Seren Chest Diseases and Surgery Education and Training Hospital, University of Health Sciences, Izmir Faculty of Medicine, Izmir, Turkey
| | - Burcu Oktay Arslan
- Department of Pulmonology, Dr. Suat Seren Chest Diseases and Surgery Education and Training Hospital, University of Health Sciences, Izmir Faculty of Medicine, Izmir, Turkey
| | - Işıl Karasu
- Department of Pulmonology, Dr. Suat Seren Chest Diseases and Surgery Education and Training Hospital, University of Health Sciences, Izmir Faculty of Medicine, Izmir, Turkey
- Department of Pulmonology, Dr. Suat Seren Chest Diseases and Surgery Education and Training Hospital, Izmir, Turkey
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Loh HH, Sukor N. Obstructive sleep apnea and vitamin D level: Has the dust settled? THE CLINICAL RESPIRATORY JOURNAL 2024; 18:e13593. [PMID: 36746181 DOI: 10.1111/crj.13593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/08/2023] [Accepted: 01/25/2023] [Indexed: 02/08/2023]
Abstract
Obstructive sleep apnea and vitamin D deficiency are associated with multiple complications with increased morbidity and mortality. However, the relationship between these two entities remains unclear, with clinical studies demonstrating contradictory results. This narrative review aims to present the current evidence and understanding of this relationship and discuss the possible mechanisms linking these two disease entities. Finally, we summarize and propose areas of opportunity for future research.
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Affiliation(s)
- Huai Heng Loh
- Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia
- Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Center (UKMMC), Kuala Lumpur, Malaysia
| | - Norlela Sukor
- Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Center (UKMMC), Kuala Lumpur, Malaysia
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7
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Behnoush AH, Khalaji A, Ghondaghsaz E, Masrour M, Shokri Varniab Z, Khalaji S, Cannavo A. Triglyceride-glucose index and obstructive sleep apnea: a systematic review and meta-analysis. Lipids Health Dis 2024; 23:4. [PMID: 38185682 PMCID: PMC10773018 DOI: 10.1186/s12944-024-02005-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/01/2024] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) has a bidirectional association with metabolic syndrome, and insulin resistance (IR). The triglyceride-glucose (TyG) index could be a simply calculated marker of IR in OSA. However, its clinical application appears still limited. Hence, this systematic review and meta-analysis aimed to respond to this question by analyzing all the existing studies showing an association between OSA and the TyG index. METHODS Four online databases, including PubMed, Scopus, the Web of Science, and Embase were searched for studies evaluating the TyG index in OSA. After screening and data extraction, a random-effect meta-analysis was performed to compare the TyG index in OSA patients vs. healthy controls by calculating standardized mean difference (SMD) and 95% confidence interval (CI) and pooling the area under the curves (AUCs) for diagnosis of OSA based on this index. RESULTS Ten studies involving 16,726 individuals were included in the current systematic review. Meta-analysis indicated that there was a significantly higher TyG index in patients with OSA, compared with the healthy controls (SMD 0.856, 95% CI 0.579 to 1.132, P < 0.001). Also, TyG had a diagnostic ability for OSA representing a pooled AUC of 0.681 (95% CI 0.627 to 0.735). However, based on the two studies' findings, no difference between different severities of OSA was observed. Finally, our data showed that the TyG index is a good potential predictor of adverse outcomes in these patients. CONCLUSION Our study revealed that the TyG index is an easy-to-measure marker of IR for assessing OSA, both in diagnosis and prognosis. Our study supports its implementation in routine practice to help clinicians in decision-making and patient stratification.
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Affiliation(s)
- Amir Hossein Behnoush
- School of Medicine, Tehran University of Medical Sciences, Poursina St., Keshavarz Blvd, Tehran, 1417613151, Iran
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirmohammad Khalaji
- School of Medicine, Tehran University of Medical Sciences, Poursina St., Keshavarz Blvd, Tehran, 1417613151, Iran.
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Elina Ghondaghsaz
- Undergraduate Program in Neuroscience, University of British Columbia, Vancouver, BC, Canada
| | - Mahdi Masrour
- School of Medicine, Tehran University of Medical Sciences, Poursina St., Keshavarz Blvd, Tehran, 1417613151, Iran
| | - Zahra Shokri Varniab
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Soheil Khalaji
- School of Medicine, Tehran University of Medical Sciences, Poursina St., Keshavarz Blvd, Tehran, 1417613151, Iran
| | - Alessandro Cannavo
- Department of Translational Medicine Sciences, Federico II University of Naples, Naples, Italy
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Rogel M, Iverson L, Hall A. Identifying Obstructive Sleep Apnea Risk Using the STOP-BANG Questionnaire in a Cardiology Clinic. J Healthc Qual 2024; 46:51-57. [PMID: 37820053 DOI: 10.1097/jhq.0000000000000408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
ABSTRACT Untreated obstructive sleep apnea (OSA) is associated with increased cardiovascular morbidity and mortality, warranting enhanced awareness, screening, and action among healthcare providers to optimize patient outcomes. Attempting to address the potential under detection of OSA, this quality improvement project implemented the STOP-Bang Sleep Apnea Questionnaire at a cardiology clinic, with the goals to stratify risk for OSA in 100% of patients and increase provider referral of high risk patients for sleep studies. The setting was an outpatient cardiology clinic in Pensacola, Florida. The sample included new and existing patients 18 years or older who had one or more of the following diagnoses: hypertension, heart failure, coronary artery disease, atrial fibrillation, or arrhythmia. Methods involved collecting and comparing preintervention sleep study referral rate data with 6-week STOP-Bang questionnaire implementation data. Results demonstrated a 65% (279 of 428 patients seen) screening implementation rate and a modest but statistically significant increase in the overall referral rate from 2.6% preintervention to 5.1% postintervention ( p = .040). Overall, standard use of the STOP-Bang questionnaire may enable higher detection and referral of OSA.
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Qian Y, Dharmage SC, Hamilton GS, Lodge CJ, Lowe AJ, Zhang J, Bowatte G, Perret JL, Senaratna CV. Longitudinal risk factors for obstructive sleep apnea: A systematic review. Sleep Med Rev 2023; 71:101838. [PMID: 37639973 DOI: 10.1016/j.smrv.2023.101838] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 08/09/2023] [Accepted: 08/14/2023] [Indexed: 08/31/2023]
Abstract
Despite substantial disease burden, existing evidence on the risk factors for obstructive sleep apnea (OSA) have been derived primarily from cross-sectional studies without determining temporality. Therefore, we aimed to systematically synthesize the literature on longitudinal risk factors for sleep study-assessed OSA and questionnaire-assessed probable OSA from cohort studies in the general adult population settings. We systematically searched Embase and Medline (on OVID) databases. Eleven studies met the inclusion criteria. Meta-analyses were not conducted due to methodological heterogeneity of exposure and outcome measurements. There was consistent evidence that weight gain was associated with incident (n = 2) and greater severity (n = 2) of OSA. One study each observed an association of higher baseline body-mass index, male sex, asthma, a specific genetic polymorphism in rs12415421, and insulin resistance/hyperglycemia, with incident OSA. Long-term exposure to ambient air pollution (NO2, n = 1) was associated with OSA, and menopausal transitions (n = 1) with higher apnea-hypopnea index. There were no eligible studies on long-term smoking or alcohol use. In conclusion, approximately 10% increase in weight, especially in males, might alert clinicians to consider potential or worsening OSA. Large, well-designed longitudinal studies are needed to consolidate knowledge on other associations with OSA development, especially on potentially modifiable risk factors.
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Affiliation(s)
- Yaoyao Qian
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie St, Carlton, Victoria, 3053, Australia
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie St, Carlton, Victoria, 3053, Australia
| | - Garun S Hamilton
- Monash Lung, Sleep, Allergy and Immunology, Monash Health, 246 Clayton Road, Clayton, VIC, 3168, Australia; School of Clinical Sciences, Monash University, 246 Clayton Road, Clayton, VIC, Australia.
| | - Caroline J Lodge
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie St, Carlton, Victoria, 3053, Australia
| | - Adrian J Lowe
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie St, Carlton, Victoria, 3053, Australia; Murdoch Children's Research Institute, 50 Flemington Rd, Parkville, VIC, 3052, Melbourne, Australia
| | - Jingwen Zhang
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie St, Carlton, Victoria, 3053, Australia
| | - Gayan Bowatte
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie St, Carlton, Victoria, 3053, Australia
| | - Jennifer L Perret
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie St, Carlton, Victoria, 3053, Australia; The Institute for Breathing and Sleep (IBAS) Melbourne, 145 Studley Rd, Heidelberg, VIC, 3084, Australia
| | - Chamara V Senaratna
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie St, Carlton, Victoria, 3053, Australia
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10
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Chang JL, Goldberg AN, Alt JA, Alzoubaidi M, Ashbrook L, Auckley D, Ayappa I, Bakhtiar H, Barrera JE, Bartley BL, Billings ME, Boon MS, Bosschieter P, Braverman I, Brodie K, Cabrera-Muffly C, Caesar R, Cahali MB, Cai Y, Cao M, Capasso R, Caples SM, Chahine LM, Chang CP, Chang KW, Chaudhary N, Cheong CSJ, Chowdhuri S, Cistulli PA, Claman D, Collen J, Coughlin KC, Creamer J, Davis EM, Dupuy-McCauley KL, Durr ML, Dutt M, Ali ME, Elkassabany NM, Epstein LJ, Fiala JA, Freedman N, Gill K, Boyd Gillespie M, Golisch L, Gooneratne N, Gottlieb DJ, Green KK, Gulati A, Gurubhagavatula I, Hayward N, Hoff PT, Hoffmann OM, Holfinger SJ, Hsia J, Huntley C, Huoh KC, Huyett P, Inala S, Ishman SL, Jella TK, Jobanputra AM, Johnson AP, Junna MR, Kado JT, Kaffenberger TM, Kapur VK, Kezirian EJ, Khan M, Kirsch DB, Kominsky A, Kryger M, Krystal AD, Kushida CA, Kuzniar TJ, Lam DJ, Lettieri CJ, Lim DC, Lin HC, Liu SY, MacKay SG, Magalang UJ, Malhotra A, Mansukhani MP, Maurer JT, May AM, Mitchell RB, Mokhlesi B, Mullins AE, Nada EM, Naik S, Nokes B, Olson MD, Pack AI, Pang EB, Pang KP, Patil SP, Van de Perck E, Piccirillo JF, Pien GW, Piper AJ, Plawecki A, Quigg M, Ravesloot MJ, Redline S, Rotenberg BW, Ryden A, Sarmiento KF, Sbeih F, Schell AE, Schmickl CN, Schotland HM, Schwab RJ, Seo J, Shah N, Shelgikar AV, Shochat I, Soose RJ, Steele TO, Stephens E, Stepnowsky C, Strohl KP, Sutherland K, Suurna MV, Thaler E, Thapa S, Vanderveken OM, de Vries N, Weaver EM, Weir ID, Wolfe LF, Tucker Woodson B, Won CH, Xu J, Yalamanchi P, Yaremchuk K, Yeghiazarians Y, Yu JL, Zeidler M, Rosen IM. International Consensus Statement on Obstructive Sleep Apnea. Int Forum Allergy Rhinol 2023; 13:1061-1482. [PMID: 36068685 PMCID: PMC10359192 DOI: 10.1002/alr.23079] [Citation(s) in RCA: 53] [Impact Index Per Article: 53.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 08/12/2022] [Accepted: 08/18/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Evaluation and interpretation of the literature on obstructive sleep apnea (OSA) allows for consolidation and determination of the key factors important for clinical management of the adult OSA patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International Consensus statement on Obstructive Sleep Apnea (ICS:OSA). METHODS Using previously defined methodology, focal topics in OSA were assigned as literature review (LR), evidence-based review (EBR), or evidence-based review with recommendations (EBR-R) formats. Each topic incorporated the available and relevant evidence which was summarized and graded on study quality. Each topic and section underwent iterative review and the ICS:OSA was created and reviewed by all authors for consensus. RESULTS The ICS:OSA addresses OSA syndrome definitions, pathophysiology, epidemiology, risk factors for disease, screening methods, diagnostic testing types, multiple treatment modalities, and effects of OSA treatment on multiple OSA-associated comorbidities. Specific focus on outcomes with positive airway pressure (PAP) and surgical treatments were evaluated. CONCLUSION This review of the literature consolidates the available knowledge and identifies the limitations of the current evidence on OSA. This effort aims to create a resource for OSA evidence-based practice and identify future research needs. Knowledge gaps and research opportunities include improving the metrics of OSA disease, determining the optimal OSA screening paradigms, developing strategies for PAP adherence and longitudinal care, enhancing selection of PAP alternatives and surgery, understanding health risk outcomes, and translating evidence into individualized approaches to therapy.
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Affiliation(s)
- Jolie L. Chang
- University of California, San Francisco, California, USA
| | | | | | | | - Liza Ashbrook
- University of California, San Francisco, California, USA
| | | | - Indu Ayappa
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | - Maurits S. Boon
- Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Pien Bosschieter
- Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | - Itzhak Braverman
- Hillel Yaffe Medical Center, Hadera Technion, Faculty of Medicine, Hadera, Israel
| | - Kara Brodie
- University of California, San Francisco, California, USA
| | | | - Ray Caesar
- Stone Oak Orthodontics, San Antonio, Texas, USA
| | | | - Yi Cai
- University of California, San Francisco, California, USA
| | | | | | | | | | | | | | | | | | - Susmita Chowdhuri
- Wayne State University and John D. Dingell VA Medical Center, Detroit, Michigan, USA
| | - Peter A. Cistulli
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - David Claman
- University of California, San Francisco, California, USA
| | - Jacob Collen
- Uniformed Services University, Bethesda, Maryland, USA
| | | | | | - Eric M. Davis
- University of Virginia, Charlottesville, Virginia, USA
| | | | | | - Mohan Dutt
- University of Michigan, Ann Arbor, Michigan, USA
| | - Mazen El Ali
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | | | | | | | - Kirat Gill
- Stanford University, Palo Alto, California, USA
| | | | - Lea Golisch
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | | | | | - Arushi Gulati
- University of California, San Francisco, California, USA
| | | | | | - Paul T. Hoff
- University of Michigan, Ann Arbor, Michigan, USA
| | - Oliver M.G. Hoffmann
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | - Jennifer Hsia
- University of Minnesota, Minneapolis, Minnesota, USA
| | - Colin Huntley
- Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | | | - Sanjana Inala
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | | | | | | | | | | | - Meena Khan
- Ohio State University, Columbus, Ohio, USA
| | | | - Alan Kominsky
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | - Meir Kryger
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Derek J. Lam
- Oregon Health and Science University, Portland, Oregon, USA
| | | | | | | | | | | | | | - Atul Malhotra
- University of California, San Diego, California, USA
| | | | - Joachim T. Maurer
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Anna M. May
- Case Western Reserve University, Cleveland, Ohio, USA
| | - Ron B. Mitchell
- University of Texas, Southwestern and Children’s Medical Center Dallas, Texas, USA
| | | | | | | | | | - Brandon Nokes
- University of California, San Diego, California, USA
| | | | - Allan I. Pack
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | | | | | | | | | | | | | - Mark Quigg
- University of Virginia, Charlottesville, Virginia, USA
| | | | - Susan Redline
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Armand Ryden
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | | | - Firas Sbeih
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | | | | | | | | | - Jiyeon Seo
- University of California, Los Angeles, California, USA
| | - Neomi Shah
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | - Ryan J. Soose
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Erika Stephens
- University of California, San Francisco, California, USA
| | | | | | | | | | - Erica Thaler
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sritika Thapa
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Nico de Vries
- Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | | | - Ian D. Weir
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Josie Xu
- University of Toronto, Ontario, Canada
| | | | | | | | | | | | - Ilene M. Rosen
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
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11
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Young R, Benjamin A. The assessment and management of obstructive sleep apnoea-hypopnoea syndrome and obesity hypoventilation syndrome in obesity. Clin Med (Lond) 2023; 23:372-379. [PMID: 38614652 PMCID: PMC10541031 DOI: 10.7861/clinmed.2023-0151] [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] [Indexed: 08/02/2023]
Abstract
Obesity is associated with respiratory dysfunction. It is a key risk and contributory factor in the sleep related breathing disorders, obstructive sleep apnoea/hypopnoea syndrome (OSAHS) and obesity hypoventilation syndrome (OHS). Weight management is an integral part of the management of these disorders, in addition to continuous positive airways pressure (CPAP) and non-invasive ventilation (NIV). Untreated, these conditions are associated with a high disease burden and as treatment is effective, early recognition and referral is critical. Best practice in on-going care is multidisciplinary.
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12
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Lorenz FJ, Goyal N. Iatrogenic Pneumothorax During Hypoglossal Nerve Stimulator Implantation: A Large Database Analysis. Otolaryngol Head Neck Surg 2023; 168:876-880. [PMID: 36066978 PMCID: PMC10474953 DOI: 10.1177/01945998221122696] [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: 06/01/2022] [Accepted: 08/11/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE There have been case reports of adverse events of hypoglossal nerve stimulator (HNS) implantation not seen in previous clinical trials, including pneumothorax and pleural effusion. The purpose of this study was to determine the rates of these complications and potential risk factors. STUDY DESIGN Retrospective case-control study during 2014 to 2021. SETTING Twenty-five health care organizations across the United States. METHODS The TriNetX Research Network was queried by using disease codes to retrospectively identify patients with obstructive sleep apnea who underwent HNS implantation. Rates of pneumothorax, pleural effusion, other complications, and need for revision/replacement or explant were determined. RESULTS We identified 1813 patients from 25 health care organizations who underwent HNS implantation. The average age was 60 years, and there were 68% males and 32% females. Of the cohort, 2.4% (n = 44 from 7 implant centers) experienced a pneumothorax, and 0.6% (n = 11) were diagnosed with a pleural effusion on the day of surgery. Patients who experienced pneumothorax were more likely to have a history of chronic lower respiratory diseases when compared with those who did not (odds ratio, 2.2; 95% CI, 1.1-4.1; P = .02). CONCLUSION The incidence of intraoperative pneumothorax and pleural effusion during HNS implantation may be greater than initially thought. Patients with chronic lower respiratory diseases may be at increased risk. This should be communicated with patients during the informed consent process.
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Affiliation(s)
- F. Jeffrey Lorenz
- College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Neerav Goyal
- Department of Otolaryngology–Head and Neck Surgery, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA
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13
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Yazan S, Karakurt H, Püşüroğlu H. Relationship Between Obstructive Sleep Apnea Severity and Serum Endocan Levels in Patients With Hypertension. Tex Heart Inst J 2023; 50:490517. [PMID: 36724451 PMCID: PMC9969776 DOI: 10.14503/thij-21-7664] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is common in middle-aged adults and has been associated with various cardiovascular disorders; endothelial dysfunction may play a role in the pathogenesis of these disorders in patients with OSA. Endothelial cell specific molecule-1 (endocan) is a marker of vascular pathology, which is correlated with endothelial dysfunction. This study investigates the relationship between serum endocan levels and OSA severity in patients with hypertension. METHODS A retrospective review included 48 patients with OSA and hypertension but without conventional cardiovascular risk factors, and 67 patients with OSA who did not have hypertension. The correlation between serum endocan levels and the apnea-hypopnea index (AHI) was investigated in both groups. RESULTS There was a significant correlation between the serum endocan level and the AHI in patients with OSA and hypertension (r = 0.308; P = .033), but there was no such correlation in patients without hypertension (r = 0.193; P = .118). However, when both groups were combined (ie, all patients with OSA), there was a significant correlation between serum endocan levels and the AHI (r = 0.228; P = .014). On multiple logistic regression analysis, endocan levels were independent predictors of OSA severity in patients with OSA and hypertension (P = .029). CONCLUSION In patients with OSA and hypertension, serum endocan levels are significantly correlated with the AHI. Measurement of endocan may have a place in evaluating patients with OSA and hypertension for adverse cardiovascular events, and they may even help to guide OSA therapy for these patients.
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Affiliation(s)
- Serkan Yazan
- Department of Cardiology, University of Health Sciences, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Hüseyin Karakurt
- Department of Cardiology, University of Health Sciences, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Hamdi Püşüroğlu
- Department of Cardiology, University of Health Sciences, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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14
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Chambers T, Ruparelia P, Ellis G, Bishop T, Gooneratne M, Singh N. Obstructive sleep apnoea and perioperative medicine: a growing concern. Br J Hosp Med (Lond) 2022; 83:1-9. [DOI: 10.12968/hmed.2022.0297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Obstructive sleep apnoea represents a sizable public health and economic burden. Owing to rising obesity rates, the prevalence of obstructive sleep apnoea is increasing, and it is a condition that is significantly underdiagnosed. Exacerbated by the COVID-19 pandemic, the backlog of elective surgeries is also sizable and growing. A combination of these factors means that many patients due to have surgery will have obstructive sleep apnoea, either diagnosed or otherwise. Patients with obstructive sleep apnoea have a significantly increased risk of operative complications, but the evidence base for optimum perioperative management of these patients is limited. This article reviews sleep apnoea, its prevalence and its impact on operative management and perioperative outcomes for patients. The evidence base for screening and treating undiagnosed obstructive sleep apnoea is also comprehensively assessed. Finally, a pathway to manage patients with possible undiagnosed obstructive sleep apnoea is proposed, and areas for further research identified.
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Affiliation(s)
- Tom Chambers
- Department of Respiratory Medicine, Barts Health NHS Trust, London, UK
| | - Prina Ruparelia
- Department of Respiratory Medicine, Barts Health NHS Trust, London, UK
| | - Georgia Ellis
- Department of Anaesthesia, The Royal London Hospital, London, UK
| | - Thomas Bishop
- Department of Anaesthesia, The Royal London Hospital, London, UK
| | - Mevan Gooneratne
- Department of Anaesthesia, The Royal London Hospital, London, UK
| | - Nanak Singh
- Department of Respiratory Medicine, Barts Health NHS Trust, London, UK
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15
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Suzuki H, Nakayama T, Sawa A, Yagi T, Iwata Y, Takeuchi H, Motoyoshi M, Chow CM, Komiyama O. Mandibular Advancement Device Therapy in Japanese Rugby Athletes with Poor Sleep Quality and Obstructive Sleep Apnea. Life (Basel) 2022; 12:life12091299. [PMID: 36143335 PMCID: PMC9505292 DOI: 10.3390/life12091299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/11/2022] [Accepted: 08/20/2022] [Indexed: 11/30/2022] Open
Abstract
Obstructive sleep apnea (OSA) may contribute to poor sleep quality. This study assessed subjective sleep quality, the Respiratory Event Index (REI), reaction times, and the therapeutic effects of a custom-made mandibular advancement device (MAD) in male Japanese elite rugby athletes. The Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and level III sleep test (REI and minimum oxygen saturation [SpO2 min]) were used to evaluate sleep quality. MAD therapy was used daily for 3 weeks. A telephone-based reaction time test of kinetic vision (the ability to identify moving objects) was recorded within 15 min of waking and over 5 days of pre- and post-MAD therapy. Differences in variables were evaluated using paired t-tests. Of the 42 players (mean age, 26.3 ± 3.7 years; mean body mass index, 28.7 ± 3.2 kg/m2) included in this study, 29 (69.0%) had poor sleep quality (PSQI > 5.5), and 27 were diagnosed with OSA (64.3%) (mild = 16/moderate = 9/severe = 2). Six were treated with MAD therapy, which significantly improved the REI (p < 0.01), SpO2 min (p < 0.001), ESS score (p < 0.001), reaction times (p < 0.01), and sleep quality. A significant reduction in reaction times suggests that OSA treatment can improve kinetic vision. Future studies should systematically evaluate the impact of sleep-disordered breathing on kinetic vision in athletes.
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Affiliation(s)
- Hiroshi Suzuki
- Department of Oral Function and Fixed Prosthodontics, Nihon University School of Dentistry at Matsudo, Chiba 271-8587, Japan
- Correspondence:
| | - Toshiyuki Nakayama
- Department of Oral Function and Fixed Prosthodontics, Nihon University School of Dentistry at Matsudo, Chiba 271-8587, Japan
| | - Arisa Sawa
- Department of Oral Function and Fixed Prosthodontics, Nihon University School of Dentistry at Matsudo, Chiba 271-8587, Japan
| | - Tatsuo Yagi
- Department of Physical Reaction, Tokai University School of Physical Education, Hiratsuka-shi 259-1292, Japan
| | - Yoshihiro Iwata
- Department of Oral Function and Fixed Prosthodontics, Nihon University School of Dentistry at Matsudo, Chiba 271-8587, Japan
| | - Hiroki Takeuchi
- Department of Oral Function and Fixed Prosthodontics, Nihon University School of Dentistry at Matsudo, Chiba 271-8587, Japan
| | - Miho Motoyoshi
- Department of Oral Function and Fixed Prosthodontics, Nihon University School of Dentistry at Matsudo, Chiba 271-8587, Japan
| | - Chin-Moi Chow
- Sleep Research Group, Charles Perkins Centre, University of Sydney, Sydney 2006, Australia
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney 2006, Australia
| | - Osamu Komiyama
- Department of Oral Function and Fixed Prosthodontics, Nihon University School of Dentistry at Matsudo, Chiba 271-8587, Japan
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Chang CW, Chang CH, Chuang HY, Cheng HY, Lin CI, Chen HT, Yang CC. What is the association between secondhand smoke (SHS) and possible obstructive sleep apnea: a meta-analysis. Environ Health 2022; 21:58. [PMID: 35710478 PMCID: PMC9202174 DOI: 10.1186/s12940-022-00868-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 05/30/2022] [Indexed: 05/31/2023]
Abstract
BACKGROUND Association between smoking and sleep apnea is well-known from previous studies. However, the influence of secondhand smoke (SHS), which is a potential risk factor of obstructive sleep apnea (OSA), remains unclear. Our aim was to investigate the relationship between SHS and OSA using a meta-analysis. MATERIALS AND METHODS For the meta-analysis, searches were performed in MEDLINE, EMBASE, and Web of Science databases on January 10, 2022, by combining various keywords including "SHS exposure" and "OSA". Data were extracted using defined inclusion and exclusion criteria. Fixed-effects model meta-analyses were used to pool risk ratio (RR) estimates with their 95% confidence intervals (CI). I2 was used to assess heterogeneity. Moreover, we performed subgroup meta-analyses of children-adults, and smoker fathers and mothers. RESULTS In total, 267 articles were obtained through an electronic search. Twenty-six articles were included in our analysis according to the inclusion and exclusion criteria. We found evidence of an association between SHS exposure and possible OSA (RR 1.64, 95% CI 1.44-1.88). The results of the subgroup analyses showed that children passive smokers (RR 1.84, 95% CI 1.60-2.13) were at greater risks of possible OSA than adult passive smokers (RR 1.35, 95% CI 1.21-1.50). Also, significant differences were observed in mothers with smoking exposure (RR 2.61, 95% CI 1.62-4.21, p < 0.0001), as well as in fathers with smoking exposure (RR 2.15, 95% CI 0.98-4.72, p = 0.06). SHORT CONCLUSION Our meta-analysis confirmed that SHS exposure is significantly associated with OSA. In the subgroup analyses, the association of SHS and possible OSA was significant in both children and adults, as well as in smoker mothers and fathers.
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Affiliation(s)
- Chen-Wei Chang
- Department of Occupational and Environmental Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan
- Department of Occupational and Environmental Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Ching-Hsiung Chang
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Hung-Yi Chuang
- Department of Occupational and Environmental Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan
- Department of Public Health and Environmental Medicine, and Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Han-Yun Cheng
- Health Management Center, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Chia-I Lin
- Health Management Center, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Hsiang-Tai Chen
- College of Health and Medicine, University of Tasmania, Hobart, Australia
| | - Chen-Cheng Yang
- Department of Occupational and Environmental Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan.
- Department of Occupational and Environmental Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan.
- Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan.
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17
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Buyse B, Bruyneel M, Verbraecken J, Testelmans D. High adherence to continuous positive airway pressure (CPAP) in patients with obstructive sleep apnea (OSA) in Belgium: a narrative review. Acta Clin Belg 2022; 77:710-720. [PMID: 34197277 DOI: 10.1080/17843286.2021.1943954] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Continuous positive airway pressure (CPAP) is the 'gold standard' treatment for moderate-to-severe obstructive sleep apnea (OSA); adherence is an important issue. The aim of this paper is to review Belgian data on CPAP users and their adherence over a period of 11 years. METHODS Data delivered annually by the CPAP centers to the Belgian National Institute for Health Insurance (RIZIV/INAMI) were studied. Comments on these results were embedded in a narrative review. RESULTS On 1 January 2008 27.266 Belgian patients were treated with CPAP, at the end of 2018 this number increased to 121.605. In 2018, the short-term adherence (≤3 months) to CPAP was at least twice as high compared to the United States: the CPAP termination rate in Belgium (mainly due to stop of reimbursement because adherence <4 h/night) was estimated to be 12.4%, considerably lower than the 31.1% of patients on CPAP in the United States using the device <4 h. CONCLUSION We speculate that this good adherence might be attributed to a stringent Belgian diagnostic and treatment convention model. This model uses 'gold standard' techniques (including in-hospital polysomnography), imposes a minimum capacity of medical doctors and paramedical collaborators, a strict follow-up of the patients, multidisciplinary care and proof of competency. Taking into account the increasing number of patients, a change in the Belgian care strategy is under consideration focusing on more out-of-centre patient's management; we propose a step-by step approach with careful monitoring of the impact of changing policy on adherence.
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Affiliation(s)
- Bertien Buyse
- Clinical Department of Respiratory Diseases, UZ Leuven, Leuven, Belgium
- BREATHE, Department CHROMETA, KU Leuven, Leuven, Belgium
| | - Marie Bruyneel
- Chest Service, Saint-Pierre University Hospital,Université Libre de Bruxelles, Brussels, Belgium
| | - Johan Verbraecken
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital- LEMP, Faculty of Medicine and Health Sciences, University of Antwerp, Edegem, Belgium
| | - Dries Testelmans
- Clinical Department of Respiratory Diseases, UZ Leuven, Leuven, Belgium
- BREATHE, Department CHROMETA, KU Leuven, Leuven, Belgium
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18
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Improving Bed Utilization in a Cohort of Bariatric Surgical Patients Using a Perioperative Obstructive Sleep Apnea Treatment and Bed Triage Protocol. Obes Surg 2022; 32:1926-1934. [PMID: 35397037 DOI: 10.1007/s11695-022-06001-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 03/02/2022] [Accepted: 03/08/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Postoperative bariatric management often includes high-intensity monitoring for respiratory complications since > 70% of patients have obstructive sleep apnea. Given the increasing number of bariatric surgeries, there is a need to determine safe and cost-effective processes for postoperative care.The objective of this study was to determine if a novel triage and perioperative management guideline reduces postoperative monitoring and costs following bariatric surgery. METHODS Using a pre-post design, this is a retrospective analysis of 501 patients who had bariatric surgery. Half the patients were managed with usual care, and the other half received obstructive sleep apnea screening and treatment of moderate/severe obstructive sleep apnea with perioperative continuous positive airway pressure. The intervention group was triaged preoperatively to a postoperative nursing location based on risk factors. RESULTS There were no significant differences in demographics, comorbidities, frequency, or severity of OSA between groups. In the intervention group, there were fewer admissions to the intensive care unit (2.0% vs 9.1%; p < 0.01) and high acuity unit (9.6% vs 18.3%; p < 0.01). The length of stay was shorter in the intervention group (1.3 vs 2.3 days; p < 0.01) with a 50% reduction in costs. There were no statistically significant differences in the incidence of postoperative respiratory and non-respiratory complications between the two groups. CONCLUSIONS Most postoperative bariatric surgery patients can be safely managed on the surgical ward with monitoring of routine vitals alone if patients with moderate/severe obstructive sleep apnea receive perioperative continuous positive airway pressure.
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Catalan Serra P, Soler X. Obstructive Sleep apnea and cardiovascular events in Elderly Patients. Expert Rev Respir Med 2022; 16:197-210. [PMID: 35041560 DOI: 10.1080/17476348.2022.2030225] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
INTRODUCTION In recent decades, life expectancy has increased considerably. The cardiovascular effects of Obstructive Sleep Apnea (OSA) in the elderly lead to patient disability and high resource consumption. Intermittent nocturnal hypoxia leads to hemodynamic stress and adrenergic activation, which promotes cardiovascular disease. However, chronic intermittent hypoxia may protect elderly patients from cardiovascular events (CVE) due to biological adaptation. AREAS COVERED OSA patients are at increased risk of cardiovascular events. The severity of OSA increases cardiovascular risk, and this association also exists in the elderly. This article reviews the association between OSA, CPAP treatment, and CVE, particularly stroke and coronary heart disease (CHD), in the elderly. MEDLINE and the Cochrane Collaboration databases were searched from inception to July 2021. EXPERT COMMENTARY Although a positive association between OSA and the incidence of cardiovascular disease in the elderly has been established, the role of sleep apnea in certain cardiovascular events remains controversial. Most authors agree that untreated OSA is a risk factor for stroke or worse stroke prognosis. However, the association between OSA and CHD is usually less pronounced than between OSA and stroke, especially in the elderly.
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Affiliation(s)
| | - Xavier Soler
- Department of Pulmonary, Critical Care, and Sleep Medicine. University of California, San Diego, California
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20
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Gupta M, Ish P, Chakrabarti S, Sen MK, Mishra P, Suri JC. Diagnostic accuracy and feasibility of portable sleep monitoring in patients with obstructive sleep apnea: Re-exploring the utility in the current COVID-19 pandemic. Monaldi Arch Chest Dis 2021; 92. [PMID: 34523322 DOI: 10.4081/monaldi.2021.1818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 08/03/2021] [Indexed: 11/23/2022] Open
Abstract
Portable sleep monitoring (PSM) is a promising alternative diagnostic tool for Obstructive Sleep Apnea (OSA) especially in high burden resource limited settings. We aimed to determine the diagnostic accuracy and feasibility of PSM device-based studies in patients presenting for evaluation of OSA at a tertiary care hospital in North-India. PSM studies (using a Type-III PSM device) were compared for technical reliability and diagnostic accuracy with the standard laboratory-based Type-I polysomnography (PSG). Patients were also interviewed about their experience on undergoing an unsupervised PSM studies. Fifty patients (68% males) were enrolled in the study, of which only 30% patients expressed their concerns about undergoing unsupervised PSM studies which included safety issues, ease of use, diagnostic accuracy, etc. Technical acceptability criteria were easily met by the PSM studies with signal loss in 12% studies (complete data loss and inaccessible data in 6% studies), warranting repetition sleep studies in four patients. The overall sensitivity of PSM device (AHI ≥5) was 93.5% (area under curve; AUC: 0.87). The diagnostic accuracy was 68.5%, 80%, and 91.4% for mild, moderate, and severe cases of OSA, respectively. An overall strong correlation was observed between PSM-AHI (apnoea-hypopnoea index) and PSG (r>0.85, p≤0.001), especially in severe OSA. The observed sensitivity was >90% for AHI>20 (clinically significant OSA), with high specificity of 91% for severe OSA (AUC: 0.94, 0.97 for AHI>20, AHI>30 respectively). The overall Bland-Altman concordance analysis also demonstrated only a small dispersion for PSM studies with a Cronbach's coefficient of 0.95. Therefore, there is good diagnostic accuracy as well as feasibility of home-based portable sleep studies in Indian patients. It can be promoted for widespread use in high burden countries like India for diagnosing and managing appropriately selected stable patients with high clinical probability of OSA, especially during the ongoing crises of COVID-19 pandemic.
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Affiliation(s)
- Mansi Gupta
- Department of Pulmonary Medicine, Sanjay Gandhi Post-graduate Institute of Medical sciences, Lucknow.
| | - Pranav Ish
- Department of Pulmonary, Critical Care and Sleep Medicine, Vardhmaan Mahavir Medical College and Safdarjung Hospital, New Delhi.
| | - Shibdas Chakrabarti
- Department of Pulmonary, Critical Care and Sleep Medicine, Vardhmaan Mahavir Medical College and Safdarjung Hospital, New Delhi.
| | - Manas Kamal Sen
- Department of Pulmonary, Critical Care and Sleep Medicine, Vardhmaan Mahavir Medical College and Safdarjung Hospital, New Delhi.
| | - Prabhakar Mishra
- Department of Biostatistics, Sanjay Gandhi Post-graduate Institute of Medical Sciences, Lucknow.
| | - Jagdish Chander Suri
- Department of Pulmonary, Critical Care and Sleep Medicine, Vardhmaan Mahavir Medical College and Safdarjung Hospital, New Delhi.
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Voulgaris A, Bonsignore MR, Schiza S, Marrone O, Steiropoulos P. Is kidney a new organ target in patients with obstructive sleep apnea? Research priorities in a rapidly evolving field. Sleep Med 2021; 86:56-67. [PMID: 34474225 DOI: 10.1016/j.sleep.2021.08.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 07/15/2021] [Accepted: 08/05/2021] [Indexed: 11/28/2022]
Abstract
The bidirectional relationship between sleep disordered breathing and chronic kidney disease (CKD) has recently gained a lot of interest. Several lines of evidence suggest the high prevalence of coexistent obstructive sleep apnea (OSA) in patients with CKD and end-stage renal disease (ESRD). In addition, OSA seems to result in loss of kidney function in some patients, especially in those with cardio-metabolic comorbidities. Treatment of CKD/ESRD and OSA can alter the natural history of each other; still better phenotyping with selection of appropriate treatment approaches is urgently needed. The aim of this narrative review is to provide an update of recent studies on epidemiological associations, pathophysiological interactions, and management of patients with OSA and CKD or ESRD.
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Affiliation(s)
- Athanasios Voulgaris
- MSc Programme in Sleep Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, Greece; Department of Respiratory Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Maria R Bonsignore
- Institute of Biomedicine and Molecular Immunology, CNR, Palermo, Italy; Sleep Disordered Breathing and Chronic Respiratory Failure Clinic, PROMISE Department, University of Palermo, and IRIB, National Research Council (CNR), Palermo, Italy
| | - Sophia Schiza
- Sleep Disorders Center, Department of Respiratory Medicine, Medical School, University of Crete, Heraklion, Greece
| | - Oreste Marrone
- Institute of Biomedicine and Molecular Immunology, CNR, Palermo, Italy
| | - Paschalis Steiropoulos
- MSc Programme in Sleep Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, Greece; Department of Respiratory Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, Greece.
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22
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Cazco MDP, Lorenzi-Filho G. Síndrome de apnea obstructiva del sueño y sus consecuencias cardiovasculares. REVISTA MÉDICA CLÍNICA LAS CONDES 2021. [DOI: 10.1016/j.rmclc.2021.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Scrutinio D, Guida P, Aliani M, Castellana G, Guido P, Carone M. Age and comorbidities are crucial predictors of mortality in severe obstructive sleep apnoea syndrome. Eur J Intern Med 2021; 90:71-76. [PMID: 33975770 DOI: 10.1016/j.ejim.2021.04.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 04/10/2021] [Accepted: 04/15/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Obstructive sleep apnoea syndrome (OSAS) is a highly prevalent disorder. The prognostic role of comorbidity in patients with OSAS and their role for risk stratification remain poorly defined. METHODS We studied 1,592 patients with severe OSAS diagnosed by polysomnography. The primary outcome was all-cause mortality. The standardized mortality ratio (SMR) was estimated as the ratio of observed deaths to expected number of deaths in the general population. The expected numbers of deaths were derived using mortality rates from the general Apulian population. The association of comorbidities with all-cause mortality was assessed using multivariable Cox regression analysis. Finally, recursive-partitioning analysis was applied to identify the combinations of comorbidities that were most influential for mortality and to cluster the patients into risk groups according to individual comorbidities RESULTS: During 11,721 person-years of follow-up, 390 deaths (3.33 deaths/100 person-years) occurred. The median follow-up was 7 (4-10) years. The SMR was 1.47 (95% confidence intervals 1.33-1.63). Age, sex, obesity, cardiovascular diseases (CVD), moderate-to-severe chronic obstructive pulmonary disease (COPD), chronic kidney disease (CKD) and malignancy were independently associated with mortality risk. Recursive-partitioning analysis allowed distinguishing three clinical phenotypes differentially associated with mortality risk. The combination of CKD with CVDs or with moderate-to-severe COPD conferred the highest risk. CONCLUSIONS Severe OSAS is associated with increased risk for all-cause death. Age and comorbidity are crucial predictors of mortality in patients with severe OSAS. Clustering patients according to comorbidities allows identifying clinically meaningful phenotypes.
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Affiliation(s)
| | - Pietro Guida
- Istituti Clinici Scientifici Maugeri IRCCS, Institute of Bari Italy
| | - Maria Aliani
- Istituti Clinici Scientifici Maugeri IRCCS, Institute of Bari Italy
| | | | - Patrizia Guido
- Istituti Clinici Scientifici Maugeri IRCCS, Institute of Bari Italy
| | - Mauro Carone
- Istituti Clinici Scientifici Maugeri IRCCS, Institute of Bari Italy
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Brigham EP, Anderson JA, Brook RD, Calverley PMA, Celli BR, Cowans NJ, Crim C, Diserens JE, Martinez FJ, McCormack MC, Newby DE, Yates J, Vestbo J, Wu TD, Wise RA. Challenging the obesity paradox: extreme obesity and COPD mortality in the SUMMIT trial. ERJ Open Res 2021; 7:00902-2020. [PMID: 34322545 PMCID: PMC8311131 DOI: 10.1183/23120541.00902-2020] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 05/01/2021] [Indexed: 01/06/2023] Open
Abstract
Populations with COPD demonstrate higher survival in overweight and obese compared with normal weight; the “obesity paradox”. Relationships in less-severe COPD are unclear, as is the impact of cardiovascular risk, and few studies include individuals at extremes of obesity. We examined the relationship between body mass index (BMI; defined as underweight: <20 kg·m−2, normal: 20–25 kg·m−2, overweight: 25– <30 kg·m−2, obese class I: 30– <35 kg·m−2, class II: 35– <40 kg·m−2 and class III: ≥40 kg·m−2), morbidity, and mortality in the SUMMIT trial population (n=16 485), characterised by moderate COPD and heightened cardiovascular risk with a substantial proportion with class III obesity. The association between BMI category and time to event was modelled via proportional hazards (reference normal weight) adjusted for demographics and cardiorespiratory disease. Consistent with the paradox, underweight individuals demonstrated higher mortality (hazard ratio (HR) 1.31 (95% CI 1.04–1.64)), with lower mortality among overweight (HR 0.62 (95% CI 0.52–0.73)) and obese class I (HR 0.75 (95% CI 0.62–0.90)). However, mortality increased in obese class III (HR 1.36 (95% CI 1.00–1.86)). Death was primarily attributable to cardiovascular causes. Within a large, multinational cohort with moderate COPD and increased cardiovascular risk, the phenomenon of reduced mortality with obesity did not persist at BMI >40 kg·m−2, suggesting that obesity may not remain protective at the extremes in this population. In a population with moderate COPD, at heightened cardiovascular risk and containing a substantial proportion of individuals with BMI ≥40 kg/m2, BMI and mortality demonstrate a U-shaped (rather than J-shaped) relationshiphttps://bit.ly/3hDztI6
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Affiliation(s)
- Emily P Brigham
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins Medicine, Baltimore, MD, USA
| | | | - Robert D Brook
- Division of Cardiovascular Diseases, Wayne State University, Detroit, MI, USA
| | - Peter M A Calverley
- Dept of Medicine, Clinical Sciences Centre, University of Liverpool, University Hospital Aintree, Liverpool, UK
| | - Bartolome R Celli
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Courtney Crim
- Research and Development, GlaxoSmithKline, Research Triangle Park, NC, USA
| | | | - Fernando J Martinez
- Division of Pulmonary and Critical Care Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Meredith C McCormack
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins Medicine, Baltimore, MD, USA
| | - David E Newby
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Julie Yates
- Research and Development, GlaxoSmithKline, Research Triangle Park, NC, USA
| | - Jorgen Vestbo
- Division of Infection, Immunity and Respiratory Medicine, Manchester Academic Health Sciences Centre, The University of Manchester and Manchester University NHS Foundation Trust, Manchester, UK
| | - Tianshi David Wu
- Section of Pulmonary, Critical Care, and Sleep Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Robert A Wise
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins Medicine, Baltimore, MD, USA
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Cheng JY. Risk of sudden unexpected death in people with epilepsy and obstructive sleep apnea. Epilepsy Res 2021; 176:106729. [PMID: 34352639 DOI: 10.1016/j.eplepsyres.2021.106729] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/13/2021] [Accepted: 07/19/2021] [Indexed: 11/19/2022]
Abstract
This study aimed to determine whether severity of newly diagnosed obstructive sleep apnea (OSA) in people with epilepsy is associated with elevated sudden unexpected death in epilepsy (SUDEP) risk as calculated by the revised SUDEP-7 Inventory (rSUDEP-7). To this aim, a retrospective cross-sectional study was conducted at a single academic center. Adults ≥18 years of age with epilepsy and newly diagnosed OSA were retrospectively identified via electronic health records. Analysis was performed for subjects with confirmed epilepsy, OSA, and complete diagnostic PSG and rSUDEP-7 data. OSA severity was categorized as mild, moderate or severe. Logistic regression analysis was used to determine the association between OSA severity and rSUDEP-7 scores, adjusting for significantly different baseline characteristics. Of 86 subjects, OSA severity was classified as mild 38(44.2 %), moderate 25(29.1 %), and severe 23(26.7 %). Multivariate logistic regression demonstrated that severe OSA was significantly associated with rSUDEP-7 ≥ 5 after adjusting for congestive heart failure and diabetes (OR:4.08,p = 0.046,CI:1.04-16.28), but was attenuated when male gender was added to the model (OR:3.91,p = 0.067,CI:0.91-16.77). In conclusion, severe OSA is associated with elevated SUDEP risk. As a treatable disorder, OSA may thus represent a modifiable SUDEP risk factor. However, future confirmatory studies involving the prospective, longitudinal evaluation of SUDEP from broader populations are required.
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Affiliation(s)
- Jocelyn Y Cheng
- Neurology, Eisai Inc., 100 Tice Blvd, Woodcliff Lake, NJ, 07677, USA.
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26
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Chen W, Li Y, Guo L, Zhang C, Tang S. An umbrella review of systematic reviews and meta-analyses of observational investigations of obstructive sleep apnea and health outcomes. Sleep Breath 2021; 26:167-188. [PMID: 33893906 PMCID: PMC8856999 DOI: 10.1007/s11325-021-02384-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/14/2021] [Accepted: 04/16/2021] [Indexed: 02/07/2023]
Abstract
Purpose The previous analysis of systematic reviews and meta-analyses have illustrated that obstructive sleep apnea (OSA) is correlated with multiple health outcomes. In the present research, our main aim was to execute an umbrella review to assess the available evidence for the associations between OSA and health outcomes. Methods Herein, a meta-analysis of previous observational investigations that have reported associations between OSA and health outcomes in all human populations and settings was performed. We used these studies to execute an umbrella review of available meta-analyses and systematic reviews. Results Sixty-six articles comprising 136 unique outcomes were enrolled in this analysis. Of the 136 unique outcomes, 111 unique outcomes had significant associations (p < 0.05). Only 7 outcomes (coronary revascularization after PCI, postoperative respiratory failure, steatosis, alaninetrans aminase (ALT) elevation, metabolic syndrome (MS), psoriasis, and Parkinson’s disease) had a high quality of evidence. Twenty-four outcomes had a moderate quality of evidence, and the remaining 80 outcomes had a weak quality of evidence. Sixty-nine outcomes exhibited significant heterogeneity. Twenty-five outcomes exhibited publication bias. Sixty-three (95%) studies showed critically low methodological quality. Conclusion Among the 66 meta-analyses exploring 136 unique outcomes, only 7 statistically significant outcomes were rated as high quality of evidence. OSA may correlate with an increased risk of coronary revascularization after PCI, postoperative respiratory failure, steatosis, ALT elevation, MS, psoriasis, and Parkinson’s disease.
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Affiliation(s)
- Weiwei Chen
- Department of Gastroenterology, The First Affiliated Hospital, Jinan University, Guangzhou, People's Republic of China
| | - Yuting Li
- Department of Gastroenterology, The First Affiliated Hospital, Jinan University, Guangzhou, People's Republic of China
| | - Liliangzi Guo
- Department of Gastroenterology, The First Affiliated Hospital, Jinan University, Guangzhou, People's Republic of China
| | - Chenxing Zhang
- Department of Gastroenterology, The First Affiliated Hospital, Jinan University, Guangzhou, People's Republic of China
| | - Shaohui Tang
- Department of Gastroenterology, The First Affiliated Hospital, Jinan University, Guangzhou, People's Republic of China.
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Budhiraja R, Quan SF. Long-term All-Cause Mortality Risk in Obstructive Sleep Apnea Using Hypopneas Defined by a ≥3 Percent Oxygen Desaturation or Arousal. SOUTHWEST JOURNAL OF PULMONARY AND CRITICAL CARE 2021; 23:23-35. [PMID: 34306818 PMCID: PMC8301604 DOI: 10.13175/swjpcc025-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
STUDY OBJECTIVES Some prior studies have demonstrated an increase in mortality associated with obstructive sleep apnea (OSA) utilizing a definition of OSA that requires a minimum 4% oxygen desaturation to identify a hypopnea. No large community-based studies have determined the risk of long-term mortality with OSA with hypopneas defined by a ≥3% O2 desaturation or arousal (AHI3%A). METHODS Data from 5591 Sleep Heart Health Study participants without prevalent cardiovascular disease at baseline who underwent polysomnography were analyzed regarding OSA diagnosed using the AHI3%A criteria and all-cause mortality over a mean follow up period of 10.9±3.2 years. RESULTS There were 1050 deaths in this group during the follow-up period. A Kaplan-Meir plot of survival revealed a reduction in survival with increasing AHI severity. Cox proportional hazards regression models revealed significantly increased all-cause mortality risk with increasing AHI, hazard ratio (HR, 95% CI) 1.13 (1.04-1.23), after adjusting for age, sex, race, BMI, cholesterol, HDL, self-reported hypertension and/or diabetes and smoking status. In categorical models, the mortality risk was significantly higher with severe OSA [adjusted HR 1.38 (1.09-1.76)]. When stratified by gender or age, severe OSA was associated with increased risk of death in men [adjusted HR 1.14 (1.01-1.28)] and in those <70 years of age [adjusted HR 1.51 (1.02-2.26)]. In contrast, AHI severity was not associated with increased mortality in women or those ≥70 years of age in fully adjusted models. CONCLUSION Severe AHI3%A OSA is associated with significantly increased mortality risk, especially in men and those <70 years of age.
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Affiliation(s)
- Rohit Budhiraja
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA
| | - Stuart F. Quan
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA
- Arizona Asthma and Airways Research Center, University of Arizona College of Medicine, Tucson, AZ
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Dodds S, Williams LJ, Roguski A, Vennelle M, Douglas NJ, Kotoulas SC, Riha RL. Mortality and morbidity in obstructive sleep apnoea-hypopnoea syndrome: results from a 30-year prospective cohort study. ERJ Open Res 2020; 6:00057-2020. [PMID: 32963994 PMCID: PMC7487348 DOI: 10.1183/23120541.00057-2020] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 06/03/2020] [Indexed: 11/23/2022] Open
Abstract
Background Obstructive sleep apnoea–hypopnoea syndrome (OSAHS) carries substantial negative health consequences. This study examines factors affecting mortality and morbidity according to continuous positive airway pressure (CPAP) use and predictors affecting CPAP adherence in a longitudinal cohort of OSAHS patients. Materials and methods This prospective, cohort study comprised 4502 patients who were diagnosed with OSAHS at a tertiary sleep disorders centre between 1982 and 2003. Of these, 1174 patients completed follow-up in 2012. Data collected included anthropometric, sleep and demographic characteristics, including comorbidities, ongoing medications and CPAP adherence. Patients were followed up for an average of 14.8±3.7 years. Results Imputation analysis showed that long-term CPAP users (>5 years) were 5.63 times more likely to be alive at study end than non-CPAP users (95% CI: 4.83–6.58, p<0.001) and 1.74-times more likely than short-term CPAP users (≤5 years) (95% CI: 1.49–2.02, p<0.001). Females had a significantly higher mortality rate during the follow-up period (26.8% versus 19.6%, p<0.001). Respiratory mortality was more common in patients with OSAHS, in particular those who did not use CPAP, compared to the general population (17.2% versus 12.2%, p=0.002 respectively), whereas deaths from cancer were less common compared to the general population (16.2% versus 25.6%, p<0.001). Compared to CPAP users, non-CPAP-users had a significantly increased incidence of type II diabetes mellitus (DMII) (27.9% versus 18.7%, p=0.003), ischaemic heart disease (IHD) (25.5% versus 12.7%, p<0.001) and myocardial infarction (MI) (14.7% versus 4.2%, p<0.001) at long-term follow-up. Conclusions Long-term CPAP use in men and women with OSAHS reduces mortality and decreases the incidence of DMII and cardiovascular disease. In this first long-term prospective cohort study to use imputation analysis in OSAHS patients, all-cause morbidity and mortality were significantly reduced in long-term CPAP users (>5 years), and equivalent for both males and femaleshttps://bit.ly/3cKL2HK
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Affiliation(s)
- Sophie Dodds
- Dept of Sleep Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Linda J Williams
- Dept of Sleep Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Amber Roguski
- Dept of Sleep Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - Neil J Douglas
- Dept of Sleep Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - Renata L Riha
- Dept of Sleep Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
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A clinic-based cluster analysis in patients with moderate-severe obstructive sleep apnea (OSA) in Chile. Sleep Med 2020; 73:16-22. [DOI: 10.1016/j.sleep.2020.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 03/31/2020] [Accepted: 04/01/2020] [Indexed: 11/22/2022]
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Low long-term mortality in patients with sleep apnoea and positive airway pressure therapy: analysis of a large German healthcare database. SOMNOLOGIE 2020. [DOI: 10.1007/s11818-020-00259-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Abstract
Background
There are limited data on long-term mortality in sleep apnoea (SA) patients with and without positive airway pressure (PAP) therapy. This retrospective cohort study investigated long-term hospitalisation and mortality rates in SA patients from a German statutory health insurance (SHI) database who did versus did not receive PAP therapy.
Methods
Patients had continuous insurance coverage from 01 January 2008 to 31 December 2013, complete medical records and ≥1 SA-related diagnosis in 2009. Those receiving PAP were matched with a control group not treated with PAP. Outcomes (hospitalisations including stays in the sleep laboratory) were compared between groups the year prior to and the 4 years after SA diagnosis. Mortality was assessed in the 4 years after SA diagnosis.
Results
2176 PAP therapy recipients were matched with 2176 controls. The PAP group had a higher rate of hospitalisation in the year before SA diagnosis than the control group (80.2% vs. 26.6%; p = 0.0016). After diagnosis, the PAP group had a higher hospitalisation rate only in year 1 (p < 0.05), and average length of stay per hospitalisation was lower in the PAP group (p < 0.05 vs. control at years 1, 2 and 4). Cumulative all-cause mortality after year 3 (3.4% vs. 4.6%; p = 0.0287) and after year 4 (4.8% vs. 6.5%; p = 0.0175) was significantly lower in SA patients receiving PAP versus controls (relative risk reduction for death after 4 years: 25.5%).
Conclusion
This real-world cohort study showed an association between long-term PAP therapy use and lower mortality, a higher rate of hospitalisations before and shorter hospital stays after treatment initiation.
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Amat P. [Obstructive sleep disordered breathing and orthodontics: primum non nocere]. Orthod Fr 2019; 90:247-262. [PMID: 34643513 DOI: 10.1051/orthodfr/2019039] [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: 06/13/2023]
Abstract
Obstructive sleep apnoea syndrome is a widespread and under-diagnosed condition, making it a major public health and safety issue. The objective of this article was to clarify some of the evidence-based elements of therapeutic decision-making and the information provided to the patient and family on the benefit-cost-security ratio of several of his therapeutic options. Published data on the effectiveness of oral appliances and functional orthopaedic appliances for obstructive sleep apnea (OSA) in children, the durability of their effects, the therapeutic possibilities of maxillary or bimaxillary expansion, and the interrelationships between permanent teeth extractions and obstructive sleep disordered breathing, were researched and analyzed. Based on available evidence, in growing patients with Class II malocclusion, treatment with functional orthopedic devices can increase the volume of the pharyngeal airway and thus hopefully reduce the risk of developing OSA. An improvement in the apnea-hypopnea index and lower oxygen saturation was observed in children treated with rapid maxillary expansion. Permanent teeth extractions prescribed for the treatment of teeth crowding in an orthodontic age patient do not result in any significant change in the upper airway. The role of the orthodontist in the multidisciplinary team in the screening and management of Obstructive Sleep Disordered Breathing (OSDB) is essential. By combining clinical experience with published data on various therapeutic approaches, the orthodontist helps the patient to benefit from better adapted care and a more sustainable outcome, while taking into account his or her preferences.
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Affiliation(s)
- Philippe Amat
- 19, Place des Comtes du Maine, 72000 Le Mans, France
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Amat P, Tran Lu Y É. [The contribution of orofacial myofunctional reeducation to the treatment of obstructive sleep apnoea syndrome (OSA): a systematic review of the literature]. Orthod Fr 2019; 90:343-370. [PMID: 34643521 DOI: 10.1051/orthodfr/2019035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Obstructive sleep apnoea syndrome (OSA) is a widespread and under-diagnosed condition, making it a major public health and safety problem. Orofacial myofunctional reeducation (OMR) has been shown to be effective in the multidisciplinary treatment of OSA in children, adolescents and adults and is prescribed at several stages of OSA management. The main objective of this systematic literature review was to evaluate the effectiveness of active or passive orofacial myofunctional reeducation (OMR) in the treatment of obstructive sleep apnoea syndrome in children, adolescents and adults. The systematic literature review was undertaken from the three electronic databases: Medline (via PubMed), Cochrane Library, Web of Science Core Collection, and supplemented by a limited grey literature search (Google Scholar) in order to identify the studies evaluating the effectiveness of the OMR on OSA. The primary outcome of interest was a decrease in the Apnea-Hypopnea Index (AHI) of at least five episodes per hour compared to the baseline state. Secondary outcomes were an improvement in subjective sleep quality, sleep quality measured by night polysomnography and subjectively measured quality of life. Only ten studies met all the inclusion criteria. Eight were randomized controlled clinical trials, one was a prospective cohort study and another was a retrospective cohort study. Six studies were devoted to adult OSA and four to pediatric OSA. All included studies were assessed as "low risk of bias" based on the 12 bias risk criteria of the Cochrane Back Review Group. Based on the available evidence, RMO allows a significant reduction in AHI, up to 90.6% in children and up to 92.06% in adults. It significantly reduces the intensity and frequency of snoring, helps reduce daytime sleepiness, limits the recurrence of OSA symptoms after adenoamygdalectomy in children and improves adherence to PPC therapy. Passive RMO, with the assistance provided to the patient by wearing a custom orthosis, increases adherence to reeducation, significantly improves snoring intensity, AHI and significantly increases the upper airway. Published data show that orofacial myofunctional rééducation is effective in the multidisciplinary treatment of OSA in children, adolescents and adults and should be widely prescribed at several stages of OSA management. Passive RMO, with the pearl mandibular advancement orthosis designed by Michèle Hervy-Auboiron, helps to compensate for the frequent non-compliance observed during active RMO treatments.
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Role of menopause and hormone replacement therapy in sleep-disordered breathing. Sleep Med Rev 2019; 49:101225. [PMID: 31739179 DOI: 10.1016/j.smrv.2019.101225] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 08/21/2019] [Accepted: 10/23/2019] [Indexed: 02/08/2023]
Abstract
There are suggestions that the loss of female sex hormones following menopause is critical for the development or progression of sleep-disordered breathing (SDB). We conducted a review of the literature on the role of menopause and hormone replacement therapy (HRT) in SDB risk. There is an increase in SDB during the menopausal transition period, but data on an effect beyond that of increasing age and changes in body habitus are weak or absent. Early community-based, observational studies reported a protective effect by HRT on SDB prevalence, but this could possibly be explained as a healthy user effect. Interventional studies of the effect of HRT on SDB are sparse, with only a few randomized placebo-controlled studies, often performed on small samples of women without clinically significant SDB. HRT regimens have varied and all the studies are fairly old. They do not definitely assure the alleviation of SDB and HRT cannot thus be recommended as treatment for SDB. It is concluded that there is no evidence that female sex hormone changes during menopause per se are able to explain the increase in SDB in midlife women and conclusions on the effect of HRT on SDB cannot be drawn from the current literature.
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Coexistence of obstructive sleep apnea and telomerase activity, concentration of selected adipose tissue hormones and vascular endothelial function in patients with arterial hypertension. Respir Med 2019; 153:20-25. [PMID: 31136928 DOI: 10.1016/j.rmed.2019.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 05/12/2019] [Accepted: 05/16/2019] [Indexed: 01/21/2023]
Abstract
AIM The aim of the present study was to determine the effect of obstructive sleep apnea (OSA) with hypertension on telomerase activity, visfatin and adipsine concentration in the blood and vascular endothelial function assessed by ultrasound measured flow-mediated dilatation of the brachial artery (FMD). MATERIAL AND METHODS The study involved a group of 106 people (average age: 54.79 years). The determination of telomerase activity and blood visfatin and adipsine concentrations, brachial artery ultrasound examination with endothelium-dependent dilatation evaluation (FMD) and polysomnography were carried out. RESULTS Patients with hypertension without OSA were characterized by significantly greater FMD in comparison to patients with arterial hypertension and OSA (8.13 ± 5.12 %vs. 6.82 ± 5.36%; p < 0.05). Negative linear relationship between apnea-hypopnea index (AHI) and FMD (r = -0.22, p < 0.05) has been demonstrated. Negative linear relationship between adipsine concentration in the blood and length of REM (Rapid Eye Movement) sleep (r = -0.21, p < 0.05) was found. Positive linear relationship between the concentration of visfatin in the blood and the length of REM sleep (r = 0.22, p < 0.05) was also observed. Higher body mass index, higher total cholesterol, triglyceride and glucose levels have been shown to be independent predictors of higher AHI values, while greater telomerase activity, greater FMD and use of angiotensin converting enzyme inhibitors are independent predicators for lower AHI values. CONCLUSION Higher values of AHI index in polysomnography in hypertensive patients can be related to lower telomerase activity in the blood and impaired function of vascular endothelial function assessed using ultrasound.
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Wada H, Nagata K, Shirahama R, Tajima T, Kimura M, Ikeda A, Maruyama K, Tamura M, Suzuki K, Tanigawa T. Impact of sleep disordered breathing on performance in judo players. BMJ Open Sport Exerc Med 2019; 5:e000418. [PMID: 31205742 PMCID: PMC6540319 DOI: 10.1136/bmjsem-2018-000418] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2019] [Indexed: 01/06/2023] Open
Abstract
Objective Previous studies have suggested that young sports players may suffer from sleep disordered breathing (SDB). It was hypothesised that SDB in heavy-class judo players was far more prevalent than expected and that it could reduce judo performance, which could be improved by appropriate therapies. To address this, the present study estimated the percentage of heavy-class judo players with SDB and investigated the effect of SDB treatment on judo performance. Methods We enrolled 19 young judo players from a university judo team with body weight >100 kg and/or body mass index >30 kg/m2. Both excessive daytime sleepiness (EDS) and respiratory disturbance index (RDI) were evaluated using the Epworth Sleepiness Scale (ESS) and an overnight type 3 sleep monitor. Results The percentages of young heavyweight-class judo players with EDS (ESS ≥11) and those with SDB (RDI ≥5) were both 63%, which was unexpectedly high for the age class. Seven of the participants underwent continuous positive airway pressure therapy, which improved both RDI and ESS scores (p<0.05 for each) and subsequently the sleep quality and judo performance of the participants. Conclusions Our study indicates that young judo players might silently suffer from SDB, leading to poorer judo performance and to future cardiovascular diseases. Clinicians should be aware of the possible presence of SDB in young sports players and consider the application of diagnostic and therapeutic remedies.
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Affiliation(s)
- Hiroo Wada
- Public Health, Juntendo University - Hongo Campus, Bunkyo-ku, Tokyo, Japan
| | - Kazumasa Nagata
- Public Health, Juntendo University - Hongo Campus, Bunkyo-ku, Tokyo, Japan
| | - Ryutaro Shirahama
- Public Health, Juntendo University - Hongo Campus, Bunkyo-ku, Tokyo, Japan
| | - Tomokazu Tajima
- Public Health, Juntendo University - Hongo Campus, Bunkyo-ku, Tokyo, Japan
| | - Manami Kimura
- Public Health, Juntendo University - Hongo Campus, Bunkyo-ku, Tokyo, Japan
| | - Ai Ikeda
- Public Health, Juntendo University - Hongo Campus, Bunkyo-ku, Tokyo, Japan
| | - Koutatsu Maruyama
- Public Health, Juntendo University - Hongo Campus, Bunkyo-ku, Tokyo, Japan
| | - Masahiro Tamura
- Public Health, Juntendo University - Hongo Campus, Bunkyo-ku, Tokyo, Japan
| | - Keiji Suzuki
- Physical Education Department, Kokushikan University, Setagaya, Tokyo, Japan
| | - Takeshi Tanigawa
- Public Health, Juntendo University - Hongo Campus, Bunkyo-ku, Tokyo, Japan
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Peppard PE, Hagen EW. The Last 25 Years of Obstructive Sleep Apnea Epidemiology-and the Next 25? Am J Respir Crit Care Med 2019; 197:310-312. [PMID: 29035088 DOI: 10.1164/rccm.201708-1614pp] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- Paul E Peppard
- University of Wisconsin-Madison School of Medicine and Public Health, Department of Population Health Sciences, Madison, Wisconsin
| | - Erika W Hagen
- University of Wisconsin-Madison School of Medicine and Public Health, Department of Population Health Sciences, Madison, Wisconsin
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A Novel Grading System for Salpingopharyngeal Fold Hypertrophy in Obstructive Sleep Apnoea. Indian J Otolaryngol Head Neck Surg 2019; 71:60-65. [PMID: 30906715 DOI: 10.1007/s12070-018-1513-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 10/11/2018] [Indexed: 10/28/2022] Open
Abstract
The present study aimed at reporting the incidence of Salpingopharyngeal Fold (SPF) hypertrophy on Drug Induced Sleep Endoscopy (DISE) in patients with Obstructive Sleep Apnoea (OSA, validate a grading system and analyse the impact of various grades on the clinical presentation while ascertaining its relation with Apnoea-Hypopnoea Index (AHI). A retrospective analysis of 169 patients with polysomnographic confirmation of obstructive sleep apnoea has been done in the study. The DISE video data of 169 patients was evaluated by two ENT surgeons individually and they graded the hypertrophy of the fold as Grade 0 being normal anatomy, Grade 1 being hypertrophy causing partial obstruction and Grade 2 being hypertrophy causing complete obstruction of lateral pharyngeal wall. It was found that the presence of SPF hypertrophy independently adds considerably to the severity of the obstruction, attributing to lateral collapse at the upper retropalatal level and also significantly increases AHI. It is thus advised to consider the grade of SPF hypertrophy while surgically planning the management of patients with OSA.
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Labarca G, Valdivia G, Oñate A, Navarrete C, Araya J, Fernandez-Bussy I, Dreyse J, Jorquera J. Prevalence of STOP BANG questionnaire and association with major cardiovascular events in hospitalized population: is it enough with currently used cardiovascular risk measurements? Sleep Med 2019; 61:82-87. [PMID: 31416696 DOI: 10.1016/j.sleep.2019.02.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 01/31/2019] [Accepted: 02/26/2019] [Indexed: 11/28/2022]
Abstract
Cardiovascular risk (CR) is associated with obstructive sleep apnea hypopnea syndrome (OSAHS). This association enhances the risk of major adverse cardiovascular events (MACE); nevertheless, data from hospitalized populations and interactions among these conditions remain unclear. PURPOSE To evaluate the risk of MACE in the population with risk of OSAHS using the STOP-BANG questionnaire. METHODS We performed a prospective study in an academic hospital from 2017 to 2018. Data included demography, admissions, STOP-BANG score and CR using AHA scores. The primary outcome was risk of MACE in participants with low risk of OSAHS (STOP-BANG 0-2 points), risk of OSAHS (≥3 points) and risk of moderate/severe OSAHS (≥5 points). Risk of MACE was evaluated using odds ratios (OR), and average CR was evaluated using the t-test. RESULTS A total of 441 participants were included. The cumulative prevalence of STOP BANG ≥3 points was 80.9%, and that of ≥5 points was 41.6%. OR of MACE ≥3 points was 3.93 (CI 2.08-7.24) (p < 0.001) compared with <3 points, and Average CR was 10.91% (SD ± 2.13) at <3 points versus 24.3% (SD ± 1.24) for ≥3 points for ≥5 points OR of MACE was 1.72 (CI 1.18-2.59) (p = 0.005) and average CR was 26.14% (SD ± 1.63). However, after multivariable analysis, gender differences and previous heart failure were independently associated to MACE. CONCLUSION The risk of OSAHS in the hospitalized population is high. This population has a higher risk of MACE and higher CRs than do low-risk participants. Conversely, gender and heart failure are potential cofounders.
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Affiliation(s)
- Gonzalo Labarca
- Facultad de Medicina, Universidad San Sebastian, Concepcion, Chile; Complejo Asistencial Dr. Victor Rios Ruiz, Los Angeles, Chile.
| | - Gabriel Valdivia
- Facultad de Medicina, Universidad de Concepcion, Los Angeles, Chile
| | - Aileen Oñate
- Facultad de Medicina, Universidad San Sebastian, Concepcion, Chile
| | - Camila Navarrete
- Facultad de Medicina, Universidad San Sebastian, Concepcion, Chile
| | - Jose Araya
- Facultad de Medicina, Universidad San Sebastian, Concepcion, Chile
| | | | - Jorge Dreyse
- Centro de Enfermedades Respiratorias, Clinica Las Condes, Santiago, Chile
| | - Jorge Jorquera
- Centro de Enfermedades Respiratorias, Clinica Las Condes, Santiago, Chile
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Kandasamy G, Almaghaslah D, Sivanandy P, Arumugam S. Effectiveness of nasal continuous airway pressure therapy in patients with obstructive sleep apnea. Int J Health Plann Manage 2019; 34:e1200-e1207. [PMID: 30793369 DOI: 10.1002/hpm.2758] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 01/24/2019] [Accepted: 01/24/2019] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES A prospective observational study was carried out with the aim of evaluating the effectiveness of nasal continuous positive airway pressure (nCPAP) therapy on the health-related quality of life (QoL) of patients with obstructive sleep apnea (OSA). METHODS The patients included in this study were those recently diagnosed with OSA (AHI > 5) and given nCPAP therapy, as well as being referred to a sleep laboratory for an assessment of their sleep disordered breathing. Prior to the start of nCPAP therapy and polysomnography evaluation, patients were asked to complete the validated Quebec sleep questionnaire (QSQ), and their baseline measurements were recorded. RESULTS Among the study population, 14.41% (n = 31) had mild OSA with an apnea and hypopnea index of 5 to 14.9 events/h, while 26.97% (n = 58) had moderate OSA and 40% (n = 86) had severe OSA. The overall average apnea and hypopnea index of the study population was 30.24 ± 9.73 events/h; mild OSA patients had an average apnea and hypopnea index of 10.09 ± 2.65 events/h, moderate OSA patients had 21.48 ± 4.40 events/h, and severe OSA patients had 59.16 ± 22.14 events/h. A significant difference was observed between the scores before treatment and after 6 months of therapy in all domains of the QSQ QoL scores (P < 0.0001). CONCLUSION Nasal continuous positive airway pressure treatment improved the QoL for patients with mild, moderate, and severe sleep apnea.
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Affiliation(s)
- Geetha Kandasamy
- Department of Clinical Pharmacy, College of Pharmacy, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - Dalia Almaghaslah
- Department of Clinical Pharmacy, College of Pharmacy, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - Palanisamy Sivanandy
- Department of Pharmacy Practice, School of Pharmacy, International Medical University, Kuala Lumpur, Malaysia
| | - Somasundaram Arumugam
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research, Kolkata, West Bengal, India
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Liu W, Zhang W, Wang T, Wu J, Zhong X, Gao K, Liu Y, He X, Zhou Y, Wang H, Zeng H. Obstructive sleep apnea syndrome promotes the progression of aortic dissection via a ROS- HIF-1α-MMPs associated pathway. Int J Biol Sci 2019; 15:2774-2782. [PMID: 31853217 PMCID: PMC6909961 DOI: 10.7150/ijbs.34888] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 08/20/2019] [Indexed: 01/25/2023] Open
Abstract
Aims: Obstructive sleep apnea syndrome (OSAS) has been increasingly recognized as an independent risk factor for aortic dissection (AD) and it is strongly associated with the extent of intermittent hypoxia and re-oxygenation (IH). This study aimed to clarify role of ROS- HIF-1α-MMPs pathway in the pathogenesis of AD and whether the HIF-1α inhibitor attenuates AD formation. Methods and results: 8-week-old male ApoE-/- mice were given β-aminopropionitrile at a concentration of 0.1 % for 3 weeks and infused via osmotic mini pumps with either saline or 2,500 ng/min/kg angiotensin II (Ang II) for 2 weeks. To mimic the OSAS, one group was exposed to IH, which consisted of alternating cycles of 20.9% O2/8% O2 FiO2 (30 episodes per hour) with 20 s at the nadir FiO2 during the 12-h light phase, 2 weeks before Ang II infusion. After Ang II infusion, we assessed remodeling in the aorta by echocardiography, histological and immunohistochemical analysis. IH treatment resulted in significant enlargement of the luminal area, destruction of the media, marked thickening of the adventitia, higher incidence of AD formation and lower survival rate in compared with the Ang II only group. Moreover, IH exposure markedly increased the aortic ROS production and subsequent HIF-1α expression, which in turn promoted the expressions of VEGF, MMP2 and MMP9 and finally leading to the progression of AD. Besides, in vitro study confirmed that IH induced HIF-1α expression plays an important role in the induction of MMPs and that is regulated by the PI3K/AKT/FRAP pathway. Intriguingly, a selective HIF-1α inhibitor KC7F2 could significantly ameliorate IH exposure induced aforementioned deleterious effects in vitro and in vivo.Conclusion: OSAS induced IH can promote the occurrence and progression of AD via a ROS- HIF-1α-MMPs associated pathway. The selective HIF-1α inhibitor KC7F2 could be a novel therapeutic agent for AD patient with OSAS.
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Affiliation(s)
- Wanjun Liu
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, PR China
- Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan, 430030, PR China
| | - Wenjun Zhang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, PR China
- Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan, 430030, PR China
| | - Tao Wang
- Department of Cardiology, Affiliated Hospital of Weifang Medical University, Weifang, Shandong, 261000, PR China
| | - Jinhua Wu
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, PR China
- Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan, 430030, PR China
| | - Xiaodan Zhong
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, PR China
- Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan, 430030, PR China
| | - Kun Gao
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, PR China
- Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan, 430030, PR China
| | - Yujian Liu
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, PR China
- Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan, 430030, PR China
| | - Xingwei He
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, PR China
- Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan, 430030, PR China
| | - Yiwu Zhou
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, PR China
| | - Hongjie Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, PR China
- Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan, 430030, PR China
- ✉ Corresponding author: Hongjie Wang, , Tel. +86-27-8369-3794, Fax: +86-27-8366-3186; Hesong Zeng, , Tel. +86-27-8369-2850, Fax: +86-27-8366-3186
| | - Hesong Zeng
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, PR China
- Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan, 430030, PR China
- ✉ Corresponding author: Hongjie Wang, , Tel. +86-27-8369-3794, Fax: +86-27-8366-3186; Hesong Zeng, , Tel. +86-27-8369-2850, Fax: +86-27-8366-3186
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Urbanik D, Gać P, Martynowicz H, Poręba M, Podgórski M, Negrusz-Kawecka M, Mazur G, Sobieszczańska M, Poręba R. Obstructive sleep apnea as a predictor of reduced heart rate variability. Sleep Med 2018; 54:8-15. [PMID: 30529071 DOI: 10.1016/j.sleep.2018.09.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 09/09/2018] [Accepted: 09/13/2018] [Indexed: 11/17/2022]
Abstract
PURPOSE This study aimed to analyze the relationship between the occurrence of obstructive sleep apnea (OSA) and heart rate variability (HRV) in a group of patients with clinical suggestion of OSA. METHODS 104 patients with clinical suspicion of OSA were qualified to participate in the study (age: 53.15 ± 13.43 years). All participants took part in a survey and were subjected to laboratory tests, 24-hour ECG Holter monitoring, and polysomnography. The participants were divided into groups depending on the criterion of the presence of OSA. RESULTS The analysis of time HRV demonstrated lower parameters of SDNN for the entire recording and a 15-minute fragment of daily activity, as well as a lower pNN50 for the entire recording in those patients with diagnosed OSA. A statistically significant difference was observed for the spectral analysis of the LF/HF which was higher in the participants with OSA during the 15-minute fragment of N3 sleep. A negative correlation was observed between AHI and the following parameters: SDSD from the entire Holter recording (r = -0.21, p < 0.05) and from the 15-minute fragment of daily activity (r = -0.19, p < 0.05), mRR from the fragment of N3 sleep (r = -0.19, p < 0.05) and VLF from the entire Holter recording (r = -0.26, p < 0.05). A statistically significant positive correlation between AHI and LF/HF in 15-minute fragments of N3 sleep was found (r = 0.26, p < 0.05). CONCLUSIONS The study group of patients with OSA is characterized by reduced HRV. The higher AHI constitutes an independent predictor of reduced HRV, both in the sympathetic and parasympathetic components, and the sympathetic-parasympathetic balance.
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Affiliation(s)
- Dominika Urbanik
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Borowska 213, PL 50-556, Wroclaw, Poland
| | - Paweł Gać
- Department of Hygiene, Wroclaw Medical University, Mikulicza-Radeckiego 7, PL 50-368 Wroclaw, Poland.
| | - Helena Martynowicz
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Borowska 213, PL 50-556, Wroclaw, Poland
| | - Małgorzata Poręba
- Department of Pathophysiology, Wroclaw Medical University, Marcinkowskiego 1, PL 50-368 Wroclaw, Poland
| | - Maciej Podgórski
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Borowska 213, PL 50-556, Wroclaw, Poland
| | - Marta Negrusz-Kawecka
- Department of Cardiology, Wroclaw Medical University, Borowska 213, PL 50-556, Wroclaw, Poland
| | - Grzegorz Mazur
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Borowska 213, PL 50-556, Wroclaw, Poland
| | - Małgorzata Sobieszczańska
- Department of Geriatrics, Wroclaw Medical University, Curie-Skłodowskiej 66, PL 50-369 Wroclaw, Poland
| | - Rafał Poręba
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Borowska 213, PL 50-556, Wroclaw, Poland
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Martinez-Garcia MA, Campos-Rodriguez F, Javaheri S, Gozal D. Pro: continuous positive airway pressure and cardiovascular prevention. Eur Respir J 2018; 51:51/5/1702400. [PMID: 29748245 DOI: 10.1183/13993003.02400-2017] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 01/23/2018] [Indexed: 02/04/2023]
Affiliation(s)
| | | | - Shahrokh Javaheri
- Pulmonary and Sleep Division, Bethesda North Hospital, Cincinnati, OH, USA
| | - David Gozal
- Dept of Pediatrics, University of Chicago, Chicago, IL, USA
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Le HH, Salas RME, Gamaldo A, Billups KL, Dziedzic P, Choi S, Bermudez N, Thorpe RJ, Gamaldo CE. The utility and feasibility of assessing sleep disruption in a men's health clinic using a mobile health platform device: A pilot study. Int J Clin Pract 2018; 72. [PMID: 28869721 DOI: 10.1111/ijcp.12999] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 08/03/2017] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Evidence linking sleep disruption and sexual dysfunction in men is mounting; yet the characterisation of sleep patterns and complaints utilising a clinically feasible method within this patient population remain largely under-reported. AIM A pilot study aiming to demonstrate a clinically feasible method to characterise the sleep patterns and complaints in a representative sample of patients treated in a men's health clinic. METHODS Male patients (n = 48) completed a battery of validated sleep questionnaires using an mHealth mobile platform, MySleepScript, at the Johns Hopkins Men's Health and Vitality Center. Metrics related to clinical feasibility such as completion time, ease of use, preference of electronic format, and patient satisfaction were also collected. MAIN OUTCOME MEASURES Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Berlin Questionnaire, Patient Health Questionnaire (PHQ-9), and Primary Care PTSD Screen (PC-PTSD). RESULTS Primary urological chief symptoms for this sample patient population were erectile dysfunction (ED; 80%), hypogonadism (40%), benign prostatic hyperplasia/lower urinary tract symptoms (BPH/LUTS; 40%) and Peyronie's disease (10%). Mean PSQI score was 7.8 [SD 4.2], with 67% of all patients falling within the "poor sleeper" range. At least mild symptoms of depression were noted in 40% and 43% were at risk for obstructive sleep apnea (OSA) on the Berlin Questionnaire. CONCLUSIONS This pilot study demonstrated the feasibility and potential utility of an mHealth platform to assist clinicians, within a men's health clinic, in detecting sleep disturbances. Disrupted sleep was revealed in well over half of this sample of patients. As a result of the growing evidence linking poor sleep and sleep disorders (eg, OSA) to the conditions relevant to men's health (eg, erectile dysfunction, hypogonadism and BPH), further efforts beyond this pilot study are necessary to identify the aetiological processes underlying the association between specific disrupted sleep disorders and urological conditions.
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Affiliation(s)
- Hai H Le
- Department of Neurology, Johns Hopkins Medicine, Baltimore, MD, USA
| | | | - Alyssa Gamaldo
- Human Development and Family Studies, Penn State University, University Park, PA, USA
| | - Kevin L Billups
- Department of Surgery, Meharry Medical College School of Medicine, Nashville, TN, USA
| | - Peter Dziedzic
- Department of Neurology, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Seulah Choi
- Department of Neurology, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Neftali Bermudez
- Department of Neurology, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Roland J Thorpe
- Program for Research on Men's Health, Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Xie C, Zhu R, Tian Y, Wang K. Association of obstructive sleep apnoea with the risk of vascular outcomes and all-cause mortality: a meta-analysis. BMJ Open 2017; 7:e013983. [PMID: 29275335 PMCID: PMC5770910 DOI: 10.1136/bmjopen-2016-013983] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE This study aimed to conduct a meta-analysis to explore and summarise the evidence regarding the association between obstructive sleep apnoea (OSA) and the subsequent risk of vascular outcomes and all-cause mortality. METHODS Electronic databases PubMed, Embase and the Cochrane Library were searched to identify studies conducted through May 2016. Prospective cohort studies that reported effect estimates with 95% CIs of major adverse cardiac events (MACEs), coronary heart disease (CHD), stroke, cardiac death, all-cause mortality and heart failure for different levels versus the lowest level of OSA were included. RESULTS A total of 16 cohort studies reporting data on 24 308 individuals were included. Of these, 11 studies reported healthy participants, and the remaining five studies reported participants with different diseases. Severe OSA was associated with an increased risk of MACEs (relative risk (RR): 2.04; 95% CI 1.56 to 2.66; P<0.001), CHD (RR: 1.63; 95% CI 1.18 to 2.26; P=0.003), stroke (RR: 2.15; 95% CI 1.42 to 3.24; P<0.001), cardiac death (RR: 2.96; 95% CI 1.45 to 6.01; P=0.003) and all-cause mortality (RR: 1.54; 95% CI 1.21 to 1.97; P<0.001). Moderate OSA was also significantly associated with increased risk of MACEs (RR: 1.16; 95% CI 1.01 to 1.33; P=0.034) and CHD (RR: 1.38; 95% CI 1.04 to 1.83; P=0.026). No significant association was found between mild OSA and the risk of vascular outcomes or all-cause mortality (P>0.05). Finally, no evidence of a factor-specific difference in the risk ratio for MACEs among participants with different levels of OSA compared with those with the lowest level of OSA was found. CONCLUSIONS Severe and moderate OSAs were associated with an increased risk of vascular outcomes and all-cause mortality. This relationship might differ between genders. Therefore, further large-scale prospective studies are needed to verify this difference.
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Affiliation(s)
- Chengjuan Xie
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Ruolin Zhu
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yanghua Tian
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Collaborative Innovation Centre of Neuropsychiatric Disorders and Mental Health, Anhui Province, Hefei, China
| | - Kai Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Collaborative Innovation Centre of Neuropsychiatric Disorders and Mental Health, Anhui Province, Hefei, China
- Department of Medical Psychology, Anhui Medical University, Hefei, China
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Peng CS, Cao YA, Tian YH, Zhang WL, Xia J, Yang L. Features of continuous glycemic profile and glycemic variability in patients with obstructive sleep apnea syndrome. Diabetes Res Clin Pract 2017; 134:106-112. [PMID: 29096240 DOI: 10.1016/j.diabres.2017.08.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 07/24/2017] [Accepted: 08/15/2017] [Indexed: 12/18/2022]
Abstract
AIMS To investigate glycemic variability (GV) in Obstructive Sleep Apnea Syndrome (OSAS) patients by monitoring continuous blood glucose profile. METHODS OSAS group (n=86) and normal control group (n=40) were included. Continuous blood glucose was monitored. The relationship of GV, insulin resistance index (IRI) and the respiratory disturbance index (AHI) were analyzed. RESULTS The daily average blood glucose level was significantly higher in the OSAS patients than in the control group (6.31±0.61vs. 4.94±0.78; P<0.01). The postprandial glycemic peaks in the OSAS patients were significantly higher and prolonged. The indicators of GV were all significantly higher in the OSAS patients, including blood glucose fluctuation coefficient (BGFC, 1.93±0.71vs. 1.21±0.38, P<0.05), mean amplitude of glycemic excursions (MAGE, 4.18±0.65vs. 2.18±0.48; P<0.05) and night mean amplitude of glycemic excursions (NMAGE, 2.00±0.53vs. 1.11±0.43; P<0.05). Pearson correlation analysis showed that among the OSAS patients, the severity of OSAS (AHI) was positively correlated with the IRI (r=0.310); and the GV indicators (MAGE and NMAGE) were positively correlated with IRI and AHI (r=0.318 and 0.349, respectively) (P<0.01 or 0.001). CONCLUSIONS Continuous glycemic spectrum and GV provide comprehensive glycemic profiles and may reveal important aspects of glucose metabolism abnormality beyond regular examinations, and are therefore of particular significance for glycemic management in OSAS patients.
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Affiliation(s)
- Chao-Sheng Peng
- Naval General Hospital of PLA, Special Care Medical Center, Beijing 100048, China
| | - Yue-An Cao
- Naval General Hospital of PLA, Special Care Medical Center, Beijing 100048, China
| | - Yu-Hong Tian
- Naval General Hospital of PLA, Special Care Medical Center, Beijing 100048, China
| | - Wen-Luo Zhang
- Naval General Hospital of PLA, Special Care Medical Center, Beijing 100048, China
| | - Jing Xia
- Naval General Hospital of PLA, Special Care Medical Center, Beijing 100048, China
| | - Lu Yang
- Naval General Hospital of PLA, Special Care Medical Center, Beijing 100048, China.
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Burchakov DI, Mayorov AY. [Intermittent hypoxia due to sleep apnea syndrome in patients with type 2 diabetes mellitus]. Zh Nevrol Psikhiatr Im S S Korsakova 2017; 117:16-21. [PMID: 29171483 DOI: 10.17116/jnevro201711710116-21] [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: 11/17/2022]
Abstract
OBJECTIVES To evaluate the possible association between intermittent hypoxia (IH) and HbA1c in patients with insufficient control type of 2 diabetes mellitus (T2DM). MATERIAL AND METHODS In this cross-sectional study 183 patients with HbAc1≥7% underwent three-channel overnight monitoring (ApneaLink) and completed Berlin Questionnaire, Epworth Sleepiness Scale and Pittsburgh Sleep Quality Index. Patients were divided in two groups, based on the cut-off value of oxygen desaturation index≥15. RESULTS AND CONCLUSION There were 79 (43%) patients with intermittent hypoxia, which was associated with poorer glycaemic control, defined as HbA1c>8.7% (sample median) in the univariate analysis and after adjustment for body mass index OR 2,40 (CI 1.21-4.95, p=0.021). Neither of three questionnaires yielded satisfactory results as a screening method in patients with T2DM. There is a need to implement instrumental screening of sleep-disordered breathing in this population and to study the effects of CPAP-therapy on glycaemic control and carbohydrate metabolism.
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Affiliation(s)
- D I Burchakov
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - A Yu Mayorov
- Sechenov First Moscow State Medical University, Moscow, Russia; Endocrinological Research Centre, Moscow, Russia
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Dhaliwal SS, Hesabgar SM, Haddad SMH, Ladak H, Samani A, Rotenberg BW. Constructing a patient-specific computer model of the upper airway in sleep apnea patients. Laryngoscope 2017; 128:277-282. [DOI: 10.1002/lary.26834] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 05/10/2017] [Accepted: 06/16/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Sandeep S. Dhaliwal
- Department of Otolaryngology-Head and Neck Surgery; Western University; London Ontario Canada
| | - Seyyed M. Hesabgar
- Department of Medical Biophysics; Western University; London Ontario Canada
| | | | - Hanif Ladak
- Department of Medical Biophysics; Western University; London Ontario Canada
| | - Abbas Samani
- Department of Medical Biophysics; Western University; London Ontario Canada
| | - Brian W. Rotenberg
- Department of Otolaryngology-Head and Neck Surgery; Western University; London Ontario Canada
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Objective short sleep duration modifies the relationship between hypertension and all-cause mortality. J Hypertens 2017; 35:830-836. [PMID: 28253221 DOI: 10.1097/hjh.0000000000001253] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Short sleep duration has been associated with cardiovascular morbidity and mortality. However, previous studies were limited by using subjective sleep measures and treating sleep duration as a sole, independent predictor. Therefore, the role of sleep duration in predicting mortality is still not well understood. We posit that objective sleep duration is an effect modifier of the relationship between hypertension and all-cause mortality. METHODS We addressed this question in the Penn State Adult Cohort, a random, general population sample of 1741 men and women (48.7 ± 13.5 years) who were studied in the sleep laboratory and followed up for 15.5 ± 4.1 years. Hypertension was defined on the basis of SBP and DBP (≥140/≥90 mmHg) or use of antihypertensive medication. Polysomnographic sleep duration was classified into three clinically meaningful categories. RESULTS We tested the interaction between hypertension and polysomnographic sleep duration on all-cause mortality using multiple logistic regression while controlling for several potential confounders (P value = 0.03). The odds (95% confidence interval) of all-cause mortality associated with hypertension were 1.77 (1.07-2.92), 2.78 (1.47-5.24), and 3.93 (2.22-6.95) for individuals who slept at least 6, 5-6, and 5 h or less, respectively. CONCLUSION The risk of mortality associated with hypertension increases in a dose-response manner as a function of shorter sleep duration. Short sleep in hypertensive individuals may be a marker of the degree of central autonomic dysfunction. Future epidemiological studies should examine this effect modification using cause-specific mortality, whereas future clinical trials should examine whether lengthening sleep improves the prognosis of individuals with hypertension.
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Sex and age differences in the associations between sleep behaviors and all-cause mortality in older adults: results from the National Health and Nutrition Examination Surveys. Sleep Med 2017; 36:141-151. [PMID: 28735912 DOI: 10.1016/j.sleep.2017.05.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 05/09/2017] [Accepted: 05/10/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Our aim was to examine sex- and age-specific relationships of sleep behaviors with all-cause mortality rates. METHODS A retrospective cohort study was conducted among 5288 adults (≥50 years) from the 2005-2008 National Health and Nutrition Examination Surveys who were followed-up for 54.9 ± 1.2 months. Sleep duration was categorized as < 7 h, 7-8 h and >8 h. Two sleep quality indices were generated through factor analyses. 'Help-seeking behavior for sleep problems' and 'diagnosis with sleep disorders' were defined as yes/no questions. Sociodemographic covariates-adjusted Cox regression models were applied to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS A positive relationship was observed between long sleep and all-cause mortality rate in the overall sample (HR = 1.90, 95% CI: 1.38, 2.60), among males (HR = 1.48, 95% CI: 1.05, 2.09), females (HR = 2.32, 95% CI: 1.48, 3.61) and elderly (≥65 years) people (HR = 1.80, 95% CI: 1.30, 2.50). 'Sleepiness/sleep disturbance' (Factor I) and all-cause mortality rate were positively associated among males (HR = 1.22, 95% CI: 1.03, 1.45), whereas 'poor sleep-related daytime dysfunction' (Factor II) and all-cause mortality (HR = 0.75, 95% CI: 0.62, 0.91) were negatively associated among elderly people. CONCLUSIONS Sex- and age-specific relationships were observed between all-cause mortality rate and specific sleep behaviors among older adults.
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Fernandez-Mendoza J, He F, LaGrotte C, Vgontzas AN, Liao D, Bixler EO. Impact of the Metabolic Syndrome on Mortality is Modified by Objective Short Sleep Duration. J Am Heart Assoc 2017; 6:e005479. [PMID: 28515112 PMCID: PMC5524093 DOI: 10.1161/jaha.117.005479] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 03/22/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND To examine whether objective sleep duration is an effect modifier of the impact of metabolic syndrome (MetS) on all-cause and cardiovascular disease/cerebrovascular mortality. METHODS AND RESULTS We addressed this question in the Penn State Adult Cohort, a random, general population sample of 1344 men and women (48.8±14.2 years) who were studied in the sleep laboratory and followed up for 16.6±4.2 years. MetS was defined by the presence of 3 or more of obesity (≥30 kg/m2), elevated total cholesterol (≥200 mg/dL), triglycerides (≥150 mg/dL), fasting glucose (≥100 mg/dL), and blood pressure (≥130/85 mm Hg). Polysomnographic sleep duration was classified into clinically meaningful categories. Among the 1344 participants, 22.0% of them died during the follow-up. We tested the interaction between MetS and polysomnographic sleep duration on mortality using Cox proportional hazard models controlling for multiple potential confounders (P<0.05). The hazard ratios (95% CI) of all-cause and cardiovascular disease/cerebrovascular mortality associated with MetS were 1.29 (0.89-1.87) and 1.49 (0.75-2.97) for individuals who slept ≥6 hours and 1.99 (1.53-2.59) and 2.10 (1.39-3.16) for individuals who slept <6 hours. Interestingly, this effect modification was primarily driven by the elevated blood pressure and glucose dysregulation components of MetS. CONCLUSIONS The risk of mortality associated with MetS is increased in those with short sleep duration. Short sleep in individuals with MetS may be linked to greater central autonomic and metabolic dysfunction. Future clinical trials should examine whether lengthening sleep improves the prognosis of individuals with MetS.
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Affiliation(s)
- Julio Fernandez-Mendoza
- Sleep Research & Treatment Center, Penn State Milton S. Hershey Medical Center, Pennsylvania State University College of Medicine, Hershey, PA
| | - Fan He
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA
| | - Caitlin LaGrotte
- Sleep Research & Treatment Center, Penn State Milton S. Hershey Medical Center, Pennsylvania State University College of Medicine, Hershey, PA
| | - Alexandros N Vgontzas
- Sleep Research & Treatment Center, Penn State Milton S. Hershey Medical Center, Pennsylvania State University College of Medicine, Hershey, PA
| | - Duanping Liao
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA
| | - Edward O Bixler
- Sleep Research & Treatment Center, Penn State Milton S. Hershey Medical Center, Pennsylvania State University College of Medicine, Hershey, PA
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