1
|
Alakörkkö I, Törmälehto S, Leppänen T, McNicholas WT, Arnardottir ES, Sund R. The economic cost of obstructive sleep apnea: A systematic review. Sleep Med Rev 2023; 72:101854. [PMID: 37939650 DOI: 10.1016/j.smrv.2023.101854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 09/15/2023] [Accepted: 09/18/2023] [Indexed: 11/10/2023]
Abstract
Obstructive sleep apnea (OSA) is a common disease associated with a high prevalence of costly comorbidities and accidents that add to the disease's economic impact. Although more attention has been focused on OSA in recent years, no previous systematic reviews have synthesized findings from existing studies that provide estimates of the economic cost of OSA. This study aims to summarize the findings of existing studies that provide estimates of the cost of OSA. Two bibliographic databases, PubMed and Scopus, were used to identify articles on the costs of OSA. The systematic literature review identified 5,938 publications, of which 31 met the inclusion criteria. According to the results, adjusted for inflation and converted to euros, the annual cost per patient ranged from €236 (the incremental cost of OSA) for New Zealand to €28,267 for the United States. The total annual cost per patient in Europe ranged from €1,669 to €5,186. OSA causes a significant burden on society, and OSA-related costs increase many years before the diagnosis and remain elevated for a long time after the diagnosis. Despite some well-conducted studies, the cost estimates for OSA are uncertain and specific to the context in which the study was conducted.
Collapse
Affiliation(s)
- Ida Alakörkkö
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
| | - Soili Törmälehto
- School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland
| | - Timo Leppänen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland; Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland; School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
| | - Walter T McNicholas
- Department of Respiratory and Sleep Medicine, St. Vincent's Hospital Group, School of Medicine, University College Dublin, Dublin, Ireland
| | - Erna S Arnardottir
- Reykjavik University Sleep Institute, School of Technology, Reykjavik University, Reykjavik, Iceland
| | - Reijo Sund
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| |
Collapse
|
2
|
Li S, Tan S, Liu D, Zhang K, Zhang Y, Wang B, Zuo H. Comorbidities are associated with self-reported sleep-disordered breathing and insomnia: a cross-sectional study from China. Sleep Breath 2023; 27:2407-2413. [PMID: 37389766 DOI: 10.1007/s11325-023-02875-4] [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: 03/15/2023] [Revised: 05/24/2023] [Accepted: 06/12/2023] [Indexed: 07/01/2023]
Abstract
PURPOSE We aimed to examine the associations of comorbidities with self-reported sleep-disordered breathing (SDB) and insomnia among Chinese adults. METHODS The study used data from a community-based cross-sectional survey performed in China in 2018-2020. Multivariable logistic regression models were used to analyze the associations of 12 comorbidities with SDB and insomnia. RESULTS A total of 4329 Han Chinese adults aged ≥ 18 years were enrolled. Of these, 1970 (45.5%) were male, with a median age of 48 years (interquartile range: 34-59). Compared with the participants without any conditions, adjusted ORs for SDB and insomnia for those with ≥ 4 comorbidities were 2.33 (95% CI: 1.58, 3.43, P-trend < 0.001) and 3.89 (95% CI: 2.69, 5.64, P-trend < 0.001), respectively. Seven comorbidities (hypertension, hyperlipidemia, coronary heart disease (CHD), bone and joint disease, neck or lumbar disease, chronic digestive diseases, and chronic urological disease) were positively associated with both SDB and insomnia. Cancer and chronic obstructive pulmonary disease (COPD) were also independently associated with insomnia. Of all comorbidities, cancer was most strongly associated with insomnia (OR = 3.16; 95% CI: 1.78, 5.63; P < 0.001), and CHD was most strongly associated with SDB (OR = 1.77; 95% CI: 1.19, 2.64; P < 0.001). CONCLUSIONS The findings showed that adults with an increasing number of comorbidities had higher odds for SDB and insomnia, which were independent of sociodemographic and lifestyle factors.
Collapse
Affiliation(s)
- Shengnan Li
- School of Public Health, Suzhou Medical College of Soochow University, 199 Ren'ai Rd., Suzhou, 215123, China
| | - Siyue Tan
- School of Public Health, Suzhou Medical College of Soochow University, 199 Ren'ai Rd., Suzhou, 215123, China
| | - Dong Liu
- School of Public Health, Suzhou Medical College of Soochow University, 199 Ren'ai Rd., Suzhou, 215123, China
| | - Ke Zhang
- School of Public Health, Suzhou Medical College of Soochow University, 199 Ren'ai Rd., Suzhou, 215123, China
| | - Yuyi Zhang
- School of Public Health, Suzhou Medical College of Soochow University, 199 Ren'ai Rd., Suzhou, 215123, China
| | - Bo Wang
- Suzhou Center for Disease Control and Prevention, 72 San'xiang Rd., Suzhou, 215004, China.
| | - Hui Zuo
- School of Public Health, Suzhou Medical College of Soochow University, 199 Ren'ai Rd., Suzhou, 215123, China.
- Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China.
| |
Collapse
|
3
|
Cetin-Atalay R, Meliton AY, Ozcan C, Woods PS, Sun KA, Fang Y, Hamanaka RB, Mutlu GM. Loss of heme oxygenase 2 causes reduced expression of genes in cardiac muscle development and contractility and leads to cardiomyopathy in mice. PLoS One 2023; 18:e0292990. [PMID: 37844118 PMCID: PMC10578579 DOI: 10.1371/journal.pone.0292990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/03/2023] [Indexed: 10/18/2023] Open
Abstract
Obstructive sleep apnea (OSA) is a common breathing disorder that affects a significant portion of the adult population. In addition to causing excessive daytime sleepiness and neurocognitive effects, OSA is an independent risk factor for cardiovascular disease; however, the underlying mechanisms are not completely understood. Using exposure to intermittent hypoxia (IH) to mimic OSA, we have recently reported that mice exposed to IH exhibit endothelial cell (EC) activation, which is an early process preceding the development of cardiovascular disease. Although widely used, IH models have several limitations such as the severity of hypoxia, which does not occur in most patients with OSA. Recent studies reported that mice with deletion of hemeoxygenase 2 (Hmox2-/-), which plays a key role in oxygen sensing in the carotid body, exhibit spontaneous apneas during sleep and elevated levels of catecholamines. Here, using RNA-sequencing we investigated the transcriptomic changes in aortic ECs and heart tissue to understand the changes that occur in Hmox2-/- mice. In addition, we evaluated cardiac structure, function, and electrical properties by using echocardiogram and electrocardiogram in these mice. We found that Hmox2-/- mice exhibited aortic EC activation. Transcriptomic analysis in aortic ECs showed differentially expressed genes enriched in blood coagulation, cell adhesion, cellular respiration and cardiac muscle development and contraction. Similarly, transcriptomic analysis in heart tissue showed a differentially expressed gene set enriched in mitochondrial translation, oxidative phosphorylation and cardiac muscle development. Analysis of transcriptomic data from aortic ECs and heart tissue showed loss of Hmox2 gene might have common cellular network footprints on aortic endothelial cells and heart tissue. Echocardiographic evaluation showed that Hmox2-/- mice develop progressive dilated cardiomyopathy and conduction abnormalities compared to Hmox2+/+ mice. In conclusion, we found that Hmox2-/- mice, which spontaneously develop apneas exhibit EC activation and transcriptomic and functional changes consistent with heart failure.
Collapse
Affiliation(s)
- Rengul Cetin-Atalay
- Department of Medicine, Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, Illinois, United States of America
| | - Angelo Y. Meliton
- Department of Medicine, Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, Illinois, United States of America
| | - Cevher Ozcan
- Department of Medicine, Section of Cardiology, University of Chicago, Chicago, Illinois, United States of America
| | - Parker S. Woods
- Department of Medicine, Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, Illinois, United States of America
| | - Kaitlyn A. Sun
- Department of Medicine, Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, Illinois, United States of America
| | - Yun Fang
- Department of Medicine, Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, Illinois, United States of America
| | - Robert B. Hamanaka
- Department of Medicine, Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, Illinois, United States of America
| | - Gökhan M. Mutlu
- Department of Medicine, Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, Illinois, United States of America
| |
Collapse
|
4
|
Patial K, Mishra HP, Pal G, Suvvari TK, Ghosh T, Mishra SS, Mahapatra C, Amanullah NA, Shukoor SA, Kamal S, Singh I, Israr J, Sharma PS, Gaur SN, Behera RK. Understanding the Association Between Obesity and Obstructive Sleep Apnea Syndrome: A Case-Control Study. Cureus 2023; 15:e45843. [PMID: 37881397 PMCID: PMC10594396 DOI: 10.7759/cureus.45843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2023] [Indexed: 10/27/2023] Open
Abstract
Introduction Obstructive sleep apnea (OSA) represents a sleep-related impairment linked to upper airway function. The question of whether OSA drives obesity or if shared underlying factors contribute to both conditions remains unresolved. Hence, this present study aims to understand the interplay between obstructive sleep apnea syndrome (OSAS) and obesity through in-depth analysis of anthropometric data within control subjects and OSA patients. Methodology A case-control study was conducted, which included 40 cases and 40 matched healthy controls. Study participants with reported symptoms of snoring, daytime drowsiness, or both were included in the study. All the study participants underwent comprehensive anthropometric assessments such as height, weight, body mass index (BMI), neck circumference, waist circumference, hip circumference, waist-to-hip ratio, skin-fold thickness, and thickness measurements of biceps, triceps, suprailiac, and subscapular muscles. Results Within the OSA group, significant disparities emerged in mean age, waist circumference, waist-to-hip ratio, and diverse fat accumulations encompassing visceral, subcutaneous, trunk, and subcutaneous leg fat. Notably, skin-fold thickness at specific sites - biceps, triceps, subscapula, and suprailiac - demonstrated considerable augmentation relative to the control group. Furthermore, mean values associated with height, weight, BMI, neck circumference, fat percentage, subcutaneous arm fat, entire arm composition, and trunk skeletal muscle either equaled or exceeded those in the control group. However, statistical significance was not attained in these comparisons. Conclusion This investigation underscored a pronounced correlation between numerous endpoints characterizing OSA patients and markers of obesity. Consequently, addressing altered levels of obesity-linked anthropometric variables through pharmacological interventions might hold promise as a pivotal strategy for improving symptoms associated with OSA.
Collapse
Affiliation(s)
- Kuldeep Patial
- Sleep Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, IND
| | - Hara Prasad Mishra
- Clinical Trial, All India Institute of Medical Sciences, New Delhi, Delhi, IND
- Pharmacology and Therapeutics, University College of Medical Sciences, University of Delhi, Delhi, IND
| | - Giridhari Pal
- Pharmacology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, IND
| | - Tarun Kumar Suvvari
- General Medicine, Rangaraya Medical College, Kakinada, IND
- Research, Squad Medicine and Research (SMR), Visakhapatnam, IND
| | - Tamoghna Ghosh
- Medicine, All India Institute of Medical Sciences, New Delhi, Delhi, IND
| | - Smruti Sikta Mishra
- Occupational Therapy, Pandit Deendayal Upadhyaya National Institute for Persons with Physical Disabilities, New Delhi, IND
| | | | - Nidhal A Amanullah
- Psychiatry and Behavioral Sciences, Sree Ramakrishna Mission Hospital, Thiruvananthapuram, IND
| | - Sara A Shukoor
- Psychiatry, Government Medical College, Trivandrum, Trivandrum, IND
| | - Sibin Kamal
- Pain and Palliative Medicine, IQRAA International Hospital & Research Centre, Kandhla, IND
| | | | - Juveriya Israr
- Biosciences and Technology, Shri Ramswaroop Memorial University, Lucknow, IND
| | - Prem S Sharma
- Biostatistics & Medical Informatics, University College of Medical Sciences, Delhi, IND
| | - S N Gaur
- Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, IND
| | | |
Collapse
|
5
|
Kujovic M, Lipka T, Zalman M, Baumann L, Jänner M, Baumann B. Treatment of hypertension and obstructive sleep apnea counteracts cognitive decline in common neurocognitive disorders in diagnosis-related patterns. Sci Rep 2023; 13:7556. [PMID: 37160982 PMCID: PMC10169815 DOI: 10.1038/s41598-023-33701-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 04/18/2023] [Indexed: 05/11/2023] Open
Abstract
The aim of this study was to investigate the effect of arterial hypertension (AH) and of obstructive sleep apnea (OSA) on cognitive course in the neurocognitive disorder (NCD) cohort RIFADE which enrolled patients with NCD due to Alzheimer's disease (AD), vascular NCD (vNCD), and mixed NCD (AD + vNCD = mNCD). Multiple risk factors (RF), including AH and OSA, that contribute to the development of various kinds of dementia have been identified in previous studies. Studies that observed AH lacked investigation of long-term effects and did not isolate it from other RF. Studies involving OSA as a risk factor did not include participants with all stages of NCD. 126 subjects were screened for AH and OSA. Repeated cognitive measurements were performed with the DemTect as primary outcome and the clock drawing test as secondary outcome measure. 90 patients had AH (71.4%) and 40 patients had OSA (31.7%). RF-status had a significant effect on cognitive outcome in models with RF as single factors (AH p = 0.027, OSA p < 0.001), a 2-factor analysis with AH × OSA (AH as main factor p = 0.027) as well as a model including the 3 factors AH × OSA × diagnosis (p = 0.038). Similarly, a 3-factor model was significant for the clock-drawing test, whereas single factor-models remained insignificant. AH and OSA appear to be risk factors in common NCD and cognitive decline can be mitigated by treatment of these RF.
Collapse
Affiliation(s)
- Milenko Kujovic
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.
- Department of Neuropsychiatry, Centre for Neurology and Neuropsychiatry, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.
| | - Tim Lipka
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Mark Zalman
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Leonie Baumann
- Department of Mental Health, University Hospital of Münster, Munster, Germany
| | - Michaela Jänner
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Bruno Baumann
- Department of Mental Health, University Hospital of Münster, Munster, Germany
| |
Collapse
|
6
|
Wang D, Zhou Y, Chen R, Zeng X, Zhang S, Su X, Luo Y, Tang Y, Li S, Zhuang Z, Zhao D, Ren Y, Zhang N. The relationship between obstructive sleep apnea and asthma severity and vice versa: a systematic review and meta-analysis. Eur J Med Res 2023; 28:139. [PMID: 36998095 PMCID: PMC10062016 DOI: 10.1186/s40001-023-01097-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 03/14/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND There is a great association between the prevalence of obstructive sleep apnea (OSA) and asthma. Nonetheless, whether OSA impacts lung function, symptoms, and control in asthma and whether asthma increases the respiratory events in OSA are unknown. This meta-analysis aimed to examine the relationship between obstructive sleep apnea and asthma severity and vice versa. METHODS We carried out a systematic search of PubMed, EMBASE, and Scopus from inception to September 2022. Primary outcomes were lung function, parameters of polysomnography, the risk of OSA in more severe or difficult-to-control asthmatic patients, and the risk of asthma in patients with more severe OSA. Heterogeneity was examined with the Q test and I2 statistics. We also performed subgroup analysis, Meta-regression, and Egger's test for bias analysis. RESULTS 34 studies with 27,912 subjects were totally included. The results showed that the comorbidity of OSA aggravated lung function in asthmatic patients with a consequent decreased forced expiratory volume in one second %predicted (%FEV1) and the effect was particularly evident in children. %FEV1 tended to decrease in adult asthma patients complicated with OSA, but did not reach statistical significance. Interestingly, the risk of asthma seemed to be slightly lower in patients with more severe OSA (OR = 0.87, 95%CI 0.763-0.998). Asthma had no significant effect on polysomnography, but increased daytime sleepiness assessed by the Epworth Sleepiness Scale in OSA patients (WMD = 0.60, 95%CI 0.16-1.04). More severe asthma or difficult-to-control asthma was independently associated with OSA (odds ratio (OR) = 4.36, 95%CI 2.49-7.64). CONCLUSION OSA was associated with more severe or difficult-to-control asthma with decreased %FEV1 in children. The effect of OSA on lung function in adult patients should be further confirmed. Asthma increased daytime sleepiness in OSA patients. More studies are warranted to investigate the effect of asthma on OSA severity and the impact of different OSA severity on the prevalence of asthma. It is strongly recommended that people with moderate-to-severe or difficult-to-control asthma screen for OSA and get the appropriate treatment.
Collapse
Affiliation(s)
- Donghao Wang
- Sleep Medicine Center, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, Guangdong, People's Republic of China
| | - Yanyan Zhou
- Sleep Medicine Center, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, Guangdong, People's Republic of China
| | - Riken Chen
- Sleep Medicine Center, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, Guangdong, People's Republic of China
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang, People's Republic of China
| | - Xiangxia Zeng
- Sleep Medicine Center, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, Guangdong, People's Republic of China
| | - Sun Zhang
- Sleep Medicine Center, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, Guangdong, People's Republic of China
| | - Xiaofen Su
- Sleep Medicine Center, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, Guangdong, People's Republic of China
| | - Yateng Luo
- Sleep Medicine Center, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, Guangdong, People's Republic of China
| | - Yongkang Tang
- Sleep Medicine Center, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, Guangdong, People's Republic of China
| | - Shiwei Li
- Sleep Medicine Center, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, Guangdong, People's Republic of China
| | - Zhiyang Zhuang
- Sleep Medicine Center, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, Guangdong, People's Republic of China
| | - Dongxing Zhao
- Sleep Medicine Center, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, Guangdong, People's Republic of China
| | - Yingying Ren
- Medical Records Management Department, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, Guangdong, People's Republic of China.
| | - Nuofu Zhang
- Sleep Medicine Center, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, Guangdong, People's Republic of China.
| |
Collapse
|
7
|
He Y, Liu W, Lin S, Li Z, Qiu H, Yim SHL, Chuang H, Ho K. Association of traffic air pollution with severity of obstructive sleep apnea in urban areas of Northern Taiwan: A cross-sectional study. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 827:154347. [PMID: 35257757 DOI: 10.1016/j.scitotenv.2022.154347] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/23/2022] [Accepted: 03/02/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Although recent studies have indicated an association between obstructive sleep apnea (OSA) and air pollution, they have reported inconsistent results. Moreover, few studies investigated the effects of short-term air pollution exposure. OBJECTIVE To estimate the health effects of short- and long-term exposure to traffic air pollution on mild OSA in Taipei. METHODS We collected participants' data from Taipei Sleep Center and air pollution data from Taiwan Environmental Protection Administration. A spatiotemporal model was used to estimate the individual exposure level. Generalized linear models were used to assess the percent change of overall apnea-hypopnea index (AHI), AHI in rapid eye movement period (AHI-REM), AHI in non-REM (AHI-NREM), and oxygen desaturation index (ODI) associated with an interquartile (IQR) increase in personal pollution exposure. A generalized logistic model was used to estimate the ORs of different severities of OSA compared with the reference group. RESULTS In the patients with AHI of <15, both short- and long-term exposure to NO2 were significantly associated with AHI and ODI increases: an IQR increase in 2-year mean NO2 increased 7.3% of AHI and 8.4% of ODI; these values were the highest among all exposure windows. The effects of NO2 on AHI increase were stronger in the men and younger patients. Moreover, the association between AHI and NO2 in the patients with AHI of <15 was mediated by the REM stage. NO2 exposure was associated with an increased risk of mild OSA that reached up to 24.8% per IQR increase in NO2 averaged over 2 years. PM2.5 exerted no effects on AHI, but an IQR increase in 1-year and 2-year mean PM2.5 was associated with 6.8% and 8.8% increases in ODI, respectively. CONCLUSIONS Both short- and long-term exposure to traffic air pollution were associated with the risk of mild OSA, which was modified by REM stage.
Collapse
Affiliation(s)
- Yansu He
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Wente Liu
- Research Center of Sleep Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan; Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Shangyang Lin
- Research Center of Sleep Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Zhiyuan Li
- Institute of Environment, Energy and Sustainability, The Chinese University of Hong Kong, Hong Kong, China
| | - Hong Qiu
- Institute of Environment, Energy and Sustainability, The Chinese University of Hong Kong, Hong Kong, China
| | - Steve Hung Lam Yim
- The Asian School of the Environment, Nanyang Technological University, Singapore
| | - Hsiaochi Chuang
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan; Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan; Cell Physiology and Molecular Image Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Kinfai Ho
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; Institute of Environment, Energy and Sustainability, The Chinese University of Hong Kong, Hong Kong, China.
| |
Collapse
|
8
|
Saeed S, Romarheim A, Solheim E, Bjorvatn B, Lehmann S. Cardiovascular remodeling in obstructive sleep apnea: focus on arterial stiffness, left ventricular geometry and atrial fibrillation. Expert Rev Cardiovasc Ther 2022; 20:455-464. [PMID: 35673889 DOI: 10.1080/14779072.2022.2081547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder that is associated with increased risk of cardiovascular disease. The main interest of this clinical review is to discuss the cardiovascular consequences of OSA with a special focus on left ventricular (LV) function and structure, arterial stiffness and atrial fibrillation. AREA COVERED We present an overview of the definition, prevalence, and risk factors of OSA and outline the association between OSA and cardiovascular complications. We then briefly discuss echocardiographic assessment in OSA with focus on the left atrium and LV. Finally, we highlight the importance of adherence to continuous positive airway pressure (CPAP) therapy with regard to reducing the risk of cardiovascular disease. EXPERT COMMENTARY Although OSA has a strong association with cardiovascular complications, it is often underdiagnosed and undertreated. Patients with resistant hypertension and atrial fibrillation with poor therapeutic success after cardioversion or catheter ablation should be more often screened for OSA. Patients with nocturnal adverse cardiovascular events (stroke, arrhythmias, angina, coronary events) should be closely assessed with regard to OSA, and if confirmed, timely treated by lifestyle modification, CPAP, and aggressive antihypertensive treatment. Adherence to CPAP in OSA patients is essential in terms of reducing the risk of cardiovascular events.
Collapse
Affiliation(s)
- Sahrai Saeed
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Andrea Romarheim
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Eivind Solheim
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Bjørn Bjorvatn
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Center for Sleep Medicine, Haukeland University Hospital, Bergen, Norway.,Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
| | - Sverre Lehmann
- Center for Sleep Medicine, Haukeland University Hospital, Bergen, Norway.,Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway.,Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
| |
Collapse
|
9
|
Wang C, Tan J, Miao Y, Zhang Q. Obstructive sleep apnea, prediabetes, and progression of type 2 diabetes: A systematic review and meta-analysis. J Diabetes Investig 2022; 13:1396-1411. [PMID: 35302714 PMCID: PMC9340883 DOI: 10.1111/jdi.13793] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/11/2022] [Accepted: 03/15/2022] [Indexed: 11/28/2022] Open
Abstract
Aims/Introduction Obstructive sleep apnea (OSA) is related to prediabetes and diabetes. Whether patients with OSA have a higher risk of prediabetes/diabetes remains unclear. We aimed to carry out a meta‐analysis of published studies to evaluate the relationships between OSA and prediabetes and diabetes, and the impact of the severity of OSA on diabetes. Materials and Methods The PubMed, EMBASE and Cochrane databases were searched from January 2011 to July 2021. The associations between OSA and impaired fasting glucose, impaired glucose tolerance, impaired glucose regulation and diabetes mellitus were analyzed. We estimated the pooled odds ratios using fixed or random effects models. We included 25 studies comprising a total of 154,948 patients with OSA and risk factors for prediabetes/diabetes (20 and 16, respectively) in the analysis. Results OSA was associated with a higher risk of impaired fasting glucose, impaired glucose tolerance, impaired glucose regulation and diabetes mellitus in the cohort studies and cross‐sectional studies. The pooled odds ratios were 2.34 (95% confidence interval [CI] 1.16–4.72), 1.58 (95% CI 1.15–2.15), 1.65 (95% CI 1.12–2.42), 2.15 (95% CI 1.68–2.75) and 3.62 (95% CI 2.75–4.75), respectively. Subgroup analyses were based on the proportions of men and women. The results showed that OSA was a risk factor, and there was no significant difference between the two groups. The risk of diabetes increased with the severity of OSA. Conclusions The risk of developing prediabetes and diabetes was higher in patients with OSA.
Collapse
Affiliation(s)
- Cong Wang
- Department of Geriatrics, Tianjin Medical University General Hospital, Tianjin Geriatrics Institute, Tianjin, China
| | - Jin Tan
- Department of Geriatrics, Tianjin Medical University General Hospital, Tianjin Geriatrics Institute, Tianjin, China
| | | | - Qiang Zhang
- Department of Geriatrics, Tianjin Medical University General Hospital, Tianjin Geriatrics Institute, Tianjin, China
| |
Collapse
|
10
|
Saeed S, Romarheim A, Mancia G, Saxvig IW, Gulati S, Lehmann S, Bjorvatn B. Characteristics of hypertension and arterial stiffness in obstructive sleep apnea: A Scandinavian experience from a prospective study of 6408 normotensive and hypertensive patients. J Clin Hypertens (Greenwich) 2022; 24:385-394. [PMID: 35156757 PMCID: PMC8989758 DOI: 10.1111/jch.14425] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/21/2021] [Accepted: 12/06/2021] [Indexed: 11/29/2022]
Abstract
The impact of obstructive sleep apnea (OSA) on arterial stiffness is less studied. We aimed to investigate the prevalence and covariates of increased pulse pressure (PP), a surrogate marker of arterial stiffness, in the entire study population as well as in separate analyses in normotensive and hypertensive patients. Further, we also explored the impact of smoking on brachial BP in hypertensive patients. Between 2012 and 2019, a total of 6408 participants with suspected OSA underwent a standard out-of-center respiratory polygraphy. OSA was defined by an apnea-hypopnea index (AHI) ≥15/h regardless of symptoms. PP ≥60 mmHg was used as a surrogate marker of increased arterial stiffness. Mean age was 49.3±13.7 years, 69.4% were male, and 34.5% had OSA. The prevalence of hypertension was 70.8% in OSA and 46.7% in No-OSA (AHI < 15/h) controls (P < .0001). Hypertension was controlled (clinic BP < 140/90 mmHg) in 45.5% and uncontrolled in 54.5% (P < .001). Mean PP was 50±12 mmHg in smokers and 52±12 mmHg in non-smokers (P = .001). Increased PP was found in 24.2% of the entire study population and was higher in patients with OSA compared to No-OSA group (27.5% vs 22.4%, P < .0001). In an unadjusted logistic regression model, OSA was associated with a 1.3-fold higher risk of having increased PP (95% CI 1.16-1.48, P < .001). In a multivariable-adjusted model, higher age, male sex, and history of hypertension, but not OSA (OR 0.89; 95% CI 0.77-1.02, P = .104) were associated with increased PP. In this large study of nearly 6500 participants who were referred with suspected OSA, one-third were diagnosed with OSA and a quarter had increased arterial stiffness by elevated brachial PP. Hypertension but not OSA per se was associated with increased arterial stiffness. Hypertension was highly prevalent and poorly controlled.
Collapse
Affiliation(s)
- Sahrai Saeed
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Andrea Romarheim
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Giuseppe Mancia
- Milano and Policlinico di Monza, University of Milano-Bicocca, Monza, Italy
| | - Ingvild West Saxvig
- Center for Sleep Medicine, Haukeland University Hospital, Bergen, Norway.,Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
| | - Shashi Gulati
- Department of Otolaryngology/Head & Neck Surgery, Haukeland University Hospital, Bergen, Norway
| | - Sverre Lehmann
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Bjørn Bjorvatn
- Center for Sleep Medicine, Haukeland University Hospital, Bergen, Norway.,Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| |
Collapse
|
11
|
Voulgaris A, Archontogeorgis K, Pataka A, Flaris AN, Ntolios P, Bonsignore MR, Schiza S, Steiropoulos P. Burden of Comorbidities in Patients with OSAS and COPD-OSAS Overlap Syndrome. Medicina (B Aires) 2021; 57:medicina57111201. [PMID: 34833419 PMCID: PMC8623094 DOI: 10.3390/medicina57111201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/23/2021] [Accepted: 11/01/2021] [Indexed: 01/10/2023] Open
Abstract
Background and Objectives: Obstructive sleep apnea syndrome (OSAS) and chronic obstructive pulmonary disease (COPD) are usually associated with multi-morbidity. The aim of this study was to retrospectively investigate the prevalence of comorbidities in a cohort of patients with OSAS and COPD-OSAS overlap syndrome (OS) patients and to explore differences between these two groups. Materials and Methods: Included were consecutive OS patients and OSAS patients who had been referred to our sleep laboratory, and were matched in terms of sex, age, BMI, and smoking history. Presence of comorbidities was recorded based on their medical history and after clinical and laboratory examination. Results: The two groups, OS patients (n = 163, AHI > 5/h and FEV1/FVC < 0.7) and OSAS patients (n = 163, AHI > 5/h, and FEV1/FVC > 0.7), did not differ in terms of apnea hypopnea index (p = 0.346), and oxygen desaturation index (p = 0.668). Compared to OSAS patients, OS patients had lower average SpO2 (p = 0.008) and higher sleep time with oxygen saturation <90% (p = 0.002) during sleep, and lower PaO2 (p < 0.001) and higher PaCO2 (p = 0.04) in wakefulness. Arterial hypertension was the most prevalent comorbidity for both OS and OSAS, followed by dyslipidemia, cardiovascular disease (CVD) and diabetes. OS was characterized by a higher prevalence of total comorbidities (median (IQR):2 (1–3) vs. 2 (1–2), p = 0.033), which was due to the higher prevalence of CVD (p = 0.016) than OSAS. No differences were observed in other comorbidities. Conclusions: In OS patients, nocturnal hypoxia and impaired gas exchange in wakefulness are more overt, while a higher burden of CVD is observed among them in comparison to sex-, age- and BMI-matched OSAS patients.
Collapse
Affiliation(s)
- Athanasios Voulgaris
- MSc Program in Sleep Medicine, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (K.A.); (P.S.)
- Department of Pneumonology, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece;
- Correspondence: ; Tel.: +30-2551030377; Fax: +30-2551352096
| | - Kostas Archontogeorgis
- MSc Program in Sleep Medicine, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (K.A.); (P.S.)
- Department of Pneumonology, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece;
| | - Athanasia Pataka
- Respiratory Failure Unit, George Papanikolaou General Hospital, Aristotle University, 57010 Thessaloniki, Greece;
| | - Alexandros N. Flaris
- Department of Surgery, Tulane University, School of Medicine, New Orleans, LA 70112, USA;
| | - Paschalis Ntolios
- Department of Pneumonology, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece;
| | - Maria R. Bonsignore
- Institute of Biomedicine and Molecular Immunology, National Research Council (CNR), 90146 Palermo, Italy;
- Biomedical Department of Internal and Specialistic Medicine (DIBIMIS), University of Palermo, 90133 Palermo, Italy
| | - Sophia Schiza
- Sleep Disorders Unit, Department of Respiratory Medicine, Medical School, University of Crete, 71500 Heraklion, Greece;
| | - Paschalis Steiropoulos
- MSc Program in Sleep Medicine, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (K.A.); (P.S.)
- Department of Pneumonology, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece;
| |
Collapse
|
12
|
Lurie A, Roche N. Obstructive Sleep Apnea in Patients with Chronic Obstructive Pulmonary Disease: Facts and Perspectives. COPD 2021; 18:700-712. [PMID: 34595967 DOI: 10.1080/15412555.2021.1950663] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The co-occurrence of obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD) in the same patient, named the overlap syndrome (OS), was first described in 1985. Although the American Thoracic Society underlined the limited knowledge of OS, stated research priorities for this condition, and recommended a "screening" strategy to identify OSA in COPD patients with chronic stable hypercapnia, research studies on OS remain scarce. This review aims to summarize the current knowledge and perspectives related to OSA in COPD patients. OS prevalence is 1.0-3.6% in the general population, 3-66% in COPD patients, and 7-55% in OSA patients. OS patients may have worse sleep quality than those with OSA or COPD alone. Scoring hypopneas may be difficult in COPD patients; desaturation episodes may have origins in these patients, namely upper airway obstruction, hypoventilation during paradoxical sleep, ventilation/perfusion mismatches, and obesity. The apnea-hypopnea index is similar in OSA and OS patients. Desaturations may be greater and more prolonged in OS patients than in patients with COPD or OSA alone. Low body mass index, hyperinflation, and less collapsible airways reduce the risk of OSA in COPD patients. OSA is a risk factor for pulmonary hypertension in COPD patients. Whether OS increases mortality and morbidity risks compared to COPD or OSA alone remains to be confirmed. No guidelines currently recommend specific approaches to the treatment of OSA in patients with COPD.
Collapse
Affiliation(s)
- Alain Lurie
- Clinique Ambroise Paré, Laboratoire du sommeil, Neuilly-sur-Seine, France.,Hôpital Cochin (AP-HP Centre), Pneumologie, Paris, France
| | - Nicolas Roche
- Hôpital Cochin (AP-HP Centre), Pneumologie, Université de Paris (Descartes), UMR 1016, Institut Cochin, Paris, France
| |
Collapse
|
13
|
Association of sleep apnea with outcomes in peripheral artery disease: Insights from the PORTRAIT study. PLoS One 2021; 16:e0256933. [PMID: 34506511 PMCID: PMC8432750 DOI: 10.1371/journal.pone.0256933] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 08/18/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Sleep apnea is a predictor of adverse cardiovascular outcome in many cardiovascular diseases but whether it is associated with worse health status outcomes or mortality in peripheral artery disease (PAD) is unknown. METHODS PORTRAIT is an international (US, Netherlands, Australia) prospective PAD registry that consecutively enrolled patients who presented with new-onset or recent exacerbations of PAD symptoms to any of 16 vascular specialty clinics. Health status was assessed upon presentation and at 12 months with the disease-specific Peripheral Artery Questionnaire (PAQ). Higher PAQ scores indicate better health status. A sequentially-adjusted hierarchical linear regression model examined the association between sleep apnea and 1-year PAQ symptoms, quality of life, and summary scores. Five-year survival curves by comorbid sleep apnea status for US patients were compared using the log-rank test. RESULTS The mean age of the 1204 PORTRAIT participants was 67.6 ± 9.4 years with 37.5% women and 8.3% (n = 100) having sleep apnea. Patients with sleep apnea were more likely to be from the US, more sedentary, and to have diabetes, obesity, coronary disease, more depressive symptoms and a history of prior peripheral interventions. Paradoxically, they also had higher ankle-brachial indices, but lower PAQ Summary scores at presentation and 12 months (41.2 ± 22.0 vs. 49. 9± 21.6 and 58.6 ± 27.9 vs. 71.3 ± 24.9, respectively, p = <0.05). The association between sleep apnea and 1-year health status persisted after multivariable adjustment, but there were no differences in all-cause mortality over 5 years (28.0% vs. 23.4%, p = 0.76). CONCLUSION In patients presenting with PAD, comorbid sleep apnea is independently associated with worse health status over time. Future studies should test whether better treatment of sleep apnea can improve the health status of patients with PAD. CLINICAL TRIAL REGISTRATION NCT01419080.
Collapse
|
14
|
Cetin-Atalay R, Meliton AY, Wu D, Woods PS, Sun KA, Peng YJ, Nanduri J, Su X, Fang Y, Hamanaka RB, Prabhakar N, Mutlu GM. Intermittent Hypoxia-Induced Activation of Endothelial Cells Is Mediated via Sympathetic Activation-Dependent Catecholamine Release. Front Physiol 2021; 12:701995. [PMID: 34322038 PMCID: PMC8311436 DOI: 10.3389/fphys.2021.701995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 06/22/2021] [Indexed: 02/03/2023] Open
Abstract
Obstructive sleep apnea (OSA) is a common breathing disorder affecting a significant percentage of the adult population. OSA is an independent risk factor for cardiovascular disease (CVD); however, the underlying mechanisms are not completely understood. Since the severity of hypoxia correlates with some of the cardiovascular effects, intermittent hypoxia (IH) is thought to be one of the mechanisms by which OSA may cause CVD. Here, we investigated the effect of IH on endothelial cell (EC) activation, characterized by the expression of inflammatory genes, that is known to play an important role in the pathogenesis of CVD. Exposure of C57BL/6 mice to IH led to aortic EC activation, while in vitro exposure of ECs to IH failed to do so, suggesting that IH does not induce EC activation directly, but indirectly. One of the consequences of IH is activation of the sympathetic nervous system and catecholamine release. We found that exposure of mice to IH caused elevation of circulating levels of catecholamines. Inhibition of the IH-induced increase in catecholamines by pharmacologic inhibition or by adrenalectomy or carotid body ablation prevented the IH-induced EC activation in mice. Supporting a key role for catecholamines, epinephrine alone was sufficient to cause EC activation in vivo and in vitro. Together, these results suggested that IH does not directly induce EC activation, but does so indirectly via release of catecholamines. These results suggest that targeting IH-induced sympathetic nerve activity and catecholamine release may be a potential therapeutic target to attenuate the CV effects of OSA.
Collapse
Affiliation(s)
- Rengul Cetin-Atalay
- Department of Medicine, University of Chicago, Chicago, IL, United States.,Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, IL, United States
| | - Angelo Y Meliton
- Department of Medicine, University of Chicago, Chicago, IL, United States.,Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, IL, United States
| | - David Wu
- Department of Medicine, University of Chicago, Chicago, IL, United States.,Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, IL, United States
| | - Parker S Woods
- Department of Medicine, University of Chicago, Chicago, IL, United States.,Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, IL, United States
| | - Kaitlyn A Sun
- Department of Medicine, University of Chicago, Chicago, IL, United States.,Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, IL, United States
| | - Ying-Jie Peng
- Department of Medicine, University of Chicago, Chicago, IL, United States.,Section of Emergency Medicine, University of Chicago, Chicago, IL, United States.,Institute for Integrative Physiology, University of Chicago, Chicago, IL, United States
| | - Jayasri Nanduri
- Department of Medicine, University of Chicago, Chicago, IL, United States.,Section of Emergency Medicine, University of Chicago, Chicago, IL, United States.,Institute for Integrative Physiology, University of Chicago, Chicago, IL, United States
| | - Xiaoyu Su
- Department of Medicine, University of Chicago, Chicago, IL, United States.,Section of Emergency Medicine, University of Chicago, Chicago, IL, United States.,Institute for Integrative Physiology, University of Chicago, Chicago, IL, United States
| | - Yun Fang
- Department of Medicine, University of Chicago, Chicago, IL, United States.,Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, IL, United States.,Institute for Integrative Physiology, University of Chicago, Chicago, IL, United States
| | - Robert B Hamanaka
- Department of Medicine, University of Chicago, Chicago, IL, United States.,Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, IL, United States.,Institute for Integrative Physiology, University of Chicago, Chicago, IL, United States
| | - Nanduri Prabhakar
- Department of Medicine, University of Chicago, Chicago, IL, United States.,Section of Emergency Medicine, University of Chicago, Chicago, IL, United States.,Institute for Integrative Physiology, University of Chicago, Chicago, IL, United States
| | - Gökhan M Mutlu
- Department of Medicine, University of Chicago, Chicago, IL, United States.,Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, IL, United States.,Institute for Integrative Physiology, University of Chicago, Chicago, IL, United States
| |
Collapse
|
15
|
Kravitz MB, Yakubova E, Yu N, Park SY. Severity of Sleep Apnea and COVID-19 Illness. OTO Open 2021; 5:2473974X211016283. [PMID: 34036239 PMCID: PMC8132102 DOI: 10.1177/2473974x211016283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 04/11/2021] [Indexed: 12/19/2022] Open
Abstract
Objective To characterize the relationship between severity of sleep apnea and coronavirus disease 2019 (COVID-19) hospitalization and severe illness. Study Design Retrospective cohort study. Setting Montefiore Health System in the Bronx, New York. Methods The data set consisted of adult patients with an active diagnosis of obstructive sleep apnea in the past 2 years and a positive severe acute respiratory syndrome coronavirus 2 quantitative polymerase chain reaction test at our institution between March 16, 2020, and May 26, 2020. Sleep apnea severity and continuous positive airway pressure compliance data were abstracted from the electronic medical record. The International Classification of Diseases, 10th Revision was used to classify comorbidities. Results A total of 461 patients with sleep apnea tested positive for COVID-19, of whom 149 were excluded for missing data in the electronic medical record. Patients with moderate and severe sleep apnea had higher rates of COVID-19 hospitalization compared to those with mild sleep apnea (P = .003). This association was reduced when accounting for confounders, most notably the Charlson Comorbidity Index, a measure of comorbid illness burden. Moderate and severe sleep apnea were associated with increased Charlson Comorbidity Indices, compared to mild sleep apnea (P = .01). Sleep apnea severity was not associated with a composite outcome of mechanical ventilation, intensive care unit admission, and death. Conclusion Sleep apnea severity was associated with the Charlson Comorbidity Index and may be a risk factor for COVID-19 hospitalization. We found no evidence that sleep apnea severity among hospitalized patients was associated with a composite outcome of mechanical ventilation, intensive care unit admission, and death.
Collapse
Affiliation(s)
| | | | - Nick Yu
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Steven Y Park
- Albert Einstein College of Medicine, Bronx, New York, USA.,Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, Bronx, New York, USA
| |
Collapse
|
16
|
Paul M. The Impact of Obstructive Sleep Apnea on the Sleep of Critically Ill Patients. Crit Care Nurs Clin North Am 2021; 33:173-192. [PMID: 34023084 DOI: 10.1016/j.cnc.2021.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Obstructive sleep apnea is becoming increasingly prevalent in society and thus critical care practitioners need to be prepared to care for these patients in the intensive care unit. Preparation begins with equipping the critical care nurse with the knowledge necessary to provide interventions which can enhance patient outcomes and mitigate complications.
Collapse
Affiliation(s)
- Michaelynn Paul
- Walla Walla University, School of Nursing, 10345 Southeast Market Street, Portland, OR 97216, USA.
| |
Collapse
|
17
|
Baran R, Grimm D, Infanger M, Wehland M. The Effect of Continuous Positive Airway Pressure Therapy on Obstructive Sleep Apnea-Related Hypertension. Int J Mol Sci 2021; 22:ijms22052300. [PMID: 33669062 PMCID: PMC7956605 DOI: 10.3390/ijms22052300] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 02/18/2021] [Accepted: 02/21/2021] [Indexed: 01/02/2023] Open
Abstract
Obstructive sleep apnea (OSA) is a common disease, with approximately 3-7% of men and 2-5% of women worldwide suffering from symptomatic OSA. If OSA is left untreated, hypoxia, microarousals and increased chemoreceptor stimulation can lead to complications like hypertension (HT). Continuous positive airway pressure (CPAP) is the most common treatment for OSA, and it works by generating airway patency, which will counteract the apnea or hypopnea. More than one billion people in the world suffer from HT, and the usual treatment is pharmacological with antihypertensive medication (AHM). The focus of this review will be to investigate whether the CPAP therapy for OSA affects HT.
Collapse
Affiliation(s)
- Ronni Baran
- Department of Biomedicine, Aarhus University, 8000 Aarhus, Denmark;
| | - Daniela Grimm
- Department of Biomedicine, Aarhus University, 8000 Aarhus, Denmark;
- Department for Microgravity Research and Translational Regenerative Medicine, Otto-von-Guericke University, D-39106 Magdeburg, Germany;
- Correspondence: (D.G.); (M.W.)
| | - Manfred Infanger
- Department for Microgravity Research and Translational Regenerative Medicine, Otto-von-Guericke University, D-39106 Magdeburg, Germany;
| | - Markus Wehland
- Department for Microgravity Research and Translational Regenerative Medicine, Otto-von-Guericke University, D-39106 Magdeburg, Germany;
- Correspondence: (D.G.); (M.W.)
| |
Collapse
|
18
|
Tan SN, Abdullah B. Phenotypes of Obstructive Sleep Apnea and Direct Targeted Therapy: A Literature Review. CURRENT RESPIRATORY MEDICINE REVIEWS 2021. [DOI: 10.2174/1573398x16999201016095352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Obstructive sleep apnea (OSA) is a heterogenous chronic disorder causing hypoxemia,
excessive daytime sleepiness, non-refreshing sleep, nocturia, morning headache, irritability, and
memory loss. Cardiovascular disease, cognitive impairment, metabolic disorders, and depression
are its long-term consequences. The difficulty in treating patients is due to poor compliance, failure
to obtain the desired outcome, and complication arising from the multimodality treatment. Direct
targeted therapy may overcome these issues. Identification of its phenotypes improves understanding
of the disease mechanism, the risk for adverse effects, and predicting response to targeted therapy.
Phenotyping of OSA allows treating patients according to their inherent disease and not based
on a “one size fits all” method, which may not be applicable for all patients. This approach may improve
patients’ compliance with treatment, minimize the associated morbidities, and consequently
improve their quality of life.
Collapse
Affiliation(s)
- Shi Nee Tan
- Department of Otorhinolaryngology Head & Neck Surgery, Hospital Tawau, Sabah, Malaysia
| | - Baharudin Abdullah
- Department of Otorhinolaryngology-Head & Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia
| |
Collapse
|
19
|
Gharib A, Loza S. Factors affecting the severity of the apnea hypoapnea index: a retrospective study on 838 Egyptian patients diagnosed with obstructive sleep apnea. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2020. [DOI: 10.1186/s43168-020-00034-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Obstructive sleep apnea (OSA) is a common condition in the general population that is highly correlated to obesity, and it is associated with major cardiovascular morbidity and mortality. In Egypt, obesity rates are known to be high; however, OSA remains largely under-diagnosed, and data on its current magnitude is very scarce. Thus, the aims of the study were to identify the percentage of OSA in a large sample of patients referred for polysomnography and to determine the effect of different demographic data on the severity of the disease.
Results
This retrospective study included 1012 patients. Medical data were reviewed by sleep specialists. The correlation between age, body mass index (BMI), and neck circumference (NC) with apnea hypoapnea index (AHI) was explored. Also, gender differences were analyzed. A total of 838 patients (81% males, 19% females) were diagnosed with OSA. Patients with mild, moderate, and severe OSA were 204 (24%), 146 (17%), and 488 (58%), respectively. Females were older than males (58.87 ± 10.25 versus 54.39 ± 22.96, p = 0.001) and BMI was not significantly different between both sexes (34.18 ± 13.53 versus 36.73 ± 23.25, p = 0.07), but NC was higher in men (43.56 ± 5.3 versus 39.34 ± 4.41, p = 0.001). AHI was significantly increased in men compared to women (47.97 ± 31.22 versus 37.95 ± 31.72, p = 0.001) and severe OSA was commonly diagnosed in men than women (p = 0.001). A positive significant correlation was found between BMI, NC with AHI, arousal index, average SpO2, and desaturation index.
Conclusion
OSA is highly prevalent among our patients. Additionally, BMI and NC independently affected the severity of their disease.
Collapse
|
20
|
Aro M, Saaresranta T, Vahlberg T, Anttalainen U. Medication of comorbidities in females with sleep-disordered breathing during long-term CPAP therapy. Respir Med 2020; 169:106014. [PMID: 32442111 DOI: 10.1016/j.rmed.2020.106014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/07/2020] [Accepted: 05/08/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Treating sleep disordered breathing (SDB) with nasal continuous positive airway pressure (CPAP) may reduce mortality, but the studies on the effect on medication use are few. Women tend to have more mild sleep apnoea and partial airway obstruction and are therefore expected to have less co-morbidity. The purpose of this study was to evaluate the effect of CPAP therapy on medication use in women as overall medication, and in different subcategories of diseases, and to evaluate the impact of nocturnal airway obstruction type as partial or complete. METHODS From the database of the Department of Pulmonary Diseases in Turku University Hospital from 1994 to 1998, 601 consecutive females with SDB were enrolled, and the type of SDB was evaluated. All were offered CPAP therapy. The medication use measured as defined daily doses (DDD) in overall medication and in nine subcategories were collected three years before and three years after CPAP initiation. RESULTS In final analyses, 182 women were included. In CPAP users (n = 66), comorbidities were more frequent and DDDs higher overall, in asthma, in chronic obstructive pulmonary disease, and in severe mental disorders, both before and after CPAP initiation. The medication use was similar regardless of the type of SDB. The change in medication use was similar as in controls. CONCLUSIONS CPAP therapy did not decrease medication use in three-year follow-up. However, possibly continuous rise in medication use was prevented, as the change in medication use was similar in controls. Complete and partial obstruction had similar effects.
Collapse
Affiliation(s)
- Miia Aro
- Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, PO Box 52, FIN-20520, Turku, Finland; Department of Pulmonary Diseases and Clinical Allergology, University of Turku, PO Box 52, FIN-20520, Turku, Finland; Sleep Research Centre, Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Lemminkäisenkatu 3b, 20520, TURKU, Finland.
| | - Tarja Saaresranta
- Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, PO Box 52, FIN-20520, Turku, Finland; Department of Pulmonary Diseases and Clinical Allergology, University of Turku, PO Box 52, FIN-20520, Turku, Finland; Sleep Research Centre, Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Lemminkäisenkatu 3b, 20520, TURKU, Finland.
| | - Tero Vahlberg
- Department of Clinical Medicine, Biostatistics, University of Turku, Biostatistiikka, 20014, Turun Yliopisto, Turku, Finland.
| | - Ulla Anttalainen
- Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, PO Box 52, FIN-20520, Turku, Finland; Department of Pulmonary Diseases and Clinical Allergology, University of Turku, PO Box 52, FIN-20520, Turku, Finland; Sleep Research Centre, Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Lemminkäisenkatu 3b, 20520, TURKU, Finland.
| |
Collapse
|
21
|
Homaie Rad E, Khodadady-Hasankiadeh N, Kouchakinejad-Eramsadati L, Javadi F, Haghdoost Z, Hosseinpour M, Tavakoli M, Davoudi-Kiakalayeh A, Mohtasham-Amiri Z, Yousefzadeh-Chabok S. The relationship between weight indices and injuries and mortalities caused by the motor vehicle accidents: a systematic review and meta-analysis. J Inj Violence Res 2019; 12:85-101. [PMID: 31863576 PMCID: PMC7001613 DOI: 10.5249/jivr.v12i1.1198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 12/04/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The relationship between weight indices and injuries and mortality in motor vehicle accidents is unknown. Systematic review studies addressing the collection and analysis of the relationship in investigations are very limited. The purpose of this systematic review is to determine the relationship between BMI, obesity and overweight with mortality and injuries and their severity and vulnerable organs after the motor vehicle accident. METHODS The databases (MEDLINE/PUBMED, EMBASE, Web of Science, etc) were searched for relevant abstracts using certain keywords. Of all the articles, similar ones were removed considering different filters. The collected data were entered into the STATA SE v 13.1. The heterogeneity of the data was analyzed using i2 statistics. In addition, the estimates of the study were done based on the age group (children and adults) and the impact of obesity on different regions of the body. RESULTS A direct relationship was observed between the overall BMI and the degrees of injuries (CI=0.503-1.139), and mortality due to motor vehicle accident (CI=1.267-1.471). A positive relationship was found between obesity and AIS+2 (CI=0.653-1.426), and AIS+3 (CI=1.184-1.741), and ISS (CI=1.086-1.589). Also, a negative relationship between overweight and injuries rates, and a direct relationship between overweight and mortality (CI=0.979-1.167), and injuries with index of AIS+2 (CI=1.178-0.768) and AIS+3 (CI=0.48-2.186) were found. CONCLUSIONS The prediction of injury, mortality and severity of injuries in the motor vehicle accident by the variable of obesity and overweight determines the need to design prevention programs for this vulnerable group at all levels.
Collapse
|
22
|
Bonsignore MR, Baiamonte P, Mazzuca E, Castrogiovanni A, Marrone O. Obstructive sleep apnea and comorbidities: a dangerous liaison. Multidiscip Respir Med 2019; 14:8. [PMID: 30809382 PMCID: PMC6374907 DOI: 10.1186/s40248-019-0172-9] [Citation(s) in RCA: 118] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 01/20/2019] [Indexed: 12/16/2022] Open
Abstract
Obstructive sleep apnea (OSA) is a highly prevalent disease, and is traditionally associated with increased cardiovascular risk. The role of comorbidities in OSA patients has emerged recently, and new conditions significantly associated with OSA are increasingly reported. A high comorbidity burden worsens prognosis, but some data suggest that CPAP might be protective especially in patients with comorbidities. Aim of this narrative review is to provide an update on recent studies, with special attention to cardiovascular and cerebrovascular comorbidities, the metabolic syndrome and type 2 diabetes, asthma, COPD and cancer. Better phenotypic characterization of OSA patients, including comorbidities, will help to provide better individualized care. The unsatisfactory adherence to CPAP in patients without daytime sleepiness should prompt clinicians to examine the overall risk profile of each patient in order to identify subjects at high risk for worse prognosis and provide the optimal treatment not only for OSA, but also for comorbidities.
Collapse
Affiliation(s)
- Maria R. Bonsignore
- Division of Respiratory Medicine, Biomedical Department of Internal Medicine and Medical Specialties (Di.Bi.M.I.S), University Hospital Paolo Giaccone, University of Palermo, Piazza delle Cliniche, 2, 90100 Palermo, Italy
- National Research Council (CNR), Institute of Biomedicine and Molecular Immunology (IBIM), Palermo, Italy
| | - Pierpaolo Baiamonte
- Division of Respiratory Medicine, Biomedical Department of Internal Medicine and Medical Specialties (Di.Bi.M.I.S), University Hospital Paolo Giaccone, University of Palermo, Piazza delle Cliniche, 2, 90100 Palermo, Italy
| | - Emilia Mazzuca
- Division of Respiratory Medicine, Biomedical Department of Internal Medicine and Medical Specialties (Di.Bi.M.I.S), University Hospital Paolo Giaccone, University of Palermo, Piazza delle Cliniche, 2, 90100 Palermo, Italy
| | - Alessandra Castrogiovanni
- Clinic for Pneumology und Allergology, Center of Sleep Medicine and Respiratory Care, Bethanien Hospital, Solingen, Germany
| | - Oreste Marrone
- National Research Council (CNR), Institute of Biomedicine and Molecular Immunology (IBIM), Palermo, Italy
| |
Collapse
|
23
|
Pichler L, Weinstein SM, Cozowicz C, Poeran J, Liu J, Poultsides LA, Saleh JN, Memtsoudis SG. Perioperative impact of sleep apnea in a high-volume specialty practice with a strong focus on regional anesthesia: a database analysis. Reg Anesth Pain Med 2019; 44:303-308. [DOI: 10.1136/rapm-2018-000038] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 08/04/2018] [Indexed: 01/13/2023]
Abstract
Background and objectivesObstructive sleep apnea (OSA) is a risk factor for adverse postoperative outcome and perioperative professional societies recommend the use of regional anesthesia to minimize perioperative detriment. We studied the impact of OSA on postoperative complications in a high-volume orthopedic surgery practice, with a strong focus on regional anesthesia.MethodsAfter Institutional Review Board approval, 41 766 cases of primary total hip and knee arthroplasties (THAs/TKAs) from 2005 to 2014 were extracted from institutional data of the Hospital for Special Surgery (approximately 5000 THAs and 5000 TKAs annually, of which around 90% under neuraxial anesthesia).The main effect was OSA (identified by the International Classification of Diseases, ninth revision codes); outcomes of interest were cardiac, pulmonary, gastrointestinal, renal/genitourinary, thromboembolic complications, delirium, and prolonged length of stay (LOS). Multivariable logistic regression models provided ORs, corresponding 95% CIs, and p values.ResultsOverall, OSA was seen in 6.3% (n=1332) of patients with THA and 9.1% (n=1896) of patients with TKA. After adjustment for relevant covariates, OSA was significantly associated with 87% (OR 1.87, 95% CI 1.51 to 2.30), 52% (OR 1.52, 95% CI 1.13 to 2.04), and 44% (OR 1.44,95% CI 1.31 to 1.57) increased odds for pulmonary gastrointestinal complications, and prolonged LOS, respectively. The odds for other outcomes remained unaltered by OSA diagnosis.ConclusionWe showed that, even in a setting with almost universal regional anesthesia use, OSA was associated with increased odds for prolonged LOS, and pulmonary and gastrointestinal complications. This puts forward the question of how effective regional anesthesia is in mitigating postoperative complications in patients with OSA.
Collapse
|
24
|
Tiotiu A, Plavec D, Novakova S, Mihaicuta S, Novakova P, Labor M, Bikov A. Current opinions for the management of asthma associated with ear, nose and throat comorbidities. Eur Respir Rev 2018; 27:27/150/180056. [PMID: 30463872 DOI: 10.1183/16000617.0056-2018] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 10/03/2018] [Indexed: 11/05/2022] Open
Abstract
Ear, nose and throat (ENT) comorbidities are common in patients with asthma and are frequently associated with poorer asthma outcomes. All these comorbidities are "treatable traits" in asthma. Identification and management of these disorders may spare medication usage and contribute to improved asthma control and quality of life, and a decrease in exacerbation rates.This review summarises recent data about the prevalence, clinical impact and treatment effects of ENT comorbidities in asthma including allergic rhinitis, chronic rhinosinusitis with and without nasal polyposis, aspirin-exacerbated respiratory disease, obstructive sleep apnoea and vocal cord dysfunction.Many of these comorbidities are possible to be managed by the pulmonologist, but the collaboration with the ENT specialist is essential for patients with chronic rhinosinusitis or vocal cord dysfunction. Further rigorous research is needed to study the efficacy of comorbidity treatment to improve asthma outcomes, in particular with the development of biotherapies in severe asthma that can also be beneficial in some ENT diseases.
Collapse
Affiliation(s)
- Angelica Tiotiu
- Pulmonology Dept, University Hospital, Nancy, France .,EA 3450 DevAH, Development, Adaptation, Cardio-Respiratory Regulations and Motor Control, University of Lorraine, Nancy, France
| | | | - Silviya Novakova
- Allergy Unit, University Hospital "St. George", Plovdiv, Bulgaria
| | | | - Plamena Novakova
- Dept of Allergology and Asthma, Aleksandrovska Hospital, Sofia, Bulgaria
| | - Marina Labor
- Pulmonology Dept, University Hospital Centre Osijek, Osijek, Croatia
| | - Andras Bikov
- NIHR Clinical Research Facility, Manchester University NHS Foundation Trust, Manchester, UK
| |
Collapse
|
25
|
Bonsignore MR, Pepin JL, Anttalainen U, Schiza SE, Basoglu OK, Pataka A, Steiropoulos P, Dogas Z, Grote L, Hedner J, McNicholas WT, Marrone O. Clinical presentation of patients with suspected obstructive sleep apnea and self-reported physician-diagnosed asthma in the ESADA cohort. J Sleep Res 2018; 27:e12729. [PMID: 29998568 DOI: 10.1111/jsr.12729] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 05/19/2018] [Accepted: 06/07/2018] [Indexed: 12/31/2022]
Abstract
Obstructive sleep apnea (OSA) and asthma are often associated and several studies suggest a bidirectional relationship between asthma and OSA. This study analyzed the characteristics of patients with suspected OSA from the European Sleep Apnea Database according to presence/absence of physician-diagnosed asthma. Cross-sectional data in 16,236 patients (29.1% female) referred for suspected OSA were analyzed according to occurrence of physician-diagnosed asthma for anthropometrics, OSA severity and sleepiness. Sleep structure was assessed in patients studied by polysomnography (i.e. 48% of the sample). The prevalence of physician-diagnosed asthma in the entire cohort was 4.8% (7.9% in women, 3.7% in men, p < 0.0001), and decreased from subjects without OSA to patients with mild-moderate and severe OSA (p = 0.02). Obesity was highly prevalent in asthmatic women, whereas BMI distribution was similar in men with and without physician-diagnosed asthma. Distribution of OSA severity was similar in patients with and without physician-diagnosed asthma, and unaffected by treatment for asthma or gastroesophageal reflux. Asthma was associated with poor sleep quality and sleepiness. Physician-diagnosed asthma was less common in a sleep clinic population than expected from the results of studies in the general population. Obesity appears as the major factor raising suspicion of OSA in asthmatic women, whereas complaints of poor sleep quality were the likely reason for referral in asthmatic men.
Collapse
Affiliation(s)
- Maria R Bonsignore
- Biomedical Department of Internal and Specialistic Medicine (DIBIMIS), University of Palermo, Palermo, Italy.,CNR Institute of Biomedicine and Molecular Immunology, Palermo, Italy
| | - Jean-Louis Pepin
- Université Grenoble Alpes, INSERM U1042, CHU de Grenoble, Grenoble, France
| | - Ulla Anttalainen
- Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, Turku, Finland.,Department of Physiology, Sleep Research Centre, University of Turku, Turku, Finland
| | - Sophia E Schiza
- Sleep Disorders Unit, Department of Respiratory Medicine, Medical School, University of Crete, Heraklion, Greece
| | - Ozen K Basoglu
- Department of Chest Diseases, Ege University Faculty of Medicine, Izmir, Turkey
| | - Athanasia Pataka
- Department of Respiratory Medicine, G. Papanikolaou Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Paschalis Steiropoulos
- Sleep Unit, Department of Pneumonology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Zoran Dogas
- Split Sleep Medicine Center and Department of Neuroscience, University of Split School of Medicine, Split, Croatia
| | - Ludger Grote
- Department of Sleep Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.,Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Jan Hedner
- Department of Sleep Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.,Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Walter T McNicholas
- Department of Respiratory and Sleep Medicine, St. Vincent's University Hospital, Dublin, Ireland.,Conway Research Institute, University College Dublin, Dublin, Ireland
| | - Oreste Marrone
- CNR Institute of Biomedicine and Molecular Immunology, Palermo, Italy
| | | |
Collapse
|