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Balagny P, Vidal-Petiot E, Renuy A, Matta J, Frija-Masson J, Steg PG, Goldberg M, Zins M, d'Ortho MP, Wiernik E. Prevalence, treatment and determinants of obstructive sleep apnoea and its symptoms in a population-based French cohort. ERJ Open Res 2023; 9:00053-2023. [PMID: 37228279 PMCID: PMC10204811 DOI: 10.1183/23120541.00053-2023] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 03/13/2023] [Indexed: 05/27/2023] Open
Abstract
Background Obstructive sleep apnoea (OSA) is associated with increased morbidity and mortality. Although the disorder has been well studied in selected high-risk populations, few data exist on its prevalence in the general population. We aimed to assess the prevalence and determinants of OSA in France. Methods Data from participants of the French population-based CONSTANCES cohort aged 18-69 years at inclusion and being treated for sleep apnoea or screened for OSA in 2017 using the Berlin Questionnaire were analysed. Weighted analyses were performed to provide recent and representative results in the general population. Results Among 20 151 participants, the prevalence of treated sleep apnoea was 3.5% (95% CI 3.0-3.9%). The prevalence of untreated subjects with a positive Berlin Questionnaire was 18.1% (95% CI 17.3-19.2%) for a total weighted prevalence of treated sleep apnoea or high risk of OSA of 20.9% (95% CI 20.0-21.9%). Regarding prevalence of OSA symptoms, it was 37.2% (95% CI 36.1-38.3%) for severe snoring and 14.6% (95% CI 13.8-15.5%) for hypersomnolence. In multivariable logistic regression analysis, male sex, age, previous cardiovascular events, smoking, low educational level, low physical activity and depressive symptoms were associated with having either treated sleep apnoea or a positive Berlin Questionnaire. Conclusion In this large French population-based cohort, one in five participants had a high likelihood of OSA, whereas only 3.5% were treated for the disorder, suggesting major underdiagnosis in the general population. OSA diagnosis should be considered more often in people with risk factors such as depressive symptoms as well as unhealthy behaviours and socioeconomic conditions.
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Affiliation(s)
- Pauline Balagny
- Université Paris Cité, UFR de Médecine, Paris, France
- Service de Physiologie Explorations Fonctionnelles, AP-HP, Hôpital Bichat, Paris, France
- Université Paris Cité, Population-based Cohorts Unit, INSERM, Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, UMS 011, Paris, France
| | - Emmanuelle Vidal-Petiot
- Université Paris Cité, UFR de Médecine, Paris, France
- Service de Physiologie Explorations Fonctionnelles, AP-HP, Hôpital Bichat, Paris, France
- INSERM U1148, Laboratory for Vascular Translational Science, Paris, France
| | - Adeline Renuy
- Université Paris Cité, Population-based Cohorts Unit, INSERM, Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, UMS 011, Paris, France
| | - Joane Matta
- Université Paris Cité, Population-based Cohorts Unit, INSERM, Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, UMS 011, Paris, France
| | - Justine Frija-Masson
- Université Paris Cité, UFR de Médecine, Paris, France
- Service de Physiologie Explorations Fonctionnelles, AP-HP, Hôpital Bichat, Paris, France
- INSERM U1148, Laboratory for Vascular Translational Science, Paris, France
| | - Philippe Gabriel Steg
- Université Paris Cité, UFR de Médecine, Paris, France
- INSERM U1148, Laboratory for Vascular Translational Science, Paris, France
- Département de Cardiologie, AP-HP, Hôpital Bichat, Paris, France
- Institut Universitaire de France, Paris, France
| | - Marcel Goldberg
- Université Paris Cité, Population-based Cohorts Unit, INSERM, Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, UMS 011, Paris, France
| | - Marie Zins
- Université Paris Cité, UFR de Médecine, Paris, France
- Université Paris Cité, Population-based Cohorts Unit, INSERM, Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, UMS 011, Paris, France
| | - Marie-Pia d'Ortho
- Université Paris Cité, UFR de Médecine, Paris, France
- Service de Physiologie Explorations Fonctionnelles, AP-HP, Hôpital Bichat, Paris, France
- INSERM U1141, NeuroDiderot, Paris, France
| | - Emmanuel Wiernik
- Université Paris Cité, Population-based Cohorts Unit, INSERM, Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, UMS 011, Paris, France
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Abstract
What are the effects of sleep disturbance and changes of sleep on aging women in the short and long term? Most research that has been done in recent years evaluates how sleep disorders and sleep disturbance may change mortality and outcomes of this population. Many confounding factors may be playing a role, including comorbid conditions. This article reviews sleep disorders including insomnia, circadian sleep-wake rhythm disorders, restless legs syndrome, disorders of hypersomnia, and sleep-disordered breathing in women aged 65 and older; prevalence of these disorders; and recommended treatment options.
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Affiliation(s)
- Wahida Akberzie
- Department of Neurology, George Washington University School of Medicine, Washington DC VA Medical Center, 3B-103, 50 Irving Street Northwest, Washington, DC 20422, USA
| | - Lynn Kataria
- Sleep Laboratory, Department of Neurology, George Washington University School of Medicine, Washington DC VA Medical Center, 3B-103, 50 Irving Street Northwest, Washington, DC 20422, USA.
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3
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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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Sheludko EG, Naumov DE, Perelman YM, Kolosov VP. [The problem of obstructive sleep apnea syndrome in asthmatic patients]. TERAPEVT ARKH 2019. [PMID: 28635907 DOI: 10.17116/terarkh2017891107-111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Asthma and obstructive sleep apnea syndrome (OSAS) are one of the most common chronic respiratory diseases. These have common risk factors that include obesity, gastroesophageal reflux disease (GERD) and impaired nasal breathing (allergic rhinitis, sinusitis). At the same time, experimental evidence demonstrates common pathophysiological mechanisms of these diseases, such as involvement in the process of the respiratory tract, a systemic inflammatory response, and implementation of neuromechanical reflexes. Thus, there is an obvious synergism between these conditions, which affects symptoms, response to therapy, and prognosis. The available data allow discussion on whether there is a need to identify and treat OSAS in asthmatic patients. By keeping in mind the high incidence of OSAS in patients with severe asthma, it may be suggested that treatment for OSAS can reduce the number of exacerbations, improve the quality of life, and decline the number of obstinate asthma cases. It is very important for general practitioners to assess risk factors, such as body weight, nasal stuffiness, and GERD, and to utilize screening tools for more efficient use of healthcare resources. Considering the known positive effects of CPAP therapy in short-term studies, future investigations should focus on the impact of CPAP therapy on asthma symptoms in the long-term, as well as on the effects of asthma drugs on the course of OSAS.
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Affiliation(s)
- E G Sheludko
- Far Eastern Research Center for Physiology and Pathology of Respiration, Blagoveshchensk, Russia
| | - D E Naumov
- Far Eastern Research Center for Physiology and Pathology of Respiration, Blagoveshchensk, Russia
| | - Yu M Perelman
- Far Eastern Research Center for Physiology and Pathology of Respiration, Blagoveshchensk, Russia
| | - V P Kolosov
- Far Eastern Research Center for Physiology and Pathology of Respiration, Blagoveshchensk, Russia
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5
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The Relation between Pregnancy-Associated Plasma Protein A and Obstructive Sleep Apnea Syndrome. Can Respir J 2018; 2018:3297810. [PMID: 29973962 PMCID: PMC6008913 DOI: 10.1155/2018/3297810] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 04/09/2018] [Accepted: 04/22/2018] [Indexed: 01/05/2023] Open
Abstract
Aim We aimed to investigate the relationship between serum pregnancy-associated plasma protein A (PAPP-A) levels and obstructive sleep apnea syndrome (OSAS). Materials and Method 44 patients with OSAS and 44 healthy adults were included in this study. The participants having rheumatic or systemic inflammatory disease, advanced liver or kidney failure, diabetes, heart failure, hypertension, pregnancy, prerenal azotemia, known history of coronary artery disease, any pulmonary disease, rhinitis, or atopy, history of major trauma or surgery within the last six 6 months, and inhaled nasal or systemic corticosteroid use or other anti-inflammatory medications and those with <18 years of age were excluded. Serum PAPP-A levels were determined by the Elisa method with the immune sandwich measuring method. Statistical analysis of the study was performed with SPSS 17.0 statistical analysis package program, and p < 0.05 was considered as significant. Results Serum PAPP-A levels of patients with OSAS (2.350 ng/ml (0.641–4.796)) were significantly higher (p < 0.001) when compared with healthy controls (0.971 ng/ml (0.109–2.679)). There was a statistically significant difference in serum PAPP-A levels between groups of OSAS patients according to the classification of OSAS severity. Between the groups of patients with OSAS, serum levels of PAPP-A in moderate group was significantly higher when compared with severe OSAS group (p < 0.001). There was positive correlations between PAPP-A levels and night minimum (p=0.042, r=0.309), and average oxygen levels (p=0.006, r=0.407). There was a negative correlation between PAPP-A levels and AHI (p=0.002, r=−0.460). Conclusion Higher PAPP-A levels in OSAS patients that were found in this study show inflammatory component in OSAS.
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Qiu C, Lawrence W, Gelaye B, Stoner L, Frederick IO, Enquobahrie DA, Sorensen TK, Williams MA. Risk of glucose intolerance and gestational diabetes mellitus in relation to maternal habitual snoring during early pregnancy. PLoS One 2017; 12:e0184966. [PMID: 28926639 PMCID: PMC5605003 DOI: 10.1371/journal.pone.0184966] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 09/04/2017] [Indexed: 12/02/2022] Open
Abstract
Background Obstructive sleep apnea (OSA) or habitual snoring is known to be associated with impaired glucose tolerance and type 2 diabetes among both men and non-pregnant women. We examined the association of habitual snoring during early pregnancy with risk of impaired glucose tolerance (IGT) and gestational diabetes mellitus (GDM). Methods A cohort of 1,579 women was interviewed during early pregnancy. We collected information about snoring frequency during early pregnancy. Results from screening and diagnostic tests for IGT and GDM were abstracted from medical records. Multivariate logistic regression models were fitted to estimate odds ratios (OR) and 95% confidence intervals (95% CI) of IGT and GDM associated with snoring in early pregnancy. Results Overall, women who snored “most or all of the time” had a 2.1-fold increased odds of IGT (OR 2.10; 95% CI 1.31–3.35) and a 2.5-fold increased odds of GDM (OR 2.50; 95% CI 1.34–4.67) as compared with women who never snored. Compared with lean women (pre-pregnancy body mass index (BMI) <25 kg/m2) who did not snore, lean snorers had a 2-fold increased odds of GDM (OR = 1.99, 95% CI: 1.07–3.68). The odds of GDM risk was particularly elevated among overweight women (BMI ≥ 25 kg/m2) who snored (OR = 5.01; 95% CI 2.71–9.26). However, there was no evidence of an interaction between overweight and snoring with GDM risk (p-value = 0.144). Conclusions These findings, if confirmed, may have important implications for tailoring prenatal care for overweight pregnant women, and /or those with a history of habitual snoring in early pregnancy.
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Affiliation(s)
- Chunfang Qiu
- Center for Perinatal Studies, Swedish Medical Center, Seattle, Washington, United States of America
- * E-mail:
| | - Wayne Lawrence
- Department of Epidemiology, Harvard T. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Bizu Gelaye
- Department of Epidemiology, Harvard T. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Lee Stoner
- Department of Sport and Exercise Science, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Ihunnaya O. Frederick
- Center for Perinatal Studies, Swedish Medical Center, Seattle, Washington, United States of America
| | - Daniel A. Enquobahrie
- Department of Epidemiology, Cardiovascular Health Research Unit, University of Washington, Seattle, WA, United States of America
| | - Tanya K. Sorensen
- Center for Perinatal Studies, Swedish Medical Center, Seattle, Washington, United States of America
| | - Michelle A. Williams
- Department of Epidemiology, Harvard T. Chan School of Public Health, Boston, Massachusetts, United States of America
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Senaratna CV, Perret JL, Lodge CJ, Lowe AJ, Campbell BE, Matheson MC, Hamilton GS, Dharmage SC. Prevalence of obstructive sleep apnea in the general population: A systematic review. Sleep Med Rev 2017; 34:70-81. [PMID: 27568340 DOI: 10.1016/j.smrv.2016.07.002] [Citation(s) in RCA: 1302] [Impact Index Per Article: 186.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 06/09/2016] [Accepted: 07/10/2016] [Indexed: 01/15/2023]
Affiliation(s)
- Chamara V Senaratna
- School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Department of Community Medicine, University of Sri Jayewardenepura, Nugegoda, Sri Lanka.
| | - Jennifer L Perret
- School of Population and Global Health, The University of Melbourne, Melbourne, Australia; The Institute for Breathing & Sleep, Heidelberg, Melbourne, Australia.
| | - Caroline J Lodge
- School of Population and Global Health, The University of Melbourne, Melbourne, Australia.
| | - Adrian J Lowe
- School of Population and Global Health, The University of Melbourne, Melbourne, Australia.
| | - Brittany E Campbell
- School of Population and Global Health, The University of Melbourne, Melbourne, Australia.
| | - Melanie C Matheson
- School of Population and Global Health, The University of Melbourne, Melbourne, Australia.
| | - Garun S Hamilton
- Department of Lung and Sleep Medicine, Monash Health, Clayton, Australia; School of Clinical Sciences, Monash University, Clayton, Australia.
| | - Shyamali C Dharmage
- School of Population and Global Health, The University of Melbourne, Melbourne, Australia.
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8
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Lindberg E, Benediktsdottir B, Franklin KA, Holm M, Johannessen A, Jögi R, Gislason T, Real FG, Schlünssen V, Janson C. Women with symptoms of sleep-disordered breathing are less likely to be diagnosed and treated for sleep apnea than men. Sleep Med 2017; 35:17-22. [PMID: 28619177 DOI: 10.1016/j.sleep.2017.02.032] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 02/16/2017] [Accepted: 02/21/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Women are often underrepresented at sleep clinics evaluating sleep-disordered breathing (SDB). The aim of the present study was to analyze gender differences in sleep apnea diagnosis and treatment in men and women with similar symptoms of SDB. METHODS Respiratory Health in Northern Europe (RHINE) provided information about snoring, excessive daytime sleepiness (EDS), BMI and somatic diseases at baseline (1999-2001) and follow-up (2010-2012) from 4962 men and 5892 women. At follow-up participants were asked whether they had a diagnosis of and/or treatment for sleep apnea. RESULTS Among those with symptoms of SDB (snoring and EDS), more men than women had been given the diagnosis of sleep apnea (25% vs. 14%, p < 0.001), any treatment (17% vs. 11%, p = 0.05) and CPAP (6% vs. 3%, p = 0.04) at follow-up. Predictors of receiving treatment were age, BMI, SDB symptoms at baseline and weight gain, while female gender was related to a lower probability of receiving treatment (adj. OR 0.3, 95% CI 0.3-0.5). In both genders, the symptoms of SDB increased the risk of developing hypertension (adj OR, 95% CI: 1.5, 1.2-1.8) and diabetes (1.5, 1.05-2.3), independent of age, BMI, smoking and weight gain. CONCLUSIONS Snoring females with daytime sleepiness may be under-diagnosed and under-treated for sleep apnea compared with males, despite running a similar risk of developing hypertension and diabetes.
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Affiliation(s)
- Eva Lindberg
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Sweden.
| | - Bryndis Benediktsdottir
- Department of Respiratory Medicine and Sleep, The National University Hospital of Iceland, Reykjavik, Iceland; University of Iceland, Faculty of Medicine, Iceland
| | - Karl A Franklin
- Department of Surgical and Perioperative Sciences, Surgery, Umea University, Sweden
| | - Mathias Holm
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ane Johannessen
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Norway
| | - Rain Jögi
- Lung Clinic, Tartu University Clinics, Tartu, Estonia
| | - Thorarinn Gislason
- Department of Respiratory Medicine and Sleep, The National University Hospital of Iceland, Reykjavik, Iceland; University of Iceland, Faculty of Medicine, Iceland
| | - Francisco Gomez Real
- Department of Gynecology and Obstetrics, Haukeland University Hospital, Bergen, Norway
| | - Vivi Schlünssen
- Department of Public Health, Section for Environment, Occupation and Health, Aarhus University, Aarhus, Denmark; National Research Center for the Working Environment, Copenhagen, Denmark
| | - Christer Janson
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Sweden
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Huang J, Qi J, Lin Q, Li S, Chen G, Ding H, Zhao J. Snoring and components of metabolic syndrome in Southeastern Chinese adults: A community-based study. CLINICAL RESPIRATORY JOURNAL 2017; 12:966-973. [PMID: 28085227 DOI: 10.1111/crj.12613] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 12/19/2016] [Accepted: 12/29/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Snoring has been associated with a number of abnormal conditions, but little work has been done on its association with components of metabolic syndrome based on the epidemiology in Chinese adults. OBJECTIVE This study aimed to investigate the association between snoring and components of metabolic syndrome in southeastern Chinese adults. METHODS A two-stage, cross-sectional community-based study was performed in Fuzhou, Southeast China, from 2005 to 2009. Stage 1: 5500 subjects were administered a questionnaire. Data on self-reported snoring status, daytime somnolence, demographic data, disease histories, and potential confounders were collected and anthropometric measurements were performed. Stage 2: 1000 subjects who were already investigated underwent a blood test and measurement of blood pressure. RESULTS Data from 4286 subjects were available; 606 subjects were habitual snorers. The prevalence of overweight or obesity, hyperglycemia, hypertension, and dyslipidemia in occasional and habitual snorers was higher than that in the study population (16.66%, 7.89%, 10.52%, and 5.81%, respectively). A significantly increasing trend based on snoring frequency existed in the prevalence of metabolic disorders. The prevalence of components of metabolic syndrome continued to be significantly associated with snoring frequency after controlling confounding factors. Odds ratios of suffering from the aforementioned conditions for occasional and habitual snorers were 1.5-2.5 (P < 0.05) and 2.4-4.8 (P < 0.001) times higher, respectively, compared with nonsnorers. CONCLUSIONS The prevalence of snoring and components of metabolic syndrome is high in southeastern Chinese adults. Both habitual and occasional snoring are closely associated with metabolic disorders independent of confounding factors.
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Affiliation(s)
- Jianchai Huang
- Department of Respiratory Medicine, First Affiliated Hospital of Fujian Medical University, Fujian Provincial Sleep-disordered Breathing Clinic Center, Laboratory of Respiratory Disease of Fujian Medical University, Fuzhou, Fujian, 350005, China
| | - Jiachao Qi
- Department of Respiratory Medicine, First Affiliated Hospital of Fujian Medical University, Fujian Provincial Sleep-disordered Breathing Clinic Center, Laboratory of Respiratory Disease of Fujian Medical University, Fuzhou, Fujian, 350005, China
| | - Qichang Lin
- Department of Respiratory Medicine, First Affiliated Hospital of Fujian Medical University, Fujian Provincial Sleep-disordered Breathing Clinic Center, Laboratory of Respiratory Disease of Fujian Medical University, Fuzhou, Fujian, 350005, China
| | - Shuqi Li
- Department of Respiratory Medicine, Ningde Hospital of Fujian Province, Ningde, Fujian, 352100, China
| | - Gongping Chen
- Department of Respiratory Medicine, First Affiliated Hospital of Fujian Medical University, Fujian Provincial Sleep-disordered Breathing Clinic Center, Laboratory of Respiratory Disease of Fujian Medical University, Fuzhou, Fujian, 350005, China
| | - Haibo Ding
- Department of Respiratory Medicine, First Affiliated Hospital of Fujian Medical University, Fujian Provincial Sleep-disordered Breathing Clinic Center, Laboratory of Respiratory Disease of Fujian Medical University, Fuzhou, Fujian, 350005, China
| | - Jianming Zhao
- Department of Respiratory Medicine, First Affiliated Hospital of Fujian Medical University, Fujian Provincial Sleep-disordered Breathing Clinic Center, Laboratory of Respiratory Disease of Fujian Medical University, Fuzhou, Fujian, 350005, China
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Lin BM, Hu FB, Curhan GC. Association Between Benzodiazepine Receptor Agonists and Snoring Among Women in the Nurses' Health Study. JAMA Otolaryngol Head Neck Surg 2017; 143:162-167. [PMID: 27893000 DOI: 10.1001/jamaoto.2016.3174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Snoring is highly prevalent among adults. The use of benzodiazepine receptor agonists is also common, with higher prevalence of use with more advanced age. Benzodiazepine receptor agonists cause muscle relaxation, which may affect muscle tone and airway dynamics and thereby increase snoring. Previous studies examining the association between use of benzodiazepine receptor agonists and snoring were underpowered to detect clinically meaningful differences or did not report the magnitude of association. Objective To investigate the association between use of benzodiazepine receptor agonists and snoring in women. Design, Setting, and Participants Women aged 62 to 86 years provided information on snoring and covariates of interest in the 2008 survey of the Nurses' Health Study, a cross-sectional cohort study of female registered nurses in the United States. Potential effect modification of the association between use of benzodiazepine receptor agonists and snoring by age, body mass index, waist circumference, smoking, alcohol consumption, and physical activity was explored. Logistic regression was used to adjust for potential confounders. Data analysis was conducted from November 2015 to March 2016. Main Outcomes and Measures Self-reported habitual snoring, defined as a few nights a week or more. Results Of 52 504 participants (mean [SD] age, 72.4 [6.7] years), 14 831 (28.2%) reported habitual snoring. There was a slightly higher prevalence of benzodiazepine receptor agonist use among habitual snorers (11.4%) compared with nonhabitual snorers (10.6%) (absolute difference, 0.8%; 95% CI, 0.2%-1.4%). After multivariable adjustment, use of benzodiazepine receptor agonists was not associated with snoring (odds ratio, 1.01; 95% CI, 0.95-1.07) compared with women who did not use benzodiazepine receptor agonists. Although there was no significant interaction with smoking, there were higher odds of snoring with use of benzodiazepine receptor agonists among current smokers (odds ratio, 1.34; 95% CI, 1.04-1.73). Conclusions and Relevance Use of benzodiazepine receptor agonists is not associated with odds of snoring in middle-aged and elderly women.
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Affiliation(s)
- Brian M Lin
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston2Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts3Harvard Medical School, Boston, Massachusetts
| | - Frank B Hu
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts3Harvard Medical School, Boston, Massachusetts4Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Gary C Curhan
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts3Harvard Medical School, Boston, Massachusetts4Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts5Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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Gislason T, Bertelsen RJ, Real FG, Sigsgaard T, Franklin KA, Lindberg E, Janson C, Arnardottir ES, Hellgren J, Benediktsdottir B, Forsberg B, Johannessen A. Self-reported exposure to traffic pollution in relation to daytime sleepiness and habitual snoring: a questionnaire study in seven North-European cities. Sleep Med 2016; 24:93-99. [PMID: 27810192 DOI: 10.1016/j.sleep.2016.08.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 08/16/2016] [Accepted: 08/17/2016] [Indexed: 01/27/2023]
Abstract
OBJECTIVE/BACKGROUND Little is known about associations between traffic exposure and sleep disturbances. We examined if self-reported exposure to traffic is associated with habitual snoring and daytime sleepiness in a general population. METHODS In the RHINE III study, 12184 adults answered questions on sleep disturbances and traffic exposure. We analysed bedrooms near roads with traffic, bedrooms with traffic noise, and travelling regularly along busy roads as proxies for traffic exposures, using logistic regression. Adjustment factors were study centre, gender, age, smoking habits, educational level, body mass index, physical activity, obstructive sleep apnoea, and sleep duration. RESULTS One in ten lived near a busy road, 6% slept in a bedroom with traffic noise, and 11% travelled regularly along busy roads. Habitual snoring affected 25% and daytime sleepiness 21%. More men reported snoring and more women reported daytime sleepiness. Having a bedroom with traffic noise was associated with snoring (adjusted OR 1.29, [95% CI 1.12, 1.48]). For daytime sleepiness, on the other hand, bedroom with traffic noise and high exposure to traffic pollution have significant risk factors (adjusted ORs 1.46 [1.11, 1.92] and 1.65 [1.11, 2.45]). Results were consistent across study centres. CONCLUSIONS Daytime sleepiness is associated with traffic pollution and traffic noise, while habitual snoring is only associated with traffic noise. Self-reported traffic exposure should be taken into account when diagnosing and planning treatment for patients with sleep disturbances, because reducing noise and pollution exposure in the bedroom may have a beneficial effect.
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Affiliation(s)
- Thorarinn Gislason
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland; Department of Respiratory Medicine and Sleep, Landspitali - National University Hospital of Iceland, Iceland
| | - Randi J Bertelsen
- Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway; Institute of Clinical Medicine, University of Bergen, Bergen, Norway
| | | | | | - Karl A Franklin
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Eva Lindberg
- Department of Medical Sciences, Respiratory-, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Christer Janson
- Department of Medical Sciences, Respiratory-, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Erna Sif Arnardottir
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland; Department of Respiratory Medicine and Sleep, Landspitali - National University Hospital of Iceland, Iceland
| | - Johan Hellgren
- Institute of Clinical Science, University of Gothenburg, Sweden; Department of Otorhinolaryngology, Head & Neck Surgery, Sahlgrenska Academy, Gothenburg, Sweden
| | - Bryndis Benediktsdottir
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland; Department of Respiratory Medicine and Sleep, Landspitali - National University Hospital of Iceland, Iceland
| | - Bertil Forsberg
- Department of Public Health and Clinical Medicine/Occupational & Environmental Medicine, Umeå University, Umeå, Sweden
| | - Ane Johannessen
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
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Sarberg M, Bladh M, Josefsson A, Svanborg E. Sleepiness and sleep-disordered breathing during pregnancy. Sleep Breath 2016; 20:1231-1237. [DOI: 10.1007/s11325-016-1345-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Revised: 03/15/2016] [Accepted: 04/07/2016] [Indexed: 12/17/2022]
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13
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Alebiosu OC, Ogunsemi OO, Familoni OB, Adebayo P, Ayodele O. Original Research: Quality of Sleep among Hypertensive Patients in a Semi-Urban Nigerian Community: A Prospective Study. Postgrad Med 2015; 121:166-72. [DOI: 10.3810/pgm.2009.01.1969] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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14
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Ogunrinde OO. Snoring, Irregular Respiration, Hypoventilation, and Apneas. Sleep Med Clin 2014. [DOI: 10.1016/j.jsmc.2014.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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15
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Factors affecting blood pressure profile in pre and postmenopausal women with obstructive sleep apnea hypopnea syndrome. Sleep Breath 2014; 19:169-74. [PMID: 24807118 DOI: 10.1007/s11325-014-0983-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 03/16/2014] [Accepted: 03/17/2014] [Indexed: 01/04/2023]
Abstract
PURPOSE Obstructive sleep apnea hypopnea syndrome (OSAHS) is an independent risk factor for development of hypertension. Epidemiological surveys have found that risk of cardiovascular diseases increased in postmenopausal women. However, it is not well known about the profiles of hypertension of women with OSAHS in their different reproductive stages. This study aimed to investigate the difference of blood pressure profile between pre and postmenopausal women with OSAHS. METHODS Women who were tested by polysomnography (PSG) (n = 207) in Ruijin Hospital were recruited in the study. The subjects were divided into two groups of premenopausal women (24 with and 30 without OSAHS), and two groups of postmenopausal women (116 with and 37 without OSAHS). Among the groups, the differences of demographic and PSG variables were compared. The factors influencing blood pressure were further studied. RESULTS The prevalence of hypertension (56.9 %) in postmenopausal OSAHS patients was higher than the other three groups. Among OSAHS patients, both average systolic blood pressure (SBP) and diastolic blood pressure (DBP) of postmenopausal women were higher than those of premenopausal ones [(129.9 ± 16.16 mmHg vs. 123.7 ± 18.89), (84.96 ± 9.88 mmHg vs. 78.81 ± 10.34), P = 0.05, P < 0.01, respectively], with the elevation of DBP being more pronounced. For premenopausal women, body mass index (BMI) was the only factor affecting blood pressure (p < 0.05); in postmenopausal women, BMI was a factor affecting SBP, while BMI and apnea hypopnea index (AHI) affecting DBP (P < 0.05). CONCLUSION Blood pressure profile of postmenopausal women with OSAHS was affected by both BMI and AHI. But those of premenopausal ones were predominantly related to BMI.
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Kum RO, Ozcan M, Yılmaz YF, Gungor V, Yurtsever Kum N, Unal A. The Relation of the Obstruction Site on Muller's Maneuver with BMI, Neck Circumference and PSG Findings in OSAS. Indian J Otolaryngol Head Neck Surg 2014; 66:167-72. [PMID: 24822156 DOI: 10.1007/s12070-014-0699-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 01/18/2014] [Indexed: 12/12/2022] Open
Abstract
We investigated relation of the site of obstruction detected on Muller maneuver (MM) with polysomnography (PSG) and physical examination findings. Data of 703 patients admitted to Ankara Numune Education and Research Hospital Sleep Laboratory between 2008 and 2013 were analyzed retrospectively; 394 patients with apnea-hypopnea indexes (AHI) ≥5/h were included. Site of collapse on MM was determined at retrolingual level at anteroposterior (M1) and lateral-lateral (M2) directions; at retropalatal level at anteroposterior (M3) and lateral-lateral (M4) directions. There were 125 (31.7 %) females and 269 (68.3 %) males. BMI had significant positive correlations with M2 (p < 0.001) and M4 (p = 0.002) scores, ESS (p = 0.013) and AHI (p = 0.001). AHI had significant positive correlations with ESS (p = 0.003), M2 (p < 0.001), M3 (p = 0.037) and M4 (p < 0.001) scores and NC (p = 0.001). Minimum oxygen saturation had significant reverse correlations with M1 (p = 0.046), M2 (p < 0.001), M3 (p = 0.003), M4 (p < 0.001), AHI (p < 0.001), ESS (p = 0.003) and BMI (p = 0.001). In OSAS patients, increased BMI, NC and AHI are correlated with lateral pharyngeal wall (LPW) collapse in retropalatal and retrolingual levels on MM. LPW collapse is more valuable to predict OSAS compared to anteroposterior collapse. LPW collapse on MM may be used as a selection criterion for ordering PSG. Further studies are needed to better clarify importance of LPW in OSAS surgery.
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Affiliation(s)
- Rauf Oguzhan Kum
- Ankara Numune Education and Research Hospital 1.ENT Clinic, Ankara, Turkey
| | - Muge Ozcan
- Ankara Numune Education and Research Hospital 1.ENT Clinic, Ankara, Turkey
| | - Yavuz Fuat Yılmaz
- Ankara Numune Education and Research Hospital 1.ENT Clinic, Ankara, Turkey
| | - Volkan Gungor
- Ankara Numune Education and Research Hospital 1.ENT Clinic, Ankara, Turkey
| | | | - Adnan Unal
- Ankara Numune Education and Research Hospital 1.ENT Clinic, Ankara, Turkey ; Department of Otolaryngology, Hitit University, Çorum, Turkey
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Kang K, Seo JG, Seo SH, Park KS, Lee HW. Prevalence and related factors for high-risk of obstructive sleep apnea in a large korean population: results of a questionnaire-based study. J Clin Neurol 2014; 10:42-9. [PMID: 24465262 PMCID: PMC3896648 DOI: 10.3988/jcn.2014.10.1.42] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 08/20/2013] [Accepted: 08/20/2013] [Indexed: 11/29/2022] Open
Abstract
Background and Purpose A population-based door-to-door study of cross-sectional methods for assessing the prevalence and factors related to a high risk of obstructive sleep apnea (OSA) was conducted using the Korean version of the Berlin Questionnaire (K-BQ). Methods Pooled data collected from Community Health Surveys by the Korea Center for Disease Control and Prevention were analyzed. Of 8,140 respondents from the population, 7,955 were finally included in this study. Results Of the 7,955 included subjects, 15.7% of the men and 9.8% of the women were at high risk of OSA. Significant differences were found in the following factors between the subjects with a high risk of OSA: gender, age, marital status, educational level, occupation, and presence of smoking, harmful alcohol use, and chronic diseases. Male sex, harmful alcohol use, and the presence of chronic diseases were identified as factors independently associated with a high risk of OSA. Conclusions This is the first study to confirm the usefulness of the K-BQ to study the prevalence of OSA in the Korean general population. The findings demonstrate that harmful alcohol use and chronic diseases are very common characteristics among those with a high risk of OSA.
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Affiliation(s)
- Kyunghun Kang
- Department of Neurology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Jong-Geun Seo
- Department of Neurology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Sung-Hyo Seo
- Division of Chronic Disease Control, Korea Center for Disease Control & Prevention, Cheongwon, Korea
| | - Ki-Soo Park
- Department of Preventive Medicine, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Ho-Won Lee
- Department of Neurology, Kyungpook National University School of Medicine, Daegu, Korea. ; Brain Science & Engineering Institute, Kyungpook National University, Daegu, Korea
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Shin MH, Kweon SS, Choi BY, Kim MK, Chun BY, Shin DH, Lee YH. Self-reported snoring and metabolic syndrome: the Korean Multi-Rural Communities Cohort Study. Sleep Breath 2013; 18:423-30. [PMID: 24194392 DOI: 10.1007/s11325-013-0902-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Revised: 09/05/2013] [Accepted: 10/07/2013] [Indexed: 11/25/2022]
Abstract
PURPOSE We investigated the association between self-reported snoring and metabolic syndrome (MetS) and its components among a community-dwelling Korean population. METHODS A total of 7,038 subjects participated in the Korean Multi-Rural Communities Cohort Study between January 2005 and February 2010 and were included in the analysis. Frequency of snoring was classified into never, rarely (<1 day/week), occasionally (1-3 days/week), and habitually (≥4 days/week). RESULTS In the fully adjusted model, compared to non-snorers, the odds ratio (OR) for MetS of snorers was significantly higher in subjects with rare snoring (OR, 1.42; 95% confidence interval (CI), 1.23-1.64), occasional snoring (OR, 1.79; 95% CI, 1.55-2.07), and habitual snoring (OR, 2.03; 95% CI, 1.77-2.33) than those who did not snore. The ORs for abdominal obesity were significantly higher in rare snoring subjects (OR, 1.51; 95% CI, 1.30-1.75), occasional snoring (OR, 1.71; 95% CI, 1.47-1.98), and habitual snoring (OR, 2.07; 95% CI, 1.80-2.38) than in non-snorers after adjusting for covariates. CONCLUSIONS Snoring was significantly and linearly associated with MetS, and this association was consistently present in both sexes. Positive and graded associations were observed between snoring frequency and MetS components including high blood pressure, elevated fasting glucose levels, and abdominal obesity, independent of conventional risk factors and other MetS components.
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Affiliation(s)
- Min-Ho Shin
- Department of Preventive Medicine, Chonnam National University Medical School, Gwangju, South Korea
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Nam H, Yang HJ, Kim YA, Kim HC. Impact of chronic simulated snoring on carotid atherosclerosis in rabbits. J Clin Neurol 2013; 9:269-73. [PMID: 24285969 PMCID: PMC3840138 DOI: 10.3988/jcn.2013.9.4.269] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 05/09/2013] [Accepted: 05/09/2013] [Indexed: 12/03/2022] Open
Abstract
Background and Purpose Chronic simulated snoring was induced in rabbits to determine the impact of snoring on the development of atherosclerosis. Methods The pressure wave of induced snoring at the carotid bifurcation of rabbits was acquired by gently pressing the airway. This wave was then simulated using custom-made mechanical devices. Twelve rabbits were used in this study, seven of which were assigned to the experimental group and the remaining five formed the control group. All of the rabbits were raised on a 1% high-cholesterol diet. Either working or sham devices were positioned at the ventral center of the neck in each rabbit. At the end of a 2-month observation period, all of the rabbits were sacrificed by perfusion fixation, the carotid arteries harvested, and the carotid atherosclerosis histology reviewed. Results All of the rabbits survived to the end of the experimental period. Blood sampling revealed the presence of hypercholesterolemia in both groups, with no significant difference between them. The presence and degree of atherosclerosis did not differ significantly between the groups. Conclusions The findings of this study show the feasibility of making a chronic simulated snoring rabbit model. However, the causative role of snoring in carotid atherosclerosis was not detected in this animal study.
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Affiliation(s)
- Hyunwoo Nam
- Department of Neurology, Boramae Hospital, Seoul National University, Seoul, Korea
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Kouismi H, El Ftouh M, Naji-Amrani H, El Fihry MEF. Overlap syndrome: Association of chronic obstructive pulmonary disease and obstructive sleep apnea syndrome. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2013. [DOI: 10.1016/j.ejcdt.2013.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Sands-Lincoln M, Grandner M, Whinnery J, Keenan BT, Jackson N, Gurubhagavatula I. The association between obstructive sleep apnea and hypertension by race/ethnicity in a nationally representative sample. J Clin Hypertens (Greenwich) 2013; 15:593-9. [PMID: 23889723 PMCID: PMC3733493 DOI: 10.1111/jch.12144] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 04/30/2013] [Accepted: 05/03/2013] [Indexed: 01/13/2023]
Abstract
The association between obstructive sleep apnea (OSA) and hypertension by race/ethnicity has not been well characterized in a national sample. Adult participants in the 2007-2008 National Health and Nutrition Examination Survey were reviewed by self-report of sleep apnea diagnosis, snorting, gasping or stopping breathing during sleep, and snoring to derive whether OSA was probable (pOSA). Multivariable logistic regression determined whether pOSA predicted hypertension in the overall cohort, and by body mass index (BMI) group and ethno-racial strata. pOSA predicted hypertension in several groups: (1) Within BMI strata, there was a significant association among overweight individuals [odds ratio [OR], 1.82; 95% confidence interval [CI], 1.26-2.62); (2) In race/ethnicity subgroups, the association was significant among Hispanic/Latinos (OR, 1.69; 95% CI, 1.13-2.53) and whites (OR, 1.40; 95% CI, 1.07-1.84); (3) In models stratified by both race/ethnicity and BMI, pOSA predicted hypertension among overweight black/African Americans (OR, 4.74; 95% CI, 1.86-12.03), overweight whites (OR, 1.65; 95% CI, 1.06-2.57), and obese Hispanic/Latino participants (OR, 2.01; 95% CI, 1.16-3.49). A simple, self-report tool for OSA was strongly associated with hypertension, and may serve as a potential future opportunity for OSA diagnosis.
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Affiliation(s)
- Megan Sands-Lincoln
- Center for Sleep and Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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22
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The prevalence and correlates of habitual snoring during pregnancy. Sleep Breath 2012; 17:541-7. [PMID: 22907649 DOI: 10.1007/s11325-012-0717-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 04/04/2012] [Accepted: 04/26/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE Mounting evidence implicate habitual snoring, a prominent symptom of sleep-disordered breathing, as an important risk factor for adverse pregnancy outcomes including preeclampsia and gestational diabetes. Little, however, is known about the determinants of habitual snoring among pregnant women. We sought to assess its prevalence and to identify maternal characteristics associated with habitual snoring during pregnancy. METHODS Pregnant women (N = 1,303) receiving prenatal care provided information about habitual snoring before and during pregnancy in in-person interviews completed in early pregnancy. We calculated adjusted odds ratios (aOR) and 95 % confidence intervals (95 % CI) from multivariable models designed to identify factors associated with snoring during pregnancy. RESULTS Approximately 7.3 % of pregnant women reported habitual snoring during early pregnancy. The odds of habitual snoring during pregnancy was strongly related with maternal reports of habitual snoring prior to the index pregnancy (aOR = 24.32; 95 % CI, 14.30-41.51). Advanced maternal age (≥35 years) (aOR = 2.02; 95 % CI, 1.11-3.68), history of pregestational diabetes (aOR = 3.61; 95 % CI, 1.07-12.2), history of mood and anxiety disorders (aOR = 1.81; 95 % CI, 1.02-3.20), and prepregnancy overweight (25-29.9 kg/m(2)) (aOR = 2.31; 95 % CI, 1.41-3.77) and obesity (≥30 kg/m(2)) (aOR = 2.81; 95 % CI, 1.44-5.48) status were statistically significant risk factors for habitual snoring during pregnancy. In addition, maternal smoking during pregnancy (aOR = 2.70; 95 % CI, 1.17-6.26) was associated with habitual snoring during pregnancy. CONCLUSIONS Identification of risk factors for habitual snoring during pregnancy has important implications for developing strategies aimed at reducing the prevalence of sleep-disordered breathing, promoting improved sleep hygiene and improved pregnancy outcomes among reproductive-age women.
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Alabi BS, Abdulkarim AA, Musa IO, Adegboye O, Aremu SK, Abdur-Rahman LO, Omokanye HK, Katibi OS, Bello OA, Anoba S, Abd'razaq-Folorunsho M. Prevalence of snoring and symptoms of sleep disordered breathing among primary school pupils in Ilorin, Nigeria. Int J Pediatr Otorhinolaryngol 2012; 76:646-8. [PMID: 22341885 DOI: 10.1016/j.ijporl.2012.01.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Revised: 01/20/2012] [Accepted: 01/21/2012] [Indexed: 11/17/2022]
Abstract
BACKGROUND/AIM Snoring is the production of sound from the upper aero-digestive tract during sleep due to turbulent airflow This study is to determine the prevalence, pattern, night and daytime symptoms of snoring among nursery and primary school pupils in Ilorin, Nigeria due to its public health importance. MATERIALS AND METHODS This cross sectional survey was carried out among nursery /primary school pupils in Ilorin, Kwara state between April and September, 2010. Ten schools were selected randomly from 100 schools sited within the 3LGAs of Ilorin municipality. Also private and public schools with different parental social economic status were selected. The pupils were selected from nursery 2 to primary 6 in each school using the class registers with the aid of a table of random numbers with 1500 children assessed. The parents/guardians were made to fill the questionnaires and same returned with visitations to the schools twice weekly and reminders sent via phone calls. Data were analyzed using EPIINFO 2002 version 2 software. RESULTS 1500 questionnaires were given out but 909 were completely filled and returned (response rate of 61%.). There were 598(65.8%) non snorers (NSn) and 311(34.2%) snorers (Sn) at different scales with 153 male snorers to 158 female snorers. The ages of the children ranges from 3 to 16 years (mean ± SD, 8.3 ± 4.8 years. The mean age for the Sn was 8.2 and 8.3 for NSn (range 3-6 years). No statistical difference in age, gender or socio-economic status between Sn and NSn. 598(65.8%) were non snorers (NSn) and 311(34.2%) were snorers (Sn) especially in the age groups 3-6 years, 121(38.9%) and above 6 years of age 101(32.7%) and below 3 years were 89(28%). CONCLUSION Snoring is an important health problem among the pupils as a significant percentage snores and most of them are between third and sixth year of life.
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Affiliation(s)
- B S Alabi
- Department of Otorhinolaryngology, University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria
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Ohayon MM. Epidemiological Overview of sleep Disorders in the General Population. SLEEP MEDICINE RESEARCH 2011. [DOI: 10.17241/smr.2011.2.1.1] [Citation(s) in RCA: 128] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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Polo-Kantola P. Sleep problems in midlife and beyond. Maturitas 2011; 68:224-32. [DOI: 10.1016/j.maturitas.2010.12.009] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Accepted: 12/16/2010] [Indexed: 12/20/2022]
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Affiliation(s)
- Markku Partinen
- Helsinki Sleep Clinic, Vital Research Centre, and Department of Neurology, University of Helsinki, Finland.
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Williams MA, Gelaye B, Qiu C, Fida N, May Cripe S. Habitual snoring and asthma comorbidity among pregnant women. J Asthma 2010; 48:91-7. [PMID: 21091394 DOI: 10.3109/02770903.2010.535882] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) or habitual snoring and asthma are known comorbid conditions in men and non-pregnant women. This comorbidity has not been evaluated among pregnant women. We assessed the habitual snoring-asthma relationship among pregnant women. METHODS A cohort of women (N = 1335) were interviewed during pregnancy, and we ascertained participants' asthma status and collected information about habitual snoring, before and during pregnancy. Logistic regression procedures were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS Compared with non-asthmatics, the adjusted OR among asthmatics for snoring before pregnancy was 2.13 (95% CI 1.10-4.12). The odds of snoring during early pregnancy was 1.79-fold (OR = 1.79; 95% C; 1.07-3.01). Associations were more pronounced among overweight (≥ 25 kg/m(2)) asthmatics (OR = 5.39; 95% CI 2.27-12.75). CONCLUSIONS We report a cross-sectional association of habitual snoring and asthma among pregnant women. If confirmed, pregnant asthmatics may benefit from more vigilant screening and management of OSA or habitual snoring during pregnancy.
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Qiu C, Enquobahrie D, Frederick IO, Abetew D, Williams MA. Glucose intolerance and gestational diabetes risk in relation to sleep duration and snoring during pregnancy: a pilot study. BMC WOMENS HEALTH 2010; 10:17. [PMID: 20470416 PMCID: PMC2885310 DOI: 10.1186/1472-6874-10-17] [Citation(s) in RCA: 128] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2009] [Accepted: 05/14/2010] [Indexed: 11/10/2022]
Abstract
BACKGROUND Insufficient sleep and poor sleep quality, considered endemic in modern society, are associated with obesity, impaired glucose tolerance and diabetes. Little, however, is known about the consequences of insufficient sleep and poor sleep quality during pregnancy on glucose tolerance and gestational diabetes. METHODS A cohort of 1,290 women was interviewed during early pregnancy. We collected information about sleep duration and snoring during early pregnancy. Results from screening and diagnostic testing for gestational diabetes mellitus (GDM) were abstracted from medical records. Generalized linear models were fitted to derive relative risk (RR) and 95% confidence intervals (95% CIs) of GDM associated with sleep duration and snoring, respectively. RESULTS After adjusting for maternal age and race/ethnicity, GDM risk was increased among women sleeping < or = 4 hours compared with those sleeping 9 hours per night (RR = 5.56; 95% CI 1.31-23.69). The corresponding RR for lean women (<25 kg/m2) was 3.23 (95% CI 0.34-30.41) and 9.83 (95% CI 1.12-86.32) for overweight women (> or = 25 kg/m2). Overall, snoring was associated with a 1.86-fold increased risk of GDM (RR = 1.86; 95% CI 0.88-3.94). The risk of GDM was particularly elevated among overweight women who snored. Compared with lean women who did not snore, those who were overweight and snored had a 6.9-fold increased risk of GDM (95% CI 2.87-16.6). CONCLUSIONS These preliminary findings suggest associations of short sleep duration and snoring with glucose intolerance and GDM. Though consistent with studies of men and non-pregnant women, larger studies that include objective measures of sleep duration, quality and apnea are needed to obtain more precise estimates of observed associations.
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Affiliation(s)
- Chunfang Qiu
- Center for Perinatal Studies, Swedish Medical Center, Seattle, Washington, USA.
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Weitzenblum E, Chaouat A, Kessler R, Canuet M, Hirschi S. [The Overlap Syndrome: association of COPD and Obstructive Sleep Apnoea]. Rev Mal Respir 2010; 27:329-40. [PMID: 20403543 DOI: 10.1016/j.rmr.2010.03.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2009] [Accepted: 12/14/2009] [Indexed: 11/16/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) and the obstructive sleep apnoea-hypopnoea syndrome (OSAHS) are both common diseases affecting respectively 10 and 5% of the adult population over 40 years of age. Their coexistence, which is denominated "Overlap Syndrome", can be expected to occur in about 0.5% of this population. Two recent epidemiologic studies have shown that the prevalence of OSAHS is not higher in COPD than in the general population, and that the coexistence of the two conditions is due to chance and not through a pathophysiological linkage. Patients with "overlap" have a higher risk of sleep-related O(2) desaturation than do patients with COPD alone and the same degree of bronchial obstruction. They have an increased risk of developing hypercapnic respiratory failure and pulmonary hypertension when compared with patients with OSAHS alone and with patients with "usual" COPD. In patients with overlap, hypoxaemia, hypercapnia, and pulmonary hypertension can be observed in the presence of mild to moderate bronchial obstruction, which is different from "usual" COPD. Treatment of the overlap syndrome consists of nasal continuous positive airway pressure or nocturnal non-invasive ventilation (NIV), with or without nocturnal O(2). Patients who are markedly hypoxaemic during the daytime (PaO(2)<55-60 mmHg) should be given conventional long-term O(2) therapy in addition to nocturnal ventilation.
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Affiliation(s)
- E Weitzenblum
- Service de pneumologie, nouvel hôpital civil, CHU de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg cedex, France.
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Chedraui P, Pérez-López FR, Mendoza M, Leimberg ML, Martínez MA, Vallarino V, Hidalgo L. Factors related to increased daytime sleepiness during the menopausal transition as evaluated by the Epworth Sleepiness Scale. Maturitas 2010; 65:75-80. [DOI: 10.1016/j.maturitas.2009.11.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2009] [Revised: 10/28/2009] [Accepted: 11/02/2009] [Indexed: 11/17/2022]
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Ayrım A, Keskin EA, Ozol D, Onaran Y, Yıldırım Z, Kafali H. Influence of self-reported snoring and witnessed sleep apnea on gestational hypertension and fetal outcome in pregnancy. Arch Gynecol Obstet 2009; 283:195-9. [DOI: 10.1007/s00404-009-1327-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2009] [Accepted: 12/03/2009] [Indexed: 11/24/2022]
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Ayuse T, Hoshino Y, Kurata S, Ayuse T, Schneider H, Kirkness JP, Patil SP, Schwartz AR, Oi K. The effect of gender on compensatory neuromuscular response to upper airway obstruction in normal subjects under midazolam general anesthesia. Anesth Analg 2009; 109:1209-18. [PMID: 19762751 DOI: 10.1213/ane.0b013e3181b0fc70] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Upper airway patency may be compromised during sleep and anesthesia by either anatomical alterations (mechanical properties) or disturbances in the neural control (compensatory neuromuscular responses). The pathophysiology of upper airway obstruction during anesthesia may differ between men and women. Recently, we reported that the upper airway mechanical properties were comparable with those found during natural nonrapid eye movement sleep, as evaluated by measurements of passive critical closing pressure (P(CRIT)) and upstream resistance (R(US)) during midazolam sedation. In this study, we compared the effects of gender on compensatory neuromuscular responses to upper airway obstruction during midazolam general anesthesia. METHOD Thirty-two subjects (14 men and 18 women) were studied. We constructed pressure-flow relationships to evaluate P(CRIT) and R(US) during midazolam anesthesia. The midazolam anesthesia was induced with an initial dose of midazolam (0.07-0.08 mg/kg bolus) and maintained by midazolam infusion (0.3-0.4 microg x kg(-1) x min(-1)), and the level of anesthesia was assessed by Ramsay score (Level 5) and Observer's Assessment of Alertness/Sedation score (Level 2). Polysomnographic and hemodynamic variables were monitored while nasal pressure (via mask), inspiratory air flow (via pneumotachograph), and genioglossal electromyograph (EMG(GG)) were recorded. P(CRIT) was obtained in both the passive condition, under conditions of decreased EMG(GG) (passive P(CRIT)), and in an active condition, whereas EMG(GG) was increased (active P(CRIT)). The difference between the active P(CRIT) and passive P(CRIT) (Delta P(CRIT) (P - A)) was calculated in each subject to determine the compensatory neuromuscular response. RESULTS The difference between the active P(CRIT) and passive P(CRIT) (Delta P(CRIT) (A - P)) was significantly greater in women than in men (4.6 +/- 2.8 cm H(2)O and 2.2 +/- 1.7 cm H(2)O, respectively; P < 0.01), suggesting greater compensatory neuromuscular response to upper airway obstruction independent of arousal. CONCLUSION We demonstrate that the arousal-independent compensatory neuromuscular responses to upper airway obstruction during midazolam anesthesia were partially maintained in women, and that gender may be a major determinant of the strength of compensatory responses during anesthesia.
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Affiliation(s)
- Takao Ayuse
- Department of Clinical Physiology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 sakamoto, Nagasaki-shi 852-8588, Japan.
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Prevalence and associated risk factors of sleep-disordered breathing symptoms in young and middle-aged Pakistani employed adults. Sleep Breath 2009; 14:137-44. [PMID: 19760442 DOI: 10.1007/s11325-009-0299-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2009] [Accepted: 08/24/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE The objective of this study was to evaluate the prevalence of self-reported sleep-disordered breathing (SDB symptoms and its associated risk factors in Pakistani employed adults. METHODS Full-time employees (n = 3470) of a medical university were evaluated. Self-administered questionnaire elicited information about demographic data, symptoms of SDB, smoking and alcohol use, presence of nasal congestion, family history of snoring, and included the Epworth Sleepiness Scale. Prevalence of self-reported snoring and of combined SDB symptoms (snoring plus at least one other SDB symptom) was evaluated. Regression analyses were used to assess risk factors associated with self-reported snoring and combined SDB symptoms. RESULTS Among the 2,497 (72%) responders, prevalence of self-reported snoring was 32%, and combined SDB symptoms 25%. A higher prevalence of snoring and combined SDB symptoms in male gender diminished with age. In univariate analysis, the odds of snoring was higher with age >or=35 yrs (odds ratio (OR) 2.6, confidence interval (CI) 2.2-3.2), body mass index >or=23 (OR 2.6, CI 2.2-3.1), and collar size above 40 cm (OR 2.7, CI 2.3-3.3). Self-reported nasal blockage (OR 1.9, CI 1.6-2.2) and family history of snoring (OR 2.9, 2.5-3.5) were other risk factors. In logistic regression analysis, significant risk factors for SDB symptoms were age, body mass index, collar size, nasal blockage, and family history of snoring. Male gender, smoking and alcohol were not significant risk factors for SDB symptoms. CONCLUSION The prevalence of SDB symptoms in Pakistani employed adults was comparable to Western populations. However, male gender and smoking were not significant risk factors for SDB symptoms.
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Li QY, Huang SG, Li M, Liu JL, Wan HY. BMI is an independent risk factor for snoring in Chinese women aged over 30 years. Sleep Breath 2008; 13:289-93. [DOI: 10.1007/s11325-008-0236-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2008] [Revised: 08/05/2008] [Accepted: 10/30/2008] [Indexed: 11/24/2022]
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Svensson M, Franklin KA, Theorell-Haglöw J, Lindberg E. Daytime sleepiness relates to snoring independent of the apnea-hypopnea index in women from the general population. Chest 2008; 134:919-924. [PMID: 18753465 DOI: 10.1378/chest.08-0847] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVES The aim was to investigate the significance of snoring and sleep apnea on daytime symptoms in a population-based sample of women. METHOD From the general population, 400 women aged 20 to 70 years were randomly selected, with oversampling of habitually snoring women. The women were investigated using full-night polysomnography and a questionnaire. The apnea-hypopnea index (AHI) was calculated, and women who acknowledged snoring loudly and disturbingly often or very often were considered habitual snorers. RESULTS Habitual snoring was independently related to excessive daytime sleepiness (odds ratio [OR], 2.28; 95% confidence interval [CI], 1.31 to 3.99), to falling asleep involuntarily during the day (OR, 2.11; 95% CI, 1.06 to 4.21), to waking up unrefreshed (OR, 2.14; 95% CI, 1.30 to 3.52), to daytime fatigue (OR, 2.77; 95% CI, 1.54 to 4.99), and to a dry mouth on awakening (OR, 2.00; 95% CI, 1.22 to 3.27) after adjustment for AHI, age, body mass index (BMI), smoking, total sleep time, percentage of slow-wave sleep, and percentage of rapid eye movement (REM) sleep. An AHI > or = 15/h was only related to a dry mouth on awakening after adjustment for snoring, age, BMI, smoking, total sleep time, percentage of slow-wave sleep, and percentage of REM sleep (OR, 2.24; 95% CI, 1.14 to 4.40). An AHI of 5 to 15/h was not related to any daytime symptom. CONCLUSIONS Excessive daytime sleepiness and daytime fatigue are related to habitual snoring independent of the apnea-hypopnea frequency, age, obesity, smoking, and sleep parameters in a population-based sample of women, but not to the AHI. This indicates that snoring is an independent cause of excess daytime sleepiness and not merely a proxy for sleep apnea.
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Affiliation(s)
- Malin Svensson
- Department of Surgical Sciences, Otorhinolaryngology, Head and Neck Surgery, Uppsala University, Uppsala.
| | - Karl A Franklin
- Department of Respiratory Medicine, University Hospital, Umeå, Sweden
| | - Jenny Theorell-Haglöw
- Department of Medical Sciences, Respiratory Medicine and Allergology, Uppsala University, Uppsala
| | - Eva Lindberg
- Department of Medical Sciences, Respiratory Medicine and Allergology, Uppsala University, Uppsala
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Shigeta Y, Ogawa T, Venturin J, Nguyen M, Clark GT, Enciso R. Gender- and age-based differences in computerized tomographic measurements of the orophaynx. ACTA ACUST UNITED AC 2008; 106:563-70. [PMID: 18602313 DOI: 10.1016/j.tripleo.2008.03.032] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2007] [Revised: 03/19/2008] [Accepted: 03/27/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Our aim was to examine the influence of aging and body mass index (BMI) on the oropharynx configuration in male and female Japanese patients. STUDY DESIGN This study examined the computerized tomography (CT) images of 19 man and 19 women, group matched for age and BMI. The airway and the soft tissue volumes between the posterior nasal spine and top of the epiglottis were compared. RESULTS The patients' height, total oropharynx length (TOL), and lower oropharynx lengths and volume measurements (soft tissue and airway) demonstrated statistically significant gender differences. Men consistently had larger TOL and volumes than women. In men, TOL changed with age, and age was a significant predictor of lower oropharynx length. In men, the upper oropharynx soft tissue volume decreased significantly with age and lower oropharynx soft tissue volume increased significantly with age. In women, no significant relationship was identified. CONCLUSION The airway lengthens with aging in males and we speculate that it becomes more collapsible, which in turn could contribute to obstructive sleep apnea.
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Affiliation(s)
- Yuko Shigeta
- Orofacial Pain/Oral Medicine Center, Division of Diagnostic Sciences, School of Dentistry, University of Southern California, Los Angeles, California, USA
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Cervical CT derived neck fat tissue distribution differences in Japanese males and females and its effect on retroglossal and retropalatal airway volume. ACTA ACUST UNITED AC 2008; 106:275-84. [PMID: 18554948 DOI: 10.1016/j.tripleo.2008.03.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2007] [Revised: 01/23/2008] [Accepted: 03/19/2008] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The objective of this study was to investigate the difference of neck fat tissue distribution by sex and its correlation with retropalatal and retroglossal airway. STUDY DESIGN A total of 38 consecutive patients (male: 19; female: 19) who received a CT scan were compared in the retroglossal region and at the narrowest cross section of the airway. Retroglossal fat tissue volume (FV) was segmented with Amira software and separated into subcutaneous and internal fat volume (SFV, IFV). These volumes were normalized by retroglossal neck volume (NV). RESULTS Men had 51.9% more IFV/NV and 64.4% less SFV/NV compared with women. Age-adjusted BMI was negatively correlated with retroglossal airway volume (normalized by NV) and with the lateral width of the smallest cross-section airway (LW) in females. In males the IFV/NV was negatively correlated with LW, after adjusting for BMI and age. CONCLUSION Upper airway collapsibility analysis is needed to rule out whether increased BMI or IFV causes an increase in airway collapsibility.
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Dunai A, Keszei AP, Kopp MS, Shapiro CM, Mucsi I, Novak M. Cardiovascular disease and health-care utilization in snorers: a population survey. Sleep 2008; 31:411-6. [PMID: 18363318 DOI: 10.1093/sleep/31.3.411] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
STUDY OBJECTIVES We assessed the prevalence of self-reported snoring in the Hungarian population and established whether different types of snoring are associated with cardiovascular disorders and increased health-care utilization. DESIGN Cross-sectional study. Door-to-door survey. SETTING Nationally representative population in Hungary. PARTICIPANTS Interviews were carried out in the homes of 12,643 persons. We used the Hungarian National Population Register as the sampling frame and implemented a clustered, stratified sampling procedure. The study population represented 0.16% of the population over the age of 18 years according to age, sex, and 150 subregions of the country. INTERVENTIONS Not applicable. MEASUREMENTS AND RESULTS Thirty-seven percent of men and 21% of women reported loud snoring with breathing pauses. Hypertension, myocardial infarction, and stroke were reported by 26%, 3%, and 4% of the respondents, respectively. There was a significant increase in the prevalence of hypertension, myocardial infarction, and stroke in quiet and loud snorers, as compared with nonsnorers. Multivariate analysis showed an association between loud snoring and hypertension (odds ratio [OR]: 1.40, 95% confidence interval [CI]: 1.24-1.58), myocardial infarction (OR: 1.34, CI: 1.04-1.73), and stroke (OR: 1.67, CI: 1.32-2.11) after statistical adjustment for age, sex, body mass index, diabetes, level of education, smoking, and alcohol consumption. Loud snoring was also associated with measures of health-care use in both sexes. CONCLUSIONS Snoring is frequent in the Hungarian adult population, and loud snoring with breathing pauses, in contrast with quiet snoring, is associated with an increased risk of cardiovascular disease and increased health-care utilization.
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Affiliation(s)
- Andrea Dunai
- Institute of Behavioral Sciences, Faculty of Medicine, Semmelweis University, Budapest, Hungary
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Ursavas A, Karadag M, Nalci N, Ercan I, Gozu RO. Self-Reported Snoring, Maternal Obesity and Neck Circumference as Risk Factors for Pregnancy-Induced Hypertension and Preeclampsia. Respiration 2008; 76:33-9. [PMID: 17728529 DOI: 10.1159/000107735] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2007] [Accepted: 05/24/2007] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Physical and hormonal changes during pregnancy alter breathing patterns of pregnant women. It is possible that occult disordered breathing during sleep may be a risk factor for the development of pregnancy-induced hypertension (PIH) and preeclampsia. OBJECTIVE Our aim was to determine the incidence of self-reported snoring in pregnant women, and to investigate the relationship of snoring, obesity and neck circumference to PIH and preeclampsia. METHODS 469 pregnant women and 208 age-matched nonpregnant women were included in the study. Both groups were asked to complete a questionnaire. Maternal complications were retrieved from the medical records. RESULTS Habitual snoring was reported from 1.9% of nonpregnant women, 2.5% of pregnant women prior to pregnancy and 11.9% of those same women during the third trimester of pregnancy (p < 0.001). Age, smoking during pregnancy, and weight before delivery were independent risk factors for habitual snoring in pregnancy. PIH and preeclampsia developed in 20 and 10.9% of pregnant women with habitual snoring, as compared to 11 and 5.8% of non-snoring pregnant women (p = 0.045, p = 0.125, p = 0.415), respectively. In women who developed preeclampsia, weight before pregnancy, weight before delivery and neck circumference were significantly higher in univariate analysis. Neck circumference was an independent risk factor for PIH and preeclampsia according to logistic regression analysis. CONCLUSION The incidence of snoring is significantly higher in pregnant women than in nonpregnant women. Snoring may indicate a risk of PIH. Neck circumference was an independent risk factor for both PIH and preeclampsia.
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Affiliation(s)
- Ahmet Ursavas
- Department of Pulmonary Medicine, University of Uludağ School of Medicine, Bursa, Turkey.
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Abstract
OBJECTIVE The aim of this study was to determine the prevalence of snoring and breathing pauses during sleep, and to assess associated factors, including morbidity and the impact on daytime functioning, in an adult Malaysian population. METHODS A cross-sectional survey of community-dwelling adults aged 30-70 years was conducted. Daytime sleepiness was assessed using the Epworth Sleepiness Scale. Physical examinations were limited to measurements of body habitus and blood pressure. RESULTS The sample consisted of 1611 adults (52.9% male). The prevalence of habitual snoring, breathing pauses and excessive daytime sleepiness were 47.3%, 15.2% and 14.8%, respectively. Seven per cent of respondents (8.8% male, 5.1% female) were clinically suspected to have obstructive sleep apnoea syndrome (OSAS). The independent predictors of habitual snoring were older age, Chinese or Indian ethnicity (compared with Malays), smoking, obesity and use of sedatives. Clinically suspected OSAS and habitual snoring were significantly associated with difficulty in getting up in the morning, morning headache, driving and workplace accidents, hypertension, and ischaemic heart disease. CONCLUSIONS The prevalence of habitual snoring is high in the Malaysian population. Sleep-related breathing disorders in Malaysian adults are associated with significant morbidity.
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TANG B. Living by a biological clock: age-related functional changes of sleep homeostasis in people aged 65?88.5�years. Sleep Biol Rhythms 2007. [DOI: 10.1111/j.1479-8425.2007.00275.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Zeng B, Ng AT, Darendeliler MA, Petocz P, Cistulli PA. Use of flow-volume curves to predict oral appliance treatment outcome in obstructive sleep apnea. Am J Respir Crit Care Med 2007; 175:726-30. [PMID: 17218619 DOI: 10.1164/rccm.200608-1205oc] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND It has been recognized that mandibular advancement splint (MAS) treatment is effective in some, but not all, patients with obstructive sleep apnea (OSA). Hence there is a need for a simple and reliable clinical tool to assist in the differentiation of treatment responses. We hypothesized that abnormalities of flow-volume curves, together with other clinical variables, may have clinical utility in the prediction of MAS treatment outcome. METHODS Fifty-four patients with known OSA underwent MAS treatment. Expiratory and inspiratory flow-volume curves were measured in the erect and supine positions to derive midinspiratory flow (MIF(50)) and the ratio of expiratory to inspiratory flow at 50% of vital capacity (MEF(50):MIF(50)). Multivariable logistic regression was performed to identify additional significant clinical variables in the prediction of treatment outcome. RESULTS The mean (+/- SD) apnea-hypopnea index (AHI) in 35 responders was significantly reduced from 28.9 +/- 13.7 to 6.7 +/- 5.8/hour (p<0.001). In 19 nonresponders there was no significant change in AHI. MIF(50) was lower (6.04 +/- 1.80 vs. 6.88 +/- 1.08 L/second; p=0.035) and the MEF(50):MIF(50) ratio was higher (0.82 +/- 0.23 vs. 0.61 +/- 0.15; p=0.001) in responders than nonresponders. Logistic regression analysis revealed that the MEF(50):MIF(50) ratio was the most important predictive factor for MAS treatment outcome, but that body mass index, age, and baseline AHI were also contributory. CONCLUSIONS These data suggest that flow-volume curves, in combination with other factors such as body mass index, age, and baseline AHI, may have a useful clinical role in the prediction of treatment outcome with MAS.
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Affiliation(s)
- Biao Zeng
- Centre for Sleep Health and Research, Department of Respiratory Medicine, Royal North Shore Hospital, University of Sydney, Sydney, Australia
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Lindberg E, Berne C, Franklin KA, Svensson M, Janson C. Snoring and daytime sleepiness as risk factors for hypertension and diabetes in women--a population-based study. Respir Med 2006; 101:1283-90. [PMID: 17127049 DOI: 10.1016/j.rmed.2006.10.015] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2006] [Revised: 10/13/2006] [Accepted: 10/13/2006] [Indexed: 11/28/2022]
Abstract
The aim of this study was to analyze whether snoring and excessive daytime sleepiness (EDS), the main symptoms of obstructive sleep apnea syndrome (OSAS), are associated with hypertension and diabetes in women. A random sample of 6779 women aged 20-99 years answered questionnaires on sleep disturbances, daytime symptoms and somatic diseases. The women were categorized into four groups: "no EDS or snoring" (reference group), "snoring but no EDS", "EDS but no snoring" and "snoring and EDS". Prevalences of hypertension and diabetes were lowest in the reference group (8.7% and 1.6%, respectively) and highest among women with both snoring and EDS (hypertension: 26.3%, diabetes: 5.8%). In a multivariate model adjusting for age, body mass index, smoking, physical activity and alcohol dependency, "snoring and EDS" was a risk factor for hypertension (adjusted OR 1.82 (95% CI 1.30-2.55)) while isolated snoring or EDS was not. "Snoring and EDS" was more closely related to hypertension among women aged <50 years (adj. OR 3.41 (1.78-6.54) vs. 1.50 (1.02-2.19), P=0.01). For diabetes, both "EDS but no snoring" and "snoring and EDS" were risk factors and the associations were most pronounced in women aged >50 years (adj. OR 2.33 (1.28-4.26) for "EDS but no snoring" and 2.00 (1.05-3.84) for "snoring and EDS"). We conclude that the combination of snoring and EDS is a risk factor for hypertension and diabetes in women. For hypertension, the risk is partly age dependent and, for diabetes, EDS without snoring is a risk factor of similar magnitude. These differences might indicate differences in pathophysiologic mechanisms underlying the association between sleep-disordered breathing and hypertension and diabetes respectively.
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Affiliation(s)
- Eva Lindberg
- Department of Medical Sciences, Respiratory Medicine and Allergology, Akademiska Sjukhuset, SE-75185 Uppsala, Sweden.
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See CQ, Mensah E, Olopade CO. Obesity, ethnicity, and sleep-disordered breathing: medical and health policy implications. Clin Chest Med 2006; 27:521-33, viii. [PMID: 16880061 DOI: 10.1016/j.ccm.2006.04.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The obesity epidemic in the United States is a major health problem, which poses im-mediate and long-term health risks with potential for significant reduction in life expectancy if not curtailed. Despite affecting all segments of the population, minorities carry a relatively larger burden of the obesity threat. Obesity is a major risk factor for develop-ing obstructive sleep apnea and the metabolic syndrome, which are associated with increased cardiovascular and cerebrovascular morbidity and mortality. This article discusses the implications of the obesity trend on the prevalence of obstructive sleep ap-nea and health, highlights ethnic differences, reviews the resultant economic implications, and suggests public health and health policy initiatives that may be beneficial in stemming the obesity scourge.
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Affiliation(s)
- Carolina Q See
- Section of Respiratory and Critical Care Medicine, Department of Medicine, M/C 719, University of Illinois at Chicago, 840 South Wood Street, Chicago, IL 60612, USA
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Svensson M, Holmstrom M, Broman JE, Lindberg E. Can anatomical and functional features in the upper airways predict sleep apnea? A population-based study in females. Acta Otolaryngol 2006; 126:613-20. [PMID: 16720446 DOI: 10.1080/00016480500468984] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
CONCLUSION The importance of clinical findings in the nose and throat, including fiberoptic endoscopy during the Muller maneuver, in predicting sleep apnea is greater in normal-weight than in overweight women. OBJECTIVES The aim of this study was to identify clinical features that could predict sleep apnea in women. METHOD From 6817 women who previously answered a questionnaire concerning snoring habits, 230 women who reported habitual snoring and 170 women from the whole cohort went through a full-night polysomnography. A nose and throat examination including fiber endoscopic evaluation of the upper airways during the Muller maneuver was performed in a random selection of 132 women aged 20-70 years. RESULTS Sleep apnea was defined as an apnea-hypopnea index of > or = 10. The influence of clinical features on the prevalence of sleep apnea varied between normal-weight and overweight women. A low soft palate, retrognathia, the uvula touching the posterior pharyngeal wall in the supine position, and a 75% or more collapse at the soft palate during the Muller maneuver were all significant predictors of sleep apnea in women with a body mass index (BMI) < 25 kg/m2 but not in overweight women.
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Affiliation(s)
- Malin Svensson
- Department of Surgical Sciences, Otolaryngology and Head- and Neck Surgery, Uppsala University, Uppsala, Sweden.
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Svensson M, Lindberg E, Naessen T, Janson C. Risk Factors Associated With Snoring in Women With Special Emphasis on Body Mass Index. Chest 2006; 129:933-41. [PMID: 16608941 DOI: 10.1378/chest.129.4.933] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES Habitual snoring may be regarded as an indicator of sleep-disordered breathing, and the health consequences of sleep-disordered breathing are well-known. The aim of this study was to analyze the risk factors associated with habitual snoring in a large sample of women, with special emphasis on the determinants of snoring in women with different body mass index (BMI) levels. DESIGN AND SETTING A cross-sectional, epidemiologic, population-based study was performed by using a postal questionnaire that was sent to a randomly selected sample of 6,817 women >/= 20 years of age in Uppsala, Sweden. RESULTS The total prevalence of self-reported habitual snoring was 7.6%. There was a clear age dependence, with the highest prevalence of habitual snoring (14%) occurring between the ages of 50 and 59 years. Self-reported habitual snoring was related to BMI, neck circumference, and smoking >/= 10 cigarettes a day, after adjusting for possible confounders. When analyzing the influence of different risk factors in separate BMI groups, the results varied among the groups. The influence of alcohol dependence on snoring frequency was only significant in women with a BMI of < 20 kg/m(2), while physical inactivity was only associated with habitual snoring in women with a BMI of >/= 30 kg/m(2). CONCLUSIONS The prevalence of self-reported habitual snoring in women was strongly dependent on age and BMI. The importance of other risk factors differed depending on BMI, with alcohol dependence being associated with self-reported snoring in lean women, whereas physical inactivity was a risk factor for self-reported snoring in women with a high BMI.
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Affiliation(s)
- Malin Svensson
- Otorhinolaryngology and Head and Neck Surgery, Akademiska sjukhuset, SE-751 85 Uppsala, Sweden.
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Cho N, Joo S, Kim J, Abbott RD, Kim J, Kimm K, Shin C. Relation of habitual snoring with components of metabolic syndrome in Korean adults. Diabetes Res Clin Pract 2006; 71:256-63. [PMID: 16112240 DOI: 10.1016/j.diabres.2005.06.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2004] [Revised: 06/24/2005] [Accepted: 06/24/2005] [Indexed: 11/24/2022]
Abstract
AIMS To examine the association between habitual snoring and components of the metabolic syndrome in Korean adults. Whether these associations are independent of obesity was also explored. METHODS Four thousand five hundred and six men and 5041 women aged 40-69 years from the Korean Health and Genome Study were examined. Information of snoring frequency was obtained by a questionnaire and components of the metabolic syndrome were measured. RESULTS There was a clear dose-response relationship between the increasing frequency of snoring and the higher prevalence of each component of the metabolic syndrome (P<0.001). After adjustment for age, abdominal obesity, and the other metabolic components, hypertension was significantly associated with a 1.2-fold excess of habitual snoring in both men (P<0.05) and women (P<0.05). The association of habitual snoring with hypertension was unaltered by obesity. Regardless of the presence or absence of abdominal obesity, there was an increase in the prevalence of habitual snoring as the number of metabolic abnormalities increased. CONCLUSIONS Habitual snoring is associated with hypertension independent of obesity. While the relationship between habitual snoring and obesity is well recognized, characterization of the role of the other components of the metabolic syndrome as a cause or result of habitual snoring warrants a further study.
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Affiliation(s)
- Namhan Cho
- Department of Preventive Medicine, Ajou University School of Medicine, Republic of Korea
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