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Yeh E, Chaudhary N, Strohl KP. Obstructive Sleep Apnea: Clinical Epidemiology and Presenting Manifestations. Respir Med 2022. [DOI: 10.1007/978-3-030-93739-3_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Liu R, Li C, Xu H, Wu K, Li X, Liu Y, Yuan J, Meng L, Zou J, Huang W, Yi H, Sheng B, Guan J, Yin S. Fusion of Whole Night Features and Desaturation Segments Combined with Feature Extraction for Event-Level Screening of Sleep-Disordered Breathing. Nat Sci Sleep 2022; 14:927-940. [PMID: 35607445 PMCID: PMC9123935 DOI: 10.2147/nss.s355369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 05/03/2022] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Misdiagnosis and missed diagnosis of sleep-disordered breathing (SDB) is common because polysomnography (PSG) is time-consuming, expensive, and uncomfortable. The use of recording methods based on the oxygen saturation (SpO2) signals detected by wearable devices is impractical and inaccurate for extracting signal features and detecting apnoeic events. We propose a method to automatically detect the apnoea-based SpO2 signal segments and compute the apnoea-hypopnea index (AHI) for SDB screening and grading. PATIENTS AND METHODS First, apnoea-related desaturation segments in raw SpO2 signals were detected; global features were extracted from whole night signals. Then, the SpO2 signal segments and global features were fed into a bi-directional long short-term memory convolutional neural network model to identify apnoea-related and non-apnoea-related events. The apnoea-related segments were used to assess the AHI. RESULTS The model was trained on 500 individuals and tested on 8131 individuals from two public hospitals and one private centre. In the testing data, the classification accuracy for apnoea-related segments was 84.3%. Individuals with SDB (AHI 15) were identified with a mean accuracy of 88.95%. CONCLUSION Using automatic SDB detection based on SpO2 signals can accurately screen for SDB.
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Affiliation(s)
- Ruhan Liu
- Department of Otolaryngology Head and Neck Surgery and Shanghai Key Laboratory of Sleep Disordered Breathing & Otolaryngological Institute of Shanghai Jiao Tong University, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China.,Department of Computer Science and Engineering, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Chenyang Li
- Department of Otolaryngology Head and Neck Surgery and Shanghai Key Laboratory of Sleep Disordered Breathing & Otolaryngological Institute of Shanghai Jiao Tong University, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Huajun Xu
- Department of Otolaryngology Head and Neck Surgery and Shanghai Key Laboratory of Sleep Disordered Breathing & Otolaryngological Institute of Shanghai Jiao Tong University, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Kejia Wu
- Department of Otolaryngology Head and Neck Surgery and Shanghai Key Laboratory of Sleep Disordered Breathing & Otolaryngological Institute of Shanghai Jiao Tong University, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Xinyi Li
- Department of Otolaryngology Head and Neck Surgery and Shanghai Key Laboratory of Sleep Disordered Breathing & Otolaryngological Institute of Shanghai Jiao Tong University, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Yupu Liu
- Department of Otolaryngology Head and Neck Surgery and Shanghai Key Laboratory of Sleep Disordered Breathing & Otolaryngological Institute of Shanghai Jiao Tong University, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Jie Yuan
- Department of Otolaryngology Head and Neck Surgery and Shanghai Key Laboratory of Sleep Disordered Breathing & Otolaryngological Institute of Shanghai Jiao Tong University, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Lili Meng
- Department of Otolaryngology Head and Neck Surgery and Shanghai Key Laboratory of Sleep Disordered Breathing & Otolaryngological Institute of Shanghai Jiao Tong University, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Jianyin Zou
- Department of Otolaryngology Head and Neck Surgery and Shanghai Key Laboratory of Sleep Disordered Breathing & Otolaryngological Institute of Shanghai Jiao Tong University, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Weijun Huang
- Department of Otolaryngology Head and Neck Surgery and Shanghai Key Laboratory of Sleep Disordered Breathing & Otolaryngological Institute of Shanghai Jiao Tong University, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Hongliang Yi
- Department of Otolaryngology Head and Neck Surgery and Shanghai Key Laboratory of Sleep Disordered Breathing & Otolaryngological Institute of Shanghai Jiao Tong University, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Bin Sheng
- Department of Computer Science and Engineering, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Jian Guan
- Department of Otolaryngology Head and Neck Surgery and Shanghai Key Laboratory of Sleep Disordered Breathing & Otolaryngological Institute of Shanghai Jiao Tong University, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Shankai Yin
- Department of Otolaryngology Head and Neck Surgery and Shanghai Key Laboratory of Sleep Disordered Breathing & Otolaryngological Institute of Shanghai Jiao Tong University, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
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Evidence of an Association of Obstructive Sleep Apnea with Diabetes and Diabetic Complications. CURRENT SLEEP MEDICINE REPORTS 2021. [DOI: 10.1007/s40675-021-00217-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Palen BN, Mattox EA, He K, Beste LA, Borgerding J, Patel S, Au DH, Chang MF, Parsons EC. Impact of Sleep Telementorship in Primary Care: Sleep VA-ECHO (Veterans Affairs-Extension for Community Healthcare Outcomes). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189914. [PMID: 34574837 PMCID: PMC8464697 DOI: 10.3390/ijerph18189914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/13/2021] [Accepted: 09/15/2021] [Indexed: 11/16/2022]
Abstract
Sleep VA-ECHO (Veterans Affairs-Extension for Community Healthcare Outcomes) is a national telementorship program intended to improve knowledge about sleep disorders among non-specialty providers. The project goal was to describe the characteristics of Sleep VA-ECHO participants from primary care and their use of program-obtained knowledge in practice. Sleep VA-ECHO consisted of 10 voluntary, 75-min teleconference sessions combining didactics and case discussion. Out of 86 participants, 21 self-identified as primary care team members and completed a program evaluation. Participants self-reported their application of knowledge gained, including changes to practice as a result of program participation. These 21 participants represented 18 sites in 11 states and attended a median of 5.0 sessions. They included physicians (29%), nurse practitioners (24%), and registered nurses (24%). Nearly all participants (95%) reported using acquired knowledge to care for their own patients at least once a month; 67% shared knowledge with colleagues at least once a month. Eighty-five percent reported improved quality of sleep care for their patients, and 76% reported an expanded clinical skillset. The greatest self-reported change in practice occurred in patient education about sleep disorders (95%) and non-pharmacologic management of insomnia (81%).
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Affiliation(s)
- Brian N. Palen
- Pulmonary and Critical Care Section, Veterans Affairs Puget Sound Health Care System, Seattle, WA 98108, USA; (K.H.); (D.H.A.); (E.C.P.)
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, WA 98195, USA
- Correspondence: (B.N.P.); (E.A.M.)
| | - Elizabeth A. Mattox
- Pulmonary and Critical Care Section, Veterans Affairs Puget Sound Health Care System, Seattle, WA 98108, USA; (K.H.); (D.H.A.); (E.C.P.)
- Correspondence: (B.N.P.); (E.A.M.)
| | - Ken He
- Pulmonary and Critical Care Section, Veterans Affairs Puget Sound Health Care System, Seattle, WA 98108, USA; (K.H.); (D.H.A.); (E.C.P.)
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, WA 98195, USA
| | - Lauren A. Beste
- General Medicine Service, Veterans Affairs Puget Sound Health Care System, Seattle, WA 98108, USA;
- Health Services Research and Development Center for Innovation, Veterans Affairs Puget Sound Health Care System, Seattle, WA 98108, USA;
| | - Joleen Borgerding
- Health Services Research and Development Center for Innovation, Veterans Affairs Puget Sound Health Care System, Seattle, WA 98108, USA;
| | - Sarah Patel
- Department of Medicine, University of Arizona, Tucson, AZ 85721, USA;
- Sonoran Sleep Center, Glendale, AZ 85306, USA
| | - David H. Au
- Pulmonary and Critical Care Section, Veterans Affairs Puget Sound Health Care System, Seattle, WA 98108, USA; (K.H.); (D.H.A.); (E.C.P.)
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, WA 98195, USA
- Health Services Research and Development Center for Innovation, Veterans Affairs Puget Sound Health Care System, Seattle, WA 98108, USA;
| | - Michael F. Chang
- Gastroenterology and Hepatology Service, Veterans Affairs Portland Health Care System, Portland, OR 97239, USA;
- Gastroenterology and Hepatology Division, Oregon Health & Sciences University, Portland, OR 97239, USA
| | - Elizabeth C. Parsons
- Pulmonary and Critical Care Section, Veterans Affairs Puget Sound Health Care System, Seattle, WA 98108, USA; (K.H.); (D.H.A.); (E.C.P.)
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, WA 98195, USA
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Diagnosis of Sleep Apnea Syndrome in the Intensive Care Unit: A Case Series of Survivors of Hypercapnic Respiratory Failure. Ann Am Thorac Soc 2021; 18:727-729. [PMID: 33171053 DOI: 10.1513/annalsats.202005-425rl] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Mandereau-Bruno L, Léger D, Delmas MC. Obstructive sleep apnea: A sharp increase in the prevalence of patients treated with nasal CPAP over the last decade in France. PLoS One 2021; 16:e0245392. [PMID: 33434230 PMCID: PMC7802947 DOI: 10.1371/journal.pone.0245392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 12/29/2020] [Indexed: 12/02/2022] Open
Abstract
Introduction Obstructive sleep apnea (OSA) is a frequent condition. In the absence of treatment, OSA is associated with a higher risk of traffic accidents and a large variety of diseases. The objectives of this study were to describe the characteristics of patients treated for OSA in France and assess the time trends in treatment. Methods The French National Health Data System is an individual database with data on all healthcare reimbursements for the entire French population. Based on this database, we included all patients aged 20 years or over who were treated with continuous positive airway pressure (CPAP) or mandibular advancement splint (MAS) between 2009 and 2018. Negative binomial models, adjusted for age, were used to assess time trends in treatment prevalence and incidence rates. Results In 2017, 2.3% of French adults aged ≥20 years were treated with CPAP (men: 3.3%; women: 1.3%). The highest prevalence was observed in people aged 70–74 years (5.0%). From 2009 to 2018, the annual prevalence of CPAP increased 3-fold and the annual incidence 1.9-fold. During the same period, the rate of patients reimbursed for MAS (first prescription or renewal) was multiplied by 7.6. The proportion of patients treated with CPAP in 2017 who were no longer treated in the subsequent year was 6.9%. Discussion The sharp increase in the incidence of OSA treatment probably reflects a better recognition of the disease in France. However, the prevalence of OSA treatment remains lower than expected based on the international literature. Further studies are needed to identify the obstacles to an optimal management of individuals with OSA in France.
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Affiliation(s)
| | - Damien Léger
- EA 7330 VIFASOM and APHP-Hôtel Dieu, Centre du Sommeil et de la Vigilance, Université de Paris, Paris, France
| | - Marie-Christine Delmas
- Santé Publique France, The French National Public Health Agency, Saint-Maurice, France
- * E-mail:
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Matsumoto T, Murase K, Tabara Y, Minami T, Kanai O, Takeyama H, Takahashi N, Hamada S, Tanizawa K, Wakamura T, Komenami N, Setoh K, Kawaguchi T, Tsutsumi T, Morita S, Takahashi Y, Nakayama T, Hirai T, Matsuda F, Chin K. Sleep disordered breathing and metabolic comorbidities across sex and menopausal status in East Asians: the Nagahama Study. Eur Respir J 2020; 56:13993003.02251-2019. [DOI: 10.1183/13993003.02251-2019] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 04/20/2020] [Indexed: 01/07/2023]
Abstract
It is well known that the prevalence of sleep disordered breathing (SDB) is increased in patients with obesity or metabolic comorbidities. However, the way in which the prevalence of SDB increases in relation to comorbidities according to the severity of obesity remains unclear.This cross-sectional study evaluated 7713 community participants using nocturnal oximetry ≥2 nights. SDB was assessed by the 3% oxygen desaturation index corrected for sleep duration obtained by wrist actigraphy (acti-ODI3%). SDB severity was defined by acti-ODI3%. Obesity was defined as body mass index ≥25 kg·m−2.The prevalence of SDB was 41.0% (95% CI 39.9–42.1%), 46.9% (45.8–48.0%), 10.1% (9.5–10.8%) and 2.0% (1.7–2.3%) in normal, mild, moderate and severe SDB, respectively, with notable sex differences evident (males>post-menopausal females>premenopausal females). Comorbidities such as hypertension, diabetes and metabolic syndrome were independently associated with the prevalence of moderate-to-severe SDB, and coincidence of any one of these with obesity was associated with a higher probability of moderate-to-severe SDB (hypertension OR 8.2, 95% CI 6.6–10.2; diabetes OR 7.8, 95% CI 5.6–10.9; metabolic syndrome OR 6.7, 95% CI 5.2–8.6). Dyslipidaemia in addition to obesity was not additively associated with the prevalence of moderate-to-severe SDB. The number of antihypertensive drugs was associated with SDB (p for trend <0.001). Proportion of a high cumulative percentage of sleep time with oxygen saturation measured by pulse oximetry <90% increased, even among moderate-to-severe SDB with increases in obesity.Metabolic comorbidities contribute to SDB regardless of the degree of obesity. We should recognise the extremely high prevalence of moderate-to-severe SDB in patients with obesity and metabolic comorbidities.
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Lubas MM, Ware JC, Szklo-Coxe M. Sleep apnea and kidney transplant outcomes: findings from a 20-year (1997-2017) historical cohort study. Sleep Med 2019; 63:151-158. [PMID: 31669818 DOI: 10.1016/j.sleep.2019.05.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/14/2019] [Accepted: 05/29/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVE/BACKGROUND A historic cohort single-center study of kidney transplant recipients with graft loss examined the associations between sleep apnea and two transplant outcomes, death with a functioning graft (DWFG), and graft survival time. PATIENT/METHODS Adult patients who received transplants and experienced graft failure or DWFG from January 1, 1997 to January 1, 2017 constituted the cohort (n = 322). Data for the study were obtained by merging two secondary data sources: the Organ Procurement and Transplantation Network (OPTN) database and the transplant center's medical records. A Cox regression modeled the association of diagnosed sleep apnea, stratified by year-of transplant surgery, with graft survival time. Using backward elimination, this model was adjusted for recipient age, race/ethnicity, gender, functional status, donor age, and antigen mismatch. RESULTS No statistically significant differences were found for proportions of DWFG in those with, versus without, sleep apnea, informing our censoring approach. When examining graft survival time, the Cox regression model was stratified given a sleep apnea and year-of-transplant interaction (p < 0.01, adjusted model). For patients transplanted between 1997 and 2008, sleep apnea was statistically significantly associated with a decreased risk of graft failure or cardiovascular-related DWFG [adjusted Hazard Ratio (aHR) = 0.63, 95%CI, 0.42-0.94]. For patients transplanted between 2009 and 2017, sleep apnea statistically significantly increased the risk of graft failure or cardiovascular-related DWFG (aHR = 2.61, 95%CI, 1.13-6.00). CONCLUSIONS In a cohort of transplant recipients with graft loss, sleep apnea increased the risk of graft loss nearly three-fold among patients transplanted between 2009 and 2017. Similar DWFG proportions by sleep apnea presence indicate this risk is likely driven by renal failure, not mortality. Further research on whether treatment of sleep apnea can improve graft survival is warranted.
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Affiliation(s)
- Margaret M Lubas
- School of Community and Environmental Health, College of Health Sciences, Old Dominion University, Norfolk, VA, USA
| | - J Catesby Ware
- Division of Sleep Medicine, Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Mariana Szklo-Coxe
- School of Community and Environmental Health, College of Health Sciences, Old Dominion University, Norfolk, VA, USA; Division of Sleep Medicine, Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA, USA.
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Vakharia RM, Cohen-Levy WB, Vakharia AM, Donnally CJ, Law TY, Roche MW. Sleep Apnea Increases Ninety-Day Complications and Cost Following Primary Total Joint Arthroplasty. J Arthroplasty 2019; 34:959-964.e1. [PMID: 30814026 DOI: 10.1016/j.arth.2018.12.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 12/12/2018] [Accepted: 12/13/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Sleep apnea (SA) negatively affects bone mineralization, cognition, and immunity. There is paucity in the literature regarding the impact of SA on total joint arthroplasty (TJA). The purpose of this study is to compare complications in patients with and without SA undergoing either total knee (TKA) or total hip arthroplasty (THA). METHODS A retrospective review from 2005 to 2014 was conducted using the Medicare Standard Analytical Files. Patients with and without SA on the day of the primary TJA were queried using the International Classification of Diseases, ninth revision codes. Patients were matched by age, gender, Charlson Comorbidity Index), and body mass index. Patients were followed for 2 years after their surgery. Ninety-day medical complications, complications related to implant, readmission rates, length of stay, and 1-year mortality were quantified and compared. Logistic regression was used to calculate odds ratios (OR) with their respective 95% confidence interval and P values. RESULTS After the random matching process there were 529,240 patients (female = 271,656, male = 252,106, unknown = 5478) with (TKA = 189,968, THA = 74,652) and without (TKA = 189,968, THA = 74,652) SA who underwent primary TJA between 2005 and 2014. Patients with SA had greater odds of developing medical complications following TKA (OR 3.71) or THA (OR 2.48). CONCLUSION The study illustrates an increased risk of developing postoperative complications in patients with SA following primary TJA. Surgeons should educate patients on these adverse effects and encourage the use of continuous positive airway pressure which has been shown to mitigate many postoperative complications.
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Affiliation(s)
| | - Wayne B Cohen-Levy
- Department of Orthopedic Surgery, University of Miami Hospital, Miami, FL
| | | | - Chester J Donnally
- Department of Orthopedic Surgery, University of Miami Hospital, Miami, FL
| | - Tsun Yee Law
- Holy Cross Hospital, Orthopedic Research Institute, Fort Lauderdale, FL
| | - Martin W Roche
- Holy Cross Hospital, Orthopedic Research Institute, Fort Lauderdale, FL
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Wang CA, Palmer JR, Madden MO, Cohen-Levy W, Vakharia RM, Roche MW. Perioperative complications in patients with sleep apnea following primary total shoulder arthroplasty: An analysis of 33,366 patients. J Orthop 2019; 16:382-385. [PMID: 31110398 DOI: 10.1016/j.jor.2019.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 04/08/2019] [Indexed: 12/22/2022] Open
Abstract
Introduction The study evaluated whether sleep apnea (SA) patients undergoing total shoulder arthroplasty (TSA) are at greater odds of: 1) medical complications; 2) implant-related complications; 3) readmission rates; and 4) costs. Methods Complications and readmissions were assessed using logistic regression analysis. Welch's t-test was used to compare CCI and cost between cohorts. Results 33,366 patients equally distributed in both cohorts. SA increased the odds of medical [Odds-ratio (OR)]: 2.52, p < 0.001) and implant-related complications (OR: 1.43, p < 0.001). Readmission rates were similar to controls (OR: 0.99, p = 0.878), whereas costs were higher (p < 0.001). Conclusion SA increases complications and costs following TSA.
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Affiliation(s)
- Christopher A Wang
- Broward Health Medical Center, Department of Orthopedic Surgery Ft. Lauderdale, FL, 33316, USA
| | - Joseph R Palmer
- Broward Health Medical Center, Department of Orthopedic Surgery Ft. Lauderdale, FL, 33316, USA
| | - Michael O Madden
- Broward Health Medical Center, Department of Orthopedic Surgery Ft. Lauderdale, FL, 33316, USA
| | - Wayne Cohen-Levy
- University of Miami Hospital, Department of Orthopedic Surgery, Miami, FL, 33136, USA
| | - Rushabh M Vakharia
- Holy Cross Hospital, Orthopedic Research Institute, Ft. Lauderdale, FL, 33308, USA
| | - Martin W Roche
- Holy Cross Hospital, Orthopedic Research Institute, Ft. Lauderdale, FL, 33308, USA
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Peppard PE, Hagen EW. The Last 25 Years of Obstructive Sleep Apnea Epidemiology-and the Next 25? Am J Respir Crit Care Med 2019; 197:310-312. [PMID: 29035088 DOI: 10.1164/rccm.201708-1614pp] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- Paul E Peppard
- University of Wisconsin-Madison School of Medicine and Public Health, Department of Population Health Sciences, Madison, Wisconsin
| | - Erika W Hagen
- University of Wisconsin-Madison School of Medicine and Public Health, Department of Population Health Sciences, Madison, Wisconsin
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Crump C, Sundquist J, Winkleby MA, Sundquist K. Cardiorespiratory fitness and long-term risk of sleep apnea: A national cohort study. J Sleep Res 2019; 28:e12851. [PMID: 30957362 DOI: 10.1111/jsr.12851] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 02/25/2019] [Accepted: 02/26/2019] [Indexed: 01/20/2023]
Abstract
Sleep apnea is increasing in prevalence, and is an important cause of cardiometabolic diseases and mortality worldwide. Its only established modifiable risk factor is obesity; however, up to half of all sleep apnea cases may occur in non-obese persons, and hence there is a pressing need to identify other modifiable risk factors to facilitate more effective prevention. We sought to examine, for the first time, cardiorespiratory fitness in relation to the risk of sleep apnea, independent of obesity. A national cohort study was conducted to examine cardiorespiratory fitness in all 1,547,478 Swedish military conscripts during 1969-1997 (97%-98% of all 18-year-old men) in relation to risk of sleep apnea through 2012 (maximum age 62 years). Cardiorespiratory fitness was measured as maximal aerobic workload in Watts, and sleep apnea was identified from nationwide outpatient and inpatient diagnoses. A total of 44,612 (2.9%) men were diagnosed with sleep apnea in 43.7 million person-years of follow-up. Adjusting for age, height, weight, socioeconomic factors and family history of sleep apnea, low cardiorespiratory fitness at age 18 years was associated with a significantly increased risk of sleep apnea in adulthood (lowest versus highest cardiorespiratory fitness tertile: incidence rate ratio, 1.44; 95% confidence interval, 1.40-1.49; p < 0.001; continuous cardiorespiratory fitness per 100 Watts: incidence rate ratio, 0.71; 95% confidence interval, 0.70-0.73; p < 0.001). An increased risk was observed even among men with normal body mass index (lowest versus highest cardiorespiratory fitness tertile: incidence rate ratio, 1.30; 95% confidence interval, 1.26-1.35; p < 0.001). These findings identify low cardiorespiratory fitness early in life as a new modifiable risk factor for development of sleep apnea in adulthood.
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Affiliation(s)
- Casey Crump
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jan Sundquist
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Marilyn A Winkleby
- Stanford Prevention Research Center, Stanford University, Stanford, CA, USA
| | - Kristina Sundquist
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Center for Primary Health Care Research, Lund University, Malmö, Sweden
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Prevalence of sleep disturbances: Sleep disordered breathing, short sleep duration, and non-restorative sleep. Respir Investig 2019; 57:227-237. [PMID: 30827934 DOI: 10.1016/j.resinv.2019.01.008] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 01/16/2019] [Accepted: 01/29/2019] [Indexed: 01/14/2023]
Abstract
Recently, interest in sleep disturbances, such as sleep disordered breathing (SDB), short sleep duration, and non-restorative sleep (NRS), has been increasing. The potentially large public health implications of sleep disturbances indicate a need to determine their prevalence in a general population. This review describes the characteristics of population-based sleep cohorts from past to present. Unavoidable methodological and baseline characteristic heterogeneity was found between studies. The prevalence of SDB (apnea hypopnea index (AHI), respiratory disturbance index (RDI), or oxygen desaturation index (ODI) ≥5/h) was 24.0-83.8% in men and 9.0-76.6% in women, and that of moderate-to-severe SDB (AHI, RDI, or ODI ≥15/h) was 7.2-67.2% in men and 4.0-50.9% in women. Additionally, the prevalence of SDB in post-menopausal women was 3-6 times higher than in pre-menopausal women. The prevalence of subjective short sleep duration (<6 h) was 7.5-9.6%, while that of objective short sleep duration (<6 h) was 22.1-53.3%. The prevalence of NRS was 19.2-31.0% in men and 26.3-42.1% in women, as determined from studies using a yes-no questionnaire, while a multi-national survey using a telephone-based expert system showed a wide range of prevalence between countries, from 2.4% to 16.1%. An association between SDB, short sleep duration, and NRS has recently been suggested. To gain a better understanding of the burden of sleep disturbances, a consensus on the definition of several sleep disturbances is needed, as methodological heterogeneity exists, including SDB scoring rules, subjective versus objective data collection for short sleep duration, and the definition of NRS itself.
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Matsumoto T, Murase K, Tabara Y, Gozal D, Smith D, Minami T, Tachikawa R, Tanizawa K, Oga T, Nagashima S, Wakamura T, Komenami N, Setoh K, Kawaguchi T, Tsutsumi T, Takahashi Y, Nakayama T, Hirai T, Matsuda F, Chin K. Impact of sleep characteristics and obesity on diabetes and hypertension across genders and menopausal status: the Nagahama study. Sleep 2018; 41:4985386. [DOI: 10.1093/sleep/zsy071] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Indexed: 12/20/2022] Open
Affiliation(s)
- Takeshi Matsumoto
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kimihiko Murase
- Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yasuharu Tabara
- Center for Genomic Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - David Gozal
- Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL
| | - Dale Smith
- Department of Behavioral Sciences, Olivet Nazarene University, Bourbonnais
| | - Takuma Minami
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ryo Tachikawa
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kiminobu Tanizawa
- Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toru Oga
- Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shunsuke Nagashima
- Nursing Science, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tomoko Wakamura
- Nursing Science, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Naoko Komenami
- Department of Food and Nutrition, Kyoto Women’s University, Kyoto, Japan
| | - Kazuya Setoh
- Center for Genomic Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takahisa Kawaguchi
- Center for Genomic Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takanobu Tsutsumi
- Center for Genomic Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yoshimitsu Takahashi
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Takeo Nakayama
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Toyohiro Hirai
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Fumihiko Matsuda
- Center for Genomic Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kazuo Chin
- Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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15
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Chin K. Respiratory sleep medicine along with conventional medicine aids in healthy life expectancy. Respir Investig 2017; 55:289-290. [PMID: 28942882 DOI: 10.1016/j.resinv.2017.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Kazuo Chin
- The Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Japan.
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16
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Namen AM, Forest DJ, Huang KE, Feldman SR, Hazzard WR, Peters SP, Haponik EF. Physicians Report Sleep Apnea Infrequently in Older and Older Vulnerable Adults. J Am Geriatr Soc 2017; 65:2023-2028. [PMID: 28470836 DOI: 10.1111/jgs.14929] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVES To determine how often outpatient physician visits detect sleep apnea (SA) in older persons in the United States. DESIGN Retrospective Analysis. SETTING US non hospital and hospital based clinics. PARTICIPANTS US physicians. MEASUREMENTS National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey data from 1993 to 2011 were used to assess the frequency of physicians' coding diagnoses of SA in persons aged 65 and older. Which specialties are most likely to report SA, the most-common comorbid conditions reported with SA, and the likelihood of reporting SA in patient visits for dementia and preoperative care were assessed. RESULTS From 1993 to 2011, physicians reported SA in 0.3% of all office visits in persons aged 65 and older. SA reported in visits increased from 130,000 in 1993 to 2,070,000 in 2011, with an annual per capita visit reporting rate of 0.07% to 0.74%. In older populations, the proportion of documented SA visits by specialists rose, and that of primary care providers decreased. Older adults with a diagnosis of SA had higher average number of comorbidities than those without SA (1.8 vs 1.3). Reporting SA was low in visits with a diagnosis of dementia and classified as a preoperative visits. CONCLUSION In two nationwide surveys, SA reporting by physicians in elderly adults was 16 as greater in 2001 as in 1993, although reporting of SA remains infrequent (<1% of visits) even in vulnerable populations.
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Affiliation(s)
- Andrew M Namen
- Section on Pulmonary, Critical Care, Allergy and Immunologic Disease, Wake Forest University, Winston-Salem, North Carolina
| | - Daniel J Forest
- Department of Anesthesiology, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Karen E Huang
- Department of Dermatology, Wake Forest University, Winston-Salem, North Carolina
| | - Steven R Feldman
- Department of Dermatology, Wake Forest University, Winston-Salem, North Carolina
| | - William R Hazzard
- Section of Gerontology, Wake Forest University, Winston-Salem, North Carolina
| | - Stephen P Peters
- Section on Pulmonary, Critical Care, Allergy and Immunologic Disease, Wake Forest University, Winston-Salem, North Carolina
| | - Edward F Haponik
- Section on Pulmonary, Critical Care, Allergy and Immunologic Disease, Wake Forest University, Winston-Salem, North Carolina
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