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Vidigal TA, Haddad FLM, Guimaraes TM, Silva LO, Andersen ML, Schwab R, Cistulli PA, Pack AI, Tufik S, Bittencourt LRA. Can intraoral and facial photos predict obstructive sleep apnea in the general and clinical population? Sleep 2024; 47:zsad307. [PMID: 38038363 DOI: 10.1093/sleep/zsad307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 11/22/2023] [Indexed: 12/02/2023] Open
Abstract
STUDY OBJECTIVES This study aimed to evaluate and compare measurements of standardized craniofacial and intraoral photographs between clinical and general population samples, between groups of individuals with an apnea-hypopnea index (AHI) ≥ 15 and AHI < 15, and their interaction, as well as the relationship with the presence and severity of obstructive sleep apnea (OSA). METHODS We used data from 929 participants from Sleep Apnea Global Interdisciplinary Consortium, in which 309 patients from a clinical setting and 620 volunteers from a general population. RESULTS AHI ≥ 15 were observed in 30.3% of the total sample and there were some interactions between facial/intraoral measures with OSA and both samples. Mandibular volume (p < 0.01) and lateral face height (p = 0.04) were higher in the AHI ≥ 15 group in the clinical sample compared to the AHI ≥ 15 group in the general population and AHI < 15 group in the clinical sample. When adjusted for sex and age, greater mandible width (p < 0.01) differed both in the clinical and in the general population samples, reflecting AHI severity and the likelihood of OSA. The measure of smaller tongue curvature (p < 0.01) reflected the severity and probability of OSA in the clinical sample and the higher posterior mandibular height (p = 0.04) showed a relationship with higher AHI and higher risk of OSA in the general population. When adjusted for sex, age, and body mass index, only smaller tongue curvature (p < 0.01) was associated with moderate/severe OSA. CONCLUSIONS Measures of greater tongue and mandible were associated with increased OSA risk in the clinical sample and craniofacial measurement was associated in the general population sample.
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Affiliation(s)
- Tatiana A Vidigal
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Fernanda L M Haddad
- Departamento de Otorrinolaringologia, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Thaís M Guimaraes
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Luciana O Silva
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Monica L Andersen
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
- Sleep Institute, São Paulo, Brazil
| | - Richard Schwab
- Division of Sleep Medicine, Pulmonary, Allergy and Critical Care Division, Department of Medicine, Penn Sleep Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Peter A Cistulli
- Department of Respiratory and Sleep Medicine, Centre for Sleep Health and Research, Royal NorthShore Hospital, St Leonards, NSW, Australia
| | - Alan I Pack
- Division of Sleep Medicine/Department of Medicine, Center for Sleep and Circadian Neurobiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Sergio Tufik
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
- Sleep Institute, São Paulo, Brazil
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Sadeghniiat-Haghighi K, Akbarpour S, Behkar A, Moradzadeh R, Alemohammad ZB, Forouzan N, Mouseli A, Amirifard H, Najafi A. A nationwide study on the prevalence and contributing factors of obstructive sleep apnea in Iran. Sci Rep 2023; 13:17649. [PMID: 37848453 PMCID: PMC10582253 DOI: 10.1038/s41598-023-44229-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 10/05/2023] [Indexed: 10/19/2023] Open
Abstract
Reliable obstructive sleep apnea (OSA) prevalence information in Iran is lacking due to inconsistent local study results. To estimate OSA prevalence and identify clinical phenotypes, we conducted a nationally representative study using multi-stage random cluster sampling. We recruited 3198 individuals and extrapolated the results to the entire Iranian population using complex sample survey analyses. We identified 3 clinical phenotypes as "sleepy," "insomnia," and "restless legs syndrome (RLS)." The prevalence of OSA was 28.7% (95%CI: 26.8-30.6). The prevalence of "sleepy," "insomnia," and "RLS" phenotypes were 82.3%, 77.8%, and 36.5% in women, and 64.8%, 67.5%, and 17.9% in men, respectively. "Sleepy" and "insomnia" phenotypes overlapped the most. Age (OR: 1.9), male sex (OR: 3.8), BMI (OR: 1.13), neck circumference (OR: 1.3), RLS (OR: 2.0), and insomnia (OR: 2.3) were significant OSA predictors (p-values: 0.001). In men, "sleepy" phenotype was associated with youth and unmarried status but not in women. The "insomnia" phenotype was associated with shorter sleep duration in women; cardiovascular diseases (CVD), urban residency, and shorter sleep duration in men. "RLS" phenotype was associated with shorter sleep duration and CVD in women and older age, lower educational level, CVD, and hypertension in men. The findings point to the need for funding of OSA screening in Iran, for a different assessment of men and women, and for future sleep research to consider overlapping phenotypes.
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Affiliation(s)
- Khosro Sadeghniiat-Haghighi
- Sleep Breathing Disorders Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Occupational Sleep Research Center, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Samaneh Akbarpour
- Sleep Breathing Disorders Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Occupational Sleep Research Center, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Atefeh Behkar
- Occupational Sleep Research Center, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Rahmatollah Moradzadeh
- Department of Epidemiology, School of Health, Arak University of Medical Sciences, Arak, Iran
| | - Zahra Banafsheh Alemohammad
- Sleep Breathing Disorders Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Occupational Sleep Research Center, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Nazanin Forouzan
- Occupational Sleep Research Center, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Mouseli
- Department of Health Services Management, Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Hamed Amirifard
- Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Arezu Najafi
- Occupational Sleep Research Center, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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O'Connor-Reina C, Alcala LR, Ignacio JM, Iriarte MTG, Llatas MC, Morente JCC, Del Rey DP, Alvarez IM, Ibarburu GH, Baptista P, Plaza G. Risk of diabetes in patients with sleep apnea: comparison of surgery versus CPAP in a long-term follow-up study. J Otolaryngol Head Neck Surg 2023; 52:16. [PMID: 36788636 PMCID: PMC9930296 DOI: 10.1186/s40463-022-00616-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 12/14/2022] [Indexed: 02/16/2023] Open
Abstract
This study aimed to obtain a comprehensive view of the risk of developing diabetes in patients with obstructive sleep apnea (OSA) and to compare this risk between patients receiving continuous positive airway pressure (CPAP) therapy versus upper airway surgery (UAS). We used local and the global-scale federated data research network TriNetX to obtain access to electronic medical records, including those for patients diagnosed with OSA, from health-care organizations (HCOs) worldwide. Using propensity score matching and the score-matched analyses of data for 5 years of follow-up, we found that patients who had undergone UAS had a lower risk of developing diabetes than those who used CPAP (risk ratio 0.415, 95% confidence interval (CI) 0.349-0.493). The risk for newly diagnosed diabetes patients showed a similar pattern (hazard ratio 0.382; 95% CI 0.317-0.459). Both therapies seem to protect against diabetes (Risk 0.081 after UAS vs. 0.195 after CPAP). Analysis of the large data sets collected from HCOs in Europe and globally lead us to conclude that, in patients with OSA, UAS can prevent the development of diabetes better than CPAP.
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Affiliation(s)
- Carlos O'Connor-Reina
- Otorhinolaryngology Department, Hospital Quironsalud Marbella, 29680, Marbella, Spain.
- Otorhinolaryngology Department, Hospital Quironsalud Campo de Gibraltar, Palmones, Spain.
| | - Laura Rodriguez Alcala
- Otorhinolaryngology Department, Hospital Quironsalud Marbella, 29680, Marbella, Spain
- Otorhinolaryngology Department, Hospital Quironsalud Campo de Gibraltar, Palmones, Spain
| | | | | | | | | | - David Perez Del Rey
- Biomedical Informatics Group, Universidad Politécnica de Madrid, Madrid, Spain
| | | | | | - Peter Baptista
- Otorhinolaryngology Department, Clínica Universitaria de Navarra, Pamplona, Spain
| | - Guillermo Plaza
- Otorhinolaryngology Department, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, Madrid, Spain
- Otorhinolaryngology Department, Hospital Sanitas la Zarzuela, Madrid, Spain
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Soccio P, Moriondo G, Lacedonia D, Tondo P, Quarato CMI, Foschino Barbaro MP, Scioscia G. EVs-miRNA: The New Molecular Markers for Chronic Respiratory Diseases. LIFE (BASEL, SWITZERLAND) 2022; 12:life12101544. [PMID: 36294979 PMCID: PMC9605003 DOI: 10.3390/life12101544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 09/30/2022] [Accepted: 10/02/2022] [Indexed: 11/16/2022]
Abstract
Idiopathic pulmonary fibrosis (IPF), chronic obstructive pulmonary disease (COPD), asthma and sleep disorders are chronic respiratory diseases that affect the airways, compromising lung function over time. These diseases affect hundreds of millions of people around the world and their frequency seems to be increasing every year. Extracellular vesicles (EVs) are small-sized vesicles released by every cell in the body. They are present in most body fluids and contain various biomolecules including proteins, lipids, mRNA and non-coding RNA (micro-RNA). The EVs can release their cargo, specifically micro-RNAs (miRNAs), to both neighboring and/or distal cells, playing a fundamental role in cell-cell communication. Recent studies have shown their possible role in the pathogenesis of various chronic respiratory diseases. The expression of miRNAs and, in particular, of miRNAs contained within the extracellular vesicles seems to be a good starting point in order to identify new potential biomarkers of disease, allowing a non-invasive clinical diagnosis. In this review we summarize some studies, present in the literature, about the functions of extracellular vesicles and miRNAs contained in extracellular vesicles in chronic respiratory diseases and we discuss the potential clinical applications of EVs and EVs-miRNAs for their possible use such as future biomarkers.
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Affiliation(s)
- Piera Soccio
- Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
| | - Giorgia Moriondo
- Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
- Correspondence:
| | - Donato Lacedonia
- Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
- Institute of Respiratory Diseases, Policlinico Riuniti of Foggia, 71122 Foggia, Italy
| | - Pasquale Tondo
- Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
| | - Carla Maria Irene Quarato
- Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
- Institute of Respiratory Diseases, Policlinico Riuniti of Foggia, 71122 Foggia, Italy
| | - Maria Pia Foschino Barbaro
- Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
- Institute of Respiratory Diseases, Policlinico Riuniti of Foggia, 71122 Foggia, Italy
| | - Giulia Scioscia
- Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
- Institute of Respiratory Diseases, Policlinico Riuniti of Foggia, 71122 Foggia, Italy
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Goodman MO, Cade BE, Shah NA, Huang T, Dashti HS, Saxena R, Rutter MK, Libby P, Sofer T, Redline S. Pathway-Specific Polygenic Risk Scores Identify Obstructive Sleep Apnea-Related Pathways Differentially Moderating Genetic Susceptibility to Coronary Artery Disease. CIRCULATION. GENOMIC AND PRECISION MEDICINE 2022; 15:e003535. [PMID: 36170352 PMCID: PMC9588629 DOI: 10.1161/circgen.121.003535] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 06/02/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) and its features, such as chronic intermittent hypoxia, may differentially affect specific molecular pathways and processes in the pathogenesis of coronary artery disease (CAD) and influence the subsequent risk and severity of CAD events. In particular, competing adverse (eg, inflammatory) and protective (eg, increased coronary collateral blood flow) mechanisms may operate, but remain poorly understood. We hypothesize that common genetic variation in selected molecular pathways influences the likelihood of CAD events differently in individuals with and without OSA, in a pathway-dependent manner. METHODS We selected a cross-sectional sample of 471 877 participants from the UK Biobank, with 4974 ascertained to have OSA, 25 988 to have CAD, and 711 to have both. We calculated pathway-specific polygenic risk scores for CAD, based on 6.6 million common variants evaluated in the CARDIoGRAMplusC4D genome-wide association study (Coronary ARtery DIsease Genome wide Replication and Meta-analysis [CARDIoGRAM] plus The Coronary Artery Disease [C4D] Genetics), annotated to specific genes and pathways using functional genomics databases. Based on prior evidence of involvement with intermittent hypoxia and CAD, we tested pathway-specific polygenic risk scores for the HIF1 (hypoxia-inducible factor 1), VEGF (vascular endothelial growth factor), NFκB (nuclear factor kappa-light-chain-enhancer of activated B cells) and TNF (tumor necrosis factor) signaling pathways. RESULTS In a multivariable-adjusted logistic generalized additive model, elevated pathway-specific polygenic risk scores for the Kyoto Encyclopedia of Genes and Genomes VEGF pathway (39 genes) associated with protection for CAD in OSA (interaction odds ratio 0.86, P=6×10-4). By contrast, the genome-wide CAD PRS did not show evidence of statistical interaction with OSA. CONCLUSIONS We find evidence that pathway-specific genetic risk of CAD differs between individuals with and without OSA in a qualitatively pathway-dependent manner. These results provide evidence that gene-by-environment interaction influences CAD risk in certain pathways among people with OSA, an effect that is not well-captured by the genome-wide PRS. This invites further study of how OSA interacts with genetic risk at the molecular level and suggests eventual personalization of OSA treatment to reduce CAD risk according to individual pathway-specific genetic risk profiles.
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Affiliation(s)
- Matthew O Goodman
- Division of Sleep & Circadian Disorders (M.O.G., B.E.C., R.S., T.S., S.R.), Brigham and Women's Hospital & Harvard Medical School
- Division of Sleep Medicine, Harvard Medical School, Boston (M.O.G., B.E.C., T.H., R.S., T.S., S.R.)
- Program in Medical & Population Genetics, Broad Institute, Cambridge, MA (M.O.G., B.E.C., H.S.D., R.S.)
| | - Brian E Cade
- Division of Sleep & Circadian Disorders (M.O.G., B.E.C., R.S., T.S., S.R.), Brigham and Women's Hospital & Harvard Medical School
- Division of Sleep Medicine, Harvard Medical School, Boston (M.O.G., B.E.C., T.H., R.S., T.S., S.R.)
- Program in Medical & Population Genetics, Broad Institute, Cambridge, MA (M.O.G., B.E.C., H.S.D., R.S.)
| | - Neomi A Shah
- Icahn School of Medicine at Mount Sinai, New York, NY (N.A.S.)
| | - Tianyi Huang
- Channing Division of Network Medicine (T.H.), Brigham and Women's Hospital & Harvard Medical School
- Division of Sleep Medicine, Harvard Medical School, Boston (M.O.G., B.E.C., T.H., R.S., T.S., S.R.)
| | - Hassan S Dashti
- Program in Medical & Population Genetics, Broad Institute, Cambridge, MA (M.O.G., B.E.C., H.S.D., R.S.)
- Center for Genomic Medicine, Massachusetts General Hospital (H.S.D., R.S.)
- Department of Anesthesia, Critical Care & Pain Medicine, Massachusetts General Hospital & Harvard Medical School, Boston (H.S.D., R.S.)
| | - Richa Saxena
- Division of Sleep & Circadian Disorders (M.O.G., B.E.C., R.S., T.S., S.R.), Brigham and Women's Hospital & Harvard Medical School
- Division of Sleep Medicine, Harvard Medical School, Boston (M.O.G., B.E.C., T.H., R.S., T.S., S.R.)
- Program in Medical & Population Genetics, Broad Institute, Cambridge, MA (M.O.G., B.E.C., H.S.D., R.S.)
- Center for Genomic Medicine, Massachusetts General Hospital (H.S.D., R.S.)
- Department of Anesthesia, Critical Care & Pain Medicine, Massachusetts General Hospital & Harvard Medical School, Boston (H.S.D., R.S.)
| | - Martin K Rutter
- Division of Diabetes, Endocrinology & Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester (M.K.R.)
- Diabetes, Endocrinology & Metabolism Centre, Manchester Univ NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom (M.K.R.)
| | - Peter Libby
- Division of Cardiovascular Medicine, Department of Medicine (P.L.), Brigham and Women's Hospital & Harvard Medical School
| | - Tamar Sofer
- Division of Sleep & Circadian Disorders (M.O.G., B.E.C., R.S., T.S., S.R.), Brigham and Women's Hospital & Harvard Medical School
- Division of Sleep Medicine, Harvard Medical School, Boston (M.O.G., B.E.C., T.H., R.S., T.S., S.R.)
| | - Susan Redline
- Division of Sleep & Circadian Disorders (M.O.G., B.E.C., R.S., T.S., S.R.), Brigham and Women's Hospital & Harvard Medical School
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Natsky AN, Vakulin A, Chai-Coetzer CL, McEvoy RD, Adams RJ, Kaambwa B. Preferred Attributes of Care Pathways for Obstructive Sleep Apnoea from the Perspective of Diagnosed Patients and High-Risk Individuals: A Discrete Choice Experiment. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2022; 20:597-607. [PMID: 35141851 PMCID: PMC9206920 DOI: 10.1007/s40258-022-00716-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/20/2022] [Indexed: 06/05/2023]
Abstract
BACKGROUND The current healthcare system is challenged with a large and rising demand for obstructive sleep apnoea (OSA) services. A paradigm shift in OSA management is required to incorporate the preferences of diagnosed patients and individuals at high risk of OSA. OBJECTIVES This study aimed to provide empirical evidence of the values and preferences of individuals diagnosed with OSA and high-risk populations regarding distinct OSA care pathway features. METHODS A discrete choice experiment was undertaken in two groups: those with a formal diagnosis of OSA (n = 421) and those undiagnosed but at high risk of having OSA (n = 1033). Participants were recruited from a large cross-sectional survey in Australia. The discrete choice experiment approach used mixed-logit regression models to determine preferences relating to eight salient features of the OSA management pathway, i.e. initial assessment provider, sleep study setting, diagnosis costs, waiting times, results interpretation, treatment options, provider of ongoing care and frequency of follow-up visits. RESULTS The findings indicate that all eight attributes investigated were statistically significant factors for respondents. Generally, both groups preferred low diagnostic costs, fewer follow-up visits, minimum waiting time for sleep study results and sleep specialists to recommend treatment. Management of OSA in primary care was acceptable to both groups and was the most preferred option by the high-risk group for the initial assessment, sleep study testing and ongoing care provision. CONCLUSIONS The discrete choice experiment results offer a promising approach for systematic incorporation of patient and high-risk group preferences into the future design and delivery of care pathways for OSA management.
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Affiliation(s)
- Andrea N Natsky
- Department of Health Economics, College of Medicine and Public Health, Flinders University, Health Sciences Building, Sturt Road, Bedford Park, Adelaide, SA, 5042, Australia.
- National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, SA, Australia.
| | - Andrew Vakulin
- Adelaide Institute for Sleep Health/FHMRI Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, SA, Australia
- Sleep and Circadian Research Group, Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
| | - Ching Li Chai-Coetzer
- Adelaide Institute for Sleep Health/FHMRI Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, SA, Australia
- Respiratory and Sleep Services, Southern Adelaide Local Health Network, SA Health, Adelaide, SA, Australia
| | - R Doug McEvoy
- Adelaide Institute for Sleep Health/FHMRI Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, SA, Australia
- Respiratory and Sleep Services, Southern Adelaide Local Health Network, SA Health, Adelaide, SA, Australia
| | - Robert J Adams
- Adelaide Institute for Sleep Health/FHMRI Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, SA, Australia
- Respiratory and Sleep Services, Southern Adelaide Local Health Network, SA Health, Adelaide, SA, Australia
| | - Billingsley Kaambwa
- Department of Health Economics, College of Medicine and Public Health, Flinders University, Health Sciences Building, Sturt Road, Bedford Park, Adelaide, SA, 5042, Australia
- National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, SA, Australia
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Midelet A, Bailly S, Tamisier R, Borel JC, Baillieul S, Le Hy R, Schaeffer MC, Pépin JL. Hidden Markov model segmentation to demarcate trajectories of residual apnoea-hypopnoea index in CPAP-treated sleep apnoea patients to personalize follow-up and prevent treatment failure. EPMA J 2021; 12:535-544. [PMID: 34956425 PMCID: PMC8648940 DOI: 10.1007/s13167-021-00264-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/02/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Continuous positive airway pressure (CPAP), the reference treatment for obstructive sleep apnoea (OSA), is used by millions of individuals worldwide with remote telemonitoring providing daily information on CPAP usage and efficacy, a currently underused resource. Here, we aimed to implement data science methods to provide tools for personalizing follow-up and preventing treatment failure. METHODS We analysed telemonitoring data from adults prescribed CPAP treatment. Our primary objective was to use Hidden Markov models (HMMs) to identify the underlying state of treatment efficacy and enable early detection of deterioration. Secondary goals were to identify clusters of rAHI trajectories which need distinct therapeutic strategies. RESULTS From telemonitoring records of 2860 CPAP-treated patients (age: 66.31 ± 12.92 years, 69.9% male), HMM estimated three states differing in variability within a given state and probability of shifting from one state to another. The daily inferred state informs on the need for a personalized action, while the sequence of states is a predictive indicator of treatment failure. Six clusters of rAHI trajectories were identified ranging from well-controlled patients (cluster 0: 669 (23%); mean rAHI 0.58 ± 0.59 events/h) to the most unstable (cluster 5: 470 (16%); mean rAHI 9.62 ± 5.62 events/h). CPAP adherence was 30 min higher in cluster 0 compared to clusters 4 and 5 (P value < 0.01). CONCLUSION This new approach based on HMM might constitute the backbone for deployment of patient-centred CPAP management improving the personalized interpretation of telemonitoring data, identifying individuals for targeted therapy and preventing treatment failure or abandonment. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s13167-021-00264-z.
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Affiliation(s)
- Alphanie Midelet
- HP2 Laboratory, Inserm U1042, Grenoble Alpes University, 38000 Grenoble, France
- Probayes, Montbonnot-Saint-Martin, France
| | - Sébastien Bailly
- HP2 Laboratory, Inserm U1042, Grenoble Alpes University, 38000 Grenoble, France
- EFCR Laboratory, Grenoble Alpes University Hospital, 38000 Grenoble, France
| | - Renaud Tamisier
- HP2 Laboratory, Inserm U1042, Grenoble Alpes University, 38000 Grenoble, France
- EFCR Laboratory, Grenoble Alpes University Hospital, 38000 Grenoble, France
| | - Jean-Christian Borel
- HP2 Laboratory, Inserm U1042, Grenoble Alpes University, 38000 Grenoble, France
- AGIR à dom. HomeCare Charity, 38240 Meylan, France
| | - Sébastien Baillieul
- HP2 Laboratory, Inserm U1042, Grenoble Alpes University, 38000 Grenoble, France
- EFCR Laboratory, Grenoble Alpes University Hospital, 38000 Grenoble, France
| | | | | | - Jean-Louis Pépin
- HP2 Laboratory, Inserm U1042, Grenoble Alpes University, 38000 Grenoble, France
- EFCR Laboratory, Grenoble Alpes University Hospital, 38000 Grenoble, France
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Ferreira-Santos D, Rodrigues PP. Obstructive sleep apnea: A categorical cluster analysis and visualization. Pulmonology 2021; 29:207-213. [PMID: 34801436 DOI: 10.1016/j.pulmoe.2021.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 10/22/2021] [Accepted: 10/24/2021] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Obstructive sleep apnea (OSA) is a prevalent sleep condition which is very heterogeneous although not formally characterized as such, resulting in missed or delayed diagnosis. Cluster analysis has been used in different clinical domains, particularly within sleep disorders. We aim to understand OSA heterogeneity and provide a variety of cluster visualizations to communicate the information clearly and efficiently. MATERIALS AND METHODS We applied an extension of k-means to be used in categorical variables: k-modes, to identify OSA patients' groups, based on demographic, physical examination, clinical history, and comorbidities characterization variables (n = 40) obtained from a derivation and validation cohorts (211 and 53, respectively) from the northern region of Portugal. Missing values were imputed with k-nearest neighbours (k-NN) and a chi-square test was held for feature selection. RESULTS Thirteen variables were inserted in phenotypes, resulting in the following three clusters: Cluster 1, middle-aged males reporting witnessed apneas and high alcohol consumption before sleep; Cluster 2, middle-aged women with increased neck circumference (NC), non-repairing sleep and morning headaches; and Cluster 3, obese elderly males with increased NC, witnessed apneas and alcohol consumption. Patients from the validation cohort assigned to different clusters showed similar proportions when compared with the derivation cohort, for mild (C1: 56 vs 75%, P = 0.230; C2: 61 vs 75%, P = 0.128; C3: 45 vs 48%, P = 0.831), moderate (C1: 24 vs 25%; C2: 20 vs 25%; C3: 25 vs 19%) and severe (C1: 20 vs 0%; C2: 18 vs 0%; C3: 29 vs 33%) levels. Therefore, the allocation supported the validation of the obtained clusters. CONCLUSIONS Our findings suggest different OSA patients' groups, creating the need to rethink these patients' stereotypical baseline characteristics.
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Affiliation(s)
- Daniela Ferreira-Santos
- MEDCIDS-FMUP - Community Medicine, Information and Decision Sciences, Faculty of Medicine of the University of Porto, Porto, Portugal; CINTESIS - Center for Health Technology and Services Research, Porto, Portugal.
| | - Pedro Pereira Rodrigues
- MEDCIDS-FMUP - Community Medicine, Information and Decision Sciences, Faculty of Medicine of the University of Porto, Porto, Portugal; CINTESIS - Center for Health Technology and Services Research, Porto, Portugal
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Su L, Xiao Y. Application of personalized medicine to obstructive sleep apnea in China. Sleep Med 2021; 87:22-29. [PMID: 34508984 DOI: 10.1016/j.sleep.2021.08.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 07/15/2021] [Accepted: 08/11/2021] [Indexed: 10/20/2022]
Abstract
Obstructive sleep apnea (OSA) is a common sleep disorder whose prevalence is increasing in China consistent with rising obesity trends. OSA is a heterogeneous disorder depends on anatomical and nonanatomical risk factors. Ethnicity differentially influences the attribution of these OSA risk factors. Chinese patients had more craniofacial bony restriction and Caucasians were more obese. This suggests ethnic differences in potential applications for diagnostics and therapeutics. However, current strategies for the management of OSA reflect a one-size-fits-all approach based on the apnea-hypopnea index (AHI). Although continuous positive airway pressure (CPAP) remains the first-line and most efficacious treatment for OSA, the acceptance is unacceptably low in China. Therefore, targeted therapies to treat OSA need to be developed. This review summarizes the differences in OSA pathogenesis of Chinese patients and analyzes the current condition of personalized medicine to patients with OSA in China. The application of personalized medicine to OSA in the Chinese population is still a long way off.
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Affiliation(s)
- Linfan Su
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China
| | - Yi Xiao
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China.
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10
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Bottaz-Bosson G, Hamon A, Pépin JL, Bailly S, Samson A. Continuous positive airway pressure adherence trajectories in sleep apnea: Clustering with summed discrete Fréchet and dynamic time warping dissimilarities. Stat Med 2021; 40:5373-5396. [PMID: 34250615 DOI: 10.1002/sim.9130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 05/06/2021] [Accepted: 06/23/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is a chronic disease characterized by recurrent pharyngeal collapses during sleep. In most severe cases, continuous positive airway pressure (CPAP) consists in keeping the airways open by administering mild air pressure. This treatment faces adherence issues. OBJECTIVES Eight hundred and forty-eight subjects were equipped with CPAP prescribed at the Grenoble University Hospital between 2016 and 2018. Their daily CPAP uses have been recorded during the first 3 months. Our aim is to cluster these adherence time series. With hierarchical agglomerative clustering, we focused on the choices of the dissimilarity measure and the internal cluster validation index (CVI). METHODS The Euclidean distance, the dynamic time warping (DTW) and the generalized summed discrete Fréchet dissimilarity were implemented with three linkage strategies ("average," "complete," and "Ward"). The performances of each method (dissimilarity and linkage) were evaluated on a simulation study through the adjusted Rand index (ARI). The Ward linkage with DTW dissimilarity provided the best ARI. Then six different internal CVIs (Silhouette, Calinski Harabasz, Davies Bouldin, Modified Davies Bouldin, Dunn, and COP) were compared on their ability to choose the best number of clusters. The Dunn index beat the others. RESULTS CPAP data were clustered with the Ward linkage, the DTW dissimilarity and the Dunn index. It identified six clusters, from a cluster of patients (N = 29 subjects) whose stopped the therapy early on to a cluster (N = 105) with increasing adherence over time. Other clusters were extremely good users (N = 151), good users (N = 150), moderate users (N = 235), and poor adherers (N = 178).
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Affiliation(s)
- Guillaume Bottaz-Bosson
- Laboratoire HP2, Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, Grenoble, France.,LJK, Univ. Grenoble Alpes, CNRS, Grenoble, France
| | - Agnès Hamon
- LJK, Univ. Grenoble Alpes, CNRS, Grenoble, France
| | - Jean-Louis Pépin
- Laboratoire HP2, Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, Grenoble, France
| | - Sébastien Bailly
- Laboratoire HP2, Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, Grenoble, France
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11
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Pevernagie D. Future Treatment of Sleep Disorders: Syndromic Approach Versus Management of Treatable Traits? Sleep Med Clin 2021; 16:465-473. [PMID: 34325823 DOI: 10.1016/j.jsmc.2021.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Sleep disorders are categorized in line with traditional taxonomy. This conventional approach allows adequate management of many patients. Failure of treatment, however, may be due to nonspecificity of symptoms, coincidental association between symptoms and pathophysiological endotype, as well as co-occurrence of different pathologic mechanisms affecting sleep. Complex phenotypes often do not respond well to standard therapeutic interventions. In these cases, the clinical workup should aim at identifying treatable traits that will likely improve under targeted therapy. The challenge for sleep medicine is to further develop this innovative approach that is driven by the principles of systems medicine.
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Affiliation(s)
- Dirk Pevernagie
- Department of Respiratory Medicine, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Gent, Belgium; Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10, 9000 Gent, Belgium.
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12
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Mohit, Shrivastava A, Chand P. Molecular determinants of obstructive sleep apnea. Sleep Med 2021; 80:105-112. [PMID: 33592435 DOI: 10.1016/j.sleep.2021.01.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 12/19/2020] [Accepted: 01/24/2021] [Indexed: 12/13/2022]
Abstract
Obstructive sleep apnea (OSA) is characterized as recurrent episodes of obstruction in the upper airway during the period of sleep. The condition occurs in approximately 11% and 4% of middle-aged men and middle-aged women, respectively. Polysomnography is a diagnostic procedure that involves the constant observation of oxygen saturation and unsaturation during sleep. Usually, positive airway pressure is considered a benchmark treatment for OSA. This review summarizes the recent developments and emerging evidence from molecular biology-based research studies that show that genetic factors have an influence on OSA. The genetic aspects of OSA that have been identified include heritability and other phenotypic co-factors such as anatomical morphology. It also draws attention to the results of a polymorphic-based study that was conducted to determine the causative single nucleotide mutations associated with obesity and adverse cardiovascular risk in OSA. However, the role of such mutations and their linkage to OSA can not yet be established. Nonetheless, a large body of evidence supports a strong association between inflammatory cytokine polymorphism and obesity in the development of OSA. There are also probable intermediate factors with several gene-gene interactions. Therefore, advanced applications and modern techniques should be applied to facilitate new findings and to minimize the risk of developing OSA.
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Affiliation(s)
- Mohit
- Department of Prosthodontics, King George's Medical University, Lucknow, Uttar Pradesh, 226003, India
| | - Ashutosh Shrivastava
- Center for Advance Research, Faculty of Medicine, King George's Medical University, Lucknow, Uttar Pradesh, 226003, India
| | - Pooran Chand
- Department of Prosthodontics, King George's Medical University, Lucknow, Uttar Pradesh, 226003, India.
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13
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Watach AJ, Hwang D, Sawyer AM. Personalized and Patient-Centered Strategies to Improve Positive Airway Pressure Adherence in Patients with Obstructive Sleep Apnea. Patient Prefer Adherence 2021; 15:1557-1570. [PMID: 34285474 PMCID: PMC8286071 DOI: 10.2147/ppa.s264927] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/23/2021] [Indexed: 12/12/2022] Open
Abstract
Obstructive sleep apnea (OSA), a common sleep disorder characterized by repeated pauses in breathing during sleep, is effectively treated with positive airway pressure (PAP) therapy. The magnitude of improvements in daily functioning and reduced negative health risks are dependent on maintaining PAP adherence, which is a significant challenge. Evidence-based interventions to improve PAP use are not easily translated to clinical practice because they are labor-intensive and require specialty expertise. Further, to date, individualized care, inclusive of personalized medicine and patient- and person-centered care have been marginally incorporated in the field's understanding of OSA and PAP adherence. This integrative review describes current PAP adherence assessment processes, interventions to improve adherence, and outlines future opportunities to advance the field, particularly as it relates to individualizing care and the use of implementation science to apply evidence to practice.
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Affiliation(s)
- Alexa J Watach
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
- Correspondence: Alexa J Watach University of Pennsylvania, School of Nursing, Claire Fagin Hall, Rm 349, 418 Curie Blvd, Philadelphia, PA, 19104, USATel +1-717-599-9908 Email
| | - Dennis Hwang
- Kaiser Permanente Southern California, Sleep Medicine and Department of Research and Evaluation, Fontana, CA, USA
| | - Amy M Sawyer
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
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14
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Gauld C, Dumas G, Darrason M, Salles N, Desvergnes P, Philip P, Micoulaud-Franchi JA. Médecine du sommeil personnalisée et syndrome d’apnées hypopnées obstructives du sommeil : entre précision et stratification, une proposition de clarification. ACTA ACUST UNITED AC 2020. [DOI: 10.1016/j.msom.2020.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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15
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Mullins AE, Kam K, Parekh A, Bubu OM, Osorio RS, Varga AW. Obstructive Sleep Apnea and Its Treatment in Aging: Effects on Alzheimer's disease Biomarkers, Cognition, Brain Structure and Neurophysiology. Neurobiol Dis 2020; 145:105054. [PMID: 32860945 PMCID: PMC7572873 DOI: 10.1016/j.nbd.2020.105054] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 08/13/2020] [Accepted: 08/18/2020] [Indexed: 02/08/2023] Open
Abstract
Here we review the impact of obstructive sleep apnea (OSA) on biomarkers of Alzheimer's disease (AD) pathogenesis, neuroanatomy, cognition and neurophysiology, and present the research investigating the effects of continuous positive airway pressure (CPAP) therapy. OSA is associated with an increase in AD markers amyloid-β and tau measured in cerebrospinal fluid (CSF), by Positron Emission Tomography (PET) and in blood serum. There is some evidence suggesting CPAP therapy normalizes AD biomarkers in CSF but since mechanisms for amyloid-β and tau production/clearance in humans are not completely understood, these findings remain preliminary. Deficits in the cognitive domains of attention, vigilance, memory and executive functioning are observed in OSA patients with the magnitude of impairment appearing stronger in younger people from clinical settings than in older community samples. Cognition improves with varying degrees after CPAP use, with the greatest effect seen for attention in middle age adults with more severe OSA and sleepiness. Paradigms in which encoding and retrieval of information are separated by periods of sleep with or without OSA have been done only rarely, but perhaps offer a better chance to understand cognitive effects of OSA than isolated daytime testing. In cognitively normal individuals, changes in EEG microstructure during sleep, particularly slow oscillations and spindles, are associated with biomarkers of AD, and measures of cognition and memory. Similar changes in EEG activity are reported in AD and OSA, such as "EEG slowing" during wake and REM sleep, and a degradation of NREM EEG microstructure. There is evidence that CPAP therapy partially reverses these changes but large longitudinal studies demonstrating this are lacking. A diagnostic definition of OSA relying solely on the Apnea Hypopnea Index (AHI) does not assist in understanding the high degree of inter-individual variation in daytime impairments related to OSA or response to CPAP therapy. We conclude by discussing conceptual challenges to a clinical trial of OSA treatment for AD prevention, including inclusion criteria for age, OSA severity, and associated symptoms, the need for a potentially long trial, defining relevant primary outcomes, and which treatments to target to optimize treatment adherence.
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Affiliation(s)
- Anna E Mullins
- Mount Sinai Integrative Sleep Center, Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Korey Kam
- Mount Sinai Integrative Sleep Center, Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Ankit Parekh
- Mount Sinai Integrative Sleep Center, Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Omonigho M Bubu
- Center for Brain Health, Department of Psychiatry, NYU Langone Medical Center, New York, NY 10016, USA
| | - Ricardo S Osorio
- Center for Brain Health, Department of Psychiatry, NYU Langone Medical Center, New York, NY 10016, USA
| | - Andrew W Varga
- Mount Sinai Integrative Sleep Center, Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
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16
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de Chazal P, Cistulli PA, Naughton MT. The future of sleep-disordered breathing: A public health crisis. Respirology 2020; 25:688-689. [PMID: 32410274 DOI: 10.1111/resp.13839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 04/27/2020] [Indexed: 11/27/2022]
Abstract
Find the whole series here https://onlinelibrary.wiley.com/doi/toc/10.1111/(ISSN)1440-1843.new-frontiers-in-sleep-disordered-breathing See cover image.
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Affiliation(s)
- Philip de Chazal
- Charles Perkins Centre and School of Biomedical Engineering, The University of Sydney, Sydney, NSW, Australia
| | - Peter A Cistulli
- Charles Perkins Centre and Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Sleep Health and Research, Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Matthew T Naughton
- Department of Respiratory Medicine, The Alfred Hospital, Melbourne, VIC, Australia.,Department of Medicine, Monash University, Melbourne, VIC, Australia
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17
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Santamaria-Martos F, Benítez I, Ortega F, Zapater A, Giron C, Pinilla L, Pascual L, Cortijo A, Dalmases M, Fernandez-Real JM, Barbé F, Sánchez-de-la-Torre M. Circulating microRNA profile as a potential biomarker for obstructive sleep apnea diagnosis. Sci Rep 2019; 9:13456. [PMID: 31530881 PMCID: PMC6748919 DOI: 10.1038/s41598-019-49940-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 08/27/2019] [Indexed: 01/30/2023] Open
Abstract
Evaluation of microRNAs (miRNAs) could allow characterization of the obstructive sleep apnea (OSA) and help diagnose it more accurately. We aimed to examine circulating miRNA profiles to establish the differences between non-OSA and OSA patients. Additionally, we aimed to analyse the effect of continuous positive airway pressure (CPAP) treatment on the miRNA profile. This observational, longitudinal study included 230 subjects referred to the Sleep Unit due to suspected OSA. Expression profiling of 188 miRNAs in plasma was performed in 27 subjects by TaqMan-Low-Density-Array. OSA-related miRNAs were selected for validation by RT-qPCR in 203 patients. Prediction models were built to discriminate between non-OSA and OSA: 1) NoSAS-score, 2) differentially expressed miRNAs, and 3) combination of NoSAS-score plus miRNAs. The differentially expressed miRNAs were measured after 6 months of follow-up. From the 14 miRNAs selected for validation, 6 were confirmed to be differentially expressed. The areas under the curve were 0.73 for the NoSAS-score, 0.81 for the miRNAs and 0.86 for the combination. After 6 months of CPAP treatment, miRNA levels in the OSA group seem to approximate to non-OSA levels. A cluster of miRNAs was identified to differentiate between non-OSA and OSA patients. CPAP treatment was associated with changes in the circulating miRNA profile.
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Affiliation(s)
- Fernando Santamaria-Martos
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova y Santa Maria, IRB Lleida, Lleida, Spain
| | - Iván Benítez
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova y Santa Maria, IRB Lleida, Lleida, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Francisco Ortega
- Department of Diabetes, Endocrinology and Nutrition, Institut d'Investigació Biomèdica de Girona (IdIBGi), Girona, Spain
- CIBER de la Fisiopatología de la Obesidad y la Nutrición (CB06/03) and Instituto de Salud Carlos III, Madrid, Spain
| | - Andrea Zapater
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova y Santa Maria, IRB Lleida, Lleida, Spain
| | - Cristina Giron
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova y Santa Maria, IRB Lleida, Lleida, Spain
| | - Lucía Pinilla
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova y Santa Maria, IRB Lleida, Lleida, Spain
| | - Lydia Pascual
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova y Santa Maria, IRB Lleida, Lleida, Spain
| | - Anunciación Cortijo
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova y Santa Maria, IRB Lleida, Lleida, Spain
| | - Mireia Dalmases
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova y Santa Maria, IRB Lleida, Lleida, Spain
| | - Jose M Fernandez-Real
- Department of Diabetes, Endocrinology and Nutrition, Institut d'Investigació Biomèdica de Girona (IdIBGi), Girona, Spain
- CIBER de la Fisiopatología de la Obesidad y la Nutrición (CB06/03) and Instituto de Salud Carlos III, Madrid, Spain
| | - Ferran Barbé
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova y Santa Maria, IRB Lleida, Lleida, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Manuel Sánchez-de-la-Torre
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova y Santa Maria, IRB Lleida, Lleida, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.
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18
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Light M, Owens RL, Schmickl CN, Malhotra A. Precision Medicine for Obstructive Sleep Apnea. Sleep Med Clin 2019; 14:391-398. [DOI: 10.1016/j.jsmc.2019.05.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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19
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Pépin J, Bailly S, Tamisier R. Big Data in sleep apnoea: Opportunities and challenges. Respirology 2019; 25:486-494. [DOI: 10.1111/resp.13669] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 06/13/2019] [Accepted: 07/23/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Jean‐Louis Pépin
- HP2 Laboratory, INSERM U1042University Grenoble Alpes Grenoble France
- EFCR LaboratoryCHU de Grenoble Alpes Grenoble France
| | - Sébastien Bailly
- HP2 Laboratory, INSERM U1042University Grenoble Alpes Grenoble France
- EFCR LaboratoryCHU de Grenoble Alpes Grenoble France
| | - Renaud Tamisier
- HP2 Laboratory, INSERM U1042University Grenoble Alpes Grenoble France
- EFCR LaboratoryCHU de Grenoble Alpes Grenoble France
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20
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Abstract
Obstructive sleep apnea (OSA) is a heterogeneous disorder. Cluster analysis has identified different physiologic subtypes with respect to symptoms. A difference exists in cardiovascular risk from OSA between the 7 subtypes identified. There are 3 basic subtypes replicated in multiple studies: (a) a group where insomnia is the main symptom; (b) an asymptomatic group; (c) a group with marked excessive sleepiness. The symptomatic benefit from treatment with nasal CPAP varies between these 3 subtypes. Data from the Sleep Heart Health Study reveal that the increased risk of cardiovascular disease from OSA occurs only in the excessively sleepy group.
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Affiliation(s)
- Allan I Pack
- Translational Research Laboratories, Center for Sleep and Circadian Neurobiology, University of Pennsylvania Perelman School of Medicine, Suite 2100, 125 South 31st Street, Philadelphia, PA 19104-3403, USA.
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21
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Excessive daytime sleepiness in obstructive sleep apnea: implications for driving licenses. Sleep Breath 2019; 24:37-47. [PMID: 31342234 DOI: 10.1007/s11325-019-01903-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 07/14/2019] [Accepted: 07/16/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE Excessive daytime sleepiness (EDS) while driving is a major international public health issue resulting in a more than doubled risk of motor vehicle accidents (MVAs). Obstructive sleep apnea (OSA) is the most frequent medical cause of EDS. Therefore, the European Union Directive 2014/85/EU determined that "untreated moderate to severe OSA coincident with EDS constitutes a medical disorder leading to unfitness to drive." The paper aims are to provide a brief review of sleepiness and its implications for driving safety, as well as to describe the subjective and objective methods to accurately evaluate EDS in order to assess fitness to drive in patients with OSA. METHODS We examined databases including PubMed, Medline, and EMBASE using the search terms "sleepiness at the wheel, excessive daytime sleepiness, sleepiness measure, sleep-wake cycle, obstructive sleep apnea, driving license, fitness to drive." RESULTS Significant interindividual variability in EDS exists in patients with comparable severity of OSA. Objective methods of measuring EDS are too expensive and time consuming to be suitable for the certification of driving licenses. The reliability of subjective methods depends upon the clinical setting and subjective tools assess only limited aspects of EDS. Objective measures, such as biochemical biomarkers, must, therefore, support subjective methods. CONCLUSIONS Extensive data have supported different subjective and objective methods for the appraisal of EDS in patients with OSA depending upon the clinical and experimental setting. Challenges remain to determine an appropriate tool for the evaluation of fitness to drive.
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22
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de Chazal P, Sutherland K, Cistulli PA. Advanced polysomnographic analysis for OSA: A pathway to personalized management? Respirology 2019; 25:251-258. [PMID: 31038827 DOI: 10.1111/resp.13564] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 03/11/2019] [Indexed: 12/15/2022]
Abstract
Obstructive sleep apnea (OSA) is a highly heterogeneous disorder, with diverse pathways to disease, expression of disease, susceptibility to co-morbidities and response to therapy, and is ideally suited to precision medicine approaches. Clinically, the content of the information-rich polysomnogram (PSG) is not currently fully utilized in determining patient management. Novel PSG parameters such as hypoxic burden, pulse transit time, cardiopulmonary coupling and the frequency representations of PSG sensor signals could predict a variety of cardiovascular disease, cancer and neurodegeneration co-morbidities. The PSG can also be used to identify key pathophysiological parameters such as loop gain, arousal threshold and muscle compensation which can enhance understanding of the causes of OSA in an individual, and thereby guide choices on therapy. Machine learning methods performing their own parameter extraction coupled with large PSG data sets offer an exciting opportunity for discovering new links between the PSG variables and disease outcomes. By exploiting existing and emerging analytical methods, the PSG may offer a pathway to personalized management for OSA.
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Affiliation(s)
- Philip de Chazal
- Charles Perkins Centre, Faculty of Engineering and I.T., University of Sydney, Sydney, NSW, Australia
| | - Kate Sutherland
- Charles Perkins Centre and Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Peter A Cistulli
- Charles Perkins Centre and Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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23
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Li L, Yao H, Wang J, Li Y, Wang Q. The Role of Chinese Medicine in Health Maintenance and Disease Prevention: Application of Constitution Theory. THE AMERICAN JOURNAL OF CHINESE MEDICINE 2019; 47:495-506. [PMID: 31023059 DOI: 10.1142/s0192415x19500253] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Traditional Chinese medicine (TCM) has guided health maintenance and disease treatment for thousands of years and has been widely used in many countries around the world. TCM regards each individual as unique so all corresponding therapeutic and preventive approaches in TCM are personalized. Personalized medicine, also referred to as precision medicine, is an emerging medical paradigm that points toward a new direction for future medical development. TCM constitution studies the holistic body condition, which is affected by both inborn and acquired factors. Body constitution lays the foundation for disease diagnosis, prevention and treatment. Different constitution types predispose individuals to different disease susceptibilities. Examining an individual's unique body constitution can promote effective health management and benefit the application of personalized medicine significantly. This review will introduce and discuss the application of the TCM constitution for health maintenance and disease prevention. In last decade, a number of modern techniques have been employed in the constitution research to evaluate the health status of individuals. The TCM constitution reflects the current status and future trends of human health in four aspects, i.e., individual differences, life processes, psychological condition and adaptability to natural and social environments. This TCM constitution theory has already been applied in the Chinese public health management at different levels with promising outcome. The constitution theory and practice provide a new approach for health maintenance and disease prevention.
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Affiliation(s)
- Lingru Li
- * School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100029, P. R. China
| | - Haiqiang Yao
- * School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100029, P. R. China.,† Tang Center for Herbal Medicine Research and Department of Anesthesia & Critical Care, Pritzker School of Medicine, University of Chicago, Chicago, Illinois 60637, USA
| | - Ji Wang
- * School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100029, P. R. China
| | - Yingshuai Li
- * School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100029, P. R. China
| | - Qi Wang
- * School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100029, P. R. China
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24
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Santamaria-Martos F, Benítez I, Zapater A, Girón C, Pinilla L, Fernandez-Real JM, Barbé F, Ortega FJ, Sánchez-de-la-Torre M. Identification and validation of circulating miRNAs as endogenous controls in obstructive sleep apnea. PLoS One 2019; 14:e0213622. [PMID: 30865706 PMCID: PMC6415855 DOI: 10.1371/journal.pone.0213622] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 02/25/2019] [Indexed: 01/01/2023] Open
Abstract
microRNAs (miRNAs) are non-coding RNAs highly relevant as biomarkers for disease. A seminal study that explored the role of miRNAs in obstructive sleep apnea syndrome (OSA) demonstrated their usefulness in clinical management. Nevertheless, the miRNAs that may act as endogenous controls (ECs) have not yet been established. The identification of ECs would contribute to the standardization of these biomarkers in OSA. The objective of the study is to identify miRNAs that can be used as ECs in OSA. We evaluated 100 patients divided into two different cohorts: a learning cohort of 10 non-OSA and 30 OSA patients, and a validation cohort (20 non-OSA and 40 OSA patients). In the learning cohort, a profile of 188 miRNAs was determined in plasma by TaqMan Low Density Array. The best EC candidates were identified by mean center+SD normalization and concordance correlation restricted normalization. The results were validated using NormFinder and geNorm to assess the stability of those ECs. Eight miRNAs were identified as EC candidates. The combination miRNA-106a/miRNA-186 was identified as the most stable among all candidates. We identified a set of ECs to be used in the determination of circulating miRNA in OSA that may contribute to the homogeneity of results.
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Affiliation(s)
- Fernando Santamaria-Martos
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova y Santa Maria, IRB Lleida, Lleida, Spain
| | - Ivan Benítez
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova y Santa Maria, IRB Lleida, Lleida, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Andrea Zapater
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova y Santa Maria, IRB Lleida, Lleida, Spain
| | - Cristina Girón
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova y Santa Maria, IRB Lleida, Lleida, Spain
| | - Lucía Pinilla
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova y Santa Maria, IRB Lleida, Lleida, Spain
| | - Jose Manuel Fernandez-Real
- Department of Diabetes, Endocrinology and Nutrition, Institut d'Investigació Biomèdica de Girona (IdIBGi), Girona, Spain
- CIBER de la Fisiopatología de la Obesidad y la Nutrición (CB06/03) and Instituto de Salud Carlos III, Madrid, Spain
| | - Ferran Barbé
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova y Santa Maria, IRB Lleida, Lleida, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Francisco Jose Ortega
- Department of Diabetes, Endocrinology and Nutrition, Institut d'Investigació Biomèdica de Girona (IdIBGi), Girona, Spain
- CIBER de la Fisiopatología de la Obesidad y la Nutrición (CB06/03) and Instituto de Salud Carlos III, Madrid, Spain
| | - Manuel Sánchez-de-la-Torre
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova y Santa Maria, IRB Lleida, Lleida, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
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25
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Kitipornchai L, Jones A, MacKay SG. Patient Phenotyping in OSA. CURRENT OTORHINOLARYNGOLOGY REPORTS 2019. [DOI: 10.1007/s40136-019-00221-5] [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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26
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Peker Y, Balcan B. Cardiovascular outcomes of continuous positive airway pressure therapy for obstructive sleep apnea. J Thorac Dis 2018; 10:S4262-S4279. [PMID: 30687542 DOI: 10.21037/jtd.2018.11.48] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Obstructive sleep apnea is a common disorder with increased risk for cardiovascular morbidity and mortality. The first choice of treatment of obstructive sleep apnea is continuous positive airway pressure, which reduces excessive daytime sleepiness and improves quality of life in sleep clinic cohorts. Nevertheless, the majority of patients with cardiovascular disease and concomitant obstructive sleep apnea do not report daytime sleepiness, and adherence to treatment is insufficient particularly in this group. The current article aims to give an updated overview of the impact of continuous positive airway pressure therapy on cardiovascular outcomes mainly based on the observational studies and the recent randomized controlled trials.
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Affiliation(s)
- Yüksel Peker
- Department of Pulmonary Medicine, School of Medicine, Koc University, Istanbul, Turkey.,Department of Clinical Sciences, Respiratory Medicine and Allergology, Faculty of Medicine, Lund University, Lund, Sweden.,Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Baran Balcan
- Department of Pulmonary Medicine, School of Medicine, Marmara University, Istanbul, Turkey
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27
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Abad VC, Guilleminault C. Solriamfetol for the treatment of daytime sleepiness in obstructive sleep apnea. Expert Rev Respir Med 2018; 12:1007-1019. [DOI: 10.1080/17476348.2018.1541742] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Vivien C. Abad
- Department of Psychiatry & Behavioral Sciences, Division of Sleep Medicine, Stanford University, Redwood City, CA, USA
| | - Christian Guilleminault
- Department of Psychiatry & Behavioral Sciences, Division of Sleep Medicine, Stanford University, Redwood City, CA, USA
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28
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Peker Y, Strollo PJ. New steps forward for obstructive sleep apnoea in the era of precision medicine. Eur Respir J 2018; 52:52/3/1801240. [PMID: 30220649 DOI: 10.1183/13993003.01240-2018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 07/09/2018] [Indexed: 11/05/2022]
Affiliation(s)
- Yüksel Peker
- Dept of Pulmonary Medicine, Faculty of Medicine, Marmara University, Istanbul, Turkey.,Dept of Clinical Sciences, Respiratory Medicine and Allergology, Faculty of Medicine, Lund University, Lund, Sweden.,Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Patrick J Strollo
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,VA Pittsburgh Health System, Pittsburgh, PA, USA
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29
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Mazzotti DR, Lim DC, Sutherland K, Bittencourt L, Mindel JW, Magalang U, Pack AI, de Chazal P, Penzel T. Opportunities for utilizing polysomnography signals to characterize obstructive sleep apnea subtypes and severity. Physiol Meas 2018; 39:09TR01. [PMID: 30047487 DOI: 10.1088/1361-6579/aad5fe] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is a heterogeneous sleep disorder with many pathophysiological pathways to disease. Currently, the diagnosis and classification of OSA is based on the apnea-hypopnea index, which poorly correlates to underlying pathology and clinical consequences. A large number of in-laboratory sleep studies are performed around the world every year, already collecting an enormous amount of physiological data within an individual. Clinically, we have not yet fully taken advantage of this data, but combined with existing analytical approaches, we have the potential to transform the way OSA is managed within an individual patient. Currently, respiratory signals are used to count apneas and hypopneas, but patterns such as inspiratory flow signals can be used to predict optimal OSA treatment. Electrocardiographic data can reveal arrhythmias, but patterns such as heart rate variability can also be used to detect and classify OSA. Electroencephalography is used to score sleep stages and arousals, but specific patterns such as the odds-ratio product can be used to classify how OSA patients responds differently to arousals. OBJECTIVE In this review, we examine these and many other existing computer-aided polysomnography signal processing algorithms and how they can reflect an individual's manifestation of OSA. SIGNIFICANCE Together with current technological advance, it is only a matter of time before advanced automatic signal processing and analysis is widely applied to precision medicine of OSA in the clinical setting.
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Affiliation(s)
- Diego R Mazzotti
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, United States of America
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30
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Montserrat JM, Sánchez-de-la Torre M, Terán J, Egea C. Respiratory Disorders During Sleep: A New Dimension for 2018. Arch Bronconeumol 2018; 55:122-123. [PMID: 30054116 DOI: 10.1016/j.arbres.2018.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 05/15/2018] [Accepted: 05/22/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Josep M Montserrat
- Unitat del Son, Servei de Pneumologia, Hospital Clinic, Barcelona, España; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, España; IDIBAPS, Universitat de Barcelona, Barcelona, España.
| | - Manuel Sánchez-de-la Torre
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, España; Hospital Universitari Arnau de Vilanova i Santa Maria, IRB Lleida, Lleida, España; Coordinación CIBER línea Sleep Apnea, España
| | - Joaquín Terán
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, España; Unidad del Sueño, Servicio de Neumología, Hospital de Burgos, Universidad de Burgos, Burgos, España; Coordinación de la Sociedad Española de Sueño, España
| | - Carlos Egea
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, España; Unidad Funcional de Sueño, OSI Araba, Hospital Universitario Araba, Vitoria-Gasteiz, Araba, España; Coordinación Área Sleep Apnea, Sociedad Española de Neumología y Cirugía Torácica (SEPAR), España
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31
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Light M, McCowen K, Malhotra A, Mesarwi OA. Sleep apnea, metabolic disease, and the cutting edge of therapy. Metabolism 2018; 84:94-98. [PMID: 28966076 PMCID: PMC5874161 DOI: 10.1016/j.metabol.2017.09.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 09/11/2017] [Accepted: 09/21/2017] [Indexed: 12/16/2022]
Abstract
Obstructive sleep apnea (OSA) is common, and many cross-sectional and longitudinal studies have established OSA as an independent risk factor for the development of a variety of adverse metabolic disease states, including hypertension, insulin resistance, type 2 diabetes, nonalcoholic fatty liver disease, dyslipidemia, and atherosclerosis. Nasal continuous positive airway pressure (CPAP) has long been the mainstay of therapy for OSA, but definitive studies demonstrating the efficacy of CPAP in improving metabolic outcomes, or in reducing incident disease burden, are lacking; moreover, CPAP has variable rates of adherence. Therefore, the future of OSA management, particularly with respect to limiting OSA-related metabolic dysfunction, likely lies in a coming wave of alternative approaches to endophenotyping OSA patients, personalized care, and defining and targeting mechanisms of OSA-induced adverse health outcomes.
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Affiliation(s)
- Matthew Light
- Division of Pulmonary, Critical Care, and Sleep Medicine, UC San Diego Department of Medicine, La Jolla, CA, United States.
| | - Karen McCowen
- Division of Endocrinology, UC San Diego Department of Medicine, La Jolla, CA, United States.
| | - Atul Malhotra
- Division of Pulmonary, Critical Care, and Sleep Medicine, UC San Diego Department of Medicine, La Jolla, CA, United States.
| | - Omar A Mesarwi
- Division of Pulmonary, Critical Care, and Sleep Medicine, UC San Diego Department of Medicine, La Jolla, CA, United States.
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32
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Randerath W, Bassetti CL, Bonsignore MR, Farre R, Ferini-Strambi L, Grote L, Hedner J, Kohler M, Martinez-Garcia MA, Mihaicuta S, Montserrat J, Pepin JL, Pevernagie D, Pizza F, Polo O, Riha R, Ryan S, Verbraecken J, McNicholas WT. Challenges and perspectives in obstructive sleep apnoea. Eur Respir J 2018; 52:13993003.02616-2017. [DOI: 10.1183/13993003.02616-2017] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 04/25/2018] [Indexed: 12/21/2022]
Abstract
Obstructive sleep apnoea (OSA) is a major challenge for physicians and healthcare systems throughout the world. The high prevalence and the impact on daily life of OSA oblige clinicians to offer effective and acceptable treatment options. However, recent evidence has raised questions about the benefits of positive airway pressure therapy in ameliorating comorbidities.An international expert group considered the current state of knowledge based on the most relevant publications in the previous 5 years, discussed the current challenges in the field, and proposed topics for future research on epidemiology, phenotyping, underlying mechanisms, prognostic implications and optimal treatment of patients with OSA.The group concluded that a revision to the diagnostic criteria for OSA is required to include factors that reflect different clinical and pathophysiological phenotypes and relevant comorbidities (e.g.nondipping nocturnal blood pressure). Furthermore, current severity thresholds require revision to reflect factors such as the disparity in the apnoea–hypopnoea index (AHI) between polysomnography and sleep studies that do not include sleep stage measurements, in addition to the poor correlation between AHI and daytime symptoms such as sleepiness. Management decisions should be linked to the underlying phenotype and consider outcomes beyond AHI.
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33
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Phenotypic approaches to obstructive sleep apnoea – New pathways for targeted therapy. Sleep Med Rev 2018; 37:45-59. [DOI: 10.1016/j.smrv.2016.12.003] [Citation(s) in RCA: 225] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 11/30/2016] [Accepted: 12/08/2016] [Indexed: 02/01/2023]
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34
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Ramos AR, Figueredo P, Shafazand S, Chediak AD, Abreu AR, Dib SI, Torre C, Wallace DM. Obstructive Sleep Apnea Phenotypes and Markers of Vascular Disease: A Review. Front Neurol 2017; 8:659. [PMID: 29259576 PMCID: PMC5723309 DOI: 10.3389/fneur.2017.00659] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 11/22/2017] [Indexed: 12/15/2022] Open
Abstract
Obstructive sleep apnea (OSA) is a chronic and heterogeneous disorder that leads to early mortality, stroke, and cardiovascular disease (CVD). OSA is defined by the apnea–hypopnea index, which is an index of OSA severity that combines apneas (pauses in breathing) and hypopneas (partial obstructions in breathing) associated with hypoxemia. Yet, other sleep metrics (i.e., oxygen nadir, arousal frequency), along with clinical symptoms and molecular markers could be better predictors of stroke and CVD outcomes in OSA. The recent focus on personalized medical care introduces the possibility of a unique approach to the treatment of OSA based on its phenotypes, defined by pathophysiological mechanisms and/or clinical presentation. We summarized what is known about OSA and its phenotypes, and review the literature on factors or intermediate markers that could increase stroke risk and CVD in patients with OSA. The OSA phenotypes where divided across three different domains (1) clinical symptoms (i.e., daytime sleepiness), (2) genetic/molecular markers, and (3) experimental data-driven approach (e.g., cluster analysis). Finally, we further highlight gaps in the literature framing a research agenda.
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Affiliation(s)
- Alberto R Ramos
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, United States.,Sleep Disorders Center, Miller School of Medicine, Bascom Palmer Eye Institute, University of Miami, Miami, FL, United States
| | - Pedro Figueredo
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Shirin Shafazand
- Sleep Disorders Center, Miller School of Medicine, Bascom Palmer Eye Institute, University of Miami, Miami, FL, United States.,Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Alejandro D Chediak
- Sleep Disorders Center, Miller School of Medicine, Bascom Palmer Eye Institute, University of Miami, Miami, FL, United States.,Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Alexandre R Abreu
- Sleep Disorders Center, Miller School of Medicine, Bascom Palmer Eye Institute, University of Miami, Miami, FL, United States.,Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Salim I Dib
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, United States.,Sleep Disorders Center, Miller School of Medicine, Bascom Palmer Eye Institute, University of Miami, Miami, FL, United States
| | - Carlos Torre
- Sleep Disorders Center, Miller School of Medicine, Bascom Palmer Eye Institute, University of Miami, Miami, FL, United States.,Department of Otolaryngology - Head and Neck Surgery, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Douglas M Wallace
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, United States.,Sleep Disorders Center, Bruce W. Carter VA Medical Center, Miami, FL, United States
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35
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Mohammadieh A, Sutherland K, Cistulli PA. Sleep disordered breathing: management update. Intern Med J 2017; 47:1241-1247. [DOI: 10.1111/imj.13606] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 04/17/2017] [Accepted: 04/20/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Anna Mohammadieh
- Centre for Sleep Health and Research, Department of Respiratory Medicine; Royal North Shore Hospital; Sydney New South Wales Australia
- Charles Perkins Centre, University of Sydney; Sydney New South Wales Australia
| | - Kate Sutherland
- Centre for Sleep Health and Research, Department of Respiratory Medicine; Royal North Shore Hospital; Sydney New South Wales Australia
- Charles Perkins Centre, University of Sydney; Sydney New South Wales Australia
| | - Peter A. Cistulli
- Centre for Sleep Health and Research, Department of Respiratory Medicine; Royal North Shore Hospital; Sydney New South Wales Australia
- Charles Perkins Centre, University of Sydney; Sydney New South Wales Australia
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36
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Bonsignore MR, Suarez Giron MC, Marrone O, Castrogiovanni A, Montserrat JM. Personalised medicine in sleep respiratory disorders: focus on obstructive sleep apnoea diagnosis and treatment. Eur Respir Rev 2017; 26:26/146/170069. [PMID: 29070581 DOI: 10.1183/16000617.0069-2017] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 08/14/2017] [Indexed: 01/07/2023] Open
Abstract
In all fields of medicine, major efforts are currently dedicated to improve the clinical, physiological and therapeutic understanding of disease, and obstructive sleep apnoea (OSA) is no exception. The personalised medicine approach is relevant for OSA, given its complex pathophysiology and variable clinical presentation, the interactions with comorbid conditions and its possible contribution to poor outcomes. Treatment with continuous positive airway pressure (CPAP) is effective, but CPAP is poorly tolerated or not accepted in a considerable proportion of OSA patients. This review summarises the available studies on the physiological phenotypes of upper airway response to obstruction during sleep, and the clinical presentations of OSA (phenotypes and clusters) with a special focus on our changing attitudes towards approaches to treatment. Such major efforts are likely to change and expand treatment options for OSA beyond the most common current choices (i.e CPAP, mandibular advancement devices, positional treatment, lifestyle changes or upper airway surgery). More importantly, treatment for OSA may become more effective, being tailored to each patient's need.
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Affiliation(s)
- Maria R Bonsignore
- Biomedical Dept of Internal and Specialistic Medicine (DiBiMIS), University of Palermo, Palermo, Italy .,Institute of Biomedicine and Molecular Immunology (IBIM), National Research Council (CNR), Palermo, Italy
| | | | - Oreste Marrone
- Institute of Biomedicine and Molecular Immunology (IBIM), National Research Council (CNR), Palermo, Italy
| | - Alessandra Castrogiovanni
- Biomedical Dept of Internal and Specialistic Medicine (DiBiMIS), University of Palermo, Palermo, Italy
| | - Josep M Montserrat
- Sleep Unit, Hospital Clinic, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
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37
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Predictors of CPAP compliance in different clinical settings: primary care versus sleep unit. Sleep Breath 2017; 22:157-163. [DOI: 10.1007/s11325-017-1549-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 07/31/2017] [Accepted: 08/02/2017] [Indexed: 10/18/2022]
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38
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Sânchez-de-la-Torre M, Gozal D. Obstructive sleep apnea: in search of precision. EXPERT REVIEW OF PRECISION MEDICINE AND DRUG DEVELOPMENT 2017; 2:217-228. [PMID: 31548993 DOI: 10.1080/23808993.2017.1361319] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Introduction Obstructive sleep apnea (OSA) is a highly prevalent condition that is viewed as a major global health concern, while affecting approximately 10% of the middle-aged population. OSA is a chronic disease that has been conclusively associated with poor quality of life, cognitive impairments and mood alterations, enhanced cardiovascular and metabolic morbidity, thereby leading to marked increments in healthcare costs. Areas covered The authors have reviewed the current evidence on the pathophysiology of OSA and its consequences, the heterogeneity of its phenotypic expression, the current therapeutic applications and their efficacy, and the implications for diagnosis, treatment and follow-up strategies in the context of the clinical management of OSA. Expert commentary Personalized medicine in OSA identifies different needs and approaches: i) phenotyping and defining the different and segregated clusters of OSA patients whose recognition may improve prognostic predictions and guide therapeutic strategies; ii) to further characterize and predict the impact of OSA and its treatment, particularly revolving around mortality and the processes closely related to ageing (cardiovascular diseases, cancer and neurocognitive diseases); iii) the introduction of new technologies including telemedicine that have shown promise in the implementation of personalized medicine approaches.
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Affiliation(s)
- Manuel Sânchez-de-la-Torre
- Hospital Universitari Arnau de Vilanova and Santa Maria. Group of Translational Research in Respiratory Medicine, IRBLleida, Lleida, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain, Hospital San Pedro de Alcántara, Cáceres, Spain
| | - David Gozal
- Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL, USA
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39
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Khalyfa A, Kheirandish-Gozal L, Gozal D. Circulating exosomes in obstructive sleep apnea as phenotypic biomarkers and mechanistic messengers of end-organ morbidity. Respir Physiol Neurobiol 2017; 256:143-156. [PMID: 28676332 DOI: 10.1016/j.resp.2017.06.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 06/13/2017] [Accepted: 06/19/2017] [Indexed: 02/08/2023]
Abstract
Obstructive sleep apnea (OSA), the most severe form of sleep disordered breathing, is characterized by intermittent hypoxia during sleep (IH), sleep fragmentation, and episodic hypercapnia. OSA is associated with increased risk for morbidity and mortality affecting cardiovascular, metabolic, and neurocognitive systems, and more recently with non-alcoholic fatty liver disease (NAFLD) and cancer-related deaths. Substantial variability in OSA outcomes suggests that genetically-determined and environmental and lifestyle factors affect the phenotypic susceptibility to OSA. Furthermore, OSA and obesity often co-exist and manifest activation of shared molecular end-organ injury mechanisms that if properly identified may represent potential therapeutic targets. A challenge in the development of non-invasive diagnostic assays in body fluids is the ability to identify clinically relevant biomarkers. Circulating extracellular vesicles (EVs) include a heterogeneous population of vesicular structures including exosomes, prostasomes, microvesicles (MVs), ectosomes and oncosomes, and are classified based on their size, shape and membrane surface composition. Of these, exosomes (30-100nm) are very small membrane vesicles derived from multi-vesicular bodies or from the plasma membrane and play important roles in mediating cell-cell communication via cargo that includes lipids, proteins, mRNAs, miRNAs and DNA. We have recently identified a unique cluster of exosomal miRNAs in both humans and rodents exposed to intermittent hypoxia as well as in patients with OSA with divergent morbid phenotypes. Here we summarize such recent findings, and will focus on exosomal miRNAs in both adult and children which mediate intercellular communication relevant to OSA and endothelial dysfunction, and their potential value as diagnostic and prognostic biomarkers.
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Affiliation(s)
- Abdelnaby Khalyfa
- Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL, USA.
| | - Leila Kheirandish-Gozal
- Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL, USA
| | - David Gozal
- Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL, USA
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40
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Lim DC, Sutherland K, Cistulli PA, Pack AI. P4 medicine approach to obstructive sleep apnoea. Respirology 2017; 22:849-860. [PMID: 28477347 DOI: 10.1111/resp.13063] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 03/20/2017] [Accepted: 03/24/2017] [Indexed: 12/22/2022]
Abstract
P4 medicine is an evolving approach to personalized medicine. The four Ps offer a means to: Predict who will develop disease and co-morbidities; Prevent rather than react to disease; Personalize diagnosis and treatment; have patients Participate in their own care. P4 medicine is very applicable to obstructive sleep apnoea (OSA) because each OSA patient has a different pathway to disease and its consequences. OSA has both structural and physiological mechanisms with different clinical subgroups, different molecular profiles and different consequences. This may explain why there are different responses to alternative therapies, such as intraoral devices and hypoglossal nerve stimulation therapy. Currently, technology facilitates patients to participate in their own care from screening for OSA (snoring and apnoea apps) to monitoring response to therapy (sleep monitoring, blood pressure, oxygen saturation and heart rate) as well as monitoring their own continuous positive airway pressure (CPAP) compliance. We present a conceptual framework that provides the basis for a new, P4 medicine approach to OSA and should be considered more in depth: predict and prevent those at high risk for OSA and consequences, personalize the diagnosis and treatment of OSA and build in patient participation to manage OSA.
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Affiliation(s)
- Diane C Lim
- Division of Sleep Medicine/Department of Medicine, Center for Sleep and Circadian Neurobiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Kate Sutherland
- Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia.,Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Peter A Cistulli
- Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia.,Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Allan I Pack
- Division of Sleep Medicine/Department of Medicine, Center for Sleep and Circadian Neurobiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Abstract
Obstructive sleep apnea is a common condition, with multiple potential neurocognitive, cardiovascular, and metabolic consequences. Efficacious treatment is available, but patient engagement is typically required for treatment to be effective. Patients with sleep apnea are phenotypically diverse and have individual needs, preferences, and values that impact treatment decisions. There has been a shift in obstructive sleep apnea management from diagnosis to chronic care management. Making treatment decisions that incorporate an individual patient's values and preferences and are personalized for that patient's biology has the potential to improve patient outcomes. A patient-centered care approach in obstructive sleep apnea is reviewed including 1) determining patient-specific needs to guide treatment decisions, 2) understanding patient values, preferences, and other factors impacting treatment decisions and using shared decision-making, 3) enhancing patient education and support to improve treatment adherence, 4) promoting patient engagement, 5) optimizing care coordination, continuity of care, and access to care, and 6) determining and assessing patient-centered outcomes.
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Affiliation(s)
- Janet Hilbert
- Yale University School of Medicine, Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, New Haven, CT, USA.
| | - Henry K Yaggi
- Yale University School of Medicine, Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, New Haven, CT, USA
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42
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Chen W, Gillett E, Khoo MCK, Davidson Ward SL, Nayak KS. Real-time multislice MRI during continuous positive airway pressure reveals upper airway response to pressure change. J Magn Reson Imaging 2017; 46:1400-1408. [PMID: 28225580 DOI: 10.1002/jmri.25675] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 02/01/2017] [Indexed: 12/28/2022] Open
Abstract
PURPOSE To determine if a real-time magnetic resonance imaging (RT-MRI) method during continuous positive airway pressure (CPAP) can be used to measure neuromuscular reflex and/or passive collapsibility of the upper airway in individual obstructive sleep apnea (OSA) subjects. MATERIALS AND METHODS We conducted experiments on four adolescents with OSA and three healthy controls, during natural sleep and during wakefulness. Data were acquired on a clinical 3T scanner using simultaneous multislice (SMS) RT-MRI during CPAP. CPAP pressure level was alternated between therapeutic and subtherapeutic levels. Segmented airway area changes in response to rapid CPAP pressure drop and restoration were used to estimate 1) upper airway loop gain (UALG), and 2) anatomical risk factors, including fluctuation of airway area (FAA). RESULTS FAA significantly differed between OSA patients (2-4× larger) and healthy controls (Student's t-test, P < 0.05). UALG and FAA measurements indicate that neuromuscular reflex and passive collapsibility varied among the OSA patients, suggesting the presence of different OSA phenotypes. Measurements had high intrasubject reproducibility (intraclass correlation coefficient r > 0.7). CONCLUSION SMS RT-MRI during CPAP can reproducibly identify physiological traits and anatomical risk factors that are valuable in the assessment of OSA. This technique can potentially locate the most collapsible airway sites. Both UALG and FAA possess large variation among OSA patients. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2017;46:1400-1408.
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Affiliation(s)
- Weiyi Chen
- Ming Hsieh Department of Electrical Engineering, University of Southern California, Los Angeles, California, USA
| | - Emily Gillett
- Children's Hospital Los Angeles, Los Angeles, California, USA.,Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Michael C K Khoo
- Department of Biomedical Engineering, University of Southern California, Los Angeles, California, USA
| | - Sally L Davidson Ward
- Children's Hospital Los Angeles, Los Angeles, California, USA.,Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Krishna S Nayak
- Ming Hsieh Department of Electrical Engineering, University of Southern California, Los Angeles, California, USA
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43
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Sánchez-de-la-Torre M, Barbé F. [Personalized medicine in sleep apnea: Towards a new paradigm of comprehensive disease management]. Med Clin (Barc) 2016; 147:444-446. [PMID: 27751511 DOI: 10.1016/j.medcli.2016.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 09/02/2016] [Accepted: 09/05/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Manuel Sánchez-de-la-Torre
- Departamento de Respiratorio, Hospital Universitari Arnau de Vilanova y Santa Maria, Institut de Recerca Biomèdica de Lleida (IRB Lleida), Universidad de Lleida, Lleida, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España.
| | - Ferran Barbé
- Departamento de Respiratorio, Hospital Universitari Arnau de Vilanova y Santa Maria, Institut de Recerca Biomèdica de Lleida (IRB Lleida), Universidad de Lleida, Lleida, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España
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44
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Personalized medicine in sleep apnea: Towards a new paradigm of comprehensive disease management. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.medcle.2016.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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45
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Wimms A, Woehrle H, Ketheeswaran S, Ramanan D, Armitstead J. Obstructive Sleep Apnea in Women: Specific Issues and Interventions. BIOMED RESEARCH INTERNATIONAL 2016; 2016:1764837. [PMID: 27699167 PMCID: PMC5028797 DOI: 10.1155/2016/1764837] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 07/26/2016] [Accepted: 08/11/2016] [Indexed: 12/21/2022]
Abstract
Obstructive sleep apnea (OSA) has traditionally been seen as a male disease. However, the importance of OSA in women is increasingly being recognized, along with a number of significant gender-related differences in the symptoms, diagnosis, consequences, and treatment of OSA. Women tend to have less severe OSA than males, with a lower apnea-hypopnea index (AHI) and shorter apneas and hypopneas. Episodes of upper airway resistance that do not meet the criteria for apneas are more common in women. Prevalence rates are lower in women, and proportionally fewer women receive a correct diagnosis. Research has also documented sex differences in the upper airway, fat distribution, and respiratory stability in OSA. Hormones are implicated in some gender-related variations, with differences between men and women in the prevalence of OSA decreasing as age increases. The limited data available suggest that although the prevalence and severity of OSA may be lower in women than in men, the consequences of the disease are at least the same, if not worse for comparable degrees of severity. Few studies have investigated gender differences in the effects of OSA treatment. However, given the differences in physiology and presentation, it is possible that personalized therapy may provide more optimal care.
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Affiliation(s)
- Alison Wimms
- ResMed Science Centre, Fraunhoferstraße 16, 82152 Planegg, Germany
- University of Sydney, Fisher Road, Sydney, NSW, Australia
| | - Holger Woehrle
- ResMed Science Centre, Fraunhoferstraße 16, 82152 Planegg, Germany
- Sleep and Ventilation Center Blaubeuren, Lung Center Ulm, Ulm, Germany
| | | | - Dinesh Ramanan
- ResMed Science Centre, Fraunhoferstraße 16, 82152 Planegg, Germany
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