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Byun JI, Jahng GH, Ryu CW, Park S, Lee KH, Hong SO, Jung KY, Shin WC. Low arousal threshold is associated with altered functional connectivity of the ascending reticular activating system in patients with obstructive sleep apnea. Sci Rep 2024; 14:18482. [PMID: 39122842 PMCID: PMC11315983 DOI: 10.1038/s41598-024-68394-8] [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: 11/29/2023] [Accepted: 07/23/2024] [Indexed: 08/12/2024] Open
Abstract
A low arousal threshold (LAT) is a pathophysiological trait of obstructive sleep apnea (OSA) that may be associated with brainstem ascending reticular activating system-cortical functional connectivity changes. We evaluated resting-state connectivity between the brainstem nuclei and 105 cortical/subcortical regions in OSA patients with or without a LAT and healthy controls. Twenty-five patients with moderate to severe OSA with an apnea-hypopnea index between 20 and 40/hr (15 with and 10 without a LAT) and 15 age- and sex-matched controls were evaluated. Participants underwent functional magnetic resonance imaging after overnight polysomnography. Three brainstem nuclei-the locus coeruleus (LC), laterodorsal tegmental nucleus (LDTg), and ventral tegmental area (VTA)-associated with OSA in our previous study were used as seeds. Functional connectivity values of the two brainstem nuclei (LC and LDTg) significantly differed among the three groups. The connectivity of the LC with the precuneus was stronger in OSA patients than in controls regardless of the concomitant LAT. The connectivity between the LDTg and the posterior cingulate cortex was also stronger in OSA patients regardless of the LAT. Moreover, OSA patients without a LAT showed stronger LDTg-posterior cingulate cortex connectivity than those with a LAT (post hoc p = 0.013), and this connectivity strength was negatively correlated with the minimum oxygen saturation in OSA patients (r = - 0.463, p = 0.023). The LAT in OSA patients was associated with altered LDTg-posterior cingulate cortex connectivity. This result may suggested that cholinergic activity may play a role in the LAT in OSA patients.
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Affiliation(s)
- Jung-Ick Byun
- Department of Neurology, Kyung Hee University College of Medicine, Kyung Hee University Hospital at Gangdong, 892 Dongnam-Ro, Gangdong-Gu, Seoul, 05278, Republic of Korea
| | - Geon-Ho Jahng
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Chang-Woo Ryu
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Soonchan Park
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Kun Hee Lee
- Department of Otorhinolaryngology, Head and Neck Surgery, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Sung Ok Hong
- Department of Oral and Maxillofacial Surgery, Kyung Hee University College of Dentistry, Kyung Hee University Dental Hospital at Gangdong, Seoul, Republic of Korea
| | - Ki-Young Jung
- Department of Neurology, Seoul National University Hospital, Neuroscience Research Institute, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 110-744, Republic of Korea.
| | - Won Chul Shin
- Department of Neurology, Kyung Hee University College of Medicine, Kyung Hee University Hospital at Gangdong, 892 Dongnam-Ro, Gangdong-Gu, Seoul, 05278, Republic of Korea.
- Department of Medicine, AgeTech-service, Convergence Major, Kyung Hee University, Seoul, Republic of Korea.
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Hsu WH, Yang CC, Tsai CY, Majumdar A, Lee KY, Feng PH, Tseng CH, Chen KY, Kang JH, Lee HC, Wu CJ, Kuan YC, Liu WT. Association of Low Arousal Threshold Obstructive Sleep Apnea Manifestations with Body Fat and Water Distribution. Life (Basel) 2023; 13:life13051218. [PMID: 37240863 DOI: 10.3390/life13051218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 04/20/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Abstract
Obstructive sleep apnea (OSA) with a low arousal threshold (low-ArTH) phenotype can cause minor respiratory events that exacerbate sleep fragmentation. Although anthropometric features may affect the risk of low-ArTH OSA, the associations and underlying mechanisms require further investigation. This study investigated the relationships of body fat and water distribution with polysomnography parameters by using data from a sleep center database. The derived data were classified as those for low-ArTH in accordance with criteria that considered oximetry and the frequency and type fraction of respiratory events and analyzed using mean comparison and regression approaches. The low-ArTH group members (n = 1850) were significantly older and had a higher visceral fat level, body fat percentage, trunk-to-limb fat ratio, and extracellular-to-intracellular (E-I) water ratio compared with the non-OSA group members (n = 368). Significant associations of body fat percentage (odds ratio [OR]: 1.58, 95% confident interval [CI]: 1.08 to 2.3, p < 0.05), trunk-to-limb fat ratio (OR: 1.22, 95% CI: 1.04 to 1.43, p < 0.05), and E-I water ratio (OR: 1.32, 95% CI: 1.08 to 1.62, p < 0.01) with the risk of low-ArTH OSA were noted after adjustments for sex, age, and body mass index. These observations suggest that increased truncal adiposity and extracellular water are associated with a higher risk of low-ArTH OSA.
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Affiliation(s)
- Wen-Hua Hsu
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan
| | - Cheng-Chang Yang
- Department of Neurology, Taipei Medical University-Shuang Ho Hospital, New Taipei City 235041, Taiwan
- Brain and Consciousness Research Center, Taipei Medical University-Shuang Ho Hospital, New Taipei City 235041, Taiwan
- International Ph.D. Program in Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei 110301, Taiwan
| | - Cheng-Yu Tsai
- Department of Civil and Environmental Engineering, Imperial College London, London SW7 2AZ, UK
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Medical University-Shuang Ho Hospital, New Taipei City 235041, Taiwan
| | - Arnab Majumdar
- Department of Civil and Environmental Engineering, Imperial College London, London SW7 2AZ, UK
| | - Kang-Yun Lee
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Medical University-Shuang Ho Hospital, New Taipei City 235041, Taiwan
| | - Po-Hao Feng
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Medical University-Shuang Ho Hospital, New Taipei City 235041, Taiwan
| | - Chien-Hua Tseng
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Medical University-Shuang Ho Hospital, New Taipei City 235041, Taiwan
| | - Kuan-Yuan Chen
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Medical University-Shuang Ho Hospital, New Taipei City 235041, Taiwan
| | - Jiunn-Horng Kang
- Research Center of Artificial Intelligence in Medicine, Taipei Medical University, Taipei 110301, Taiwan
- Graduate Institute of Nanomedicine and Medical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei 110301, Taiwan
| | - Hsin-Chien Lee
- Department of Psychiatry, Taipei Medical University Hospital, Taipei 110301, Taiwan
| | - Cheng-Jung Wu
- Department of Otolaryngology, Taipei Medical University-Shuang Ho Hospital, New Taipei City 235041, Taiwan
| | - Yi-Chun Kuan
- Department of Neurology, Taipei Medical University-Shuang Ho Hospital, New Taipei City 235041, Taiwan
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan
- Taipei Neuroscience Institute, Taipei Medical University, Taipei 110301, Taiwan
- Dementia Center, Taipei Medical University-Shuang Ho Hospital, New Taipei City 235041, Taiwan
- Sleep Center, Taipei Medical University-Shuang Ho Hospital, New Taipei City 235041, Taiwan
| | - Wen-Te Liu
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Medical University-Shuang Ho Hospital, New Taipei City 235041, Taiwan
- Research Center of Artificial Intelligence in Medicine, Taipei Medical University, Taipei 110301, Taiwan
- Sleep Center, Taipei Medical University-Shuang Ho Hospital, New Taipei City 235041, Taiwan
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3
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Hirani R, Smiley A. A Scoping Review of Sleep Apnea: Where Do We Stand? Life (Basel) 2023; 13:life13020387. [PMID: 36836743 PMCID: PMC9961756 DOI: 10.3390/life13020387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/11/2023] [Accepted: 01/28/2023] [Indexed: 02/01/2023] Open
Abstract
Obstructive sleep apnea (OSA), a condition in which there is a recurrent collapse of the upper airway while sleeping, is a widespread disease affecting 5% to 10% people worldwide. Despite several advances in the treatment modalities for OSA, morbidity and mortality remain a concern. Common symptoms include loud snoring, gasping for air during sleep, morning headache, insomnia, hypersomnia, attention deficits, and irritability. Obese individuals, male gender, older age (65+), family history, smoking, and alcohol consumption are well recognized risk factors of OSA. This condition holds the ability to increase inflammatory cytokines, cause metabolic dysfunction, and increase the sympathetic output, all of which exacerbate OSA due to their effect on the cardiovascular system. In this review, we discuss its brief history, risk factors, complications, treatment modalities, and the role of clinicians in curbing its risk.
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Affiliation(s)
- Rahim Hirani
- School of Medicine, New York Medical College, Valhalla, NY 10595, USA
- Department of Surgery, Westchester Medical Center, New York, NY 10595, USA
| | - Abbas Smiley
- School of Medicine, New York Medical College, Valhalla, NY 10595, USA
- Department of Surgery, Westchester Medical Center, New York, NY 10595, USA
- Correspondence:
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Plouffe AA, Vranish JR. What keeps us up at night? The cardiovascular impact of nighttime arousals from sleep. Am J Physiol Heart Circ Physiol 2021; 321:H613-H614. [PMID: 34448638 DOI: 10.1152/ajpheart.00462.2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Audrey A Plouffe
- Department of Integrative Physiology and Health Science, Alma College, Alma, Michigan
| | - Jennifer R Vranish
- Department of Integrative Physiology and Health Science, Alma College, Alma, Michigan
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Cardis R, Lecci S, Fernandez LM, Osorio-Forero A, Chu Sin Chung P, Fulda S, Decosterd I, Lüthi A. Cortico-autonomic local arousals and heightened somatosensory arousability during NREMS of mice in neuropathic pain. eLife 2021; 10:65835. [PMID: 34227936 PMCID: PMC8291975 DOI: 10.7554/elife.65835] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 07/02/2021] [Indexed: 12/22/2022] Open
Abstract
Frequent nightly arousals typical for sleep disorders cause daytime fatigue and present health risks. As such arousals are often short, partial, or occur locally within the brain, reliable characterization in rodent models of sleep disorders and in human patients is challenging. We found that the EEG spectral composition of non-rapid eye movement sleep (NREMS) in healthy mice shows an infraslow (~50 s) interval over which microarousals appear preferentially. NREMS could hence be vulnerable to abnormal arousals on this time scale. Chronic pain is well-known to disrupt sleep. In the spared nerve injury (SNI) mouse model of chronic neuropathic pain, we found more numerous local cortical arousals accompanied by heart rate increases in hindlimb primary somatosensory, but not in prelimbic, cortices, although sleep macroarchitecture appeared unaltered. Closed-loop mechanovibrational stimulation further revealed higher sensory arousability. Chronic pain thus preserved conventional sleep measures but resulted in elevated spontaneous and evoked arousability. We develop a novel moment-to-moment probing of NREMS vulnerability and propose that chronic pain-induced sleep complaints arise from perturbed arousability.
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Affiliation(s)
- Romain Cardis
- Department of Fundamental Neurosciences, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.,Pain Center, Department of Anesthesiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Sandro Lecci
- Department of Fundamental Neurosciences, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Laura Mj Fernandez
- Department of Fundamental Neurosciences, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Alejandro Osorio-Forero
- Department of Fundamental Neurosciences, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Paul Chu Sin Chung
- Pain Center, Department of Anesthesiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Stephany Fulda
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Civic Hospital (EOC) of Lugano, Lugano, Switzerland
| | - Isabelle Decosterd
- Pain Center, Department of Anesthesiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Anita Lüthi
- Department of Fundamental Neurosciences, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
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Zinchuk AV, Chu JH, Liang J, Celik Y, Op de Beeck S, Redeker NS, Wellman A, Yaggi HK, Peker Y, Sands SA. Physiological Traits and Adherence to Therapy of Sleep Apnea in Individuals with Coronary Artery Disease. Am J Respir Crit Care Med 2021; 204:703-712. [PMID: 34156917 DOI: 10.1164/rccm.202101-0055oc] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Untreated obstructive sleep apnea (OSA) is associated with adverse outcomes in patients with coronary artery disease (CAD). Continuous positive airway pressure (CPAP) is the most common treatment, but despite interventions addressing established adherence determinants, CPAP use remains poor. OBJECTIVES To determine whether physiological traits that cause OSA are associated with long-term CPAP adherence in patients with CAD. METHODS Participants in the RICCADSA trial with objective CPAP adherence (hours/night) over 2 years and analyzable raw polysomnography data were included (n=249). The physiological traits -loop gain, arousal threshold (ArTH), collapsibility and muscle compensation- were measured from polysomnography. Linear mixed models assessed the relationship between the traits and adherence. We also compared actual CPAP adherence between physiology-predicted "poor" (lowest quartile of predicted adherence) and "good" (all others) adherers. MEASUREMENTS AND RESULTS Median (IQR) CPAP use declined from 3.2 (1.0, 5.8) to 3.0 (0.0, 5.6) hours/night over 24-mo (p<0.001). In analyses adjusted for demographics, anthropometrics, OSA characteristics and clinical comorbidities, lower ArTH was associated with worse CPAP adherence (0.7 hours/SD ArTH, p=0.021). Both high and low muscle compensation were associated with lower adherence (p=0.008). Predicted "poor" adherers exhibited markedly lower CPAP use compared to "good" adherers for up to 2 years of follow-up (group differences: 2.0 to 3.2 hours/night, p<0.003 for all). CONCLUSIONS A low ArTH as well as a very low and high muscle compensation are associated with worse long-term CPAP adherence in patients with CAD and OSA. Physiological traits, alongside established determinants, may help predict and improve CPAP adherence.
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Affiliation(s)
- Andrey V Zinchuk
- Yale School of Medicine, 12228, Section of Pulmonary and Critical Care Medicine, New Haven, Connecticut, United States;
| | - Jen-Hwa Chu
- Yale School of Medicine, 12228, Pulmonary, Critical Care, & Sleep Medicine, New Haven, Connecticut, United States
| | - Jiasheng Liang
- Yale University School of Medicine, 12228, New Haven, Connecticut, United States
| | - Yeliz Celik
- Koc Universitesi, 52979, Koc University Research Center for Translational Medicine (KUTTAM), Istanbul, Turkey
| | - Sara Op de Beeck
- Universiteit Antwerpen Faculteit geneeskunde en gezondheidswetenschappen, 81844, Translational Neurosciences, Wilrijk, Belgium.,Universitair Ziekenhuis Antwerpen, 60202, Ear Nose Throat, Edegem, Belgium
| | - Nancy S Redeker
- Yale University Yale School of Nursing, 16230, New Haven, Connecticut, United States
| | - Andrew Wellman
- Brigham and Women's Hospital Department of Medicine, 370908, Medicine, Boston, Massachusetts, United States.,Harvard Medical School, 1811, Boston, Massachusetts, United States
| | - H Klar Yaggi
- Yale School of Medicine, 12228, Internal Medicine, New Haven, Connecticut, United States.,VA Connecticut Healthcare System, 19985, Clinical Epidemiology Research Center, West Haven, Connecticut, United States
| | - Yüksel Peker
- Koc Universitesi, 52979, Koc University Research Center for Translational Medicine (KUTTAM) , Istanbul, Turkey.,University of Gothenburg Faculty of Health Sciences, 70712, Molecular and Clinical Medicine/Cardiology, Goteborg, Sweden.,Lund University Faculty of Medicine, 59568, Clinical Sciences, Respiratory Medicine and Allergology, Lund, Sweden.,University of Pittsburgh Medical Center, 6595, Pittsburgh, Pennsylvania, United States
| | - Scott A Sands
- Brigham and Women's Hospital, 1861, Boston, Massachusetts, United States
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Cardiovascular issues in obstructive sleep apnoea in children: A brief review. Paediatr Respir Rev 2021; 38:45-50. [PMID: 32972854 DOI: 10.1016/j.prrv.2020.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 04/30/2020] [Accepted: 05/28/2020] [Indexed: 11/23/2022]
Abstract
Obstructive sleep apnoea (OSA) is a very common disease with a prevalence that ranges from 1% to 6% in children. It is characterized by intermittent partial or complete occlusion of the upper airway during sleep, leading to recurrent arousals and disturbed sleep architecture, to neurocognitive disorders and alterations in homeostatic gas exchange. Cardiovascular complications may develop in children with OSA through various mechanisms including activation and dysregulation of the sympathetic nervous system, induction of pro-inflammatory and pro-oxidant status and increased risk of systemic hypertension. As the deleterious effects of OSA on the cardio-vascular system may start early in life, in this brief review we focused our attention both on early and late cardiological changes induced by apnoeic events in the paediatric population, by reviewing recent findings in the literature.
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Alessi CA, Fung CH, Dzierzewski JM, Fiorentino L, Stepnowsky C, Rodriguez Tapia JC, Song Y, Zeidler MR, Josephson K, Mitchell MN, Jouldjian S, Martin JL. Randomized controlled trial of an integrated approach to treating insomnia and improving the use of positive airway pressure therapy in veterans with comorbid insomnia disorder and obstructive sleep apnea. Sleep 2021; 44:zsaa235. [PMID: 33221910 PMCID: PMC8033453 DOI: 10.1093/sleep/zsaa235] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 09/26/2020] [Indexed: 12/11/2022] Open
Abstract
STUDY OBJECTIVES Cognitive behavioral therapy for insomnia (CBTI) for comorbid insomnia and obstructive sleep apnea (OSA) has had mixed results. We integrated CBTI with a positive airway pressure (PAP) adherence program and tested effects on sleep and PAP use. METHODS 125 veterans (mean age 63.2, 96% men, 39% non-Hispanic white, 26% black/African American, 18% Hispanic/Latino) with comorbid insomnia and newly-diagnosed OSA (apnea-hypopnea index ≥ 15) were randomized to 5-weekly sessions integrating CBTI with a PAP adherence program provided by a "sleep coach" (with behavioral sleep medicine supervision), or 5-weekly sleep education control sessions. Participants and assessment staff were blinded to group assignment. Outcomes (baseline, 3 and 6 months) included Pittsburgh Sleep Quality Index (PSQI), 7-day sleep diary (sleep onset latency [SOL-D], wake after sleep onset [WASO-D], sleep efficiency [SE-D]), 7-day actigraphy (SE-A), and objective PAP use (hours/night and nights ≥ 4 h). Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), and Functional Outcomes of Sleep Questionnaire-10 (FOSQ-10) were also collected. RESULTS Compared to controls, intervention participants showed greater improvement (baseline to 3 and 6 months, respectively) in PSQI (-3.2 and -1.7), SOL-D (-16.2 and -15.5 minutes), SE-D (10.5% and 8.5%), SE-A (4.4% and 2.6%) and more 90-day PAP use (1.3 and 0.9 more hours/night, 17.4 and 11.3 more nights PAP ≥ 4 h). 90-day PAP use at 3 months was 3.2 and 1.9 h/night in intervention versus controls. Intervention participants also had greater improvements in ISI, ESS, and FOSQ-10 (all p < 0.05). CONCLUSIONS An intervention integrating CBTI with a PAP adherence program delivered by a supervised sleep coach improved sleep and PAP use in adults with comorbid insomnia and OSA. TRIAL REGISTRATION ClinicalTrials.govStudy name: Novel Treatment of Comorbid Insomnia and Sleep Apnea in Older VeteransURL: https://clinicaltrials.gov/ct2/results?cond=&term=NCT02027558&cntry=&state=&city=&dist=Registration: NCT02027558.
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Affiliation(s)
- Cathy A Alessi
- Geriatric Research, Education and Clinical Center (GRECC), VA Greater Los Angeles Healthcare System, Los Angeles, CA
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Constance H Fung
- Geriatric Research, Education and Clinical Center (GRECC), VA Greater Los Angeles Healthcare System, Los Angeles, CA
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | | | - Lavinia Fiorentino
- Department of Psychiatry, University of California, San Diego, San Diego, CA
| | - Carl Stepnowsky
- Department of Medicine, University of California, San Diego, San Diego, CA
- VA San Diego Healthcare System, San Diego, CA
| | | | - Yeonsu Song
- Geriatric Research, Education and Clinical Center (GRECC), VA Greater Los Angeles Healthcare System, Los Angeles, CA
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
- School of Nursing, University of California Los Angeles, Los Angeles, CA
| | - Michelle R Zeidler
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
- Pulmonary, Critical Care and Sleep Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Karen Josephson
- Geriatric Research, Education and Clinical Center (GRECC), VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Michael N Mitchell
- Geriatric Research, Education and Clinical Center (GRECC), VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Stella Jouldjian
- Geriatric Research, Education and Clinical Center (GRECC), VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Jennifer L Martin
- Geriatric Research, Education and Clinical Center (GRECC), VA Greater Los Angeles Healthcare System, Los Angeles, CA
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
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Mohammadi H, Aarabi A, Rezaei M, Khazaie H, Brand S. Sleep Spindle Characteristics in Obstructive Sleep Apnea Syndrome (OSAS). Front Neurol 2021; 12:598632. [PMID: 33716919 PMCID: PMC7947924 DOI: 10.3389/fneur.2021.598632] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 01/21/2021] [Indexed: 01/08/2023] Open
Abstract
Background: We compared the density and duration of sleep spindles topographically in stage 2 and 3 of non-rapid eye movement sleep (N2 and N3) among adults diagnosed with Obstructive Sleep Apnea Syndrome (OSAS) and healthy controls. Materials and Methods: Thirty-one individuals with OSAS (mean age: 48.50 years) and 23 healthy controls took part in the study. All participants underwent a whole night polysomnography. Additionally, those with OSAS were divided into mild, moderate and severe cases of OSAS. Results: For N2, sleep spindle density did not significantly differ between participants with and without OSAS, or among those with mild, moderate and severe OSAS. For N3, post-hoc analyses revealed significantly higher spindle densities in healthy controls and individuals with mild OSAS than in those with moderate or severe OSAS. Last, in N2 a higher AHI was associated with a shorter sleep spindle duration. Conclusion: OSAS is associated with a significantly lower spindle density in N3 and a shorter spindle duration in N2. Our results also revealed that, in contrast to moderate and severe OSAS, the sleep spindle characteristics of individuals with mild OSAS were very similar to those of healthy controls.
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Affiliation(s)
- Hiwa Mohammadi
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.,Department of Neurology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran.,Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ardalan Aarabi
- Laboratory of Functional Neuroscience and Pathologies (LNFP, EA4559), University Research Center (CURS), University Hospital of Amiens, Amiens, France.,Faculty of Medicine, University of Picardie Jules Verne, Amiens, France
| | - Mohammad Rezaei
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.,Department of Medical Physics and Biomedical Engineering, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Habibolah Khazaie
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Serge Brand
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.,University of Basel, Psychiatric Clinics (UPK), Center for Affective, Stress and Sleep Disorders (ZASS), Basel, Switzerland.,Department of Sport, Exercise and Health, Division of Sport Science and Psychosocial Health, University of Basel, Basel, Switzerland.,Substance Abuse Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.,School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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10
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Hang LW, Huang CS, Cheng WJ. Clinical characteristics of Asian patients with sleep apnea with low arousal threshold and sleep structure change with continuous positive airway pressure. Sleep Breath 2020; 25:1309-1317. [PMID: 33123927 DOI: 10.1007/s11325-020-02235-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 10/04/2020] [Accepted: 10/21/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Low respiratory arousal threshold (ArTH) has been observed to be prevalent in patients with obstructive sleep apnea (OSA), and is associated with poor adherence to continuous positive airway pressure (CPAP) treatment. This study aimed to examine the associations between low ArTH and clinical characteristics. The second aim was to examine sleep structure changes between diagnostic polysomnography (PSG) and CPAP titration studies. METHODS PSG data for 3718 adults who had an apnea-hypopnea index (AHI) ≥ 5 were reviewed retrospectively, as well as 206 CPAP titration studies among these participants. Participants were dichotomized into low- and high-ArTH groups according to their PSG parameters. The associations between low ArTH and clinical characteristics were examined by multivariate logistic regressions. The sleep structure changes between PSG and CPAP titration studies were examined by repeated measures ANOVA. RESULTS Fifty percent of patients with OSA had low ArTH. Compared with high-ArTH patients, low-ArTH patients were less obese and composed of a higher percentage of women. In logistic regression models, low ArTH was associated with bruxism and nocturia, but not with illnesses after adjusting for AHI and body mass index. Compared with diagnostic PSG studies, low-ArTH patients had significantly decreased stage changes and increased percentage of rapid eye movement sleep during CPAP titration studies. CONCLUSION Low ArTH was prevalent in this large sample of patients with OSA. Arousal threshold was not associated with an increased risk of physical illnesses but was with certain clinical complaints. Low-ArTH patients benefited from CPAP titration study for improved sleep structure.
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Affiliation(s)
- Liang-Wen Hang
- Sleep Medicine Center, Department of Pulmonary and Critical Care Medicine, China Medical University Hospital, Taichung, Taiwan.,School of Nursing & Graduate Institute of Nursing, China Medical University, Taichung, Taiwan
| | - Chun-Sen Huang
- Sleep Medicine Center, Department of Pulmonary and Critical Care Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Wan-Ju Cheng
- Department of Psychiatry, China Medical University Hospital, 2 Yude Road, Taichung, 40447, Taiwan. .,Department of Public Health, China Medical University, Taichung, Taiwan.
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Chylinski D, Rudzik F, Coppieters ‘t Wallant D, Grignard M, Vandeleene N, Van Egroo M, Thiesse L, Solbach S, Maquet P, Phillips C, Vandewalle G, Cajochen C, Muto V. Validation of an Automatic Arousal Detection Algorithm for Whole-Night Sleep EEG Recordings. Clocks Sleep 2020; 2:258-272. [PMID: 32803153 PMCID: PMC7115937 DOI: 10.3390/clockssleep2030020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/10/2020] [Indexed: 11/23/2022] Open
Abstract
Arousals during sleep are transient accelerations of the EEG signal, considered to reflect sleep perturbations associated with poorer sleep quality. They are typically detected by visual inspection, which is time consuming, subjective, and prevents good comparability across scorers, studies and research centres. We developed a fully automatic algorithm which aims at detecting artefact and arousal events in whole-night EEG recordings, based on time-frequency analysis with adapted thresholds derived from individual data. We ran an automated detection of arousals over 35 sleep EEG recordings in healthy young and older individuals and compared it against human visual detection from two research centres with the aim to evaluate the algorithm performance. Comparison across human scorers revealed a high variability in the number of detected arousals, which was always lower than the number detected automatically. Despite indexing more events, automatic detection showed high agreement with human detection as reflected by its correlation with human raters and very good Cohen's kappa values. Finally, the sex of participants and sleep stage did not influence performance, while age may impact automatic detection, depending on the human rater considered as gold standard. We propose our freely available algorithm as a reliable and time-sparing alternative to visual detection of arousals.
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Affiliation(s)
- Daphne Chylinski
- GIGA-Cyclotron Research Centre-In Vivo Imaging, University of Liège, Allée du 6 Août 8 B30, B-4000 Sart-Tilman, 4000 Liège, Belgium; (D.C.); (M.G.); (N.V.); (M.V.E.); (P.M.); (C.P.); (G.V.)
| | - Franziska Rudzik
- Centre for Chronobiology, Psychiatric Hospital of the University of Basel, Willhelm Klein-Strasse 27, 4002 Basel, Switzerland; (F.R.); (L.T.); (S.S.); (C.C.)
- Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Birmannsgasse 8, CHF-4055 Basel, Switzerland
| | - Dorothée Coppieters ‘t Wallant
- Department of Electrical Engineering and Computer Science, University of Liège, Allée de la Découverte 10 B28, B-4000 Sart-Tilman, 4000 Liège, Belgium;
| | - Martin Grignard
- GIGA-Cyclotron Research Centre-In Vivo Imaging, University of Liège, Allée du 6 Août 8 B30, B-4000 Sart-Tilman, 4000 Liège, Belgium; (D.C.); (M.G.); (N.V.); (M.V.E.); (P.M.); (C.P.); (G.V.)
| | - Nora Vandeleene
- GIGA-Cyclotron Research Centre-In Vivo Imaging, University of Liège, Allée du 6 Août 8 B30, B-4000 Sart-Tilman, 4000 Liège, Belgium; (D.C.); (M.G.); (N.V.); (M.V.E.); (P.M.); (C.P.); (G.V.)
| | - Maxime Van Egroo
- GIGA-Cyclotron Research Centre-In Vivo Imaging, University of Liège, Allée du 6 Août 8 B30, B-4000 Sart-Tilman, 4000 Liège, Belgium; (D.C.); (M.G.); (N.V.); (M.V.E.); (P.M.); (C.P.); (G.V.)
| | - Laurie Thiesse
- Centre for Chronobiology, Psychiatric Hospital of the University of Basel, Willhelm Klein-Strasse 27, 4002 Basel, Switzerland; (F.R.); (L.T.); (S.S.); (C.C.)
- Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Birmannsgasse 8, CHF-4055 Basel, Switzerland
| | - Stig Solbach
- Centre for Chronobiology, Psychiatric Hospital of the University of Basel, Willhelm Klein-Strasse 27, 4002 Basel, Switzerland; (F.R.); (L.T.); (S.S.); (C.C.)
| | - Pierre Maquet
- GIGA-Cyclotron Research Centre-In Vivo Imaging, University of Liège, Allée du 6 Août 8 B30, B-4000 Sart-Tilman, 4000 Liège, Belgium; (D.C.); (M.G.); (N.V.); (M.V.E.); (P.M.); (C.P.); (G.V.)
- Department of Neurology, University of Liège Hospital, B35, B-4000 Liège, Belgium
| | - Christophe Phillips
- GIGA-Cyclotron Research Centre-In Vivo Imaging, University of Liège, Allée du 6 Août 8 B30, B-4000 Sart-Tilman, 4000 Liège, Belgium; (D.C.); (M.G.); (N.V.); (M.V.E.); (P.M.); (C.P.); (G.V.)
- GIGA-In Silico Medicine, University of Liège, Avenue de l’Hôpital 1-11, B-4000 Liège, Belgium
| | - Gilles Vandewalle
- GIGA-Cyclotron Research Centre-In Vivo Imaging, University of Liège, Allée du 6 Août 8 B30, B-4000 Sart-Tilman, 4000 Liège, Belgium; (D.C.); (M.G.); (N.V.); (M.V.E.); (P.M.); (C.P.); (G.V.)
| | - Christian Cajochen
- Centre for Chronobiology, Psychiatric Hospital of the University of Basel, Willhelm Klein-Strasse 27, 4002 Basel, Switzerland; (F.R.); (L.T.); (S.S.); (C.C.)
- Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Birmannsgasse 8, CHF-4055 Basel, Switzerland
| | - Vincenzo Muto
- GIGA-Cyclotron Research Centre-In Vivo Imaging, University of Liège, Allée du 6 Août 8 B30, B-4000 Sart-Tilman, 4000 Liège, Belgium; (D.C.); (M.G.); (N.V.); (M.V.E.); (P.M.); (C.P.); (G.V.)
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12
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Souza GMPR, Stornetta RL, Stornetta DS, Abbott SBG, Guyenet PG. Contribution of the Retrotrapezoid Nucleus and Carotid Bodies to Hypercapnia- and Hypoxia-induced Arousal from Sleep. J Neurosci 2019; 39:9725-9737. [PMID: 31641048 PMCID: PMC6891059 DOI: 10.1523/jneurosci.1268-19.2019] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 09/03/2019] [Accepted: 10/16/2019] [Indexed: 11/21/2022] Open
Abstract
The combination of hypoxia and hypercapnia during sleep produces arousal, which helps restore breathing and normalizes blood gases. Hypercapnia and hypoxia produce arousal in mammals by activating central (pH-sensitive) and peripheral (primarily O2-sensitive) chemoreceptors. The relevant chemoreceptors and the neuronal circuits responsible for arousal are largely unknown. Here we examined the contribution of two lower brainstem nuclei that could be implicated in CO2 and hypoxia-induced arousal: the retrotrapezoid nucleus (RTN), a CO2-responsive nucleus, which mediates the central respiratory chemoreflex; and the C1 neurons, which are hypoxia activated and produce arousal and blood pressure increases when directly stimulated. Additionally, we assessed the contribution of the carotid bodies (CBs), the main peripheral chemoreceptors in mammals, to hypoxia and CO2-induced arousal. In unanesthetized male rats, we tested whether ablation of the RTN, CBs, or C1 neurons affects arousal from sleep and respiratory responses to hypercapnia or hypoxia. The sleep-wake pattern was monitored by EEG and neck EMG recordings and breathing by whole-body plethysmography. The latency to arousal in response to hypoxia or hypercapnia was determined along with changes in ventilation coincident with the arousal. RTN lesions impaired CO2-induced arousal but had no effect on hypoxia-induced arousal. CB ablation impaired arousal to hypoxia and, to a lesser extent, hypercapnia. C1 neuron ablation had no effect on arousal. Thus, the RTN contributes to CO2-induced arousal, whereas the CBs contribute to both hypoxia and CO2-induced arousal. Asphyxia-induced arousal likely requires the combined activation of RTN, CBs and other central chemoreceptors.SIGNIFICANCE STATEMENT Hypercapnia and hypoxia during sleep elicit arousal, which facilitates airway clearing in the case of obstruction and reinstates normal breathing in the case of hypoventilation or apnea. Arousal can also be detrimental to health by interrupting sleep. We sought to clarify how CO2 and hypoxia cause arousal. We show that the retrotrapezoid nucleus, a brainstem nucleus that mediates the effect of brain acidification on breathing, also contributes to arousal elicited by CO2 but not hypoxia. We also show that the carotid bodies contribute predominantly to hypoxia-induced arousal. Lesions of the retrotrapezoid nucleus or carotid bodies attenuate, but do not eliminate, arousal to CO2 or hypoxia; therefore, we conclude that these structures are not the sole trigger of CO2 or hypoxia-induced arousal.
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Affiliation(s)
- George M P R Souza
- Department of Pharmacology, University of Virginia, Charlottesville, Virginia 22908
| | - Ruth L Stornetta
- Department of Pharmacology, University of Virginia, Charlottesville, Virginia 22908
| | - Daniel S Stornetta
- Department of Pharmacology, University of Virginia, Charlottesville, Virginia 22908
| | - Stephen B G Abbott
- Department of Pharmacology, University of Virginia, Charlottesville, Virginia 22908
| | - Patrice G Guyenet
- Department of Pharmacology, University of Virginia, Charlottesville, Virginia 22908
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He B, Al-Sherif M, Nido M, Tas R, Beach M, Schwarz EI, Cheng M, Ishak A, Lee K, Shah N, Kent B, Eze-John P, Ratneswaran C, Rafferty G, Williams AJ, Hart N, Luo Y, Moxham J, Pengo M, Steier J. Domiciliary use of transcutaneous electrical stimulation for patients with obstructive sleep apnoea: a conceptual framework for the TESLA home programme. J Thorac Dis 2019; 11:2153-2164. [PMID: 31285910 PMCID: PMC6588784 DOI: 10.21037/jtd.2019.05.04] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 04/30/2019] [Indexed: 12/31/2022]
Abstract
Obstructive sleep apnoea (OSA) is a global health problem of increasing prevalence. Effective treatments are available with continuous positive airway pressure (CPAP) therapy and mandibular advancement devices (MAD). However, there is limited long-term adherence to therapy, as CPAP and MAD require permanent usage to avoid recurrence of the symptoms and adverse ill health. Alternative treatments would aid in the treatment cascade to manage OSA effectively whenever standard therapy has been trialled and failed. Hypoglossal nerve stimulation (HNS), an invasive approach to stimulate the pharyngeal dilator muscles of the upper airway during sleep, has been approved for the treatment of OSA by several healthcare systems in recent years. In parallel to the development of HNS, a non-invasive approach has been developed to deliver electrical stimulation. Transcutaneous electrical stimulation in obstructive sleep apnoea (TESLA) uses non-invasive electrical stimulation to increase neuromuscular tone of the upper airway dilator muscles of patients with OSA during sleep. Data from previous feasibility studies and randomised controlled trials have helped to identify a subgroup of patients who are "responders" to this treatment. However, further investigations are required to assess usability, functionality and task accomplishment of this novel treatment. Consideration of these factors in the study design of future clinical trials will strengthen research methodology and protocols, improve patient related outcome measures and assessments, to optimise this emerging therapeutical option. In this review, we will introduce a conceptual framework for the TESLA home programme highlighting qualitative aspects and outcomes.
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Affiliation(s)
- Baiting He
- Lane Fox Unit/Sleep Disorders Centre, Guy’s & St Thomas’ NHS Foundation Trust, London, UK
- Faculty of Life Sciences and Medicine, King’s College London, UK
- Key National Laboratory for Respiratory Disease, Guangzhou Medical University, Guangzhou 510000, China
| | - Miral Al-Sherif
- Lane Fox Unit/Sleep Disorders Centre, Guy’s & St Thomas’ NHS Foundation Trust, London, UK
- Faculty of Life Sciences and Medicine, King’s College London, UK
- Department of Respiratory Medicine, University of Minia, Minia, Egypt
| | - Miriam Nido
- Lane Fox Unit/Sleep Disorders Centre, Guy’s & St Thomas’ NHS Foundation Trust, London, UK
- Institute for Work Research and Organizational Consultancy, Switzerland
| | - Rukiye Tas
- Faculty of Life Sciences and Medicine, King’s College London, UK
| | - Marianne Beach
- Faculty of Life Sciences and Medicine, King’s College London, UK
| | - Esther I. Schwarz
- Lane Fox Unit/Sleep Disorders Centre, Guy’s & St Thomas’ NHS Foundation Trust, London, UK
- Faculty of Life Sciences and Medicine, King’s College London, UK
- Department of Respiratory Medicine, University of Zurich, Zurich, Switzerland
| | - Michael Cheng
- Lane Fox Unit/Sleep Disorders Centre, Guy’s & St Thomas’ NHS Foundation Trust, London, UK
- Faculty of Life Sciences and Medicine, King’s College London, UK
- Department of Respiratory Medicine, University of Sydney, Sydney, Australia
| | - Athanasius Ishak
- Lane Fox Unit/Sleep Disorders Centre, Guy’s & St Thomas’ NHS Foundation Trust, London, UK
- Faculty of Life Sciences and Medicine, King’s College London, UK
| | - Kai Lee
- Faculty of Life Sciences and Medicine, King’s College London, UK
- Department of Respiratory Medicine, King’s College Hospital, London, UK
| | - Nimish Shah
- Jaslok Hospital and Research Centre, Mumbai, India
| | - Brian Kent
- Lane Fox Unit/Sleep Disorders Centre, Guy’s & St Thomas’ NHS Foundation Trust, London, UK
- Faculty of Life Sciences and Medicine, King’s College London, UK
| | - Paul Eze-John
- Lane Fox Unit/Sleep Disorders Centre, Guy’s & St Thomas’ NHS Foundation Trust, London, UK
| | - Culadeeban Ratneswaran
- Lane Fox Unit/Sleep Disorders Centre, Guy’s & St Thomas’ NHS Foundation Trust, London, UK
- Faculty of Life Sciences and Medicine, King’s College London, UK
| | - Gerrard Rafferty
- Faculty of Life Sciences and Medicine, King’s College London, UK
| | - Adrian J. Williams
- Lane Fox Unit/Sleep Disorders Centre, Guy’s & St Thomas’ NHS Foundation Trust, London, UK
- Faculty of Life Sciences and Medicine, King’s College London, UK
| | - Nicholas Hart
- Lane Fox Unit/Sleep Disorders Centre, Guy’s & St Thomas’ NHS Foundation Trust, London, UK
- Faculty of Life Sciences and Medicine, King’s College London, UK
| | - Yuanming Luo
- Faculty of Life Sciences and Medicine, King’s College London, UK
- Key National Laboratory for Respiratory Disease, Guangzhou Medical University, Guangzhou 510000, China
| | - John Moxham
- Faculty of Life Sciences and Medicine, King’s College London, UK
| | - Martino Pengo
- Lane Fox Unit/Sleep Disorders Centre, Guy’s & St Thomas’ NHS Foundation Trust, London, UK
- Faculty of Life Sciences and Medicine, King’s College London, UK
- Istituto Auxologico Italiano, University of Milan, Milan, Italy
| | - Joerg Steier
- Lane Fox Unit/Sleep Disorders Centre, Guy’s & St Thomas’ NHS Foundation Trust, London, UK
- Faculty of Life Sciences and Medicine, King’s College London, UK
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