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Dharmakulaseelan L, Boulos MI. Sleep Apnea and Stroke: A Narrative Review. Chest 2024; 166:857-866. [PMID: 38815623 DOI: 10.1016/j.chest.2024.04.028] [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: 08/24/2023] [Revised: 04/16/2024] [Accepted: 04/19/2024] [Indexed: 06/01/2024] Open
Abstract
TOPIC IMPORTANCE Stroke is the second-leading cause of death worldwide. OSA is an independent risk factor for stroke and is associated with multiple vascular risk factors. Poststroke OSA is prevalent and closely linked with various stroke subtypes, including cardioembolic stroke and cerebral small vessel disease. Observational studies have shown that untreated poststroke OSA is associated with an increased risk of recurrent stroke, mortality, poorer functional recovery, and longer hospitalizations. REVIEW FINDINGS Poststroke OSA tends to be underdiagnosed and undertreated, possibly because patients with stroke and OSA present atypically compared with the general population with OSA. Objective testing, such as the use of ambulatory sleep testing or in-laboratory polysomnography, is recommended for diagnosing OSA. The gold standard for treating OSA is CPAP therapy. Randomized controlled trials have shown that treatment of poststroke OSA using CPAP improves nonvascular outcomes such as cognition and neurologic recovery. However, findings from randomized controlled trials that have evaluated the effect of CPAP on recurrent stroke risk and mortality have been largely negative. SUMMARY There is a need for high-quality randomized controlled trials in poststroke OSA that may provide evidence to support the utility of CPAP (and/or other treatment modalities) in reducing recurrent vascular events and mortality. This goal may be achieved by examining treatment strategies that have yet to be trialed in poststroke OSA, tailoring interventions according to poststroke OSA endotypes and phenotypes, selecting high-risk populations, and using metrics that reflect the physiologic abnormalities that underlie the harmful effects of OSA on cardiovascular outcomes.
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Affiliation(s)
- Laavanya Dharmakulaseelan
- Department of Medicine, Division of Neurology, Sunnybrook Health Sciences Centre, and University of Toronto, Toronto, ON, Canada; Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Mark I Boulos
- Department of Medicine, Division of Neurology, Sunnybrook Health Sciences Centre, and University of Toronto, Toronto, ON, Canada; Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Sleep Laboratory, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
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Sousa S, Correia S, de Almeida AM, Videira G, Dias R, Ramos SF, Fonseca J. Treatment of obstructive sleep apnea syndrome (OSAS) with mandibular advancement devices-A statement of the Portuguese society of pulmonology, the Portuguese society of stomatology and dental medicine, the Portuguese dental association, and the Portuguese society of temporomandibular disorders, orofacial pain and sleep. Pulmonology 2024:S2531-0437(24)00093-X. [PMID: 39003191 DOI: 10.1016/j.pulmoe.2024.05.006] [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: 03/24/2023] [Revised: 05/21/2024] [Accepted: 05/27/2024] [Indexed: 07/15/2024] Open
Abstract
With the purpose of establishing a consensus around clinical orientations for professionals involved in managing patients with sleep breathing disorders (SBD), an interdisciplinary group of scientific societies involved in this field discussed and reviewed all the published international guidelines from the American Dental Association, American Academy of Sleep Medicine, American Academy of Dental Sleep Medicine and the European counterparts. Treatment of SBD is multidisciplinary and should be made in concert with the patient, the sleep physician, and the qualified dentist to solve the individual, social, and economic burden of the disease,. This consensus document represents the current thinking of a team of Portuguese experts on managing patients with SBD based on the available evidence.
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Affiliation(s)
- Susana Sousa
- CUF Tejo Hospital, Lisbon, Portugal; CUF Descobertas Hospital, Lisbon, Portugal; Nova Medical School, Lisbon, Portugal.
| | - Sílvia Correia
- Hospital da Boa Nova, Matosinhos, Portugal; Hospital Privado de Braga, Braga, Portugal
| | - André Mariz de Almeida
- CUF Tejo Hospital, Lisbon, Portugal; Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz School of Health and Science, Instituto Universitário Egas Moniz (IUEM), Almada, Portugal; Portuguese Society of Temporomandibular Disorders, Orofacial Pain and Sleep
| | - Gabriela Videira
- Portuguese Society of Temporomandibular Disorders, Orofacial Pain and Sleep; Luz Lisbon Hospital, Lisbon, Portugal
| | - Ricardo Dias
- Portuguese Society of Stomatology and Dental Medicine; Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Susana Falardo Ramos
- Portuguese Dental Association, Portugal; Universidade Católica Portuguesa, Faculty of Dental Medicine, Centre for Interdisciplinary Research in Health, Viseu, Portugal
| | - Júlio Fonseca
- Portuguese Society of Temporomandibular Disorders, Orofacial Pain and Sleep; ORISCLINIC, Coimbra, Portugal
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Sanchez-Azofra A, Orr JE, Sanz-Rubio D, Marin-Oto M, Alarcon-Sisamon S, Vicente E, Ancochea J, Soriano JB, DeYoung P, Azarbarzin A, Malhotra A, Marin JM. Apnea-Specific Pulse-Rate Response is Associated With Early Subclinical Atherosclerosis in Obstructive Sleep Apnea. Arch Bronconeumol 2024:S0300-2896(24)00242-4. [PMID: 39084963 DOI: 10.1016/j.arbres.2024.07.003] [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: 04/12/2024] [Revised: 06/15/2024] [Accepted: 07/02/2024] [Indexed: 08/02/2024]
Abstract
INTRODUCTION In patients with obstructive sleep apnea (OSA), novel metrics such as hypoxic burden (HB) and sleep apnea-specific pulse-rate response (ΔHR) may better correlate with cardiovascular diseases (CVD) than the apnea-hypopnea index (AHI). This manuscript aims to assess the correlation between ΔHR and HB with subclinical atherosclerosis in patients with OSA, testing the hypothesis that elevated ΔHR and HB are associated with subclinical atherosclerosis development. METHODS In a prospective study, individuals aged 20-65 years with suspected OSA without known comorbidities were consecutively recruited and defined as OSA (AHI≥5events/h) or healthy controls. Using bilateral carotid ultrasonography, common carotid intima-media thickness (CIMT) was assessed and the identification of at least one atheromatous plaque defined the presence of subclinical atherosclerosis. ΔHR, and HB were derived from pulse-oximetry. RESULTS We studied 296 patients of age 45±10 years old, of whom 28% were women, and with a BMI of 30.3±5.3kg/m2. Overall, 245 had OSA and 51 were healthy controls. After controlling for confounding variables higher ΔHR but not HB, was associated with higher CIMT (p=0.006) and higher time spent with oxygen saturation below 90% (T90) was associated with an increase in carotid atheroma plaques (p=0.032). When stratifying OSA based on HB tertiles, we observed that within tertile 2 of HB, an increase in ΔHR was associated with larger CIMT (p=0.017). CONCLUSION A higher ΔHR is associated with an increase in CIMT among adult patients with OSA. This study suggests that ΔHR could be a biomarker of risk for CVD in patients with OSA.
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Affiliation(s)
- Ana Sanchez-Azofra
- Division of Pulmonary, Critical Care, and Sleep Medicine and Physiology, Department of Medicine, University of California San Diego, 9500 Gilman Dr, La Jolla, CA 92093, USA; Division of Pulmonary Medicine, Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Calle Diego de Leon 62, 28006 Madrid, Spain.
| | - Jeremy E Orr
- Division of Pulmonary, Critical Care, and Sleep Medicine and Physiology, Department of Medicine, University of California San Diego, 9500 Gilman Dr, La Jolla, CA 92093, USA
| | - David Sanz-Rubio
- Translational Research Unit, IIS Aragón, Hospital Universitario Miguel Servet, Avda. San Juan Bosco 13, 50009 Zaragoza, Spain
| | - Marta Marin-Oto
- Translational Research Unit, IIS Aragón, Hospital Universitario Miguel Servet, Avda. San Juan Bosco 13, 50009 Zaragoza, Spain; Department of Medicine, Faculty of Medicine, University of Zaragoza, Edificio A, 50009 Zaragoza, Spain
| | - Sergio Alarcon-Sisamon
- Translational Research Unit, IIS Aragón, Hospital Universitario Miguel Servet, Avda. San Juan Bosco 13, 50009 Zaragoza, Spain
| | - Eugenio Vicente
- Translational Research Unit, IIS Aragón, Hospital Universitario Miguel Servet, Avda. San Juan Bosco 13, 50009 Zaragoza, Spain
| | - Julio Ancochea
- Division of Pulmonary Medicine, Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Calle Diego de Leon 62, 28006 Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Joan B Soriano
- Division of Pulmonary Medicine, Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Calle Diego de Leon 62, 28006 Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Pamela DeYoung
- Division of Pulmonary, Critical Care, and Sleep Medicine and Physiology, Department of Medicine, University of California San Diego, 9500 Gilman Dr, La Jolla, CA 92093, USA
| | - Ali Azarbarzin
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Harvard University, 75 Francis St, 02115 Boston, MA, USA
| | - Atul Malhotra
- Division of Pulmonary, Critical Care, and Sleep Medicine and Physiology, Department of Medicine, University of California San Diego, 9500 Gilman Dr, La Jolla, CA 92093, USA
| | - Jose M Marin
- Translational Research Unit, IIS Aragón, Hospital Universitario Miguel Servet, Avda. San Juan Bosco 13, 50009 Zaragoza, Spain; Department of Medicine, Faculty of Medicine, University of Zaragoza, Edificio A, 50009 Zaragoza, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
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Self AA, Mesarwi OA. Intermittent Versus Sustained Hypoxemia from Sleep-disordered Breathing: Outcomes in Patients with Chronic Lung Disease and High Altitude. Sleep Med Clin 2024; 19:327-337. [PMID: 38692756 DOI: 10.1016/j.jsmc.2024.02.011] [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] [Indexed: 05/03/2024]
Abstract
In a variety of physiologic and pathologic states, people may experience both chronic sustained hypoxemia and intermittent hypoxemia ("combined" or "overlap" hypoxemia). In general, hypoxemia in such instances predicts a variety of maladaptive outcomes, including excess cardiovascular disease or mortality. However, hypoxemia may be one of the myriad phenotypic effects in such states, making it difficult to ascertain whether adverse outcomes are primarily driven by hypoxemia, and if so, whether these effects are due to intermittent versus sustained hypoxemia.
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Affiliation(s)
- Alyssa A Self
- Division of Pulmonary, Critical Care, and Sleep Medicine and Physiology, University of California, San Diego, 9500 Gilman Drive Mail Code 0623A, La Jolla, CA 92093, USA
| | - Omar A Mesarwi
- Division of Pulmonary, Critical Care, and Sleep Medicine and Physiology, University of California, San Diego, 9500 Gilman Drive Mail Code 0623A, La Jolla, CA 92093, USA.
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Li C, Peng Y, Zhu X, Liu Y, Zou J, Zhu H, Li X, Yi H, Guan J, Zhang X, Xu H, Yin S. Independent relationship between sleep apnea-specific hypoxic burden and glucolipid metabolism disorder: a cross-sectional study. Respir Res 2024; 25:214. [PMID: 38762509 PMCID: PMC11102635 DOI: 10.1186/s12931-024-02846-7] [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: 12/08/2023] [Accepted: 05/12/2024] [Indexed: 05/20/2024] Open
Abstract
OBJECTIVES Obstructive sleep apnea (OSA) is associated with abnormal glucose and lipid metabolism. However, whether there is an independent association between Sleep Apnea-Specific Hypoxic Burden (SASHB) and glycolipid metabolism disorders in patients with OSA is unknown. METHODS We enrolled 2,173 participants with suspected OSA from January 2019 to July 2023 in this study. Polysomnographic variables, biochemical indicators, and physical measurements were collected from each participant. Multiple linear regression analyses were used to evaluate independent associations between SASHB, AHI, CT90 and glucose as well as lipid profile. Furthermore, logistic regressions were used to determine the odds ratios (ORs) for abnormal glucose and lipid metabolism across various SASHB, AHI, CT90 quartiles. RESULTS The SASHB was independently associated with fasting blood glucose (FBG) (β = 0.058, P = 0.016), fasting insulin (FIN) (β = 0.073, P < 0.001), homeostasis model assessment of insulin resistance (HOMA-IR) (β = 0.058, P = 0.011), total cholesterol (TC) (β = 0.100, P < 0.001), total triglycerides (TG) (β = 0.063, P = 0.011), low-density lipoprotein cholesterol (LDL-C) (β = 0.075, P = 0.003), apolipoprotein A-I (apoA-I) (β = 0.051, P = 0.049), apolipoprotein B (apoB) (β = 0.136, P < 0.001), apolipoprotein E (apoE) (β = 0.088, P < 0.001) after adjustments for confounding factors. Furthermore, the ORs for hyperinsulinemia across the higher SASHB quartiles were 1.527, 1.545, and 2.024 respectively, compared with the lowest quartile (P < 0.001 for a linear trend); the ORs for hyper-total cholesterolemia across the higher SASHB quartiles were 1.762, 1.998, and 2.708, compared with the lowest quartile (P < 0.001 for a linear trend) and the ORs for hyper-LDL cholesterolemia across the higher SASHB quartiles were 1.663, 1.695, and 2.316, compared with the lowest quartile (P < 0.001 for a linear trend). Notably, the ORs for hyper-triglyceridemia{1.471, 1.773, 2.099} and abnormal HOMA-IR{1.510, 1.492, 1.937} maintained a consistent trend across the SASHB quartiles. CONCLUSIONS We found SASHB was independently associated with hyperinsulinemia, abnormal HOMA-IR, hyper-total cholesterolemia, hyper-triglyceridemia and hyper-LDL cholesterolemia in Chinese Han population. Further prospective studies are needed to confirm that SASHB can be used as a predictor of abnormal glycolipid metabolism disorders in patients with OSA. TRIAL REGISTRATION ChiCTR1900025714 { http://www.chictr.org.cn/ }; Prospectively registered on 6 September 2019; China.
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Affiliation(s)
- Chenyang Li
- Department of Otolaryngology-Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Yu Peng
- Department of Otolaryngology-Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Xiaoyue Zhu
- Department of Otolaryngology-Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Yupu Liu
- Department of Otolaryngology-Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Jianyin Zou
- Department of Otolaryngology-Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Huaming Zhu
- Department of Otolaryngology-Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Xinyi Li
- Department of Otolaryngology-Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Hongliang Yi
- Department of Otolaryngology-Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Jian Guan
- Department of Otolaryngology-Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, Shanghai, China.
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China.
| | - Xu Zhang
- School of Biomedical Engineering, Shenzhen University Medical School, Shenzhen, China.
| | - Huajun Xu
- Department of Otolaryngology-Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, Shanghai, China.
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China.
| | - Shankai Yin
- Department of Otolaryngology-Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
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Lee E, Lee H. Clinical and Polysomnographic Characteristics of Adult Patients with Suspected Obstructive Sleep Apnea from Different Sleep Clinics at a Single Tertiary Center. Neurol Ther 2024; 13:399-414. [PMID: 38308801 PMCID: PMC10951132 DOI: 10.1007/s40120-024-00581-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/12/2024] [Indexed: 02/05/2024] Open
Abstract
INTRODUCTION The characteristics of patients across different sleep clinics may vary because they selectively visit specific specialists on the basis of their primary symptoms. This study aimed to compare the clinical and polysomnography (PSG) features of patients with suspected obstructive sleep apnea (OSA) at three sleep specialty clinics (otolaryngology [ENT], neurology [NR], and psychiatry [PSY]). METHODS We retrospectively analyzed the medical records and PSG reports of adult patients who underwent full-night PSG between January 2022 and June 2023 at a tertiary medical center. The demographic, questionnaire, and PSG variables were compared. RESULTS Of the 407 patients, 83.0% exhibited sleep-disordered breathing (apnea-hypopnea index ≥ 5) with varying severity among the specialty pathways. Patients in the ENT group (n = 231) were the youngest and had the shortest sleep latency and most severe OSA markers with the highest positive airway pressure (PAP) acceptance, while those in the NR group (n = 79) had similar OSA-related PSG parameters to those in the ENT group but were older and had more OSA-related comorbidities, although their PAP acceptance was relatively low. The PSY group (n = 97) included a significant proportion of patients with normal or mild OSA, a female majority, high levels of depression, and subjective sleep distress. CONCLUSION Our results highlight the multidisciplinary aspects of sleep medicine and diverse patients, and specialist needs for diagnosing sleep disorders and PAP acceptance. Exploring the potential differences in prognosis and treatment responses across various sleep specialty clinics would facilitate the development of personalized strategies.
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Affiliation(s)
- Eunmi Lee
- Department of Neurology, Ulsan University Hospital, University of Ulsan College of Medicine, 25, Daehakbyeongwon-Ro, Dong-Gu, Ulsan, 44033, Republic of Korea.
| | - Hyunjo Lee
- Department of Neurology, Ulsan University Hospital, University of Ulsan College of Medicine, 25, Daehakbyeongwon-Ro, Dong-Gu, Ulsan, 44033, Republic of Korea
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Aksu S, Çaman T, Özdemir İ, Bek S, Kutlu G. Lower handgrip strength in short-sleeper individuals with obstructive sleep apnea. Sleep Med 2023; 112:352-358. [PMID: 37977019 DOI: 10.1016/j.sleep.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 10/30/2023] [Accepted: 11/02/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is a frequently observed and remarkably incapacitating disorder worldwide. As a multisystem disorder, OSA has been linked to a plethora of clinical parameters though physical parameters like muscle strength have been scantily studied. Hand grip strength (HGS) is a practical marker of physical function that has been associated with mortality and an array of clinical outcomes as well as physiological parameters like sleep duration. A few seminal studies have observed no link between HGS and OSA severity while no studies evaluated the relationship between objectively determined sleep duration and HGS in OSA. OBJECTIVE The present study aimed to evaluate the HGS indices among both OSA severity groups and objectively determined sleep duration groups in OSA. METHODS 111 treatment-naïve mostly middle-aged individuals with OSA (86 males) were recruited in a tertiary sleep center. Three OSA severity groups were determined by the Apnea-Hypopnea Index while three sleep duration groups were objectively determined by Total Sleep Time (TST). Dominant and non-dominant maximum and average HGS were calculated using a digital hand dynamometer. RESULTS Short-sleeper individuals with OSA were found to have lower HGS indices than intermediate or sufficient sleepers with OSA while no differences in HGS indices among OSA severity groups were observed. All HGS indices correlated with TST. CONCLUSIONS Future insights can be gleaned from the present results regarding the conceivably transdiagnostic relationship between sleep duration and HGS as well as the potential use of HGS as a marker in OSA.
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Affiliation(s)
- Serkan Aksu
- Department of Physiology, Faculty of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey.
| | - Tuğçe Çaman
- Department of Neurology, Faculty of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey.
| | - İnan Özdemir
- Department of Neurology, Faculty of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey.
| | - Semai Bek
- Department of Neurology, Faculty of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey.
| | - Gülnihal Kutlu
- Department of Neurology, Faculty of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey.
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Li C, Gao Y, Huang W, Xu H, Liu Y, Zou J, Zhu H, Li X, Han F, Liu J, Wu K, Yi H, Guan J, Yin S. The use of the sleep apnea-specific hypoxic burden to predict obstructive sleep apnea hypopnea syndrome: Evidence from a large cross-sectional study. Sleep Med 2023; 111:94-100. [PMID: 37742592 DOI: 10.1016/j.sleep.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 09/05/2023] [Accepted: 09/05/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVES Obstructive sleep apnea hypopnea syndrome (OSA) is an independent risk factor for neurocognitive and behavioral problems and cardiovascular and metabolic morbidities, ultimately increasing mortality. However, OSA diagnosis is time-consuming, labor-intensive, and expensive. We evaluated the predictive utility of the sleep apnea-specific hypoxic burden (SASHB) in terms of OSA and the severity thereof in Han Chinese individuals. METHODS From January 2019 to July 2022, subjects with suspected OSA were recruited in the sleep center of the Shanghai Sixth People's Hospital during sleep evaluation via standard polysomnography. Basic anthropometric measurements and polysomnographic indicators were collected; SASHB was calculated based on the SpO2 trends of apnea or hypopnea events. Models predictive of OSA were established via logistic regression in the experimental group and verified in an independent group by drawing receiver operating characteristic (ROC) curves. RESULTS A total of 2303 subjects with suspected OSA (1200 in the experimental group and 1103 in the validation group) were included. SASHB was positively correlated with the apnea-hyponea index (AHI) in all subjects (r = 0.823, P < 0.001). SASHB distinguished OSA from non-OSA subjects in both the experimental group {area under the curve (AUC) 0.948 [0.934∼0.962]} and the validation group (AUC 0.931 [0.913∼0.949]). SASHB predicted OSA severity well, better than did the neck, waist, or hip circumference; the lowest or mean oxygen saturation; and the Epworth sleepiness scale score. CONCLUSION SASHB predicted OSA both accurately and efficiently in a Chinese Han population. Further studies are warranted to verify our findings in community samples.
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Affiliation(s)
- Chenyang Li
- Department of Otolaryngology-Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, Shanghai, China; Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Yiqing Gao
- Department of Otolaryngology-Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, Shanghai, China; Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Weijun Huang
- Department of Otolaryngology-Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, Shanghai, China; Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Huajun Xu
- Department of Otolaryngology-Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, Shanghai, China; Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China.
| | - Yupu Liu
- Department of Otolaryngology-Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, Shanghai, China; Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Jianyin Zou
- Department of Otolaryngology-Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, Shanghai, China; Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Huaming Zhu
- Department of Otolaryngology-Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, Shanghai, China; Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Xinyi Li
- Department of Otolaryngology-Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, Shanghai, China; Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Fangkai Han
- Department of Oral & Maxillofacial Imaging, Shanghai Stomatological Hospital & School of Stomatology, Fudan University. Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai, China.
| | - Jingjing Liu
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Kejia Wu
- Department of Otolaryngology-Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, Shanghai, China; Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Hongliang Yi
- Department of Otolaryngology-Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, Shanghai, China; Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Jian Guan
- Department of Otolaryngology-Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, Shanghai, China; Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China.
| | - Shankai Yin
- Department of Otolaryngology-Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, Shanghai, China; Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
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He S, Cistulli PA, de Chazal P. A Review of Novel Oximetry Parameters for the Prediction of Cardiovascular Disease in Obstructive Sleep Apnoea. Diagnostics (Basel) 2023; 13:3323. [PMID: 37958218 PMCID: PMC10649141 DOI: 10.3390/diagnostics13213323] [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: 08/30/2023] [Revised: 10/18/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023] Open
Abstract
Obstructive sleep apnoea (OSA) is a sleep disorder with repetitive collapse of the upper airway during sleep, which leads to intermittent hypoxic events overnight, adverse neurocognitive, metabolic complications, and ultimately an increased risk of cardiovascular disease (CVD). The standard diagnostic parameter for OSA, apnoea-hypopnoea index (AHI), is inadequate to predict CVD morbidity and mortality, because it focuses only on the frequency of apnoea and hypopnoea events, and fails to reveal other physiological information for the prediction of CVD events. Novel parameters have been introduced to compensate for the deficiencies of AHI. However, the calculation methods and criteria for these parameters are unclear, hindering their use in cross-study analysis and studies. This review aims to discuss novel parameters for predicting CVD events from oximetry signals and to summarise the corresponding computational methods.
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Affiliation(s)
- Siying He
- Charles Perkins Centre, Faculty of Engineering, Sydney University, Camperdown, NSW 2050, Australia;
| | - Peter A. Cistulli
- Charles Perkins Centre, Faculty of Medicine and Health, Sydney University, Camperdown, NSW 2050, Australia;
- Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, St Leonards, NSW 2065, Australia
| | - Philip de Chazal
- Charles Perkins Centre, Faculty of Engineering, Sydney University, Camperdown, NSW 2050, Australia;
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10
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Wei H, Zhu J, Lei F, Luo L, Zhang Y, Ren R, Li T, Tan L, Tang X. Clinical phenotypes of obstructive sleep apnea: a cluster analysis based on sleep perception and sleep quality. Sleep Breath 2023; 27:1829-1837. [PMID: 36853471 PMCID: PMC10539408 DOI: 10.1007/s11325-023-02786-4] [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: 11/09/2022] [Revised: 01/22/2023] [Accepted: 01/30/2023] [Indexed: 03/01/2023]
Abstract
PURPOSE To determine obstructive sleep apnea (OSA) phenotypes using cluster analysis including variables of sleep perception and sleep quality and to further explore factors correlated with poor sleep quality in different clusters. METHODS This retrospective study included patients with OSA undergoing polysomnography (PSG) between December 2020 and April 2022. Two-step cluster analysis was performed to detect distinct clusters using sleep perception variables including discrepancy in total sleep time (TST), sleep onset latency (SOL), and wakefulness after sleep onset (WASO); objective TST, SOL, and WASO; and sleep quality. One-way analysis of variance or chi-squared tests were used to compare clinical and PSG characteristics between clusters. Binary logistic regression analyses were used to explore factors correlated with poor sleep quality. RESULTS A total of 1118 patients were included (81.6% men) with mean age ± SD 43.3 ± 13.1 years, Epworth sleepiness score, 5.7 ± 4.4, and insomnia severity index 3.0 ± 2.4. Five distinct OSA clusters were identified: cluster 1 (n = 254), underestimated TST; cluster 2 (n = 158), overestimated TST; cluster 3 (n = 169), overestimated SOL; cluster 4 (n = 155), normal sleep discrepancy and poor sleep quality; and cluster 5 (n = 382), normal sleep discrepancy and good sleep quality. Patients in cluster 2 were older, more commonly had hypertension, and had the lowest apnea-hypopnea index and oxygen desaturation index. Age and sleep efficiency were correlated with poor sleep quality in clusters 1, 2, and 5, and also AHI in cluster 2. CONCLUSION Subgroups of patients with OSA have different patterns of sleep perception and quality that may help us to further understand the characteristics of sleep perception in OSA and provide clues for personalized treatment.
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Affiliation(s)
- Huasheng Wei
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, 28 Dian Xin Nan Jie, Chengdu, 610041, Sichuan, China
- Department of Respiratory and Critical Care Medicine, Dazhou Central Hospital, Dazhou, China
| | - Jie Zhu
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, 28 Dian Xin Nan Jie, Chengdu, 610041, Sichuan, China
| | - Fei Lei
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, 28 Dian Xin Nan Jie, Chengdu, 610041, Sichuan, China
| | - Lian Luo
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, 28 Dian Xin Nan Jie, Chengdu, 610041, Sichuan, China
| | - Ye Zhang
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, 28 Dian Xin Nan Jie, Chengdu, 610041, Sichuan, China
| | - Rong Ren
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, 28 Dian Xin Nan Jie, Chengdu, 610041, Sichuan, China
| | - Taomei Li
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, 28 Dian Xin Nan Jie, Chengdu, 610041, Sichuan, China
| | - Lu Tan
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, 28 Dian Xin Nan Jie, Chengdu, 610041, Sichuan, China.
| | - Xiangdong Tang
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, 28 Dian Xin Nan Jie, Chengdu, 610041, Sichuan, China.
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11
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Solano-Pérez E, Coso C, Castillo-García M, Romero-Peralta S, Lopez-Monzoni S, Laviña E, Cano-Pumarega I, Sánchez-de-la-Torre M, García-Río F, Mediano O. Diagnosis and Treatment of Sleep Apnea in Children: A Future Perspective Is Needed. Biomedicines 2023; 11:1708. [PMID: 37371803 DOI: 10.3390/biomedicines11061708] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/06/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
Obstructive sleep apnea (OSA) in children is a prevalent, but still, today, underdiagnosed illness, which consists of repetitive episodes of upper airway obstruction during sleep with important repercussions for sleep quality. OSA has relevant consequences in the pediatric population, mainly in the metabolic, cardiovascular (CV), and neurological spheres. However, contrary to adults, advances in diagnostic and therapeutic management have been scarce in the last few years despite the increasing scientific evidence of the deleterious consequences of pediatric OSA. The problem of underdiagnosis and the lack of response to treatment in some groups make an update to the management of OSA in children necessary. Probably, the heterogeneity of OSA is not well represented by the classical clinical presentation and severity parameters (apnea/hypopnea index (AHI)), and new strategies are required. A specific and consensus definition should be established. Additionally, the role of simplified methods in the diagnosis algorithm should be considered. Finally, the search for new biomarkers for risk stratification is needed in this population. In conclusion, new paradigms based on personalized medicine should be implemented in this population.
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Affiliation(s)
- Esther Solano-Pérez
- Sleep Unit, Pneumology Department, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
| | - Carlota Coso
- Sleep Unit, Pneumology Department, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
| | - María Castillo-García
- Sleep Unit, Pneumology Department, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain
- Medicine Department, Universidad de Alcalá, 28805 Madrid, Spain
- Sleep Research Institute, 28036 Madrid, Spain
| | - Sofía Romero-Peralta
- Sleep Unit, Pneumology Department, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain
- Medicine Department, Universidad de Alcalá, 28805 Madrid, Spain
- Sleep Research Institute, 28036 Madrid, Spain
| | - Sonia Lopez-Monzoni
- Sleep Unit, Pneumology Department, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain
| | - Eduardo Laviña
- Sleep Unit, Pneumology Department, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain
| | - Irene Cano-Pumarega
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
- Sleep Unit, Pneumology Department, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), 28034 Madrid, Spain
| | - Manuel Sánchez-de-la-Torre
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
- Group of Precision Medicine in Chronic Diseases, University Hospital Arnau de Vilanova and Santa María, 25198 Lleida, Spain
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, Institut de Recerca Biomèdica de Lleida (IRBLleida), University of Lleida, 25002 Lleida, Spain
| | - Francisco García-Río
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
- Respiratory Diseases Group, Respiratory Service, Hospital Universitario La Paz, IdiPAZ, 28046 Madrid, Spain
- Pneumology Department, Hospital Universitario La Paz, IdiPAZ, 28046 Madrid, Spain
- Faculty of Medicine, Universidad Autónoma de Madrid, 28049 Madrid, Spain
| | - Olga Mediano
- Sleep Unit, Pneumology Department, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
- Medicine Department, Universidad de Alcalá, 28805 Madrid, Spain
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12
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Howarth TP, Karhu T, Kainulainen S, Chen X, Mahamid A, Töyräs J, Leppänen T. Oxygen resaturation rate is significantly associated with objectively assessed excessive daytime sleepiness in suspected obstructive sleep apnoea patients. Sleep Med 2023; 107:171-178. [PMID: 37187080 DOI: 10.1016/j.sleep.2023.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/22/2023] [Accepted: 04/27/2023] [Indexed: 05/17/2023]
Abstract
INTRODUCTION Commonly utilised metrics such as the apnoea-hypopnoea index show limited correlation to excessive daytime sleepiness (EDS). Oxygen desaturation parameters show better predictive power, however oxygen resaturation parameters have not yet been investigated. Oxygen resaturation may represent increased cardiovascular fitness and thus we hypothesized that a higher resaturation rate would be protective against EDS. METHODS Oxygen saturation parameters were computed via ABOSA software for adult patients referred for polysomnography and multiple sleep latency test in Israel Loewenstein hospital 2001-2011. EDS was defined as a mean sleep latency (MSL) below 8 min. RESULTS 1629 patients (75% male, 53% obese, median age of 54 years) were included for analysis. The average desaturation event nadir was 90.4% and resaturation rate 0.59%/second. Median MSL was 9.6 min, and 606 patients met criteria for EDS. Patients who were younger, female, and with larger desaturations had significantly higher resaturation rates (p < 0.001). In multivariate models, adjusted for age, sex, body mass index, and average desaturation depth, resaturation rate showed a significant negative correlation with MSL (z-score standardised beta, -1 (95%CI -0.49, -1.52)), and significantly increased odds ratio (OR) of EDS (OR, 1.28 (95%CI 1.07, 1.53)). The beta associated with resaturation rate was larger, though non-significantly, than that of desaturation depth (difference 0.36 (95% CI -1.34, 0.62), p = 0.470). CONCLUSION Oxygen resaturation parameters show significant associations with objectively assessed EDS independent of desaturation parameters. Thus, resaturation and desaturation parameters may reflect differing underlying mechanistic pathways and both be considered novel and appropriate markers for assessing sleep-disordered breathing and associated outcomes.
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Affiliation(s)
- Timothy P Howarth
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland; Darwin Respiratory and Sleep Health, Darwin Private Hospital, Darwin, Australia; College of Health and Human Sciences, Charles Darwin University, Darwin, Australia.
| | - Tuomas Karhu
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland; Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Samu Kainulainen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland; Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Xin Chen
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
| | - Alaa Mahamid
- Sleep Disorders Unit, Loewenstein Hospital-Rehabilitation Center, Raanana, Israel
| | - Juha Töyräs
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland; School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia; Science Service Center, Kuopio University Hospital, Kuopio, Finland
| | - Timo Leppänen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland; Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland; School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
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13
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Cao W, Luo J, Huang R, Xiao Y. Implication of a novel measure of obstructive sleep apnea severity for cardiovascular morbidity. Sleep Med 2023; 103:204-210. [PMID: 36857991 DOI: 10.1016/j.sleep.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/29/2023] [Accepted: 02/01/2023] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To evaluate the association between cardiovascular morbidity and obstructive sleep apnea (OSA) severity quantified using the sleep breathing impairment index (SBII), a novel measure that captures both respiratory events and event-associated hypoxia. PATIENTS AND METHODS This retrospective follow-up study included 737 participants with OSA who were diagnosed based on an apnea-hypopnea index of >5/h in polysomnography from January 1, 2012 to December 31, 2015. Data on baseline clinical characteristics and polysomnography parameters were collected. SBII was determined as the sum of products of respiratory events and event-related desaturation areas, and was categorized based on its quintiles. The outcomes were any hospital admission for cardiovascular diseases, including coronary heart disease, stroke, peripheral vascular disease, or heart failure after the diagnosis of OSA. Logistic regression models were constructed to estimate the potential association between SBII and cardiovascular morbidity after adjusting for confounders. RESULTS A total of 60 cardiovascular events were recorded. Compared with the first quintile of SBII, the odds ratio (95% confidence interval [CI]) of cardiovascular morbidity for the second, third, and fourth quintiles were 4.01 (95% CI, 1.22-13.24), 3.91 (95% CI, 1.05-14.53), and 7.57 (95% CI, 1.70-33.68) after adjusting for covariables, including anthropometric variables, medical conditions, and sleep parameters. CONCLUSION In patients with OSA, higher SBII was associated with an increased cardiovascular risk. These findings suggest that a more comprehensive measure, such as SBII incorporating the respiratory event and related hypoxia during sleep, may better capture the disease burden and reflect the OSA-associated adverse outcomes.
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Affiliation(s)
- Wenhao Cao
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jinmei Luo
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Rong Huang
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 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, China.
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14
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Martinez-Garcia MA, Sánchez-de-la-Torre M, White DP, Azarbarzin A. Hypoxic Burden in Obstructive Sleep Apnea: Present and Future. Arch Bronconeumol 2023; 59:36-43. [PMID: 36115739 DOI: 10.1016/j.arbres.2022.08.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 08/12/2022] [Indexed: 12/27/2022]
Abstract
Conventional measures of obstructive sleep apnea (OSA) severity, such as the apnea-hypopnea index (AHI) and oxygen desaturation index (ODI) are commonly used to quantify OSA severity and guide therapeutical decision-making processes. However, it is widely recognized that both AHI and ODI have important limitations and novel physiologically-informed metrics are needed to better capture the severity of OSA and characterize its physiological consequences, particularly the severity of recurrent nocturnal hypoxemia, ensuing the respiratory events. According to recent studies, the sleep apnea-specific "hypoxic burden (HB)", defined as the sum of individual areas under the oxygen desaturation curve, has shown some promise in identifying high risk individuals with OSA. In addition to the frequency of respiratory events, HB capture the depth and duration of OSA-related hypoxemia that may prove to be important disease characterizing features, not captured by the conventional "frequency-based" metrics, such as AHI and ODI. In this "perspective" paper the methods to quantify the HB, its characteristics, associations with health outcomes, and its limitations will be discussed.
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Affiliation(s)
- Miguel A Martinez-Garcia
- Respiratory Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.
| | - Manuel Sánchez-de-la-Torre
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain; Precision Medicine in Chronic Diseases, Hospital Universitari Arnau de Vilanova-Santa Maria, IRB Lleida, Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
| | - David P White
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Ali Azarbarzin
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
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15
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Pu Q, Wu Z, Li AL, Guo XX, Hu JJ, Li XY. Association between poor sleep quality and an increased risk of dry eye disease in patients with obstructive sleep apnea syndrome. Front Med (Lausanne) 2022; 9:870391. [PMID: 36388897 PMCID: PMC9659957 DOI: 10.3389/fmed.2022.870391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 10/05/2022] [Indexed: 11/26/2022] Open
Abstract
Purpose Obstructive sleep apnea (OSA) is related to an increased incidence of dry eye disease (DED). However, their exact relationship is unknown and requires further well-designed studies with advanced mechanisms detection. Patients and methods This case–control study included 125 OSA cases and 125 age–gender-matched controls enrolled in the hospital between 1 January and 1 October 2021. OSA diagnosis and classification were performed using a polysomnography (PSG) assay. Detailed ophthalmological examinations, including the Schirmer I test, corneal staining, and ocular surface disease index (OSDI), were used to detect DED-related parameters. A comprehensive ocular surface assay was performed to measure a series of parameters, including first non-invasive first tear film break-up time (f-NIBUT), average non-invasive first tear film break-up time (av-NIBUT), tear meniscus height (TMH), and loss of meibomian gland. In addition, the Pittsburgh Sleep Quality Index (PSQI) scale was used to assess sleep quality. Results Compared to the control, the OSA group showed an increased DED risk (P = 0.016) along with an increased PSQI score and a higher rate of poor quality sleep (P < 0.001 and P = 0.007, respectively). Stratification of OSA cases indicated that DED-related parameters were impaired in patients with severe OSA (P < 0.05). The analysis of DED-parameters-related factors showed significant correlations between OSA-related indexes and PSQI (P < 0.05). Moreover, the poor sleep quality group in the OSA cases showed worse DED-related parameters (P < 0.05), which was not observed in the control group. Conclusion OSA, especially the severe stage OSA, was related to an increased risk of DED. Also, sleep quality was correlated with the onset of both OSA and DED, where poor sleep quality revealed a relationship between OSA and the risk of DED. Overall, our findings provided evidence for advanced management of DED and OSA in future.
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Affiliation(s)
- Qi Pu
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhen Wu
- Department of Ear, Nose, and Throat, Changshu No. 2 People’s Hospital, Changshu, China
| | - Ao-Ling Li
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiao-Xiao Guo
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing-Jie Hu
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xin-Yu Li
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Xin-Yu Li,
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16
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Hypoxic Burden in Obstructive Sleep Apnea: Present and Future. Arch Bronconeumol 2022:S0300-2896(22)00524-5. [PMID: 36127216 DOI: 10.1016/j.arbres.2022.08.009] [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: 07/15/2022] [Revised: 08/11/2022] [Accepted: 08/12/2022] [Indexed: 11/24/2022]
Abstract
Conventional measures of obstructive sleep apnea (OSA) severity, such as the apnea-hypopnea index (AHI) and oxygen desaturation index (ODI) are commonly used to quantify OSA severity and guide therapeutical decision-making processes. However, it is widely recognized that both AHI and ODI have important limitations and novel physiologically informed metrics are needed to better capture the severity of OSA and characterize its physiological consequences, particularly the severity of recurrent nocturnal hypoxemia, ensuing the respiratory events. According to recent studies, the sleep apnea-specific "Hypoxic Burden (HB)", defined as the sum of individual areas under the oxygen desaturation curve, has shown some promise in identifying high risk individuals with OSA. In addition to the frequency of respiratory events, HB capture the depth and duration of OSA-related hypoxemia that may prove to be important disease characterizing features, not captured by the conventional "frequency-based" metrics, such as AHI and ODI. In this "Perspective" paper the methods to quantify the HB, its characteristics, associations with health outcomes, and its limitations will be discussed.
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17
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Blekic N, Bold I, Mettay T, Bruyneel M. Impact of Desaturation Patterns versus Apnea-Hypopnea Index in the Development of Cardiovascular Comorbidities in Obstructive Sleep Apnea Patients. Nat Sci Sleep 2022; 14:1457-1468. [PMID: 36045914 PMCID: PMC9423119 DOI: 10.2147/nss.s374572] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 08/15/2022] [Indexed: 11/23/2022] Open
Abstract
Various phenotypes of obstructive sleep apnea (OSA) have been recently described and are poorly assessed by the commonly used polysomnographic indices, such as the apnea-hypopnea index and oxygen desaturation index. Nocturnal hypoxemia is the hallmark of OSA and new quantitative markers, as hypoxic burden or desaturation severity, have been shown to be associated with cardiovascular (CV) mortality. The purpose of this overview is to review the endophenotypical and clinical characteristics of OSA, the current metrics, and to analyze different measurements of hypoxemia in OSA to predict the cardiovascular impact (eg hypoxic burden). Potential interest of multidimensional models to classify OSA, such as BAVENO classification, is also discussed, with the goal of focusing on specific endophenotypes that are likely to develop CV comorbidities, in order to guide clinicians to more aggressive management of OSA in these individuals.
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Affiliation(s)
- Nathan Blekic
- Department of Pulmonary Medicine, Saint-Pierre University Hospital, Brussels, Belgium and Université Libre de Bruxelles, Brussels, Belgium
| | - Ionela Bold
- Department of Pulmonary Medicine, Saint-Pierre University Hospital, Brussels, Belgium and Université Libre de Bruxelles, Brussels, Belgium
| | - Thomas Mettay
- Department of Pulmonary Medicine, Brugmann University Hospital, Brussels, Belgium and Université Libre de Bruxelles, Brussels, Belgium
| | - Marie Bruyneel
- Department of Pulmonary Medicine, Saint-Pierre University Hospital, Brussels, Belgium and Université Libre de Bruxelles, Brussels, Belgium
- Department of Pulmonary Medicine, Brugmann University Hospital, Brussels, Belgium and Université Libre de Bruxelles, Brussels, Belgium
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18
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S ME, K B, H D, Ludwig K, N K, T H, H G, M M. A Novel Quantitative Arousal-Associated EEG-Metric to Predict Severity of Respiratory Distress in Obstructive Sleep Apnea Patients. Front Physiol 2022; 13:885270. [PMID: 35812317 PMCID: PMC9257225 DOI: 10.3389/fphys.2022.885270] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 05/31/2022] [Indexed: 11/25/2022] Open
Abstract
Respiratory arousals (RA) on polysomnography (PSG) are an important predictor of obstructive sleep apnea (OSA) disease severity. Additionally, recent reports suggest that more global indices of desaturation such as the hypoxic burden, namely the area under the curve (AUC) of the oxygen saturation (SaO2) PSG trace may better depict the desaturation burden in OSA. Here we investigated possible associations between a new metric, namely the AUC of the respiratory arousal electroencephalographic (EEG) recording, and already established parameters as the apnea/hypopnea index (AHI), arousal index and hypoxic burden in patients with OSA. In this data-driven study, polysomnographic data from 102 patients with OSAS were assessed (32 female; 70 male; mean value of age: 52 years; mean value of Body-Mass-Index-BMI: 31 kg/m2). The marked arousals from the pooled EEG signal (C3 and C4) were smoothed and the AUC was estimated. We used a support vector regressor (SVR) analysis to predict AHI, arousal index and hypoxic burden as captured by the PSG. The SVR with the arousal-AUC metric could quite reliably predict the AHI with a high correlation coefficient (0,58 in the training set, 0,65 in the testing set and 0,64 overall), as well as the hypoxic burden (0,62 in the training set, 0,58 in the testing set and 0,59 overall) and the arousal index (0,58 in the training set, 0,67 in the testing set and 0,66 overall). This novel arousal-AUC metric may predict AHI, hypoxic burden and arousal index with a quite high correlation coefficient and therefore could be used as an additional quantitative surrogate marker in the description of obstructive sleep apnea disease severity.
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Affiliation(s)
- Malatantis-Ewert S
- Department of Otorhinolaryngology, Sleep Medicine Center, Medical Center of the University of Mainz, Mainz, Germany
- Movement Disorders and Neurostimulation, Department of Neurology, Biomedical Statistics and Multimodal Signal Processing Unit, Medical Center of the University of Mainz, Mainz, Germany
| | - Bahr K
- Department of Otorhinolaryngology, Sleep Medicine Center, Medical Center of the University of Mainz, Mainz, Germany
| | - Ding H
- Movement Disorders and Neurostimulation, Department of Neurology, Biomedical Statistics and Multimodal Signal Processing Unit, Medical Center of the University of Mainz, Mainz, Germany
| | - Katharina Ludwig
- Department of Otorhinolaryngology, Sleep Medicine Center, Medical Center of the University of Mainz, Mainz, Germany
| | - Koirala N
- Haskins Laboratories, Yale University, New Haven, CT, United States
| | - Huppertz T
- Department of Otorhinolaryngology, Sleep Medicine Center, Medical Center of the University of Mainz, Mainz, Germany
| | - Gouveris H
- Department of Otorhinolaryngology, Sleep Medicine Center, Medical Center of the University of Mainz, Mainz, Germany
| | - Muthuraman M
- Movement Disorders and Neurostimulation, Department of Neurology, Biomedical Statistics and Multimodal Signal Processing Unit, Medical Center of the University of Mainz, Mainz, Germany
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19
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Powell TA, Mysliwiec V, Brock MS, Morris MJ. OSA and cardiorespiratory fitness: a review. J Clin Sleep Med 2022; 18:279-288. [PMID: 34437054 PMCID: PMC8807904 DOI: 10.5664/jcsm.9628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The effects of untreated obstructive sleep apnea (OSA) on cardiopulmonary function remain unclear. Cardiorespiratory fitness (CRF), commonly reflected by VO2 max measured during cardiopulmonary exercise testing, has gained popularity in evaluating numerous cardiopulmonary conditions and may provide a novel means of identifying OSA patients with the most clinically significant disease. This emerging testing modality provides simultaneous assessment of respiratory and cardiovascular function with results helping uncover evidence of evolving pathology in either organ system. In this review, we highlight the current state of the literature in regard to OSA and CRF with a specific focus on changes in cardiovascular function that have been previously noted. While OSA does not appear to limit respiratory function during exercise, studies seem to suggest an abnormal cardiovascular exercise response in this population including decreased cardiac output, a blunted heart rate response (ie, chronotropic incompetence), and exaggerated blood pressure response. Surprisingly, despite these observed changes in the cardiovascular response to exercise, results involving VO2 max in OSA remain inconclusive. This is reflected by VO2 max studies involving middle-aged OSA patients showing both normal and reduced CRF. As prior studies have not extensively characterized oxygen desaturation burden, we propose that reductions in VO2 max may exist in OSA patients with only the most significant disease (as reflected by nocturnal hypoxia). Further characterizing this relationship remains important as some research suggests that positive airway pressure therapy or aerobic exercise may improve CRF in patients with OSA. In conclusion, while it likely that severe OSA, via an abnormal cardiovascular response to exercise, is associated with decreased CRF, further study is clearly warranted to include determining if OSA with decreased CRF is associated with increased morbidity or mortality. CITATION Powell TA, Mysliwiec V, Brock MS, Morris MJ. OSA and cardiorespiratory fitness: a review. J Clin Sleep Med. 2022;18(1):279-288.
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Affiliation(s)
- Tyler A. Powell
- Sleep Medicine Service, Wilford Hall Ambulatory Surgery Center, JBSA Lackland Air Force Base, Texas,Address correspondence to: Tyler A. Powell, MD, Sleep Medicine Service, Wilford Hall Ambulatory Service Center, JBSA Lackland Air Force Base, TX 78234; ,
| | - Vincent Mysliwiec
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Matthew S. Brock
- Sleep Medicine Service, Wilford Hall Ambulatory Surgery Center, JBSA Lackland Air Force Base, Texas
| | - Michael J. Morris
- Graduate Medical Education, Brooke Army Medical Center, JBSA Fort Sam Houston, Texas
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20
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Neagos A, Vrinceanu D, Dumitru M, Costache A, Cergan R. Demographic, anthropometric, and metabolic characteristics of obstructive sleep apnea patients from Romania before the COVID-19 pandemic. Exp Ther Med 2021; 22:1487. [PMID: 34765028 DOI: 10.3892/etm.2021.10922] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 09/09/2021] [Indexed: 01/02/2023] Open
Abstract
Obstructive sleep apnea (OSA) syndrome is one of the major pathologies of modern life, with multiple etiologies intertwining: the increase in life expectancy, facial and dental changes, metabolic syndrome, and others. The current diagnosis is based on sleep studies, flexible endoscopy, imaging studies and a complete differential diagnosis from other possible pathologies. We present a retrospective study of 80 cases with OSA managed in 2019 prior to the beginning of the COVID-19 pandemic. We analyzed various demographic, anthropometric and metabolic data recorded in our study group. Some of the results, such as high levels of cholesterol and triglycerides, were consistent with worldwide literature. However, regarding the anthropometric data, we underline a general decrease in height in the Romanian population. In addition, demographic data have changed in the last decade due to the work immigration in the European Union. This data will be used in a future analysis for comparison with variables recorded from cases with OSA during the COVID-19 pandemic. Current cases with OSA are not a priority for healthcare systems, and patients avoid referral to a specialist as much as possible.
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Affiliation(s)
- Adriana Neagos
- ENT Department, 'George Emil Palade' University of Medicine, Pharmacy, Science and Technology, 540139 Targu Mures, Romania.,ENT Department, 'Galenus' Medical Center, 540342 Targu Mures, Romania
| | - Daniela Vrinceanu
- ENT Department, Bucharest Emergency University Hospital, 010271 Bucharest, Romania
| | - Mihai Dumitru
- ENT Department, Bucharest Emergency University Hospital, 010271 Bucharest, Romania.,Department of Anatomy, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Adrian Costache
- Department of Pathology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Romica Cergan
- Department of Anatomy, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
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21
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A novel parameter is better than the AHI to assess nocturnal hypoxaemia and excessive daytime sleepiness in obstructive sleep apnoea. Sci Rep 2021; 11:4702. [PMID: 33633338 PMCID: PMC7907378 DOI: 10.1038/s41598-021-84239-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 02/12/2021] [Indexed: 01/15/2023] Open
Abstract
To evaluate whether the percentage of total sleep time spent with apnoea and hypopnoea duration time (AHT%) is better than the apnoea-hypopnoea index (AHI) for the assessment of nocturnal hypoxaemia and excessive daytime sleepiness (EDS) in patients with obstructive sleep apnoea (OSA). Patients with suspected OSA were enrolled. Polysomnography, Epworth Sleepiness Scale, self-administered surveys and anthropometric measures were performed. The efficiency of AHT% and the AHI was evaluated for nocturnal hypoxaemia and EDS. A total of 160 eligible participants were analysed. The median AHT% in normal, mild, moderate and severe OSA patients was significantly different in the four-group patients with OSA. Spearman rank correlations analysis found that the associations were stronger between AHT% with percentage of total sleep time and O2 saturation of < 90% and minimum nocturnal oxygen saturation than these parameters with the AHI. AHT% had a greater area under the curve than the AHI for predicting EDS in patients with OSA. AHT% was significantly higher in the EDS group. We present a novel parameter, AHT%, to evaluate nocturnal hypoxaemia and EDS in OSA patients. AHT% partially compensates for the shortcomings of the AHI. AHT% is better than the AHI for assessing nocturnal hypoxaemia and EDS. AHT% reflects different clinical characteristics associated with OSA from a new perspective.
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