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Balk EM, Adam GP, Cao W, Bhuma MR, D’Ambrosio C, Trikalinos TA. Long-term effects on clinical event, mental health, and related outcomes of CPAP for obstructive sleep apnea: a systematic review. J Clin Sleep Med 2024; 20:895-909. [PMID: 38300818 PMCID: PMC11145052 DOI: 10.5664/jcsm.11030] [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: 10/16/2023] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 02/03/2024]
Abstract
STUDY OBJECTIVES We performed a systematic review of long-term health outcomes of continuous positive airway pressure (CPAP) use in adults with obstructive sleep apnea. METHODS We updated prior systematic reviews with searches in multiple databases through January 3, 2023. We included randomized controlled trials (RCTs) and adjusted nonrandomized comparative studies that reported prespecified long-term (mostly > 1 year) health outcomes. We assessed risk of bias, conducted meta-analyses, and evaluated strength of evidence. RESULTS We found 38 eligible studies (16 trials, 22 observational). All conclusions were of low strength of evidence given study and data limitations. RCTs found no evidence of effect of CPAP on mortality (summary effect size [ES] 0.89; 95% confidence interval [CI] 0.66, 1.21); inclusion of adjusted nonrandomized comparative studies yields an association with reduced risk of death (ES 0.57; 95% CI 0.44, 0.73). RCTs found no evidence of effects of CPAP for cardiovascular death (ES 0.99; 95% CI 0.64, 1.53), stroke (ES 0.99; 95% CI 0.73, 1.35), myocardial infarction (ES 1.05; 95% CI 0.78, 1.41), incident atrial fibrillation (ES 0.89; 95% CI 0.48, 1.63), or composite cardiovascular outcomes (all statistically nonsignificant). RCTs found no evidence of effects for incident diabetes (ES 1.02; 95% CI 0.69, 1.51) or accidents (all nonsignificant) and no clinically significant effects on depressive symptoms, anxiety symptoms, or cognitive function. CONCLUSIONS Whether CPAP use for obstructive sleep apnea affects long-term health outcomes remains largely unanswered. RCTs and nonrandomized comparative studies are inconsistent regarding the effect of CPAP on mortality. Current studies are underpowered, with relatively short duration follow-up and methodological limitations. CITATION Balk EM, Adam GP, Cao W, Bhuma MR, D'Ambrosio C, Trikalinos TA. Long-term effects on clinical event, mental health, and related outcomes of CPAP for obstructive sleep apnea: a systematic review. J Clin Sleep Med. 2024;20(6):895-909.
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Affiliation(s)
- Ethan M. Balk
- Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, Rhode Island
| | - Gaelen P. Adam
- Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, Rhode Island
| | - Wangnan Cao
- Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, Rhode Island
| | - Monika Reddy Bhuma
- Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, Rhode Island
| | - Carolyn D’Ambrosio
- Section of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Thomas A. Trikalinos
- Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, Rhode Island
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Erickson TS, Durr ML. Sex Differences in Obstructive Sleep Apnea Including Pregnancy and Response to Treatment. Otolaryngol Clin North Am 2024; 57:467-480. [PMID: 38485541 DOI: 10.1016/j.otc.2024.02.001] [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: 04/30/2024]
Abstract
This article highlights the sex differences in obstructive sleep apnea (OSA) and sheds light on the varying presentations, diagnostic challenges, as well as treatment responses observed in men and women. The disparities in prevalence, manifestations, and therapeutic outcomes underscore the need for a nuanced approach to OSA diagnosis and management that considers sex-specific factors. Furthermore, this article highlights the importance of recognizing and treating OSA during pregnancy, as it poses unique challenges and potential risks to both maternal and fetal health.
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Affiliation(s)
- Taylor S Erickson
- Department of Otolaryngology-Head & Neck Surgery, University of California, San Francisco, 2233 Post Street, San Francisco, CA 94115, USA
| | - Megan L Durr
- Department of Otolaryngology-Head & Neck Surgery, University of California, San Francisco, 1001 Potrero Avenue, #3A30, San Francisco, CA 94110, USA.
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Varol Y, Uçar ZZ, Oktay Arslan B, Karasu I. Apnea-hypopnea index and the polysomnographic risk factors for predicting 5- to 8-year mortality in patients with OSA. Sleep Breath 2024; 28:103-112. [PMID: 37422579 DOI: 10.1007/s11325-023-02868-3] [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: 06/13/2022] [Revised: 05/22/2023] [Accepted: 06/02/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND The purpose of this study was to investigate the long-term mortality rates of patients with obstructive sleep apnea (OSA) who received an overnight polysomnogram (PSG) for obtaining the diagnosis and to determine the relationship between PSG parameters and overall mortality. METHODS Between 2007 and 2013, patients who had overnight PSG and were diagnosed with OSA were included in the study. Factors which are thought to influence mortality were assessed for 5-year and overall survival using the log rank test and Kaplan-Meier survival curves. Using multivariable Cox regression analysis, a model was constructed for factors influencing 5-year and overall survival. RESULTS A total of 762 patients with a mean age of 52.7 (±10.8) and a dominance of men (74.7%) were studied. Gender, OSA severity subgroups, and apnea hypopnea index (AHI) were not statistically significantly associated with either 5-year or overall mortality (p<0.05 for both). Age, having a cardiovascular comorbidity, proportion of rapid eye movement (%REM), and total sleep time with an oxyhemoglobin saturation of less than 90% (T90) all showed a significant correlation with overall all-cause mortality in the model. For 5-year mortality and overall mortality, the hazard ration (HR) for T90 was 3.6 (95% CI (1.6-8.0) p=0.001) and 3 (95% CI (1.6-5.7) p=0.001), respectively. CONCLUSION The study findings suggest that not AHI but PSG parameters of hypoxia, mainly T90, having cardiovascular comorbidity, and %REM sleep were significant risk factors for all-cause mortality in patients with OSA. The association of OSA, hypoxia, and mortality is an area that deserves further study.
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Affiliation(s)
- Yelda Varol
- Department of Pulmonology, Dr. Suat Seren Chest Diseases and Surgery Education and Training Hospital, University of Health Sciences, Izmir Faculty of Medicine, Izmir, Turkey.
| | - Zeynep Zeren Uçar
- Department of Pulmonology, Dr. Suat Seren Chest Diseases and Surgery Education and Training Hospital, University of Health Sciences, Izmir Faculty of Medicine, Izmir, Turkey
| | - Burcu Oktay Arslan
- Department of Pulmonology, Dr. Suat Seren Chest Diseases and Surgery Education and Training Hospital, University of Health Sciences, Izmir Faculty of Medicine, Izmir, Turkey
| | - Işıl Karasu
- Department of Pulmonology, Dr. Suat Seren Chest Diseases and Surgery Education and Training Hospital, University of Health Sciences, Izmir Faculty of Medicine, Izmir, Turkey
- Department of Pulmonology, Dr. Suat Seren Chest Diseases and Surgery Education and Training Hospital, Izmir, Turkey
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Güngördü N, Börekçi Ş, Çulpan HC, Coşkun E, Ayan F, Mutlu B. Effect of Continuous Positive Airway Pressure Therapy on Pro-Brain Natriuretic Peptide, C-Reactive Protein, Homocysteine, and Cardiac Markers in Patients with Obstructive Sleep Apnea. THORACIC RESEARCH AND PRACTICE 2023; 24:76-84. [PMID: 37503643 PMCID: PMC10652070 DOI: 10.5152/thoracrespract.2023.22130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 10/07/2022] [Indexed: 07/29/2023]
Abstract
OBJECTIVE Obstructive sleep apnea is associated with increased morbidity and mortality, especially cardiovascular and cerebrovascular, and affects a significant proportion of the population. The study was aimed to determine the levels of pro-brain natriuretic peptide, C-reactive protein, homocysteine, and cardiac markers (creatine kinase, creatine kinase isoenzyme MB, troponin T) and evaluate the effectiveness of continuous positive airway pressure therapy in patients with obstructive sleep apnea. MATERIAL AND METHODS Pro-brain natriuretic peptide, C-reactive protein, homocysteine, and cardiac markers (creatine kinase, creatine kinase isoenzyme MB, troponin T) were assessed in blood samples collected before and after continuous positive airway pressure treatment from the 30 patients included in the study, and their results were compared. RESULTS There was a significant decrease between the baseline pro-brain natriuretic peptide and the 6-month pro-brain natriuretic peptide values after continuous positive airway pressure therapy (P < .05). There was a significant increase in creatine kinase-MB and troponin T values 6 months after continuous positive airway pressure therapy compared to baseline values (P < .05). CONCLUSIONS A significant decrease was observed in pro-brain natriuretic peptide values after continuous positive airway pressure therapy in obstructive sleep apnea patients without cardiac failure, while a more significant decrease was especially observed among hypertension patients. This finding suggests that pro-brain natriuretic peptide may be used as an early indicator of cardiac dysfunction in obstructive sleep apnea patients without any heart diseases except for hypertension.
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Affiliation(s)
- Nejdiye Güngördü
- Department of Pulmonary Diseases, İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
| | - Şermin Börekçi
- Department of Pulmonary Diseases, İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
| | | | - Erkam Coşkun
- Department of Biochemistry, İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
| | - Faruk Ayan
- Department of Cardiology, İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
| | - Birsen Mutlu
- Department of Pulmonary Diseases, İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
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Silveira MG, Sampol G, Mota-Foix M, Ferrer J, Lloberes P. Cluster-derived obstructive sleep apnea phenotypes and outcomes at 5-year follow-up. J Clin Sleep Med 2022; 18:597-607. [PMID: 34569926 PMCID: PMC8804983 DOI: 10.5664/jcsm.9674] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) is a heterogeneous, complex disease. We aimed to identify OSA phenotypes through cluster analysis and to perform a long-term follow-up to validate the phenotypes. METHODS We applied a partitioning around medioids technique in a cohort of 1,217 participants recently diagnosed with OSA. We performed a 5-year follow-up analyzing the incidence of comorbidities, chronic medication, hospital admissions, mortality, and the influence of continuous positive airway pressure treatment on mortality risk. RESULTS We identified three phenotypes: two predominantly male clusters, one composed of middle-aged participants with overweight, moderate OSA, and cardiovascular risk factors and the other consisting of older, obese participants with severe OSA, cardiovascular risk factors, ischemic heart disease (18.4%), and atrial fibrillation (9.7%). The third cluster was composed of 77% female participants with moderate OSA; cardiovascular risk factors; the highest prevalence of depression (15.7%); and high prescription of antidepressants (55.1%), anxiolytics (40.0%), hypnotics, sedatives (11.1%), nonsteroidal anti-inflammatory drugs (67.9%), and weak opioids (15.1%). The baseline characteristics of each cluster maintained the same trend over time regarding the incidence of new comorbidities, medication intake, hospitalization rates, and reasons for admission. The absence of continuous positive airway pressure treatment was associated with a significantly higher risk of all-cause mortality (hazard ratio 5.84, confidence interval 2.9-11.8), especially in the older men (hazard ratio 7.7, confidence interval 4.06-14.63) and predominantly female clusters (hazard ratio 2.79, confidence interval 1.34-5.79). CONCLUSIONS We identified three phenotypes with relevant clinical and prognostic implications in order to improve personalized strategies in OSA management. CITATION Silveira MG, Sampol G, Mota-Foix M, Ferrer J, Lloberes P. Cluster-derived obstructive sleep apnea phenotypes and outcomes at 5-year follow-up. J Clin Sleep Med. 2022;18(2):597-607.
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Affiliation(s)
- María Guadalupe Silveira
- Pneumology Department, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain,Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Gabriel Sampol
- Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain,Multidisciplinary Sleep Unit, Pneumology Department, Vall d’Hebron University Hospital, Barcelona, Spain,Pneumology Department, Vall d’Hebron University Hospital, Barcelona, Spain,Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Instituto de la Salud Carlos III (ISCIIII), Madrid, Spain
| | - Miriam Mota-Foix
- Statistics and Bioinformatics Unit, Vall d’Hebron Research Institute, Barcelona, Spain
| | - Jaume Ferrer
- Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain,Pneumology Department, Vall d’Hebron University Hospital, Barcelona, Spain,Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Instituto de la Salud Carlos III (ISCIIII), Madrid, Spain
| | - Patricia Lloberes
- Multidisciplinary Sleep Unit, Pneumology Department, Vall d’Hebron University Hospital, Barcelona, Spain,Pneumology Department, Vall d’Hebron University Hospital, Barcelona, Spain,Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Instituto de la Salud Carlos III (ISCIIII), Madrid, Spain,Address correspondence to: Patricia Lloberes, MD, PhD, Servicio de Neumología, Hospital Universitario Vall d’Hebron, Passeig de la Vall d’Hebron 119, 08035, Barcelona, Spain;
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Lee YC, Chang KY, Mador MJ. Racial disparity in sleep apnea-related mortality in the United States. Sleep Med 2022; 90:204-213. [PMID: 35202926 DOI: 10.1016/j.sleep.2021.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 10/22/2021] [Accepted: 11/22/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Sleep apnea is one of the most common sleep disorders in the United States (US). Although the prevalence, risk factors, and clinical presentations of sleep apnea vary by racial groups, the racial disparity in sleep apnea-related mortality remains unclear. METHODS Sleep apnea-related mortality for 1999-2019 was obtained from the National Center for Health Statistics provided by the Centers for Disease Control and Prevention. We examined the mortality trends for sleep apnea using Joinpoint regression analysis and compared the associated outcomes and multiple causes of death between Blacks and Whites. RESULTS For 1999-2019, sleep apnea was documented as the underlying cause of death in 17,053 decedents, with 2593 Blacks and 14,127 Whites. The overall age-adjusted mortality rates in all population, Blacks, and Whites were 2.5, 3.5, and 2.4 per 1,000,000 population, respectively (P < 0.001). Both Blacks and Whites had the highest mortality rates in the Midwest and the lowest in the Northeast. Despite the flattened mortality trend in the last decade overall, Black males had a continuous mortality increase over the study period (Annual Percentage Change 2.7%, 95% CI: 1.2-4.2). For both genders of sleep apnea decedents, Blacks were more likely to have multiple cause of death of Cardiac Arrest, Hypertension, Obesity, and Chronic Renal Failure, but Arrhythmia was more common in Whites (P < 0.05). CONCLUSIONS There is a significant racial disparity in sleep apnea-related mortality in the US. The uptrend in mortality in Black males and associated outcomes related to cardiovascular disease should raise concerns specifically in Blacks with sleep apnea.
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Affiliation(s)
- Yu-Che Lee
- Department of Medicine, University at Buffalo-Catholic Health System, Buffalo, NY, United States.
| | - Ko-Yun Chang
- Division of Chest Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - M Jeffery Mador
- Division of Pulmonary, Critical Care and Sleep Medicine, University at Buffalo, Buffalo, NY, United States; Western New York Veterans Affairs Healthcare System, Buffalo, NY, United States
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Carter J, Chang J, Birriel TJ, Moustarah F, Sogg S, Goodpaster K, Benson-Davies S, Chapmon K, Eisenberg D. ASMBS position statement on preoperative patient optimization before metabolic and bariatric surgery. Surg Obes Relat Dis 2021; 17:1956-1976. [PMID: 34629296 DOI: 10.1016/j.soard.2021.08.024] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 08/11/2021] [Accepted: 08/27/2021] [Indexed: 12/12/2022]
Affiliation(s)
- Jonathan Carter
- Clinical Issues Committee, American Society of Metabolic and Bariatric Surgeons; Department of Clinical Surgery, University of California-San Francisco, San Francisco, California.
| | - Julietta Chang
- Clinical Issues Committee, American Society of Metabolic and Bariatric Surgeons; Department of Clinical Surgery, University of California-San Francisco, San Francisco, California
| | - T Javier Birriel
- Clinical Issues Committee, American Society of Metabolic and Bariatric Surgeons; Department of Clinical Surgery, University of California-San Francisco, San Francisco, California
| | - Fady Moustarah
- Clinical Issues Committee, American Society of Metabolic and Bariatric Surgeons; Department of Clinical Surgery, University of California-San Francisco, San Francisco, California
| | - Stephanie Sogg
- Clinical Issues Committee, American Society of Metabolic and Bariatric Surgeons; Department of Clinical Surgery, University of California-San Francisco, San Francisco, California
| | - Kasey Goodpaster
- Clinical Issues Committee, American Society of Metabolic and Bariatric Surgeons; Department of Clinical Surgery, University of California-San Francisco, San Francisco, California
| | - Sue Benson-Davies
- Clinical Issues Committee, American Society of Metabolic and Bariatric Surgeons; Department of Clinical Surgery, University of California-San Francisco, San Francisco, California
| | - Katie Chapmon
- Clinical Issues Committee, American Society of Metabolic and Bariatric Surgeons; Department of Clinical Surgery, University of California-San Francisco, San Francisco, California
| | - Dan Eisenberg
- Clinical Issues Committee, American Society of Metabolic and Bariatric Surgeons; Department of Clinical Surgery, University of California-San Francisco, San Francisco, California
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8
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Shikora SA, Edgerton C, Harris D, Buchwald H. Metabolic surgery. Curr Probl Surg 2021; 59:101059. [DOI: 10.1016/j.cpsurg.2021.101059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 09/03/2021] [Indexed: 11/29/2022]
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Bouloukaki I, Tsiligianni I, Schiza S. Evaluation of Obstructive Sleep Apnea in Female Patients in Primary Care: Time for Improvement? Med Princ Pract 2021; 30:508-514. [PMID: 34438402 PMCID: PMC8740168 DOI: 10.1159/000518932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 08/05/2021] [Indexed: 11/19/2022] Open
Abstract
Obstructive sleep apnea (OSA) has historically been regarded as a male disease. However, there are a number of significant gender-related differences in the symptoms, diagnosis, and consequences of OSA, which seems to be more severe in male than in female patients, although this sex difference decreases with increasing age. Female patients with OSA tend to present nonspecific symptoms, such as insomnia, depressive symptoms, fatigue, morning headache, and nightmares, often resulting in underdiagnosis and undertreatment compared to male patients. Understanding these differences in women is essential for early identification and referral of patients for diagnosis and treatment of OSA.
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Affiliation(s)
- Izolde Bouloukaki
- Department of Thoracic Medicine, Sleep Disorders Center, University of Crete, Heraklion, Greece
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
- *Izolde Bouloukaki,
| | - Ioanna Tsiligianni
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Sophia Schiza
- Department of Thoracic Medicine, Sleep Disorders Center, University of Crete, Heraklion, Greece
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Gharib A, Loza S. Factors affecting the severity of the apnea hypoapnea index: a retrospective study on 838 Egyptian patients diagnosed with obstructive sleep apnea. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2020. [DOI: 10.1186/s43168-020-00034-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Obstructive sleep apnea (OSA) is a common condition in the general population that is highly correlated to obesity, and it is associated with major cardiovascular morbidity and mortality. In Egypt, obesity rates are known to be high; however, OSA remains largely under-diagnosed, and data on its current magnitude is very scarce. Thus, the aims of the study were to identify the percentage of OSA in a large sample of patients referred for polysomnography and to determine the effect of different demographic data on the severity of the disease.
Results
This retrospective study included 1012 patients. Medical data were reviewed by sleep specialists. The correlation between age, body mass index (BMI), and neck circumference (NC) with apnea hypoapnea index (AHI) was explored. Also, gender differences were analyzed. A total of 838 patients (81% males, 19% females) were diagnosed with OSA. Patients with mild, moderate, and severe OSA were 204 (24%), 146 (17%), and 488 (58%), respectively. Females were older than males (58.87 ± 10.25 versus 54.39 ± 22.96, p = 0.001) and BMI was not significantly different between both sexes (34.18 ± 13.53 versus 36.73 ± 23.25, p = 0.07), but NC was higher in men (43.56 ± 5.3 versus 39.34 ± 4.41, p = 0.001). AHI was significantly increased in men compared to women (47.97 ± 31.22 versus 37.95 ± 31.72, p = 0.001) and severe OSA was commonly diagnosed in men than women (p = 0.001). A positive significant correlation was found between BMI, NC with AHI, arousal index, average SpO2, and desaturation index.
Conclusion
OSA is highly prevalent among our patients. Additionally, BMI and NC independently affected the severity of their disease.
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Dodds S, Williams LJ, Roguski A, Vennelle M, Douglas NJ, Kotoulas SC, Riha RL. Mortality and morbidity in obstructive sleep apnoea-hypopnoea syndrome: results from a 30-year prospective cohort study. ERJ Open Res 2020; 6:00057-2020. [PMID: 32963994 PMCID: PMC7487348 DOI: 10.1183/23120541.00057-2020] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 06/03/2020] [Indexed: 11/23/2022] Open
Abstract
Background Obstructive sleep apnoea–hypopnoea syndrome (OSAHS) carries substantial negative health consequences. This study examines factors affecting mortality and morbidity according to continuous positive airway pressure (CPAP) use and predictors affecting CPAP adherence in a longitudinal cohort of OSAHS patients. Materials and methods This prospective, cohort study comprised 4502 patients who were diagnosed with OSAHS at a tertiary sleep disorders centre between 1982 and 2003. Of these, 1174 patients completed follow-up in 2012. Data collected included anthropometric, sleep and demographic characteristics, including comorbidities, ongoing medications and CPAP adherence. Patients were followed up for an average of 14.8±3.7 years. Results Imputation analysis showed that long-term CPAP users (>5 years) were 5.63 times more likely to be alive at study end than non-CPAP users (95% CI: 4.83–6.58, p<0.001) and 1.74-times more likely than short-term CPAP users (≤5 years) (95% CI: 1.49–2.02, p<0.001). Females had a significantly higher mortality rate during the follow-up period (26.8% versus 19.6%, p<0.001). Respiratory mortality was more common in patients with OSAHS, in particular those who did not use CPAP, compared to the general population (17.2% versus 12.2%, p=0.002 respectively), whereas deaths from cancer were less common compared to the general population (16.2% versus 25.6%, p<0.001). Compared to CPAP users, non-CPAP-users had a significantly increased incidence of type II diabetes mellitus (DMII) (27.9% versus 18.7%, p=0.003), ischaemic heart disease (IHD) (25.5% versus 12.7%, p<0.001) and myocardial infarction (MI) (14.7% versus 4.2%, p<0.001) at long-term follow-up. Conclusions Long-term CPAP use in men and women with OSAHS reduces mortality and decreases the incidence of DMII and cardiovascular disease. In this first long-term prospective cohort study to use imputation analysis in OSAHS patients, all-cause morbidity and mortality were significantly reduced in long-term CPAP users (>5 years), and equivalent for both males and femaleshttps://bit.ly/3cKL2HK
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Affiliation(s)
- Sophie Dodds
- Dept of Sleep Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Linda J Williams
- Dept of Sleep Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Amber Roguski
- Dept of Sleep Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - Neil J Douglas
- Dept of Sleep Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - Renata L Riha
- Dept of Sleep Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
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12
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Does gender matter: sex-specific aspects of symptoms, outcome, and therapy of obstructive sleep apnea. Curr Opin Pulm Med 2020; 26:642-649. [DOI: 10.1097/mcp.0000000000000728] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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13
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Pochetti P, Azzolina D, Ragnoli B, Tillio PA, Cantaluppi V, Malerba M. Interrelationship among Obstructive Sleep Apnea, Renal Function and Survival: A Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17144922. [PMID: 32650497 PMCID: PMC7400305 DOI: 10.3390/ijerph17144922] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/03/2020] [Accepted: 07/06/2020] [Indexed: 12/16/2022]
Abstract
Previous studies showed a bidirectional relationship between renal function decline and obstructive sleep apnea (OSA) syndrome. Continuous Positive Airway Pressure (C-PAP) treatment was shown to preserve the kidney function in OSA patients. This study aims to investigate the progression of long-term renal function in OSA patients treated with different PAP strategies (patients were divided into two groups, fixed C-PAP or other PAP—automatic and bilevel pressure). Comorbidities and 10-years survival were also evaluated. We performed a retrospective, observational, single-center, cohort study, including the first 40 consecutive patients enrolled from 2009 in the Respiratory disease Unit at the Vercelli University Hospital database. The patient inclusion criteria were: age ≥ 18 years with OSA syndrome according to AASM (American Academy of Sleep Medicine) guidelines. Creatinine serum levels (mg/dL) and the estimated Glomerular Filtration Rate (eGFR, mL/min calculated by CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration equation)) were measured at 3 different time points: at baseline, 3 years and 8 years after PAP treatment. The Kaplan–Meier survival curves stratified according to PAP treatment and compliance have been reported together with log-rank test estimation. In our study, we found a significant creatinine serum level reduction after 3 years of fixed C-PAP treatment (p value = 0.006) when compared to baseline values. However, we observed that the long-term C-PAP benefit was not significant (p value = 0.060). Our data confirmed the progressive renal function decline in OSA patients, especially in those using other-PAP treatments; nevertheless, OSA treatment with a fixed C-PAP device has shown, in the short term, a significant improvement in renal function. By contrast, in our study, long-term benefits after 8 years are not been demonstrated probably because of the lack of compliance of the patients and the aging effect.
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Affiliation(s)
- Patrizia Pochetti
- Respiratory Unit, Sant’ Andrea Hospital, 13100 Vercelli, Italy; (P.P.); (B.R.); (P.A.T.)
| | - Danila Azzolina
- Department of Traslational Medicine, University of Eastern Piedmont, 28100 Novara, Italy;
| | - Beatrice Ragnoli
- Respiratory Unit, Sant’ Andrea Hospital, 13100 Vercelli, Italy; (P.P.); (B.R.); (P.A.T.)
- Department of Traslational Medicine, University of Eastern Piedmont, 28100 Novara, Italy;
| | - Paolo Amedeo Tillio
- Respiratory Unit, Sant’ Andrea Hospital, 13100 Vercelli, Italy; (P.P.); (B.R.); (P.A.T.)
- Department of Traslational Medicine, University of Eastern Piedmont, 28100 Novara, Italy;
| | - Vincenzo Cantaluppi
- Department of Traslational Medicine, Nephrology and Kidney Transplant Unit, University of Eastern Piedmont, 28100 Novara, Italy;
| | - Mario Malerba
- Respiratory Unit, Sant’ Andrea Hospital, 13100 Vercelli, Italy; (P.P.); (B.R.); (P.A.T.)
- Department of Traslational Medicine, University of Eastern Piedmont, 28100 Novara, Italy;
- Correspondence:
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14
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Lisan Q, Van Sloten T, Marques Vidal P, Haba Rubio J, Heinzer R, Empana JP. Association of Positive Airway Pressure Prescription With Mortality in Patients With Obesity and Severe Obstructive Sleep Apnea: The Sleep Heart Health Study. JAMA Otolaryngol Head Neck Surg 2020; 145:509-515. [PMID: 30973594 DOI: 10.1001/jamaoto.2019.0281] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance The association of positive airway pressure (PAP) with reduced mortality in patients with obstructive sleep apnea (OSA) remains uncertain. Objective To investigate the association between PAP prescription and mortality. Design, Setting, and Participants This multicenter, population-based cohort study evaluated data from the Sleep Heart Health Study (SHHS), a long-term observational cohort study that included participants between 1995 and 1998, with a mean follow-up of 11.1 years. Analyses were performed in September 2018. Within the SHHS, we compared patients with obesity and severe OSA with (n = 81) and without (n = 311) prescription of PAP therapy, after matching patients from each group by age, sex, and apnea-hypopnea index. Exposures Self-reported use of PAP. Main Outcomes and Measures All-cause mortality. Results Of 392 study participants, 316 (80.6%) were men, and mean (SD) age was 63.1 (11.0) years. Ninety-six deaths occurred; 12 among the prescribed-PAP group and 84 among the nonprescribed-PAP group, yielding crude incidence rates of 12.8 vs 24.7 deaths per 1000 person-years. In Cox multivariate analysis, the hazard ratio (HR) of all-cause mortality for prescribed PAP therapy was 0.38 (95% CI, 0.18-0.81). After propensity matching, the HR of all-cause mortality for prescribed PAP therapy was 0.58 (95% CI, 0.35-0.96). According to survival curves, the difference in mortality appears 6 to 7 years after initiation of PAP therapy. Conclusions and Relevance Positive airway pressure prescription is associated with reduced all-cause mortality, and this association appears several years after PAP initiation. If replicated, these findings may have strong clinical implications.
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Affiliation(s)
- Quentin Lisan
- Paris Descartes University, Faculty of Medicine, Paris, France.,INSERM, UMR-S970, Paris Cardiovascular Research Center, Department of Epidemiology, Paris, France.,Department of Head and Neck Surgery, Georges Pompidou European Hospital, Paris, France
| | - Thomas Van Sloten
- Paris Descartes University, Faculty of Medicine, Paris, France.,INSERM, UMR-S970, Paris Cardiovascular Research Center, Department of Epidemiology, Paris, France.,CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, Netherlands.,Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Pedro Marques Vidal
- Department of medicine, Service of internal medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Jose Haba Rubio
- Center for Investigation and Research in Sleep, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Raphael Heinzer
- Center for Investigation and Research in Sleep, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Jean Philippe Empana
- Paris Descartes University, Faculty of Medicine, Paris, France.,INSERM, UMR-S970, Paris Cardiovascular Research Center, Department of Epidemiology, Paris, France
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15
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Aro M, Saaresranta T, Vahlberg T, Anttalainen U. Medication of comorbidities in females with sleep-disordered breathing during long-term CPAP therapy. Respir Med 2020; 169:106014. [PMID: 32442111 DOI: 10.1016/j.rmed.2020.106014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/07/2020] [Accepted: 05/08/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Treating sleep disordered breathing (SDB) with nasal continuous positive airway pressure (CPAP) may reduce mortality, but the studies on the effect on medication use are few. Women tend to have more mild sleep apnoea and partial airway obstruction and are therefore expected to have less co-morbidity. The purpose of this study was to evaluate the effect of CPAP therapy on medication use in women as overall medication, and in different subcategories of diseases, and to evaluate the impact of nocturnal airway obstruction type as partial or complete. METHODS From the database of the Department of Pulmonary Diseases in Turku University Hospital from 1994 to 1998, 601 consecutive females with SDB were enrolled, and the type of SDB was evaluated. All were offered CPAP therapy. The medication use measured as defined daily doses (DDD) in overall medication and in nine subcategories were collected three years before and three years after CPAP initiation. RESULTS In final analyses, 182 women were included. In CPAP users (n = 66), comorbidities were more frequent and DDDs higher overall, in asthma, in chronic obstructive pulmonary disease, and in severe mental disorders, both before and after CPAP initiation. The medication use was similar regardless of the type of SDB. The change in medication use was similar as in controls. CONCLUSIONS CPAP therapy did not decrease medication use in three-year follow-up. However, possibly continuous rise in medication use was prevented, as the change in medication use was similar in controls. Complete and partial obstruction had similar effects.
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Affiliation(s)
- Miia Aro
- Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, PO Box 52, FIN-20520, Turku, Finland; Department of Pulmonary Diseases and Clinical Allergology, University of Turku, PO Box 52, FIN-20520, Turku, Finland; Sleep Research Centre, Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Lemminkäisenkatu 3b, 20520, TURKU, Finland.
| | - Tarja Saaresranta
- Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, PO Box 52, FIN-20520, Turku, Finland; Department of Pulmonary Diseases and Clinical Allergology, University of Turku, PO Box 52, FIN-20520, Turku, Finland; Sleep Research Centre, Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Lemminkäisenkatu 3b, 20520, TURKU, Finland.
| | - Tero Vahlberg
- Department of Clinical Medicine, Biostatistics, University of Turku, Biostatistiikka, 20014, Turun Yliopisto, Turku, Finland.
| | - Ulla Anttalainen
- Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, PO Box 52, FIN-20520, Turku, Finland; Department of Pulmonary Diseases and Clinical Allergology, University of Turku, PO Box 52, FIN-20520, Turku, Finland; Sleep Research Centre, Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Lemminkäisenkatu 3b, 20520, TURKU, Finland.
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16
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Berends F, Aarts EO. Preoperative Screening and Treatment of OSA Is Like Using a Sledgehammer for Cracking Nuts. Obes Surg 2020; 30:1140-1142. [DOI: 10.1007/s11695-020-04388-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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17
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Silvestri R, Aricò I, Bonanni E, Bonsignore M, Caretto M, Caruso D, Di Perri M, Galletta S, Lecca R, Lombardi C, Maestri M, Miccoli M, Palagini L, Provini F, Puligheddu M, Savarese M, Spaggiari M, Simoncini T. Italian Association of Sleep Medicine (AIMS) position statement and guideline on the treatment of menopausal sleep disorders. Maturitas 2019; 129:30-39. [DOI: 10.1016/j.maturitas.2019.08.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 08/14/2019] [Indexed: 12/29/2022]
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18
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Santamaria-Martos F, Benítez I, Ortega F, Zapater A, Giron C, Pinilla L, Pascual L, Cortijo A, Dalmases M, Fernandez-Real JM, Barbé F, Sánchez-de-la-Torre M. Circulating microRNA profile as a potential biomarker for obstructive sleep apnea diagnosis. Sci Rep 2019; 9:13456. [PMID: 31530881 PMCID: PMC6748919 DOI: 10.1038/s41598-019-49940-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 08/27/2019] [Indexed: 01/30/2023] Open
Abstract
Evaluation of microRNAs (miRNAs) could allow characterization of the obstructive sleep apnea (OSA) and help diagnose it more accurately. We aimed to examine circulating miRNA profiles to establish the differences between non-OSA and OSA patients. Additionally, we aimed to analyse the effect of continuous positive airway pressure (CPAP) treatment on the miRNA profile. This observational, longitudinal study included 230 subjects referred to the Sleep Unit due to suspected OSA. Expression profiling of 188 miRNAs in plasma was performed in 27 subjects by TaqMan-Low-Density-Array. OSA-related miRNAs were selected for validation by RT-qPCR in 203 patients. Prediction models were built to discriminate between non-OSA and OSA: 1) NoSAS-score, 2) differentially expressed miRNAs, and 3) combination of NoSAS-score plus miRNAs. The differentially expressed miRNAs were measured after 6 months of follow-up. From the 14 miRNAs selected for validation, 6 were confirmed to be differentially expressed. The areas under the curve were 0.73 for the NoSAS-score, 0.81 for the miRNAs and 0.86 for the combination. After 6 months of CPAP treatment, miRNA levels in the OSA group seem to approximate to non-OSA levels. A cluster of miRNAs was identified to differentiate between non-OSA and OSA patients. CPAP treatment was associated with changes in the circulating miRNA profile.
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Affiliation(s)
- Fernando Santamaria-Martos
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova y Santa Maria, IRB Lleida, Lleida, Spain
| | - Iván Benítez
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova y Santa Maria, IRB Lleida, Lleida, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Francisco Ortega
- Department of Diabetes, Endocrinology and Nutrition, Institut d'Investigació Biomèdica de Girona (IdIBGi), Girona, Spain
- CIBER de la Fisiopatología de la Obesidad y la Nutrición (CB06/03) and Instituto de Salud Carlos III, Madrid, Spain
| | - Andrea Zapater
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova y Santa Maria, IRB Lleida, Lleida, Spain
| | - Cristina Giron
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova y Santa Maria, IRB Lleida, Lleida, Spain
| | - Lucía Pinilla
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova y Santa Maria, IRB Lleida, Lleida, Spain
| | - Lydia Pascual
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova y Santa Maria, IRB Lleida, Lleida, Spain
| | - Anunciación Cortijo
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova y Santa Maria, IRB Lleida, Lleida, Spain
| | - Mireia Dalmases
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova y Santa Maria, IRB Lleida, Lleida, Spain
| | - Jose M Fernandez-Real
- Department of Diabetes, Endocrinology and Nutrition, Institut d'Investigació Biomèdica de Girona (IdIBGi), Girona, Spain
- CIBER de la Fisiopatología de la Obesidad y la Nutrición (CB06/03) and Instituto de Salud Carlos III, Madrid, Spain
| | - Ferran Barbé
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova y Santa Maria, IRB Lleida, Lleida, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Manuel Sánchez-de-la-Torre
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova y Santa Maria, IRB Lleida, Lleida, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.
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Treatment of obstructive sleep apnoea as primary or secondary prevention of cardiovascular disease: where do we stand now? Curr Opin Pulm Med 2019; 24:537-542. [PMID: 30124525 DOI: 10.1097/mcp.0000000000000523] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW The aim of this study was to provide an update of the primary and secondary prevention of obstructive sleep apnoea (OSA) treatment on cardiovascular disease. RECENT FINDINGS Consistent evidence suggest that OSA can contribute to cardiovascular diseases, including hypertension, atrial fibrillation, coronary artery disease and stroke. In patients with no previous history of cardiovascular events (primary prevention scenario), observational studies suggest that continuous positive airway pressure (CPAP), the main treatment for OSA, is able to prevent hypertension incidence and to decrease nonfatal cardiovascular events in men and fatal cardiovascular events in men, women and elderly. In patients with a previous history of cardiovascular events (secondary prevention scenario), recent randomized trials showed that CPAP was not able to prevent a new cardiovascular event. These findings may suggest that in patients with high cardiovascular risk and multiple comorbidities, OSA may not have an incremental role on cardiovascular disease. However, a subanalysis from the same trials showed that good CPAP compliance was able to prevent cerebrovascular events. SUMMARY OSA may predispose to cardiovascular disease, but additional efforts for improving CPAP use or development of new treatments may help to understand the magnitude of OSA on cardiovascular disease.
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20
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Neck Grasp Predicts Obstructive Sleep Apnea in Type 2 Diabetes Mellitus. SLEEP DISORDERS 2019; 2019:3184382. [PMID: 31355009 PMCID: PMC6633920 DOI: 10.1155/2019/3184382] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 06/07/2019] [Indexed: 01/03/2023]
Abstract
Aims Obstructive sleep apnea (OSA) is a common disorder with high morbidity, mortality, and an increasing prevalence in the general population. It has an even higher prevalence among individuals with type 2 diabetes mellitus (DM). The snoring, tiredness, observed apnea, high blood pressure, body-mass-index, age, neck circumference and male gender (STOP-BANG) questionnaire and Berlin Questionnaire can be cumbersome in clinical practice and require subjective data on sleepiness. We proposed prospectively studying a primary care population with type 2 DM comparing neck grasp, neck circumference, and common screening questionnaires to identify OSA. Methods Persons with a diagnosis of type 2 DM were recruited from a primary care clinic. Participants were screened using Easy Sleep Apnea Predictor (ESAP), STOP-Bang questionnaire, and Berlin questionnaire. A positive ESAP was defined as a 1cm gap when a patient encircled their hands around the neck. All subjects underwent in-laboratory PSG testing. Results Forty-three participants were enrolled and the prevalence of OSA was 90.7% (AHI ≥ 5). The median BMI was 38.0. The prevalence of mild OSA by PSG (AHI 5-14) was 27.9%, moderate OSA (AHI 15-29) was 25.6%, and severe OSA (AHI >30) was 37.2%. For mild OSA both ESAP and neck circumference showed 100% specificity. Conclusions This study reinforces the need for screening diabetic persons for obstructive sleep apnea. ESAP and neck circumference are useful for identifying persons with type 2 DM who are at risk for OSA. Together these findings could improve recognition of OSA in persons at risk for cardiovascular disease. Trial Registration of “Neck grasp as a predictor of Sleep Apnea,” https://clinicaltrials.gov/ct2/show/NCT02474823, Clinical Trials.gov Identifier, is NCT02474823.
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Azarbarzin A, Sands SA, Stone KL, Taranto-Montemurro L, Messineo L, Terrill PI, Ancoli-Israel S, Ensrud K, Purcell S, White DP, Redline S, Wellman A. The hypoxic burden of sleep apnoea predicts cardiovascular disease-related mortality: the Osteoporotic Fractures in Men Study and the Sleep Heart Health Study. Eur Heart J 2019; 40:1149-1157. [PMID: 30376054 PMCID: PMC6451769 DOI: 10.1093/eurheartj/ehy624] [Citation(s) in RCA: 389] [Impact Index Per Article: 77.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 08/08/2018] [Accepted: 09/18/2018] [Indexed: 12/13/2022] Open
Abstract
AIMS Apnoea-hypopnoea index (AHI), the universal clinical metric of sleep apnoea severity, poorly predicts the adverse outcomes of sleep apnoea, potentially because the AHI, a frequency measure, does not adequately capture disease burden. Therefore, we sought to evaluate whether quantifying the severity of sleep apnoea by the 'hypoxic burden' would predict mortality among adults aged 40 and older. METHODS AND RESULTS The samples were derived from two cohort studies: The Outcomes of Sleep Disorders in Older Men (MrOS), which included 2743 men, age 76.3 ± 5.5 years; and the Sleep Heart Health Study (SHHS), which included 5111 middle-aged and older adults (52.8% women), age: 63.7 ± 10.9 years. The outcomes were all-cause and Cardiovascular disease (CVD)-related mortality. The hypoxic burden was determined by measuring the respiratory event-associated area under the desaturation curve from pre-event baseline. Cox models were used to calculate the adjusted hazard ratios for hypoxic burden. Unlike the AHI, the hypoxic burden strongly predicted CVD mortality and all-cause mortality (only in MrOS). Individuals in the MrOS study with hypoxic burden in the highest two quintiles had hazard ratios of 1.81 [95% confidence interval (CI) 1.25-2.62] and 2.73 (95% CI 1.71-4.36), respectively. Similarly, the group in the SHHS with hypoxic burden in the highest quintile had a hazard ratio of 1.96 (95% CI 1.11-3.43). CONCLUSION The 'hypoxic burden', an easily derived signal from overnight sleep study, predicts CVD mortality across populations. The findings suggest that not only the frequency but the depth and duration of sleep related upper airway obstructions, are important disease characterizing features.
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Affiliation(s)
- Ali Azarbarzin
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Sleep Disordered Breathing Lab, 221 Longwood Avenue, Boston, MA, USA
| | - Scott A Sands
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Sleep Disordered Breathing Lab, 221 Longwood Avenue, Boston, MA, USA
| | - Katie L Stone
- Research Institute, California Pacific Medical Center, 550 16th Street, 2nd Floor, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, 550 16th St, San Francisco, CA, USA
| | - Luigi Taranto-Montemurro
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Sleep Disordered Breathing Lab, 221 Longwood Avenue, Boston, MA, USA
| | - Ludovico Messineo
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Sleep Disordered Breathing Lab, 221 Longwood Avenue, Boston, MA, USA
| | - Philip I Terrill
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
| | - Sonia Ancoli-Israel
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive La Jolla, CA, USA
- Department of Medicine, University of California San Diego, 9500 Gilman Drive La Jolla, CA, USA
| | - Kristine Ensrud
- University of Minnesota and Minneapolis Veterans Affairs Health Care System, 1 Veterans Dr, Minneapolis, MN, USA
| | - Shaun Purcell
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Sleep Disordered Breathing Lab, 221 Longwood Avenue, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT & Harvard, 415 Main St, Cambridge, MA, USA
| | - David P White
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Sleep Disordered Breathing Lab, 221 Longwood Avenue, Boston, MA, USA
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Sleep Disordered Breathing Lab, 221 Longwood Avenue, Boston, MA, USA
| | - Andrew Wellman
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Sleep Disordered Breathing Lab, 221 Longwood Avenue, Boston, MA, USA
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Perger E, Pengo MF, Lombardi C. Hypertension and atrial fibrillation in obstructive sleep apnea: Is it a menopause issue? Maturitas 2019; 124:32-34. [PMID: 31097175 DOI: 10.1016/j.maturitas.2019.02.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 02/21/2019] [Accepted: 02/27/2019] [Indexed: 11/30/2022]
Abstract
Obstructive sleep apnoea (OSA) is a common disorder, in which loss of pharyngeal dilator muscle tone during sleep causes recurrent collapse of the upper airway and temporary cessation of breathing. Repeated apneas and hypopneas lead to cycles of intermittent hypoxia/hypercapnia, increased negative intrathoracic pressure and arousals from sleep. These consequences of OSA are associated with a cascade of cardiovascular and neurohumoral consequences, including sympathetic nervous system hyperactivity, raised heart rate variability, increases in blood pressure, myocardial wall stress, oxidative stress, systemic inflammation, platelet aggregation and impaired vascular endothelial function, which contribute, in turn, to increased cardiovascular risk and, in particular, to the development of chronic systemic arterial hypertension and arrhythmias, especially atrial fibrillation (AF). Given that the prevalence of OSA is modified by age and gender, OSA-related cardiovascular diseases may also be affected by the same factors. This review focuses on the potential role of OSA in systemic arterial hypertension and AF, and discusses the most interesting studies on age and gender as predisposing factors.
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Affiliation(s)
- Elisa Perger
- Istituto Auxologico Italiano, IRCCS, Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy
| | - Martino F Pengo
- Istituto Auxologico Italiano, IRCCS, Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy
| | - Carolina Lombardi
- Istituto Auxologico Italiano, IRCCS, Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
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Bonsignore MR, Baiamonte P, Mazzuca E, Castrogiovanni A, Marrone O. Obstructive sleep apnea and comorbidities: a dangerous liaison. Multidiscip Respir Med 2019; 14:8. [PMID: 30809382 PMCID: PMC6374907 DOI: 10.1186/s40248-019-0172-9] [Citation(s) in RCA: 118] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 01/20/2019] [Indexed: 12/16/2022] Open
Abstract
Obstructive sleep apnea (OSA) is a highly prevalent disease, and is traditionally associated with increased cardiovascular risk. The role of comorbidities in OSA patients has emerged recently, and new conditions significantly associated with OSA are increasingly reported. A high comorbidity burden worsens prognosis, but some data suggest that CPAP might be protective especially in patients with comorbidities. Aim of this narrative review is to provide an update on recent studies, with special attention to cardiovascular and cerebrovascular comorbidities, the metabolic syndrome and type 2 diabetes, asthma, COPD and cancer. Better phenotypic characterization of OSA patients, including comorbidities, will help to provide better individualized care. The unsatisfactory adherence to CPAP in patients without daytime sleepiness should prompt clinicians to examine the overall risk profile of each patient in order to identify subjects at high risk for worse prognosis and provide the optimal treatment not only for OSA, but also for comorbidities.
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Affiliation(s)
- Maria R. Bonsignore
- Division of Respiratory Medicine, Biomedical Department of Internal Medicine and Medical Specialties (Di.Bi.M.I.S), University Hospital Paolo Giaccone, University of Palermo, Piazza delle Cliniche, 2, 90100 Palermo, Italy
- National Research Council (CNR), Institute of Biomedicine and Molecular Immunology (IBIM), Palermo, Italy
| | - Pierpaolo Baiamonte
- Division of Respiratory Medicine, Biomedical Department of Internal Medicine and Medical Specialties (Di.Bi.M.I.S), University Hospital Paolo Giaccone, University of Palermo, Piazza delle Cliniche, 2, 90100 Palermo, Italy
| | - Emilia Mazzuca
- Division of Respiratory Medicine, Biomedical Department of Internal Medicine and Medical Specialties (Di.Bi.M.I.S), University Hospital Paolo Giaccone, University of Palermo, Piazza delle Cliniche, 2, 90100 Palermo, Italy
| | - Alessandra Castrogiovanni
- Clinic for Pneumology und Allergology, Center of Sleep Medicine and Respiratory Care, Bethanien Hospital, Solingen, Germany
| | - Oreste Marrone
- National Research Council (CNR), Institute of Biomedicine and Molecular Immunology (IBIM), Palermo, Italy
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Ryynänen OP, Leppänen T, Kekolahti P, Mervaala E, Töyräs J. Bayesian Network Model to Evaluate the Effectiveness of Continuous Positive Airway Pressure Treatment of Sleep Apnea. Healthc Inform Res 2018; 24:346-358. [PMID: 30443423 PMCID: PMC6230541 DOI: 10.4258/hir.2018.24.4.346] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 07/31/2018] [Accepted: 09/21/2018] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES The association between obstructive sleep apnea (OSA) and mortality or serious cardiovascular events over a long period of time is not clearly understood. The aim of this observational study was to estimate the clinical effectiveness of continuous positive airway pressure (CPAP) treatment on an outcome variable combining mortality, acute myocardial infarction (AMI), and cerebrovascular insult (CVI) during a follow-up period of 15.5 years (186 ± 58 months). METHODS The data set consisted of 978 patients with an apnea-hypopnea index (AHI) ≥5.0. One-third had used CPAP treatment. For the first time, a data-driven causal Bayesian network (DDBN) and a hypothesis-driven causal Bayesian network (HDBN) were used to investigate the effectiveness of CPAP. RESULTS In the DDBN, coronary heart disease (CHD), congestive heart failure (CHF), and diuretic use were directly associated with the outcome variable. Sleep apnea parameters and CPAP treatment had no direct association with the outcome variable. In the HDBN, CPAP treatment showed an average improvement of 5.3 percentage points in the outcome. The greatest improvement was seen in patients aged ≤55 years. The effect of CPAP treatment was weaker in older patients (>55 years) and in patients with CHD. In CHF patients, CPAP treatment was associated with an increased risk of mortality, AMI, or CVI. CONCLUSIONS The effectiveness of CPAP is modest in younger patients. Long-term effectiveness is limited in older patients and in patients with heart disease (CHD or CHF).
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Affiliation(s)
- Olli-Pekka Ryynänen
- Department of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- General Practice & Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland
| | - Timo Leppänen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
- Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland
| | - Pekka Kekolahti
- Department of Communications and Networking, School of Electrical Engineering, Aalto University, Espoo, Finland
| | - Esa Mervaala
- Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Juha Töyräs
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
- Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland
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Jennum P, Tønnesen P, Ibsen R, Kjellberg J. Obstructive sleep apnea: effect of comorbidities and positive airway pressure on all-cause mortality. Sleep Med 2017; 36:62-66. [DOI: 10.1016/j.sleep.2017.04.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 04/13/2017] [Accepted: 04/28/2017] [Indexed: 10/19/2022]
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Chen YC, Chen KD, Su MC, Chin CH, Chen CJ, Liou CW, Chen TW, Chang YC, Huang KT, Wang CC, Wang TY, Chang JC, Lin YY, Zheng YX, Lin MC, Hsiao CC. Genome-wide gene expression array identifies novel genes related to disease severity and excessive daytime sleepiness in patients with obstructive sleep apnea. PLoS One 2017; 12:e0176575. [PMID: 28520763 PMCID: PMC5435176 DOI: 10.1371/journal.pone.0176575] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 04/12/2017] [Indexed: 01/01/2023] Open
Abstract
We aimed to identify novel molecular associations between chronic intermittent hypoxia with re-oxygenation and adverse consequences in obstructive sleep apnea (OSA). We analyzed gene expression profiles of peripheral blood mononuclear cells from 48 patients with sleep-disordered breathing stratified into four groups: primary snoring (PS), moderate to severe OSA (MSO), very severe OSA (VSO), and very severe OSA patients on long-term continuous positive airway pressure treatment (VSOC). Comparisons of the microarray gene expression data identified eight genes up-regulated with OSA and down-regulated with CPAP treatment, and five genes down-regulated with OSA and up-regulated with CPAP treatment. Protein expression levels of two genes related to endothelial tight junction (AMOT P130, and PLEKHH3), and three genes related to anti-or pro-apoptosis (BIRC3, ADAR1 P150, and LGALS3) were all increased in the VSO group, while AMOT P130 was further increased, and PLEKHH3, BIRC3, and ADAR1 P150 were all decreased in the VSOC group. Subgroup analyses revealed that AMOT P130 protein expression was increased in OSA patients with excessive daytime sleepiness, BIRC3 protein expression was decreased in OSA patients with hypertension, and LGALS3 protein expression was increased in OSA patients with chronic kidney disease. In vitro short-term intermittent hypoxia with re-oxygenation experiment showed immediate over-expression of ADAR1 P150. In conclusion, we identified a novel association between AMOT/PLEKHH3/BIRC3/ADAR1/LGALS3 over-expressions and high severity index in OSA patients. AMOT and GALIG may constitute an important determinant for the development of hypersomnia and kidney injury, respectively, while BIRC3 may play a protective role in the development of hypertension.
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Affiliation(s)
- Yung-Che Chen
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Sleep Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Department of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kuang-Den Chen
- Center of Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Mao-Chang Su
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Sleep Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Chang Gung University of Science and Technology, Chia-yi, Taiwan
| | - Chien-Hung Chin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Sleep Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chung-Jen Chen
- Division of Rheumatology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chia-Wei Liou
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ting-Wen Chen
- Molecular Medicine Research Center, and Bioinformatics Center, Chang Gung University, Taoyuan, Taiwan
| | - Ya-Chun Chang
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Sleep Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kuo-Tung Huang
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Sleep Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chin-Chou Wang
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Sleep Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Chang Gung University of Science and Technology, Chia-yi, Taiwan
| | - Ting-Ya Wang
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Jen-Chieh Chang
- Center of Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yong-Yong Lin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yi-Xin Zheng
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Meng-Chih Lin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Sleep Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Department of Medicine, Chang Gung University, Taoyuan, Taiwan
- * E-mail: (MCL); (CCH)
| | - Chang-Chun Hsiao
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- * E-mail: (MCL); (CCH)
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Fung CH, Vitiello MV, Alessi CA, Kuchel GA. Report and Research Agenda of the American Geriatrics Society and National Institute on Aging Bedside-to-Bench Conference on Sleep, Circadian Rhythms, and Aging: New Avenues for Improving Brain Health, Physical Health, and Functioning. J Am Geriatr Soc 2016; 64:e238-e247. [PMID: 27858974 PMCID: PMC5173456 DOI: 10.1111/jgs.14493] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The American Geriatrics Society, with support from the National Institute on Aging and other funders, held its eighth Bedside-to-Bench research conference, entitled "Sleep, Circadian Rhythms, and Aging: New Avenues for Improving Brain Health, Physical Health and Functioning," October 4 to 6, 2015, in Bethesda, Maryland. Part of a conference series addressing three common geriatric syndromes-delirium, sleep and circadian rhythm (SCR) disturbance, and voiding dysfunction-the series highlighted relationships and pertinent clinical and pathophysiological commonalities between these three geriatric syndromes. The conference provided a forum for discussing current sleep, circadian rhythm, and aging research; identifying gaps in knowledge; and developing a research agenda to inform future investigative efforts. The conference also promoted networking among developing researchers, leaders in the field of SCR and aging, and National Institutes of Health program personnel.
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Affiliation(s)
- Constance H Fung
- Geriatric Research, Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Michael V Vitiello
- Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Cathy A Alessi
- Geriatric Research, Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - George A Kuchel
- Center on Aging, University of Connecticut Health Center, Farmington, Connecticut
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Treatment of Obstructive Sleep Apnea. Prospects for Personalized Combined Modality Therapy. Ann Am Thorac Soc 2016; 13:101-8. [PMID: 26569377 DOI: 10.1513/annalsats.201508-537fr] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Obstructive sleep apnea (OSA) is a common sleep disorder with serious associated morbidities. Although several treatment options are currently available, variable efficacy and adherence result in many patients either not being treated or receiving inadequate treatment long term. Personalized treatment based on relevant patient characteristics may improve adherence to treatment and long-term clinical outcomes. Four key traits of upper airway anatomy and neuromuscular control interact to varying degrees within individuals to cause OSA. These are: (1) the pharyngeal critical closing pressure, (2) the stability of ventilator chemoreflex feedback control (loop gain), (3) the negative intraesophageal pressure that triggers arousal (arousal threshold), and (4) the level of stimulus required to activated upper airway dilator muscles (upper airway recruitment threshold). Simplified diagnostic methods are being developed to assess these pathophysiological traits, potentially allowing prediction of which treatment would best suit each patient. In contrast to current practice of using various treatment modes alone, model predictions and pilot clinical trials show improved outcomes by combining several treatments targeted to each patient's pathophysiology profile. These developments could theoretically improve efficacy and adherence to treatment and in turn reduce the social and economic health burden of OSA and the associated life-threatening morbidities. This article reviews OSA pathophysiology and identifies currently available and investigational treatments that may be combined in the future to optimize therapy based on individual profiles of key patient pathophysiological traits.
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Westlake K, Plihalova A, Pretl M, Lattova Z, Polak J. Screening for obstructive sleep apnea syndrome in patients with type 2 diabetes mellitus: a prospective study on sensitivity of Berlin and STOP-Bang questionnaires. Sleep Med 2016; 26:71-76. [PMID: 27613528 DOI: 10.1016/j.sleep.2016.07.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 06/06/2016] [Accepted: 07/07/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is highly prevalent in patients with Type 2 diabetes mellitus representing an additional risk factor for already increased cardiovascular mortality. As cardiovascular diseases are the main cause of death in this population, there is a need to identify patients with moderate to severe OSA indicated for treatment. We aimed to evaluate the performance of the Berlin, STOP, and STOP-Bang screening questionnaires in a population of patients with Type 2 diabetes mellitus. METHODS 294 consecutive patients with Type 2 diabetes mellitus filled in the questionnaires and underwent overnight home sleep monitoring using a type IV sleep monitor. RESULTS Severe, moderate, and mild OSA was found in 31 (10%), 61 (21%), and 121 (41%) patients, respectively. The questionnaires showed a similar sensitivity and specificity for AHI ≥ 15: 0.69 and 0.50 for Berlin, 0.65 and 0.49 for STOP, and 0.59 and 0.68 for STOP-Bang. However, the performance of the STOP-Bang questionnaire was different in men vs. women, sensitivity being 0.74 vs. 0.29 (p < 0.05) and specificity 0.56 vs. 0.82 (p < 0.05). CONCLUSIONS Even the best-performing Berlin questionnaire failed to identify 31% of patients with moderate to severe OSA as being at high risk of OSA, thus preventing them from receiving a correct diagnosis and treatment. Considering that patients with Type 2 diabetes mellitus are at high risk of cardiovascular mortality and also have a high prevalence of moderate to severe OSA, we find screening based on the questionnaires suboptimal and suggest that OSA screening should be performed using home sleep monitoring devices.
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Affiliation(s)
- Katerina Westlake
- 2nd Internal Medicine Department, Vinohrady Teaching Hospital, Srobarova 50, Prague, Czech Republic; Diabetology Practice Diainmed s.r.o., Slunecna 2, Prague, Czech Republic
| | - Andrea Plihalova
- 2nd Internal Medicine Department, Vinohrady Teaching Hospital, Srobarova 50, Prague, Czech Republic; Centre for Research on Diabetes, Metabolism and Nutrition, Third Faculty of Medicine, Charles University in Prague, Ruska 87, Prague, Czech Republic
| | - Martin Pretl
- Neurology and Sleep Laboratory, INSPAMED s.r.o., Kubelikova 46, Prague, Czech Republic
| | - Zuzana Lattova
- Sleep Medicine Department, National Institute of Mental Health, Topolová 748, Klecany, Czech Republic
| | - Jan Polak
- 2nd Internal Medicine Department, Vinohrady Teaching Hospital, Srobarova 50, Prague, Czech Republic; Centre for Research on Diabetes, Metabolism and Nutrition, Third Faculty of Medicine, Charles University in Prague, Ruska 87, Prague, Czech Republic.
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Meta-analysis of all-cause and cardiovascular mortality in obstructive sleep apnea with or without continuous positive airway pressure treatment. Sleep Breath 2016; 21:181-189. [PMID: 27502205 DOI: 10.1007/s11325-016-1393-1] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 07/10/2016] [Accepted: 07/25/2016] [Indexed: 12/11/2022]
Abstract
PURPOSE The associations between obstructive sleep apnea (OSA) and all-cause and cardiovascular mortality are well established but are not entirely consistent. To accurately evaluate these associations as well as the therapeutic effects of continuous positive airway pressure (CPAP), we conducted a comprehensive meta-analysis of all eligible cohort studies. METHODS Electronic literature databases (i.e., PubMed and Embase) were searched for relevant studies published before January 2016 that evaluated the associations between OSA and all-cause or cardiovascular mortality. Random-effect models were used to calculate the pooled hazard ratio (HR) and corresponding 95 % confidence intervals (CIs) for categorical risk estimates. The therapeutic effects of CPAP treatment for all-cause and cardiovascular mortality in OSA were examined through the meta-analysis. RESULTS The 27 cohort studies included in the meta-analysis included 3,162,083 participants. Compared to the control group, the pooled HR of all-cause mortality was 1.19 (95 % CI, 0.86-1.65) for mild OSA, 1.28 (0.96-1.69) for moderate OSA, and 2.13 (1.68-2.68) for severe OSA. The pooled HR of cardiovascular mortality was 1.24 (0.53-2.55) for mild OSA, 2.05 (0.57-5.47) for moderate OSA, and 2.73 (1.94-3.85) for severe OSA. All-cause mortality (HR 0.66; 0.59-0.73) and cardiovascular mortality (HR 0.37; 0.16-0.54) were significantly lower in CPAP-treated than in untreated patients. There were no differences in cardiovascular mortality in CPAP-treated OSA patients vs. normal control subjects (HR 0.82; 0.52-1.29). CONCLUSIONS Greater attention should be paid to severe OSA, as it is an independent predictor for risk for all-cause and cardiovascular mortality. CPAP is an effective treatment that reduces risk of mortality.
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Guul MK, Jennum P, Sorensen HBD. Portable prescreening system for sleep apnea. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2016; 2016:4917-4920. [PMID: 28269371 DOI: 10.1109/embc.2016.7591830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Obstructive sleep apnea (OSA) occurs in more than 4 % of the adult population. Diagnoses for OSA in sleep clinics are costly and more than half of those submitted to a sleep clinic do not have OSA. A simple, easy, and portable homebased monitoring system to evaluate who are in high-or low risk of suffering from OSA would be beneficial. The system must be able to identify individuals with a high pre-test reliability regarding OSA with the aim of referral and further investigation. We aimed to develop a portable, smartphone, and homebased monitoring system to classify whether a patient screened for sleep apnea is at high risk or low risk of having OSA. A new test setup was developed containing an Android based smartphone, the built in accelerometer, and a microphone. To ease the clinical analysis of the data a MATLAB based graphical user interface has been developed visualizing the data allowing the user to navigate through the data and the detected apnea events. The events are classified using both features from the audio and the signal from the accelerometer placed on sternum. Furthermore using the accelerometer data the sleep position is estimated and the morphology from the respiratory pattern is available describing the events and making it possible to distinguish between OSA and central sleep apnea (CSA).
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Netzer NC, Ancoli-Israel S, Bliwise DL, Fulda S, Roffe C, Almeida F, Onen H, Onen F, Raschke F, Martinez Garcia MA, Frohnhofen H. Principles of practice parameters for the treatment of sleep disordered breathing in the elderly and frail elderly: the consensus of the International Geriatric Sleep Medicine Task Force. Eur Respir J 2016; 48:992-1018. [DOI: 10.1183/13993003.01975-2015] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 05/03/2016] [Indexed: 12/11/2022]
Abstract
Sleep disordered breathing (SDB) is a leading cause of morbidity worldwide. Its prevalence increases with age. Due to the demographic changes in industrial societies, pulmonologists and sleep physicians are confronted with a rapidly growing number of elderly SDB patients. For many physicians, it remains unclear how current guidelines for SDB management apply to elderly and frail elderly patients. The goal of this consensus statement is to provide guidance based on published evidence for SDB treatment in this specific patient group.Clinicians and researchers with expertise in geriatric sleep medicine representing several countries were invited to participate in a task force. A literature search of PubMed from the past 12 years and a systematic review of evidence of studies deemed relevant was performed.Recommendations for treatment management of elderly and frail elderly SDB patients based on published evidence were formulatedviadiscussion and consensus.In the last 12 years, there have been surprisingly few studies examining treatment of SDB in older adults and even fewer in frail older adults. Studies that have been conducted on the management of SDB in the older patient population were rarely stratified for age. Studies in SDB treatment that did include age stratification mainly focused on middle-aged and younger patient groups. Based on the evidence that is available, this consensus statement highlights the treatment forms that can be recommended for elderly SDB patients and encourages treatment of SDB in this large patient group.
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Bauters F, Rietzschel ER, Hertegonne KBC, Chirinos JA. The Link Between Obstructive Sleep Apnea and Cardiovascular Disease. Curr Atheroscler Rep 2016; 18:1. [PMID: 26710793 DOI: 10.1007/s11883-015-0556-z] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Obstructive sleep apnea (OSA) is common in the general population and highly prevalent in patients with cardiovascular disease. In this paper, we review (1) the pathophysiological mechanisms of OSA that may causally contribute to cardiovascular disease; (2) current evidence regarding the association between OSA and hypertension, stroke, ischemic heart disease, heart failure, atrial fibrillation, and cardiovascular mortality; and (3) the impact of continuous positive airway pressure (CPAP) treatment on cardiovascular risk factors and outcomes. We emphasize the importance of obesity as a comorbidity of OSA and a confounder in the association between OSA and cardiovascular disease. We also discuss the importance of addressing obesity in patients with OSA, as a strategy to reduce the burden of cardiovascular risk factors in this population. Implications for the approach of patients' OSA in clinical practice and future research directions are discussed.
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Affiliation(s)
| | | | | | - Julio A Chirinos
- Ghent University Hospital, Ghent, Belgium.
- Hospital of the University of Pennsylvania, 3400 Spruce Street. Gates 9021, Philadelphia, PA, 19060, USA.
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Value of routine polysomnography in bariatric surgery. Surg Endosc 2016; 31:245-248. [DOI: 10.1007/s00464-016-4963-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 04/28/2016] [Indexed: 12/15/2022]
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Sharma S, Chowdhury A, Tang L, Willes L, Glynn B, Quan SF. Hospitalized Patients at High Risk for Obstructive Sleep Apnea Have More Rapid Response System Events and Intervention Is Associated with Reduced Events. PLoS One 2016; 11:e0153790. [PMID: 27168330 PMCID: PMC4864239 DOI: 10.1371/journal.pone.0153790] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 04/04/2016] [Indexed: 01/09/2023] Open
Abstract
Background Rapid response system (RRS) is a safety tool designed for early detection and intervention of a deteriorating patient on the general floor in the hospital. Obstructive sleep apnea (OSA) has been associated with significant cardiovascular complications. We hypothesized that patients with high-risk of OSA have higher rate of RRS events and intervention with positive airway pressure therapy in these patients can mitigate the RRS events. Methods As part of a clinical pathway, during a 15 month period, patients with BMI ≥ 30 kg/m2 in select medical services were screened with a validated sleep questionnaire. Patients were characterized as high or low risk based on the screening questionnaire. RRS rates were compared between the groups. Subsequently the impact of PAP therapy on RRS events was evaluated. Results Out of the 2,590 patients screened, 1,973 (76%) were identified as high-risk. RRS rates calculated per 1,000 admissions, were 43.60 in the High-Risk OSA group versus 25.91 in the Low-Risk OSA Group. The PAP therapy compliant group had significantly reduced RRS event rates compared to non-compliant group and group with no PAP therapy (16.99 vs. 53.40 vs. 56.21) (p < 0.01). Conclusion In a large cohort of patients at a tertiary care hospital, we show an association of increased rate of RRS events in high-risk OSA patients and reduction of the risk with PAP intervention in the compliant group.
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Affiliation(s)
- Sunil Sharma
- Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
- * E-mail:
| | - Anindita Chowdhury
- Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
| | - Lili Tang
- Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
| | - Leslee Willes
- Willes Consulting Group Inc., Encinitas, California, United States of America
| | - Brian Glynn
- Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
| | - Stuart F. Quan
- Harvard Medical School, Boston, Massachusetts, United States of America
- University of Arizona College of Medicine, Tucson, Arizona, United States of America
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Tsapanou A, Gu Y, O'Shea D, Manly J, Schupf N, Scarmeas N, Stern Y. Self-Reported Sleep Disordered Breathing as Risk Factor for Mortality in the Elderly. J Stroke Cerebrovasc Dis 2016; 25:1524-31. [PMID: 27053028 DOI: 10.1016/j.jstrokecerebrovasdis.2016.03.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 03/03/2016] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND This study aimed to examine the association between self-reported sleep disordered breathing (SDB) ("awaken short of breath or with a headache") and mortality in a large and ethnically diverse group of community-dwelling elderly people. METHODS A total of 1288 participants, 65 years and older, were examined longitudinally. Sleep problems were estimated using the Medical Outcomes Study Sleep Scale examining sleep disturbance, snoring, awaken short of breath or with a headache, sleep adequacy, and sleep somnolence. Cox regression analysis was used to examine the association between sleep problems and mortality. Age, gender, education, ethnicity, and body mass index were included as covariates. In further analyses we included hypertension, diabetes, heart disease, and stroke as additional covariates. RESULTS The participants were followed for up to 6 years (mean = 2.9, standard deviation = 1.1), and 239 (18.6%) participants died during the follow-up. In unadjusted models, SDB at the initial visit was associated with mortality (hazard ratio [HR] = 1.37; 95% confidence interval [CI] 1.21-1.55; P < .0001). After adjusting for all the covariates, the relationship between SDB and mortality remained significant (HR = 1.48; 95% CI 1.29-1.70; P < .0001). Participants with Caribbean-Hispanic ancestry have higher risk for mortality. CONCLUSIONS Our results suggest that SDB is a risk factor for mortality in a large and ethnically diverse group of older adults, independent of demographic and clinical factors. Further research is needed to examine the underlying mechanisms of this association.
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Affiliation(s)
- Angeliki Tsapanou
- Cognitive Neuroscience Division, Department of Neurology and The Taub Institute for Research on Alzheimer's disease and the Aging Brain, Columbia University College of Physicians and Surgeons, New York, New York; National and Kapodistrian University of Athens Medical School, Athens, Greece.
| | - Yian Gu
- Cognitive Neuroscience Division, Department of Neurology and The Taub Institute for Research on Alzheimer's disease and the Aging Brain, Columbia University College of Physicians and Surgeons, New York, New York
| | - Deirdre O'Shea
- Cognitive Neuroscience Division, Department of Neurology and The Taub Institute for Research on Alzheimer's disease and the Aging Brain, Columbia University College of Physicians and Surgeons, New York, New York
| | - Jennifer Manly
- The Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, New York; The Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Nicole Schupf
- Cognitive Neuroscience Division, Department of Neurology and The Taub Institute for Research on Alzheimer's disease and the Aging Brain, Columbia University College of Physicians and Surgeons, New York, New York; The Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, New York; The Division of Epidemiology, Joseph P. Mailman School of Public Health, Columbia University, New York, New York
| | - Nikolaos Scarmeas
- Cognitive Neuroscience Division, Department of Neurology and The Taub Institute for Research on Alzheimer's disease and the Aging Brain, Columbia University College of Physicians and Surgeons, New York, New York; National and Kapodistrian University of Athens Medical School, Athens, Greece; The Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, New York; The Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Yaakov Stern
- Cognitive Neuroscience Division, Department of Neurology and The Taub Institute for Research on Alzheimer's disease and the Aging Brain, Columbia University College of Physicians and Surgeons, New York, New York; The Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, New York; The Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York
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Pan L, Xie X, Liu D, Ren D, Guo Y. Obstructive sleep apnoea and risks of all-cause mortality: preliminary evidence from prospective cohort studies. Sleep Breath 2016; 20:345-53. [PMID: 26779904 DOI: 10.1007/s11325-015-1295-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 11/22/2015] [Accepted: 12/08/2015] [Indexed: 12/16/2022]
Abstract
PURPOSE A meta-analysis of prospective cohort studies was conducted to clarify the association between obstructive sleep apnoea (OSA) and future risk of all-cause mortality. METHODS Eligible studies were identified by searching the PubMed and EMBASE databases up to July 2015. Pooled hazard ratios (HRs) and their corresponding 95 % confidence intervals (CIs) were calculated to estimate the association between OSA and risk of all-cause mortality. Sources of heterogeneity were identified by subgroup and meta-regression analyses. RESULTS Twelve prospective cohort studies involving 34,382 participants were included in this meta-analysis. The pooled HR of all-cause mortality was 1.262 (95 % CI 1.093-1.431) with significant heterogeneity. Subgroup analyses indicated that the pooled HRs of all-cause mortality in patients with mild, moderate and severe OSA were 0.945 (95 % CI 0.810-1.081), 1.178 (95 % CI 0.978-1.378) and 1.601 (95 % CI 1.298-1.902), respectively. OSA severity could be a possible sources of heterogeneity. Existing publication bias produced a minor contribution to effect size. CONCLUSION Severe, but not mild to moderate, OSA is significantly associated with increased risk of all-cause mortality.
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Affiliation(s)
- Lei Pan
- Department of Respiratory and Critical Care Medicine, Binzhou Medical University Hospital, Binzhou, Shandong, 256603, China
| | - Xiaomei Xie
- Department of Radiotherapy, Xuzhou Central Hospital, The Affiliated Xuzhou Hospital of Medical College of Southeast University, Xuzhou, Jiangsu, 221009, China
| | - Dayue Liu
- Department of Respiratory Medicine, XuZhou Central Hospital, The Affiliated XuZhou Hospital of Medical College of Southeast University, 199 South Jiefang Road, Xuzhou, Jiangsu, 221009, China
| | - Dunqiang Ren
- Department of Respiratory Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266003, China
| | - Yongzhong Guo
- Department of Respiratory Medicine, XuZhou Central Hospital, The Affiliated XuZhou Hospital of Medical College of Southeast University, 199 South Jiefang Road, Xuzhou, Jiangsu, 221009, China.
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Westlake K, Polak J. Screening for Obstructive Sleep Apnea in Type 2 Diabetes Patients - Questionnaires Are Not Good Enough. Front Endocrinol (Lausanne) 2016; 7:124. [PMID: 27679608 PMCID: PMC5020099 DOI: 10.3389/fendo.2016.00124] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Accepted: 08/30/2016] [Indexed: 11/13/2022] Open
Affiliation(s)
- Katerina Westlake
- 2nd Internal Medicine Department, Vinohrady Teaching Hospital, Prague, Czech Republic
| | - Jan Polak
- 2nd Internal Medicine Department, Vinohrady Teaching Hospital, Prague, Czech Republic
- Third Faculty of Medicine, Center for Research on Diabetes, Metabolism and Nutrition, Charles University in Prague, Prague, Czech Republic
- *Correspondence: Jan Polak,
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Berman AM, Thosar SS, Shea SA. Are we underestimating the lifelong benefits of therapy for obstructive sleep apnea? Nat Sci Sleep 2016; 8:87-9. [PMID: 27051325 PMCID: PMC4807943 DOI: 10.2147/nss.s106224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Alec M Berman
- Oregon Institute of Occupational Health Sciences, Oregon Health and Science University, Portland, OR, USA
| | - Saurabh S Thosar
- Oregon Institute of Occupational Health Sciences, Oregon Health and Science University, Portland, OR, USA
| | - Steven A Shea
- Oregon Institute of Occupational Health Sciences, Oregon Health and Science University, Portland, OR, USA
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Abbate R, Al-Daghri NM, Andreozzi P, Borregaard N, Can G, Caridi G, Carstensen-Kirberg M, Cioni G, Conte E, Cuomo R, Denis MA, Fakhfouri G, Fakhfouri G, Fiasse R, Glenthøj A, Goliasc G, Gremmel T, Herder C, Iemmolo M, Jing ZC, Krause R, Marrone O, Miazgowski B, Miazgowski T, Minchiotti L, Mousavizadeh K, Ndrepepa G, Niessner A, Ogayar Luque C, Onat A, Papassotiriou I, Ruiz Ortiz M, Sabico S, Schooling CM, Sakka SD, Sołtysiak P, Visseren FLJ, Wagner J, Wang XJ, Westerink J. Research update for articles published in EJCI in 2013. Eur J Clin Invest 2015; 45:1005-16. [PMID: 26394055 DOI: 10.1111/eci.12512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 08/04/2015] [Indexed: 01/14/2023]
Affiliation(s)
- Rosanna Abbate
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Nasser M Al-Daghri
- Prince Mutaib Chair for Biomarkers of Osteoporosis, Biochemistry Department, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Paolo Andreozzi
- Department of Clinical Medicine and Surgery, 'Federico II' University, Naples, Italy
| | - Niels Borregaard
- The Granulocyte Research Laboratory, Department of Hematology, National University Hospital, Copenhagen, Denmark
| | - Günay Can
- Departments of Cardiology and Public Health, Cerrahpaşa Medical Faculty, University of Istanbul, Istanbul, Turkey
| | - Gianluca Caridi
- Laboratory on Pathophysiology of Uremia, Istituto Giannina Gaslini IRCCS, Genoa, Italy
| | - Maren Carstensen-Kirberg
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,German Center for Diabetes Research (DZD e.V.), Partner Düsseldorf, Düsseldorf, Germany
| | - Gabriele Cioni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Enrico Conte
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Rosario Cuomo
- Department of Clinical Medicine and Surgery, 'Federico II' University, Naples, Italy
| | - Marie A Denis
- Department of Gastroenterology, St. Luc University Hospital, Brussels, Belgium
| | - Gohar Fakhfouri
- Department of Psychiatry and Neuroscience, Faculty of Medicine, Laval University, Québec City, QC, Canada
| | - G Fakhfouri
- Institut Universitaire en Santé Mentale de Québec, Québec City, QC, Canada
| | - Renné Fiasse
- Department of Gastroenterology, St. Luc University Hospital, Brussels, Belgium
| | - Andreas Glenthøj
- The Granulocyte Research Laboratory, Department of Hematology, National University Hospital, Copenhagen, Denmark
| | - Georg Goliasc
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Thomas Gremmel
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.,Center for Platelet Research Studies, Division of Hematology/Oncology, Boston Children's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Christian Herder
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,German Center for Diabetes Research (DZD e.V.), Partner Düsseldorf, Düsseldorf, Germany
| | - Maria Iemmolo
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Zhi-Cheng Jing
- State Key Laboratory of Cardiovascular Disease, FuWai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Robert Krause
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Oreste Marrone
- Institute of Biomedicine and Molecular Immunology, National Research Council, Palermo, Italy
| | - Bartosz Miazgowski
- Department of Hypertension and Internal Medicine, Pomeranian Medical University, Szczecin, Poland
| | - Tomasz Miazgowski
- Department of Hypertension and Internal Medicine, Pomeranian Medical University, Szczecin, Poland
| | | | - Kazem Mousavizadeh
- Cellular and Molecular Research Center and Department of Molecular Medicine, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, Iran
| | | | - Alexander Niessner
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | | | - Altan Onat
- Departments of Cardiology and Public Health, Cerrahpaşa Medical Faculty, University of Istanbul, Istanbul, Turkey
| | - Ioannis Papassotiriou
- Department of Clinical Biochemistry, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Martín Ruiz Ortiz
- Cardiology Department, Reina Sofía University Hospital, Córdoba, Spain
| | - Shaun Sabico
- Biomarkers Research Program, Biochemistry Department, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - C Mary Schooling
- CUNY School of Public Health and Hunter College, New York, NY, USA
| | - Sophia D Sakka
- Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham, UK
| | - P Sołtysiak
- Department of Hypertension and Internal Medicine, Pomeranian Medical University, Szczecin, Poland
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jasmin Wagner
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Xiao-Jian Wang
- State Key Laboratory of Cardiovascular Disease, FuWai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jan Westerink
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
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