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Mohammadi I, Adibparsa M, Yashooa RK, Sehat MS, Sadeghi M. Effect of continuous positive airway pressure therapy on blood levels of IL-6, IL-10, IL-18, IL-1β, IL-4, and IL-17 in obstructive sleep apnoea adults: A systematic review, meta-analysis and trial sequential analysis. Int Orthod 2024; 22:100917. [PMID: 39213713 DOI: 10.1016/j.ortho.2024.100917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 08/11/2024] [Accepted: 08/15/2024] [Indexed: 09/04/2024]
Abstract
INTRODUCTION Obstructive sleep apnoea (OSA) is a long-term disorder characterized by frequent blockages in the upper respiratory tract during sleep, often leading to abrupt awakenings, with or without a decrease in oxygen levels. The systematic review and meta-analysis aimed to assess the effect of continuous positive airway pressure therapy (CPAP) on blood interleukin (IL) levels of IL-6, IL-10, IL-18, IL-1β, IL-4, and IL-17 in OSA adults. MATERIALS AND METHODS The published databases from PubMed, Scopus, Web of Science, and Cochrane Library were searched from 2003 to 2024, without any restrictions. The Review Manager software 5.3 was employed to compute effect sizes, which were presented as the standardized mean difference (SMD) along with a 95% confidence interval (CI). RESULTS In total, 320 records were identified through database searching; ultimately, 42 articles were included in the qualitative synthesis and then the meta-analysis. The CPAP therapy significantly reduces IL-6 levels, as indicated SMD=0.64 [95% CI: 0.35, 0.93] and P<0.0001. CPAP therapy significantly reduced IL-18 and IL-1β levels in adults with OSA, but there is no significant difference in IL-10, IL-4, or IL-17 levels. Age, blood sample, body mass index, ethnicity, and treatment duration for IL-6 and apnoea-hypopnea index with IL-10 levels were effective factors in the pooled results. Experimentally, there was an interaction between IL-18 and IL-1β. CONCLUSIONS CPAP therapy has a positive impact on inflammatory markers in OSA adults; remarkably, it reduces IL-6 and IL-1β levels. Nevertheless, more evidence (such as the role of ethnicity) and understanding of interactions are needed.
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Affiliation(s)
- Iman Mohammadi
- Oral and Maxillofacial Surgery Department, School of Dentistry, Isfahan University of Medical Sciences, 81746-73461 Isfahan, Iran
| | - Mehrdad Adibparsa
- Department of Plastic Surgery, School of Medicine, Isfahan University of Medical Sciences, 81746-73461 Isfahan, Iran
| | - Raya Kh Yashooa
- Department of Medical Microbiology, College of Science, Knowledge University, Kirkuk Road, 44001 Erbil, Kurdistan Region, Iraq
| | - Mohammad Soroush Sehat
- Oral and Maxillofacial Surgery Department, School of Dentistry, Isfahan University of Medical Sciences, 81746-73461 Isfahan, Iran
| | - Masoud Sadeghi
- Medical Biology Research Center, Health Technology Institute, Kermanshah University of Medical Sciences, 67144-15185 Kermanshah, Iran.
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Ogbu I, Menon T, Chahil V, Kahlon A, Devanand D, Kalra DK. Sleep Disordered Breathing and Neurocognitive Disorders. J Clin Med 2024; 13:5001. [PMID: 39274214 PMCID: PMC11396397 DOI: 10.3390/jcm13175001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Revised: 08/16/2024] [Accepted: 08/19/2024] [Indexed: 09/16/2024] Open
Abstract
Sleep-disordered breathing (SDB), which includes conditions such as obstructive sleep apnea (OSA) and central sleep apnea (CSA), is an independent risk factor for cerebral small vessel disease (CSVD), stroke, heart failure, arrhythmias, and other cardiovascular disorders. The influence of OSA on brain structure and cognitive function has become an essential focus in the heart-brain axis, given its potential role in developing neurocognitive abnormalities. In this review, we found that OSA plays a significant role in the cardio-neural pathway that leads to the development of cerebral small vessel disease and neurocognitive decline. Although data is still limited on this topic, understanding the critical role of OSA in the heart-brain axis could lead to the utilization of imaging modalities to simultaneously identify early signs of pathology in both organ systems based on the known OSA-driven pathological pathways that result in a disease state in both the cardiovascular and cerebrovascular systems. This narrative review aims to summarize the current link between OSA and neurocognitive disorders, cardio-neural pathophysiology, and the treatment options available for patients with OSA-related neurocognitive disorders.
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Affiliation(s)
- Ikechukwu Ogbu
- Department of Cardiology, University of Louisville, Louisville, KY 40202, USA
| | - Tushar Menon
- Department of Cardiology, University of Louisville, Louisville, KY 40202, USA
| | - Vipanpreet Chahil
- Department of Cardiology, University of Louisville, Louisville, KY 40202, USA
| | - Amrit Kahlon
- Department of Cardiology, University of Louisville, Louisville, KY 40202, USA
| | | | - Dinesh K Kalra
- Department of Cardiology, University of Louisville, Louisville, KY 40202, USA
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Lee YH, Jeon S, Auh QS, Chung EJ. Automatic prediction of obstructive sleep apnea in patients with temporomandibular disorder based on multidata and machine learning. Sci Rep 2024; 14:19362. [PMID: 39169169 PMCID: PMC11339326 DOI: 10.1038/s41598-024-70432-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 08/16/2024] [Indexed: 08/23/2024] Open
Abstract
Obstructive sleep apnea (OSA) is closely associated with the development and chronicity of temporomandibular disorder (TMD). Given the intricate pathophysiology of both OSA and TMD, comprehensive diagnostic approaches are crucial. This study aimed to develop an automatic prediction model utilizing multimodal data to diagnose OSA among TMD patients. We collected a range of multimodal data, including clinical characteristics, portable polysomnography, X-ray, and MRI data, from 55 TMD patients who reported sleep problems. This data was then analyzed using advanced machine learning techniques. Three-dimensional VGG16 and logistic regression models were used to identify significant predictors. Approximately 53% (29 out of 55) of TMD patients had OSA. Performance accuracy was evaluated using logistic regression, multilayer perceptron, and area under the curve (AUC) scores. OSA prediction accuracy in TMD patients was 80.00-91.43%. When MRI data were added to the algorithm, the AUC score increased to 1.00, indicating excellent capability. Only the obstructive apnea index was statistically significant in predicting OSA in TMD patients, with a threshold of 4.25 events/h. The learned features of the convolutional neural network were visualized as a heatmap using a gradient-weighted class activation mapping algorithm, revealing that it focuses on differential anatomical parameters depending on the absence or presence of OSA. In OSA-positive cases, the nasopharynx, oropharynx, uvula, larynx, epiglottis, and brain region were recognized, whereas in OSA-negative cases, the tongue, nose, nasal turbinate, and hyoid bone were recognized. Prediction accuracy and heat map analyses support the plausibility and usefulness of this artificial intelligence-based OSA diagnosis and prediction model in TMD patients, providing a deeper understanding of regions distinguishing between OSA and non-OSA.
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Affiliation(s)
- Yeon-Hee Lee
- Department of Orofacial Pain and Oral Medicine, Kyung Hee University, Kyung Hee University Dental Hospital, #613 Hoegi-dong, Dongdaemun-gu, Seoul, 02447, Korea.
| | - Seonggwang Jeon
- Department of Computer Science, Hanyang University, Seoul, 04763, Korea
| | - Q-Schick Auh
- Department of Orofacial Pain and Oral Medicine, Kyung Hee University, Kyung Hee University Dental Hospital, #613 Hoegi-dong, Dongdaemun-gu, Seoul, 02447, Korea
| | - Eun-Jae Chung
- Otorhinolaryngology-Head and Neck Surgery, SNUCM Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital Otorhinolaryngology-Head & Neck Surgery, Seoul, Korea
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Meng X, Wen H, Lian L. Association between triglyceride glucose-body mass index and obstructive sleep apnea: a study from NHANES 2015-2018. Front Nutr 2024; 11:1424881. [PMID: 39221158 PMCID: PMC11363548 DOI: 10.3389/fnut.2024.1424881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Accepted: 08/06/2024] [Indexed: 09/04/2024] Open
Abstract
Background The association between TyG-BMI index and the risk of obstructive sleep apnea (OSA), a recently identified biomarker indicating insulin resistance, has yet to be elucidated. Therefore, this study aimed to investigate the association between TyG-BMI index and the risk of OSA using the NHANES database. Methods Analyses were performed on NHANES data conducted between 2015 and 2018. Logistic regression, stratified analyses, curve-fitting analyses, and threshold effects analyses were utilized to assess the association between TyG-BMI index and the risk of OSA. Results The study included 4,588 participants. Multifactorial logistic regression analyses found a significant association between TyG-BMI and increased risk of OSA [OR: 1.54 (CI:1.39-1.70)]. In stratified analyses, age interacted with the association, with TyG-BMI being associated with increased risk of OSA only in a subgroup of subjects younger than 60 years [1.31 (1.14-1.50)], but gender, smoking status, and alcohol use, did not influence the association. The presence of diabetes, hypertension, and cardiovascular diseases also modified the association, but the number of the included subjects with such conditions was significantly lower, therefore the significance of associations was not observed in those subgroups. Additionally, the risk was non-linearly associated, with the inflection point of TyG-BMI at 12.09, after which the lower slope in the risk was observed. Conclusion This study demonstrates that elevated levels of the TyG-BMI index are correlated with risk for OSA, underscoring the significance of these findings in facilitating early prevention or timely intervention for OSA.
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Affiliation(s)
- Xingru Meng
- Department of Respiratory Medicine, Dongguan Hospital of Traditional Chinese Medicine, Dongguan, Guangdong, China
| | - Haihua Wen
- The Ninth Clinical Medical College, Guangzhou University of Chinese Medicine, Dongguan, Guangdong, China
| | - Leshen Lian
- Department of Respiratory Medicine, Dongguan Hospital of Traditional Chinese Medicine, Dongguan, Guangdong, China
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Kovbasyuk Z, Ramos-Cejudo J, Parekh A, Bubu OM, Ayappa IA, Varga AW, Chen MH, Johnson AD, Gutierrez-Jimenez E, Rapoport DM, Osorio RS. Obstructive Sleep Apnea, Platelet Aggregation, and Cardiovascular Risk. J Am Heart Assoc 2024; 13:e034079. [PMID: 39056328 DOI: 10.1161/jaha.123.034079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 05/31/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Although related, the precise mechanisms linking obstructive sleep apnea (OSA) and cardiovascular disease (CVD) are unclear. Platelets are mediators of CVD risk and thrombosis and prior studies suggested associations of OSA and platelet activity. The aim of this study is to assess the link between OSA, platelet activity, and CVD-related risk factors. METHODS AND RESULTS We studied the association of OSA-measures and platelet aggregation in participants dually enrolled in the SHHS (Sleep Heart and Health Study) and FHS (Framingham Heart Study). We applied linear regression models with adjustment for demographic and clinical covariates and explored interactions with OSA and CVD-related factors, including age, sex, body mass index, hypertension, OSA diagnosis (apnea-hypopnea index 4%≥5), and aspirin use. Our final sample was of 482 participants (60 years [14.00], 50.4% female). No associations were observed between apnea-hypopnea index 4% and platelet aggregation in the main sample. Stratified analysis revealed an association in aspirin users (n=65) for our primary exposure (apnea-hypopnea index 4%, β=0.523; P<0.001; n=65), and secondary exposures: hypoxic burden (β=0.358; P<0.001), minimum saturation (β=-0.519; P=0.026), and oxygen desaturation index 3% (β=74.672; P=0.002). No associations were detected in nonaspirin users (n=417). CONCLUSIONS No associations were detected between OSA and platelet aggregation in a community sample. Our finding that OSA associates with increased platelet aggregation in the aspirin group, most of whom use it for primary prevention of CVD, suggests that platelet aggregation may mediate the adverse impact of OSA on vascular health in individuals with existing CVD risk, supporting further investigation.
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Affiliation(s)
- Zanetta Kovbasyuk
- Healthy Brain Aging and Sleep Center Department of Psychiatry New York University Langone Medical Center New York City NY
| | - Jaime Ramos-Cejudo
- Division of Brain Aging Department of Psychiatry New York University Grossman School of Medicine New York City NY
| | - Ankit Parekh
- Division of Pulmonary Critical Care and Sleep Medicine Icahn School of Medicine at Mount Sinai New York City NY
| | - Omonigho M Bubu
- Healthy Brain Aging and Sleep Center Department of Psychiatry New York University Langone Medical Center New York City NY
| | - Indu A Ayappa
- Division of Pulmonary Critical Care and Sleep Medicine Icahn School of Medicine at Mount Sinai New York City NY
| | - Andrew W Varga
- Division of Pulmonary Critical Care and Sleep Medicine Icahn School of Medicine at Mount Sinai New York City NY
| | - Ming-Huei Chen
- Population Sciences Branch National Heart, Lung, and Blood Institute Framingham MA
| | - Andrew D Johnson
- Population Sciences Branch National Heart, Lung, and Blood Institute Framingham MA
| | | | - David M Rapoport
- Division of Brain Aging Department of Psychiatry New York University Grossman School of Medicine New York City NY
| | - Ricardo S Osorio
- Healthy Brain Aging and Sleep Center Department of Psychiatry New York University Langone Medical Center New York City NY
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Hardy A, Belzile EL, Roy V, Pageau-Bleau J, Tremblay F, Dartus J, Germain G, Pelet S. Sleep Apnea is Not an Obstacle for Outpatient Hip and Knee Arthroplasty. J Arthroplasty 2024; 39:1982-1987.e1. [PMID: 38355063 DOI: 10.1016/j.arth.2024.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 02/02/2024] [Accepted: 02/07/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Up to 25% of patients requiring hip or knee arthroplasty have sleep apnea (SA), and these patients have historically been excluded from outpatient programs. The objectives of this study were to evaluate same-day discharge failure as well as 30-day complications, readmissions, and unexpected visits. METHODS A retrospective case-control study comparing patients who have and do not have SA matched for age, sex and arthroplasty type (total hip arthroplasty, total knee arthroplasty, unicompartimental knee arthroplasty) who underwent primary outpatient surgery between February 2019 and December 2022 in 2 academic hospitals was conducted. Cases with mild SA, moderate SA with a body mass index (BMI) <35, and SA of all severity treated by continuous positive airway pressure machines were eligible. There were 156 patients included (78 cases). Complications were assessed according to the Clavien-Dindo Classification and the Comprehensive Complication Index. Continuous variables were evaluated by Student's T or Mann-Whitney tests, while categorical data were analyzed by Chi-square or Fisher tests. Univariate analyses were performed to determine discharge failure risk factors. RESULTS There were 6 cases (7.7%) and 5 controls (6.4%) who failed to be discharged on surgery day (P = .754), with postoperative hypoxemia (6, [3.8%]) and apnea periods (3, [1.9%]) being the most common causes. Higher BMI (odds ratio = 1.19, P = .013) and general anesthesia (odds ratio = 11.97, P = .004) were found to be risk factors for discharge failure. No difference was observed on 30-day readmissions (P = .497), unexpected visits (P = 1.000), and complications on the Clavien-Dindo Classification (P > .269) and Comprehensive Complication Index (P > .334) scales. CONCLUSIONS Selected patients who have SA can safely undergo outpatient hip or knee arthroplasty. Higher BMI and general anesthesia increased the odds of same-day discharge failure. LEVEL OF EVIDENCE Level III, Case-control Study.
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Affiliation(s)
- Alexandre Hardy
- Department of Orthopaedic Surgery, CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Etienne L Belzile
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Vincent Roy
- Department of Orthopaedic Surgery, CHU de Québec-Université Laval, Quebec City, QC, Canada; Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Julien Pageau-Bleau
- Department of Orthopaedic Surgery, CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Félix Tremblay
- Department of Orthopaedic Surgery, CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Julien Dartus
- Department of Orthopaedic Surgery, CHU de Québec-Université Laval, Quebec City, QC, Canada; Faculty of Medicine, Division of Orthopaedic Surgery, Department of Surgery, Université de Lille, Lille, France
| | - Geneviève Germain
- Department of Anesthesiology, CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Stéphane Pelet
- Department of Orthopaedic Surgery, CHU de Québec-Université Laval, Quebec City, QC, Canada; CHU de Québec-Université Laval FRQS Research Center - Regenerative Medicine Axis, Quebec City, QC, Canada
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Melaku YA, Appleton S, Reynolds AC, Milne RL, Lynch BM, Eckert DJ, Adams R. Healthy lifestyle is associated with reduced cardiovascular disease, depression and mortality in people at elevated risk of sleep apnea. J Sleep Res 2024; 33:e14069. [PMID: 37867414 DOI: 10.1111/jsr.14069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 09/04/2023] [Accepted: 10/02/2023] [Indexed: 10/24/2023]
Abstract
We assessed: (1) the independent and joint association of obstructive sleep apnea risk and healthy lifestyle with common consequences (excessive daytime sleepiness, depression, cardiovascular disease and stroke) of obstructive sleep apnea; and (2) the effect of healthy lifestyle on survival in people with increased obstructive sleep apnea risk. Data from 13,694 adults (median age 46 years; 50% men) were used for cross-sectional and survival analyses (mortality over 15 years). A healthy lifestyle score with values from 0 (most unhealthy) to 5 (most healthy) was determined based on diet, alcohol intake, physical activity, smoking and body mass index. In the cross-sectional analysis, obstructive sleep apnea risk was positively associated with all chronic conditions and excessive daytime sleepiness in a dose-response manner (p for trend < 0.001). The healthy lifestyle was inversely associated with all chronic conditions (p for trend < 0.001) but not with excessive daytime sleepiness (p for trend = 0.379). Higher healthy lifestyle score was also associated with reduced odds of depression and cardiovascular disease. We found an inverse relationship between healthy lifestyle score with depression (p for trend < 0.001), cardiovascular disease (p for trend = 0.003) and stroke (p for trend = 0.025) among those who had high obstructive sleep apnea risk. In the survival analysis, we found an inverse association between healthy lifestyle and all-cause mortality for all categories of obstructive sleep apnea risk (moderate/high- and high-risk groups [p for trend < 0.001]). This study emphasises the crucial role of a healthy lifestyle in mitigating the effects of obstructive sleep apnea risk in individuals with an elevated obstructive sleep apnea risk.
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Affiliation(s)
- Yohannes Adama Melaku
- FHMRI Sleep (Adelaide Institute for Sleep Health), College of Medicine and Public Health, Flinders University, Bedford Park, Adelaide, South Australia, Australia
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Sarah Appleton
- FHMRI Sleep (Adelaide Institute for Sleep Health), College of Medicine and Public Health, Flinders University, Bedford Park, Adelaide, South Australia, Australia
| | - Amy C Reynolds
- FHMRI Sleep (Adelaide Institute for Sleep Health), College of Medicine and Public Health, Flinders University, Bedford Park, Adelaide, South Australia, Australia
| | - Roger L Milne
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Brigid M Lynch
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Physical Activity Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Danny J Eckert
- FHMRI Sleep (Adelaide Institute for Sleep Health), College of Medicine and Public Health, Flinders University, Bedford Park, Adelaide, South Australia, Australia
| | - Robert Adams
- FHMRI Sleep (Adelaide Institute for Sleep Health), College of Medicine and Public Health, Flinders University, Bedford Park, Adelaide, South Australia, Australia
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Cheng HJ, Li CY, Lin CY. Inclusion of blood pressure parameter increases predictive capability of severe obstructive sleep apnea: A decision tree approach. J Clin Hypertens (Greenwich) 2024. [PMID: 39037154 DOI: 10.1111/jch.14871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 06/21/2024] [Accepted: 07/03/2024] [Indexed: 07/23/2024]
Abstract
Few studies included objective blood pressure (BP) to construct the predictive model of severe obstructive sleep apnea (OSA). This study used binary logistic regression model (BLRM) and the decision tree method (DTM) to constructed the predictive models for identifying severe OSA, and to compare the prediction capability between the two methods. Totally 499 adult patients with severe OSA and 1421 non-severe OSA controls examined at the Sleep Medicine Center of a tertiary hospital in southern Taiwan between October 2016 and April 2019 were enrolled. OSA was diagnosed through polysomnography. Data on BP, demographic characteristics, anthropometric measurements, comorbidity histories, and sleep questionnaires were collected. BLRM and DTM were separately applied to identify predictors of severe OSA. The performance of risk scores was assessed by area under the receiver operating characteristic curves (AUCs). In BLRM, body mass index (BMI) ≥27 kg/m2, and Snore Outcomes Survey score ≤55 were significant predictors of severe OSA (AUC 0.623). In DTM, mean SpO2 <96%, average systolic BP ≥135 mmHg, and BMI ≥39 kg/m2 were observed to effectively differentiate cases of severe OSA (AUC 0.718). The AUC for the predictive models produced by the DTM was higher in older adults than in younger adults (0.807 vs. 0.723) mainly due to differences in clinical predictive features. In conclusion, DTM, using a different set of predictors, seems more effective in identifying severe OSA than BLRM. Differences in predictors ascertained demonstrated the necessity for separately constructing predictive models for younger and older adults.
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Affiliation(s)
- Hsiang-Ju Cheng
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Cheng-Yu Lin
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Sleep Medicine Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Florek K, Kübler M, Górka M, Kübler P. New Modifiable Risk Factors Influencing Coronary Artery Disease Severity. Int J Mol Sci 2024; 25:7766. [PMID: 39063008 PMCID: PMC11276953 DOI: 10.3390/ijms25147766] [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: 05/22/2024] [Revised: 07/03/2024] [Accepted: 07/07/2024] [Indexed: 07/28/2024] Open
Abstract
Cardiovascular diseases (CVDs) remain the leading cause of death worldwide with coronary artery disease (CAD) being the first culprit in this group. In terms of CAD, not only its presence but also its severity plays a role in the patient's treatment and prognosis. CAD complexity can be assessed with the indicator named the SYNTAX score (SS). A higher SS is associated with major adverse cardiovascular event (MACE) occurrence in short- and long-term observations. Hence, the risk factors affecting CAD severity based on SS results may help lower the risk among patients with already developed CAD to reduce their impact on coronary atherosclerosis progression. The well-established risk factors of CAD are consistent with those associated with the coronary plaque burden. However, recently, it was shown that new indicators exist, which we present in this paper, that significantly contribute to CAD complexity such as inflammatory parameters, C-reactive protein (CRP), ratios based on blood smear results, and uric acid. Moreover, microbiota alteration, vitamin D deficiency, and obstructive sleep apnea (OSA) also predicted CAD severity. However, sometimes, certain indicators were revealed as significant only in terms of chronic coronary syndromes (CCSs) or specific acute coronary syndromes (ACSs). Importantly, there is a need to apply the interdisciplinary and translational approach to the novel CAD severity risk assessment to maximize the impact of secondary prevention among patients at risk of coronary atherosclerosis progression.
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Affiliation(s)
- Kamila Florek
- Student Scientific Group of Invasive Cardiology, Institute of Heart Diseases, Wroclaw Medical University, 50-369 Wroclaw, Poland
| | - Maja Kübler
- Student Scientific Group of Invasive Cardiology, Institute of Heart Diseases, Wroclaw Medical University, 50-369 Wroclaw, Poland
| | - Magdalena Górka
- Student Scientific Group of Invasive Cardiology, Institute of Heart Diseases, Wroclaw Medical University, 50-369 Wroclaw, Poland
| | - Piotr Kübler
- Institute of Heart Diseases, University Hospital, 50-556 Wroclaw, Poland
- Department of Cardiology, Faculty of Medicine, Institute of Heart Diseases, Wroclaw Medical University, 50-367 Wroclaw, Poland
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10
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Chan TG, Plageman J, Yu JL. The Repeatability of Pharyngeal Opening Pressure Under Drug-Induced Sleep Endoscopy. Otolaryngol Head Neck Surg 2024; 171:295-302. [PMID: 38606621 PMCID: PMC11211064 DOI: 10.1002/ohn.730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 02/01/2024] [Accepted: 02/09/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVE Pharyngeal opening pressure (PhOP) is a measure of upper airway collapsibility that can be obtained during drug-induced sleep endoscopy (DISE) using a continuous positive airway pressure (CPAP) titration. However, the stability of PhOP over the course of sedation during DISE remains unclear. This study aims to compare repeat measures of PhOP over the course of DISE. STUDY DESIGN Single arm prospective study. SETTING Single tertiary care institution. METHODS Patients had 2 CPAP titrations while undergoing DISE. Collected data included patient demographics, PhOP, patient sedation index (PSI), and duration of and between CPAP titrations. t Tests, test-retest coefficient analysis, and repeated measures correlation were performed. RESULTS Twenty-five patients completed the study between 2022 and 2023 with 22 patients having sedation depth (PSI) recording. Most were male (76%), obese (average body mass index: 30.24 kg/m2), with severe obstructive sleep apnea (average apnea-hypopnea index: 39.8 events/hr). Test-retest analysis showed good-excellent correlation between PhOP values (intraclass correlation coefficient = 0.892, P < .0001, n = 25). Average time between CPAP titrations was 15 minutes to 6 seconds. Over that time, PhOP increased by an average of 0.72 cmH2O (P = .06, n = 25) and PSI decreased by 9.5 units (P = .01, n = 22). Repeated measures correlation showed a weak negative correlation between PhOP and PSI (r = -.45, P = .03, n = 22). CONCLUSION The results showed repeatability of PhOP values over the course of DISE. When adjusted for sedation depth (PSI), deeper sedation was weakly associated with greater PHOP. However, the magnitude of this change was small and we conclude that PhOP remains relatively stable over the course of DISE (Effects of Lung Volume on Upper Airway Patency During DISE [DISE-Pulm], NCT05350332, clinicaltrials.gov).
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Affiliation(s)
- Tyler G Chan
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jack Plageman
- Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia, USA
| | - Jason L Yu
- Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia, USA
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Fujita Y, Yamauchi M, Muro S. Assessment and management of continuous positive airway pressure therapy in patient with obstructive sleep apnea. Respir Investig 2024; 62:645-650. [PMID: 38759606 DOI: 10.1016/j.resinv.2024.05.004] [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: 12/27/2023] [Revised: 04/18/2024] [Accepted: 05/09/2024] [Indexed: 05/19/2024]
Abstract
Obstructive sleep apnea (OSA) causes excessive daytime sleepiness, impaired daytime functioning, and an increased risk of cardiovascular diseases. Continuous positive airway pressure (CPAP) is a highly effective therapy for moderate to severe OSA. Although CPAP adherence is commonly assessed using a 4-hthreshold, determining the optimal usage time based on clinical outcomes is crucial. While subjective sleepiness often improves with ≥4 h of CPAP usage, an extended duration (≥6 h) may be necessary to impact objective sleepiness. CPAP demonstrated a modest yet clinically meaningful dose-dependent effect on lowering blood pressure. For patients seeking antihypertensive benefits from CPAP therapy, the goal should extend beyond 4 h of use to maximize the therapeutic impact. Recognizing individual variations in sleep duration and responses to CPAP therapy is essential. The adoption of 'individualized goals for CPAP use,' outlining target times for specific outcomes, should also consider an individual's total sleep duration, including periods without CPAP. The impact of CPAP on clinical outcomes may vary, even with the same duration of CPAP use, depending on the period without CPAP use, particularly during the first or second half of sleep. Patients who remove or initiate CPAP midway or have a low CPAP usage frequency may require different forms of guidance. Tailoring patient education to address CPAP usage patterns may be necessary to enhanced satisfaction, self-efficacy, and adherence to therapy. Management of CPAP treatment should be personalized to meet individual needs and adapted based on specific response patterns for achieving treatment efficacy.
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Affiliation(s)
- Yukio Fujita
- Department of Respiratory Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
| | - Motoo Yamauchi
- Department of Respiratory Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan; Department of Clinical Pathophysiology of Nursing, Nara Medical University, Kashihara, Nara, 634-8522, Japan
| | - Shigeo Muro
- Department of Respiratory Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
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12
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Zhao DF, Zhang YZ, Sun X, Su CY, Zhang LQ. Association between obstructive sleep apnea severity and depression risk: a systematic review and dose-response meta-analysis. Sleep Breath 2024:10.1007/s11325-024-03083-4. [PMID: 38888794 DOI: 10.1007/s11325-024-03083-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 05/31/2024] [Accepted: 06/10/2024] [Indexed: 06/20/2024]
Abstract
Obstructive sleep apnea (OSA) has received considerable attention as a potential risk factor for depressive symptoms. The systematic review was conducted to confirm the dose‒response connection between OSA severity and depression risk. A systematic literature search of English and Chinese articles published in PubMed, EMBASE, Scopus, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), and SinoMed databases from their inception to 28 August 2023 was conducted. An evaluation using the Newcastle‒Ottawa Scale was performed. A meta-analysis was used to evaluate the impact of OSA severity. A random-effects dose‒response model was conducted to evaluate the linear and nonlinear dose‒response connections. We evaluated publication bias by funnel plots, and symmetry by Egger's test. We identified 18 cross-sectional researches. 3143 participants which were involved in the dose‒response meta-analysis. Contrasted with mild OSA, individuals with severe OSA had a higher adjusted risk of depression (rate ratio: 1.34, 95% confidence interval = 1.05-1.70), with substantial heterogeneity (I2 = 70.9%, Pheterogeneity<0.001). There is a significant linear connection between OSA severity and depression risk. The depression risk increased by 0.4% for every 1 event per hour increase in the apnea-hypopnea index (AHI). The protocol for this unfunded research was drafted and registered at PROSPERO (ID CRD42023474097).
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Affiliation(s)
- Dong-Fang Zhao
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, China
| | - Yi-Zhu Zhang
- Peking University School of Nursing, Beijing, China
| | - Xue Sun
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, China
| | - Chun-Yan Su
- Department of Nephrology, Peking University Third Hospital, 49 Huayuanbei Road, Haidian District, Beijing, 100191, China.
| | - Li-Qiang Zhang
- Department of Respiratory and Critical Care Medicine, Sleep Medicine Center, Peking University Third Hospital, 49 Huayuanbei Road, Haidian District, Beijing, 100191, China.
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13
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Erfanian R, Pouremamali R, Zamani R, Moazeni SA, Borghei P. Globus sensation in obstructive sleep apnea patients; A cross-sectional study of 120 patients. Sleep Breath 2024:10.1007/s11325-024-03087-0. [PMID: 38884696 DOI: 10.1007/s11325-024-03087-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 06/11/2024] [Accepted: 06/14/2024] [Indexed: 06/18/2024]
Abstract
PURPOSE Globus pharyngeus (GP) is a common complaint in many disciplines, especially otolaryngology. Pharyngeal symptoms and abnormalities, including GP, are frequent in obstructive sleep apnea (OSA) patients. This study aims to investigate globus sensation in non-operated OSA patients. METHODS After translation and validation, the Laryngopharyngeal Measure of Perceived Sensation (LUMP) was administered to 120 untreated OSA patients. All patients underwent polysomnography and thorough physical examination. The association between LUMP scores and OSA measures was evaluated. RESULTS LUMP score had a significant correlation with the Epworth Sleepiness Scale (ESS) (Spearman's ρ = 0.269, p = 0.004), and BMI (Spearman's ρ = 0.249, p = 0.007), the anatomical position of the tongue (ρ = -0.191, p = 0.04) and the Friedman grade of tonsils (ρ = 0.241, p = 0.01). It correlated with SpO2 nadir, though it did not reach statistical significance. CONCLUSION The results of our study depict a relationship between a self-report measure of globus sensation and daytime sleepiness, BMI and tonsil size. In the absence of a direct relationship between OSA severity parameters and GP, we hypothesize a role for shared comorbidities and anatomical phenotypes. The increased frequency of GP in OSA patients should be considered when evaluating the complications of surgical interventions in these patients.
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Affiliation(s)
- Reza Erfanian
- Otorhinolaryngology Research Center, Amir Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Rozhina Pouremamali
- Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Raha Zamani
- Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyedeh Atiyeh Moazeni
- Otorhinolaryngology Research Center, Amir Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Pedram Borghei
- Otorhinolaryngology Research Center, Amir Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran
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14
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Cavalcante-Silva V, Morelhão PK, Fernandes GL, D'Almeida V, Tufik S, Andersen ML. Homocysteine as a predictor of apnea-hypopnea index in obstructive sleep apnea: a longitudinal epidemiological study (EPISONO). Eur Arch Otorhinolaryngol 2024; 281:3237-3243. [PMID: 38568296 DOI: 10.1007/s00405-024-08614-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 03/11/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) affects nearly 1 billion people globally, and has established links with cardiovascular and neurocognitive complications. Although it has some limitations, the apnea-hypopnea index (AHI) is commonly used to gauge OSA severity and therapeutic response. Homocysteine (Hcy) metabolism, when impaired, can elicit cellular senescence mechanisms that may be shared with OSA. Hence, our objective was to explore the role of Hcy concentrations both as a predictor of AHI values and as a potential risk factor for OSA. METHODS Involving 1042 volunteers aged 20 to 80 years, the initial study (2007) included polysomnographic evaluations, questionnaires on sleep and general health, as well as biochemical analyses. After an 8-year interval, 715 participants from the initial study were invited for a follow-up assessment in 2015. RESULTS Our findings showed that Hcy was a predictor for an increased AHI, and AHI increased over time. Individuals with plasma Hcy concentrations ≥ 15 µmol/L experienced an average AHI increase of 7.43 events/hour ([beta coefficient] β = 7.43; 95%CI 2.73 to 12.13) over time, compared to those with plasma concentrations < 10 µmol/L. A similar trend was apparent in those with plasma Hcy concentrations between 10 ≥ and < 15 µmol/L, who had an AHI increase with an average beta coefficient of 3.20 events/hour (95%CI 1.01 to 5.39) compared to those with plasma Hcy concentrations < 10 µmol/L. CONCLUSIONS In summary, our study suggests that increased plasma Hcy concentrations could be considered a risk factor for the development of OSA. These findings highlight that elevated plasma Hcy concentrations can predict the severity of OSA, underscoring their correlation with the AHI.
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Affiliation(s)
- Vanessa Cavalcante-Silva
- Departamento de Psicobiologia, Universidade Federal de São Paulo, Rua Napoleão de Barros, 925 - CEP, São Paulo, 04024-002, Brazil
| | - Priscila Kalil Morelhão
- Departamento de Psicobiologia, Universidade Federal de São Paulo, Rua Napoleão de Barros, 925 - CEP, São Paulo, 04024-002, Brazil
- Sleep Institute, São Paulo, Brazil
| | - Guilherme Luiz Fernandes
- Departamento de Psicobiologia, Universidade Federal de São Paulo, Rua Napoleão de Barros, 925 - CEP, São Paulo, 04024-002, Brazil
| | - Vânia D'Almeida
- Departamento de Psicobiologia, Universidade Federal de São Paulo, Rua Napoleão de Barros, 925 - CEP, São Paulo, 04024-002, Brazil
| | - Sergio Tufik
- Departamento de Psicobiologia, Universidade Federal de São Paulo, Rua Napoleão de Barros, 925 - CEP, São Paulo, 04024-002, Brazil
- Sleep Institute, São Paulo, Brazil
| | - Monica L Andersen
- Departamento de Psicobiologia, Universidade Federal de São Paulo, Rua Napoleão de Barros, 925 - CEP, São Paulo, 04024-002, Brazil.
- Sleep Institute, São Paulo, Brazil.
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15
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Xu SD, Hao LL, Liu FF, Xu CZ. The effects of obstructive sleep apnea on blood pressure variability and load in patients with hypertension. Sleep Breath 2024; 28:1251-1260. [PMID: 38326691 DOI: 10.1007/s11325-024-03005-4] [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: 11/19/2023] [Revised: 01/15/2024] [Accepted: 01/24/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND Hypertension frequently coexists with obstructive sleep apnea (OSA), and their interplay substantially impacts the prognosis of affected individuals. Investigating the influence of OSA on blood pressure variability (BPV) and blood pressure load (BPL) in hypertensive patients has become a focal point of clinical research. METHODS This cross-sectional study recruited hypertensive patients (n = 265) without discrimination and classified them into four groups based on their apnea-hypopnea index (AHI): control group (n = 40), AHI < 5; mild group (n = 74), 5 ≤ AHI ≤ 15; moderate group (n = 68), 15 < AHI ≤ 30; severe group (n = 83), AHI > 30. All participants underwent comprehensive assessments, including polysomnography (PSG) monitoring, 24-h ambulatory blood pressure (ABP) monitoring, cardiac Doppler ultrasound, and additional examinations when indicated. RESULTS BPV and BPL exhibited significant elevations in the moderate and severe OSA groups compared to the control and mild OSA groups (P < 0.05). Moreover, interventricular septum thickness and left ventricular end-diastolic volume (LVEDV) demonstrated higher values in the moderate and severe OSA groups (P < 0.05). Multiple stepwise regression analysis identified noteworthy risk factors for elevated BPV in hypertensive patients with OSA, including AHI, maximum apnea time, total times of oxygen reduction, and mean time of apnea. CONCLUSION Hypertensive patients with moderate to severe OSA exhibited substantially increased BPV and BPL. Moreover, BPV was correlated with AHI, maximum apnea time, total times of oxygen reduction, and mean time of apnea in hypertensive patients with OSA.
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Affiliation(s)
- Shao-Dong Xu
- Department of Cardiology, The Third Affiliated Hospital of Anhui Medical University, Hefei, 230001, Anhui Province, China.
| | - Ling-Li Hao
- Department of Sleep Monitoring Center, The Third Affiliated Hospital of Anhui Medical University, Hefei, 230001, Anhui Province, China
| | - Fei-Fei Liu
- Department of Sleep Monitoring Center, The Third Affiliated Hospital of Anhui Medical University, Hefei, 230001, Anhui Province, China
| | - Chuan-Zhi Xu
- Department of Electrocardiogram, The Third Affiliated Hospital of Anhui Medical University, Hefei, 230001, Anhui Province, China
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16
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Strausz S, Agafonova E, Tiullinen V, Kiiskinen T, Broberg M, Ruotsalainen SE, Koskela J, Bachour A, Sofer T, Gottlieb DJ, Palotie A, Palotie T, Ripatti S, Ollila HM. Genetic Analysis of Obstructive Sleep Apnea and Its Relationship with Severe COVID-19. Ann Am Thorac Soc 2024; 21:961-970. [PMID: 38330144 PMCID: PMC11160132 DOI: 10.1513/annalsats.202303-215oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 02/07/2024] [Indexed: 02/10/2024] Open
Abstract
Rationale: Although patients with obstructive sleep apnea (OSA) have a higher risk for coronavirus disease (COVID-19) hospitalization, the causal relationship has remained unexplored. Objectives: To understand the causal relationship between OSA and COVID-19 by leveraging data from vaccination and electronic health records, genetic risk factors from genome-wide association studies, and Mendelian randomization. Methods: We elucidated genetic risk factors for OSA using FinnGen (total N = 377,277), performing genome-wide association. We used the associated variants as instruments for univariate and multivariate Mendelian randomization (MR) analyses and computed absolute risk reduction against COVID-19 hospitalization with or without vaccination. Results: We identified nine novel loci for OSA and replicated our findings in the Million Veteran Program. Furthermore, MR analysis showed that OSA was a causal risk factor for severe COVID-19 (P = 9.41 × 10-4). Probabilistic modeling showed that the strongest genetic risk factor for OSA at the FTO locus reflected a signal of higher body mass index (BMI), whereas BMI-independent association was seen with the earlier reported SLC9A4 locus and a MECOM locus, which is a transcriptional regulator with 210-fold enrichment in the Finnish population. Similarly, multivariate MR analysis showed that the causality for severe COVID-19 was driven by BMI (multivariate MR P = 5.97 × 10-6, β = 0.47). Finally, vaccination reduced the risk for COVID-19 hospitalization more in the patients with OSA than in the non-OSA controls, with respective absolute risk reductions of 13.3% versus 6.3%. Conclusions: Our analysis identified novel genetic risk factors for OSA and showed that OSA is a causal risk factor for severe COVID-19. The effect is predominantly explained by higher BMI and suggests BMI-dependent effects at the level of individual variants and at the level of comorbid causality.
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Affiliation(s)
- Satu Strausz
- Institute for Molecular Medicine Finland, Helsinki Institute of Life Science, and
- Orthodontics, Department of Oral and Maxillofacial Diseases, Clinicum, Faculty of Medicine
- Department of Oral and Maxillofacial Diseases
- Department of Plastic Surgery, Cleft Palate and Craniofacial Center, and
- Department of Genetics, Stanford University School of Medicine, Stanford, California
| | - Elizabete Agafonova
- Orthodontics, Department of Oral and Maxillofacial Diseases, Clinicum, Faculty of Medicine
- Vantaa Health Center, Vantaa, Finland
| | - Varvara Tiullinen
- Institute for Molecular Medicine Finland, Helsinki Institute of Life Science, and
| | - Tuomo Kiiskinen
- Institute for Molecular Medicine Finland, Helsinki Institute of Life Science, and
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Martin Broberg
- Institute for Molecular Medicine Finland, Helsinki Institute of Life Science, and
| | | | - Jukka Koskela
- Institute for Molecular Medicine Finland, Helsinki Institute of Life Science, and
- Broad Institute of MIT, Harvard, Cambridge, Massachusetts
| | - Adel Bachour
- Sleep Unit, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Tamar Sofer
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Daniel J. Gottlieb
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Massachusetts Veterans Epidemiology Research and Information Center, VA Healthcare System, Boston, Massachusetts
| | - Aarno Palotie
- Institute for Molecular Medicine Finland, Helsinki Institute of Life Science, and
- Broad Institute of MIT, Harvard, Cambridge, Massachusetts
- Analytic and Translational Genetics Unit (ATGU), Department of Medicine, Department of Neurology, Department of Psychiatry
| | - Tuula Palotie
- Orthodontics, Department of Oral and Maxillofacial Diseases, Clinicum, Faculty of Medicine
- Department of Plastic Surgery, Cleft Palate and Craniofacial Center, and
| | - Samuli Ripatti
- Institute for Molecular Medicine Finland, Helsinki Institute of Life Science, and
- Department of Public Health, University of Helsinki, Helsinki, Finland
- Broad Institute of MIT, Harvard, Cambridge, Massachusetts
| | - Hanna M. Ollila
- Institute for Molecular Medicine Finland, Helsinki Institute of Life Science, and
- Broad Institute of MIT, Harvard, Cambridge, Massachusetts
- Center for Genomic Medicine, and
- Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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17
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Li E, Ai F, Liang C, Chen Q, Zhao Y, Xu K, Kong J. Latent profile analysis of depression in US adults with obstructive sleep apnea hypopnea syndrome. Front Psychiatry 2024; 15:1398669. [PMID: 38736623 PMCID: PMC11082792 DOI: 10.3389/fpsyt.2024.1398669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 04/08/2024] [Indexed: 05/14/2024] Open
Abstract
Objective This study used latent profile analysis to explore the level of depression among US adults with obstructive sleep apnea hypopnea syndrome (OSAHS) symptoms and to identify different latent categories of depression to gain insight into the characteristic differences between these categories. Methods The data of this study were obtained from the National Health and Nutrition Examination Survey (NHANES) database, and the subjects with OSAHS symptoms were aged 18 years and older. The latent profile analysis (LPA) method was used to fit the latent depression categories in subjects with OSAHS symptoms. The chi-square test, rank sum test, and binary logistic regression were used to analyze the influencing factors of depression subgroups in subjects with OSAHS symptoms. Results Three latent profiles were identified: low-level (83.7%), moderate-level (14.5%) and high-level (1.8%) depression. The scores of 9 items in the high-level depression group were higher than those in the other two groups. Among them, item 4 "feeling tired or lack of energy" had the highest score in all categories. Conclusion Depression in subjects with OSAHS symptoms can be divided into low-level, moderate-level and high-level depression. There are significant differences among different levels of depression in gender, marital status, PIR, BMI, smoking, general health condition, sleep duration and OSAHS symptom severity.
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Affiliation(s)
| | | | - Chunguang Liang
- Department of Nursing, Jinzhou Medical University, Jinzhou, China
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18
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Honglertnapakul Y, Peanchitlertkajorn S, Likitkulthanaporn A, Saengfai NN, Chaweewannakorn C, Boonpratham S. Impacts of mandibular setback with or without maxillary advancement for class III skeletal correction on sleep-related respiratory parameters: A systematic review and meta-analysis. Orthod Craniofac Res 2024. [PMID: 38661057 DOI: 10.1111/ocr.12798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2024] [Indexed: 04/26/2024]
Abstract
A systematic review and meta-analysis was conducted to evaluate the impacts of mandibular setback with or without maxillary advancement for class III skeletal correction on respiratory parameters measured by polysomnography (PSG) and to compare these respiratory parameters between these procedures for class III skeletal correction. Six electronic databases were searched up to June 2023. Studies comparing PSG parameters before and after orthognathic surgery for skeletal class III patients were selected for further analysis. The outcomes of interest were apnoea-hypopnea index (AHI), respiratory disturbance index (RDI), the lowest oxygen saturation (lowest SpO2), the average oxygen saturation (mean SpO2), and the 3% oxygen desaturation index (3% ODI). Data extraction, methodological quality assessment, risk of bias assessment, meta-analysis, and subgroup analysis were performed. Sixteen studies with a total of 476 patients who underwent orthognathic surgery for class III skeletal correction were included for meta-analysis. The risk of bias level was moderate for most studies. All PSG parameters before and after orthognathic surgery were not significantly different. The different surgical procedures also did not significantly affect post-operative PSG parameters. 5.8% of patients developed post-operative obstructive sleep apnoea (OSA). Most of them underwent a large distance of mandibular setback. There is a moderate level of evidence that mandibular setback with or without maxillary advancement for class III skeletal correction does not pre-dispose young and healthy patients to obstructive sleep apnoea when evaluated in the short term after surgery. However, post-operatively developed OSA was found in several isolated cases that underwent a large amount of mandibular setback with or without maxillary advancement.
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Affiliation(s)
| | | | | | | | | | - Supatchai Boonpratham
- Department of Orthodontics, Faculty of Dentistry, Mahidol University, Nakhon Pathom, Thailand
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19
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Li Z, Cai S, Qiao J, Li Y, Wang Q, Chen R. Implications of depressive mood in OSAHS patients: insights from event-related potential. BMC Psychiatry 2024; 24:307. [PMID: 38654234 DOI: 10.1186/s12888-024-05772-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 04/17/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Obstructive sleep apnea-hypopnea syndrome (OSAHS) is a chronic breathing disorder characterized by recurrent upper airway obstruction during sleep. Although previous studies have shown a link between OSAHS and depressive mood, the neurobiological mechanisms underlying mood disorders in OSAHS patients remain poorly understood. This study aims to investigate the emotion processing mechanism in OSAHS patients with depressive mood using event-related potentials (ERPs). METHODS Seventy-four OSAHS patients were divided into the depressive mood and non-depressive mood groups according to their Self-rating Depression Scale (SDS) scores. Patients underwent overnight polysomnography and completed various cognitive and emotional questionnaires. The patients were shown facial images displaying positive, neutral, and negative emotions and tasked to identify the emotion category, while their visual evoked potential was simultaneously recorded. RESULTS The two groups did not differ significantly in age, BMI, and years of education, but showed significant differences in their slow wave sleep ratio (P = 0.039), ESS (P = 0.006), MMSE (P < 0.001), and MOCA scores (P = 0.043). No significant difference was found in accuracy and response time on emotional face recognition between the two groups. N170 latency in the depressive group was significantly longer than the non-depressive group (P = 0.014 and 0.007) at the bilateral parieto-occipital lobe, while no significant difference in N170 amplitude was found. No significant difference in P300 amplitude or latency between the two groups. Furthermore, N170 amplitude at PO7 was positively correlated with the arousal index and negatively with MOCA scores (both P < 0.01). CONCLUSION OSAHS patients with depressive mood exhibit increased N170 latency and impaired facial emotion recognition ability. Special attention towards the depressive mood among OSAHS patients is warranted for its implications for patient care.
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Affiliation(s)
- Zhiqiang Li
- Department of Respiratory and Critical Care Medicine, Sleep Center, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Sijie Cai
- Department of Respiratory and Critical Care Medicine, Sleep Center, The Second Affiliated Hospital of Soochow University, Suzhou, China
- Department of Pulmonary and Critical Care Medicine, Affiliated Kunshan Hospital of Jiangsu University, Suzhou, China
| | - Jiamin Qiao
- Department of Respiratory and Critical Care Medicine, Sleep Center, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yezhou Li
- Oxford University Clinical Academic Graduate School and Buckinghamshire Healthcare NHS Trust, Oxford, UK
| | - Qiaojun Wang
- Department of Respiratory and Critical Care Medicine, Sleep Center, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Rui Chen
- Department of Respiratory and Critical Care Medicine, Sleep Center, The Second Affiliated Hospital of Soochow University, Suzhou, China.
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20
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Zhou T, Chen S, Mao J, Zhu P, Yu X, Lin R. Association between obstructive sleep apnea and visceral adiposity index and lipid accumulation product: NHANES 2015-2018. Lipids Health Dis 2024; 23:100. [PMID: 38600516 PMCID: PMC11005189 DOI: 10.1186/s12944-024-02081-5] [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: 02/16/2024] [Accepted: 03/18/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Obesity refers to a significant contributor to the development of obstructive sleep apnea (OSA). Early prediction of OSA usually leads to better treatment outcomes, and this study aims to employ novel metabolic markers, visceral adiposity index (VAI), and lipid accumulation product (LAP) to evaluate the relationship to OSA. METHODS The data used in the current cross-sectional investigation are from the National Health and Nutrition Examination Survey (NHANES), which was carried out between 2015 and 2018. To examine the correlation between LAP and VAI levels and OSA, multivariate logistic regression analysis was adopted. In addition, various analytical methods were applied, including subgroup analysis, smooth curve fitting, and threshold effect analysis. RESULTS Among totally 3932 participants, 1934 were included in the OSA group. The median (Q1-Q3) values of LAP and VAI for the participants were 40.25 (21.51-68.26) and 1.27 (0.75-2.21), respectively. Logistic regression studies indicated a positive correlation between LAP, VAI, and OSA risk after adjusting for potential confounding variables. Subgroup analysis revealed a stronger correlation between LAP, VAI levels, and OSA among individuals aged < 60 years. Through smooth curve fitting, specific saturation effects of LAP, VAI, and BMD were identified, with inflection points at 65.684 and 0.428, respectively. CONCLUSION This study demonstrates that elevated levels of LAP and VAI increase the risk of OSA, suggesting their potential as predictive markers for OSA and advocating for dietary and exercise interventions to mitigate OSA risk in individuals with high LAP and VAI levels.
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Affiliation(s)
- Tingfeng Zhou
- Department of Otolaryngology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Shihao Chen
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jiesheng Mao
- Department of Neurology, Postgraduate Training Base Alliance of Wenzhou Medical University (WenzhouPeople's Hospital), Wenzhou, China
| | - Pei Zhu
- Department of Ophthalmology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xinru Yu
- Department of Otolaryngology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Renyu Lin
- Department of Otolaryngology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
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21
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Brikman S, Lubani Y, Mader R, Bieber A. High prevalence of diffuse idiopathic skeletal hyperostosis (DISH) among obese young patients - A retrospective observational study. Semin Arthritis Rheum 2024; 65:152356. [PMID: 38181545 DOI: 10.1016/j.semarthrit.2023.152356] [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: 11/06/2023] [Revised: 12/05/2023] [Accepted: 12/18/2023] [Indexed: 01/07/2024]
Abstract
OBJECTIVE Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by ossification of ligaments and entheses, and most commonly affects the spinal column. The prevalence of DISH is increasing with age and is considered uncommon before the age of 50 years, with an estimated prevalence of less than 5 %. DISH is known to be highly associated with metabolic syndrome and obesity. We aim to assess the prevalence of DISH among young (≤50 yr.) patients suffering from severe obesity (BMI of 35 kg/m2 or higher). METHODS A retrospective analysis assessing chest and spine radiographs (including Computed Tomography, CT) of patients with BMI≥35 visiting the bariatric ambulatory clinic in an academic medical center from 2013 to 2022. Patients included in the analysis were 31-50 years old. Diagnosis of DISH was made according to the Resnick criteria. The prevalence of DISH was calculated. Demographic, clinical and laboratory data were collected and compared between the DISH and non-DISH groups. RESULTS 183 young (mean age: 40.4; 118 females, 64.2 %) obese (BMI median: 40.6; range 35-73) patients were included in the radiographic review. DISH was diagnosed in 33 patients (18.0 %; 95 % CI: 13.1-24.2 %) which was significantly higher than the expected 10 % (Z = 3.62, p<.001); another 8 patients (4.4 %; 95 % CI: 2.2-8.4 %) were considered as "near DISH" (not fulfilling yet the Resnick criteria) as it represents a pre-disease state. Patients diagnosed with DISH were significantly older than patients without DISH (t = 4.54, p<.001), as the prevalence of DISH increased by age (linear association=14.95, p<.001). There was a statistically significantly higher prevalence of hypertension (χ2 = 8.30, p<.004), smoking (χ2 = 4.69, p<.03) and OSA (χ2 = 6.16, p<.013) in the DISH group as compared to their non-DISH counterparts. CONCLUSION The prevalence of DISH among obese young patients was 18 %, which is much higher than in the general population. Early-onset DISH should be regarded as a musculoskeletal obesity-related complication.
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Affiliation(s)
- Shay Brikman
- Rheumatic Diseases Unit, Emek Medical Center, Afula, Israel; Rappaport Faculty of Medicine, Technion, Haifa, Israel.
| | - Yazan Lubani
- Internal Medicine C, Emek Medical Center, Afula, Israel
| | - Reuven Mader
- Rheumatic Diseases Unit, Emek Medical Center, Afula, Israel; Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Amir Bieber
- Rheumatic Diseases Unit, Emek Medical Center, Afula, Israel
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Nara-Sauceda J, Moreno-Pacheco M, Patiño-García J. [Obstructive sleep apnea in cardiology clinical practice. Epidemiology, diagnosis, and treatment. Observational, cross-sectional, retrospective study]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2024; 94:141-150. [PMID: 38306451 PMCID: PMC11160540 DOI: 10.24875/acm.23000078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 07/07/2023] [Indexed: 02/04/2024] Open
Abstract
Objective To determine the clinical-epidemiological characteristics, diagnostic feasibility of home respiratory polygraphy and treatment of patients with suspected obstructive sleep apnea (OSA) at cardiovascular risk. Methods An observational, cross-sectional, descriptive study was conducted in patients seen in a cardiology outpatient service with suspected OSA, from January 2015 to December 2019. The information was obtained from medical records, and a descriptive statistical analysis was applied to this information. Results 138 files were reviewed; only 8% of the home respiratory polygraphs were discarded, because they did not meet the required quality standards. It was demonstrated that 89% suffered from OSA, 60% moderate to severe; in men after 50 years of age. The main cardiovascular risk factors was hypertension (89%). The most prevalent heart disease was hypertension (52%). Cardiovascular pharmacological treatment was improved in 82% of the cases. Cardiac rehabilitation in 30%, noninvasive mechanical ventilation 41%, fixed modality 33%, and self-adjustable 9%, all with telemetry. Conclusions The prevalence and severity of OSA is higher in the presence of risk or established cardiovascular disease. In the presence of clinical suspicion, it is feasible to confirm the diagnosis with home respiratory poligrafy due to the level of precision and the lower infrastructure required. Greater involvement of the cardiologist in the diagnosis and treatment of this disorder is necessary due to the significant risk of cardiovascular disease it represents.
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Affiliation(s)
- Jorge Nara-Sauceda
- Área de Investigación, Clínica Cardiológica, Cardio Integral Unidad Médica, Centro Hospitalario MAC
| | - Mario Moreno-Pacheco
- Departamento de Investigación, DM Laboratorio Análisis Clínicos. Celaya, Gto., México
| | - Jesica Patiño-García
- Área de Investigación, Clínica Cardiológica, Cardio Integral Unidad Médica, Centro Hospitalario MAC
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Velescu DR, Marc MS, Traila D, Pescaru CC, Hogea P, Suppini N, Crisan AF, Wellmann N, Oancea C. A Narrative Review of Self-Reported Scales to Evaluate Depression and Anxiety Symptoms in Adult Obstructive Sleep Apnea Patients. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:261. [PMID: 38399548 PMCID: PMC10889932 DOI: 10.3390/medicina60020261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 01/14/2024] [Accepted: 02/01/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: Obstructive sleep apnea (OSA) is a prevalent chronic condition that has been associated with mental disorders like depression and anxiety. This study intends to provide a practical overview of the most relevant self-reported and self-rating scales that assess depression and anxiety in OSA patients. Materials and Methods: A search for articles was performed using PubMed, Google Scholar, and Semantic Scholar using a combination of words for obstructive sleep apnea, depression, anxiety, and scales. The tools were ordered by type (screening and rating) and arranged chronologically according to the year of publication. Results: Three scales were identified for assessing depression, which were the Center for Epidemiologic Studies Depression Scale (CES-D), the Hospital Anxiety and Depression Scale (HADS-D), and the Patient Health Questionnaire-9 (PHQ-9). For rating depression, two scales were discussed: the Zung Self-Rating Depression Scale (SDS) and the Beck Depression Inventory (BDI), which has three versions (the BDI, the BDI-II, and the Fast Screen (BDI-FS)). For assessing anxiety, the Generalized Anxiety Disorder-7 (GAD-7) scale was identified. Two scales were reviewed for rating anxiety: the State-Trait Anxiety Inventory (STAI) and the Beck Anxiety Inventory (BAI). Each scale is accompanied by a brief description of its practicality and psychometric qualities and an analysis of its strengths and limitations. Conclusions: The findings of this review will contribute to the understanding of the importance of assessing mental health comorbidities in the context of OSA, ultimately guiding clinical practice and future research in this area.
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Affiliation(s)
- Diana Raluca Velescu
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (D.R.V.); (D.T.); (C.C.P.); (P.H.); (N.S.); (A.F.C.); (C.O.)
- Department of Infectious Diseases, Discipline of Pulmonology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Monica Steluta Marc
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (D.R.V.); (D.T.); (C.C.P.); (P.H.); (N.S.); (A.F.C.); (C.O.)
- Department of Infectious Diseases, Discipline of Pulmonology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Daniel Traila
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (D.R.V.); (D.T.); (C.C.P.); (P.H.); (N.S.); (A.F.C.); (C.O.)
- Department of Infectious Diseases, Discipline of Pulmonology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Camelia Corina Pescaru
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (D.R.V.); (D.T.); (C.C.P.); (P.H.); (N.S.); (A.F.C.); (C.O.)
- Department of Infectious Diseases, Discipline of Pulmonology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Patricia Hogea
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (D.R.V.); (D.T.); (C.C.P.); (P.H.); (N.S.); (A.F.C.); (C.O.)
- Department of Infectious Diseases, Discipline of Pulmonology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Noemi Suppini
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (D.R.V.); (D.T.); (C.C.P.); (P.H.); (N.S.); (A.F.C.); (C.O.)
- Department of Infectious Diseases, Discipline of Pulmonology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Alexandru Florian Crisan
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (D.R.V.); (D.T.); (C.C.P.); (P.H.); (N.S.); (A.F.C.); (C.O.)
- Research Center for the Assessment of Human Motion, Functionality and Disability (CEMFD), “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Norbert Wellmann
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
| | - Cristian Oancea
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (D.R.V.); (D.T.); (C.C.P.); (P.H.); (N.S.); (A.F.C.); (C.O.)
- Department of Infectious Diseases, Discipline of Pulmonology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
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Di Fusco SA, Mocini E, Gulizia MM, Gabrielli D, Grimaldi M, Oliva F, Colivicchi F. ANMCO (Italian Association of Hospital Cardiologists) scientific statement: obesity in adults-an approach for cardiologists. Eat Weight Disord 2024; 29:1. [PMID: 38168872 PMCID: PMC10761446 DOI: 10.1007/s40519-023-01630-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/27/2023] [Indexed: 01/05/2024] Open
Abstract
Obesity is a complex, chronic disease requiring a multidisciplinary approach to its management. In clinical practice, body mass index and waist-related measurements can be used for obesity screening. The estimated prevalence of obesity among adults worldwide is 12%. With the expected further increase in overall obesity prevalence, clinicians will increasingly be managing patients with obesity. Energy balance is regulated by a complex neurohumoral system that involves the central nervous system and circulating mediators, among which leptin is the most studied. The functioning of these systems is influenced by both genetic and environmental factors. Obesity generally occurs when a genetically predisposed individual lives in an obesogenic environment for a long period. Cardiologists are deeply involved in evaluating patients with obesity. Cardiovascular risk profile is one of the most important items to be quantified to understand the health risk due to obesity and the clinical benefit that a single patient can obtain with weight loss. At the individual level, appropriate patient involvement, the detection of potential obesity causes, and a multidisciplinary approach are tools that can improve clinical outcomes. In the near future, we will probably have new pharmacological tools at our disposal that will facilitate achieving and maintaining weight loss. However, pharmacological treatment alone cannot cure such a complex disease. The aim of this paper is to summarize some key points of this field, such as obesity definition and measurement tools, its epidemiology, the main mechanisms underlying energy homeostasis, health consequences of obesity with a focus on cardiovascular diseases and the obesity paradox.Level of evidence V: report of expert committees.
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Affiliation(s)
- Stefania Angela Di Fusco
- Emergency Department, Clinical and Rehabilitation Cardiology Unit, San Filippo Neri Hospital, ASL Roma 1, Rome, Italy
| | - Edoardo Mocini
- Department of Experimental Medicine, Sapienza University, 00161, Rome, Italy.
| | | | - Domenico Gabrielli
- Cardio-Thoracic-Vascular Department, San Camillo-Forlanini Hospital, Rome, Italy
- Heart Care Foundation, Florence, Italy
| | - Massimo Grimaldi
- Department of Cardiology, General Regional Hospital "F. Miulli", Acquaviva delle Fonti, 70021, Bari, Italy
| | - Fabrizio Oliva
- De Gasperis Cardio Center, Niguarda Hospital, 20162, Milan, Italy
| | - Furio Colivicchi
- Emergency Department, Clinical and Rehabilitation Cardiology Unit, San Filippo Neri Hospital, ASL Roma 1, Rome, Italy
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Jung TY, Lee E, Park M, Lee JY, Hong YS, Cho J, Guallar E, Hong SD, Jung YG, Gu S, Ryoo JW, Joo EY, Yeon JY, Ryu G, Kim HY. Obstructive Sleep Apnea and Its Influence on Intracranial Aneurysm. J Clin Med 2023; 13:144. [PMID: 38202154 PMCID: PMC10780116 DOI: 10.3390/jcm13010144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 12/21/2023] [Accepted: 12/23/2023] [Indexed: 01/12/2024] Open
Abstract
Obstructive sleep apnea syndrome (OSAS) is associated with cerebrovascular disease, which can lead to life-threatening outcomes. The purpose of the study was to investigate the relationship between OSAS and comorbid intracranial aneurysms. We retrospectively reviewed 564 patients who underwent a polysomnography and brain magnetic resonance angiography as part of their health checkup. We calculated the prevalence of an intracranial aneurysm and OSAS in patients and measured the size of the intracranial aneurysm if present. The mean patient age was 55.6 ± 8.5 years, and 82.3% of them were men. The prevalence of an intracranial aneurysm in patients with OSAS was 12.1%, which is significantly higher than patients with non-OSAS (5.9%, p = 0.031). Patients with OSAS had a much higher prevalence of intracranial aneurysms, after adjusting all possible confounding factors such as age, sex, smoking status, alcohol drinking, and body mass index (odds ratio: 2.32; 95% confidence interval: 1.07-5.04). Additionally, the OSAS group had noticeably larger aneurysms compared with those of the non-OSAS group (3.2 ± 2.0 mm vs. 2.0 ± 0.4 mm, p = 0.013). We found a significant association between OSAS and intracranial aneurysms. OSAS could be another risk factor for the development of intracranial aneurysms.
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Affiliation(s)
- Tae Young Jung
- Department of Otorhinolaryngology, Maryknoll Hospital, Busan 48972, Republic of Korea
| | - Eunkyu Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul 06351, Republic of Korea (M.P.); (Y.G.J.)
| | - Minhae Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul 06351, Republic of Korea (M.P.); (Y.G.J.)
| | - Jin-Young Lee
- Health Promotion Center, Samsung Medical Center, Seoul 06351, Republic of Korea;
| | - Yun Soo Hong
- Department of Epidemiology, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Juhee Cho
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Science and Technology, Sungkyunkwan University, Seoul 06355, Republic of Korea;
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
- Department of Digital Healthcare, Samsung Advanced Institute for Health Science and Technology, Sungkyunkwan University, Seoul 06355, Republic of Korea
| | - Eliseo Guallar
- Department of Epidemiology, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Science and Technology, Sungkyunkwan University, Seoul 06355, Republic of Korea;
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Sang Duk Hong
- Department of Otorhinolaryngology-Head and Neck Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul 06351, Republic of Korea (M.P.); (Y.G.J.)
| | - Yong Gi Jung
- Department of Otorhinolaryngology-Head and Neck Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul 06351, Republic of Korea (M.P.); (Y.G.J.)
| | - Seonhye Gu
- Biostatistics and Clinical Epidemiology Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea;
| | - Jae Wook Ryoo
- Department of Radiology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul 06351, Republic of Korea
| | - Eun-Yeon Joo
- Department of Neurology, Sleep Center, Samsung Medical Center, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea;
| | - Je Young Yeon
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea;
| | - Gwanghui Ryu
- Department of Otorhinolaryngology-Head and Neck Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul 06351, Republic of Korea (M.P.); (Y.G.J.)
| | - Hyo Yeol Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul 06351, Republic of Korea (M.P.); (Y.G.J.)
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Al Oweidat K, Toubasi AA, Al-Sayegh TN, Sinan RA, Mansour SH, Makhamreh HK. Cardiovascular diseases across OSA phenotypes: A retrospective cohort study. Sleep Med X 2023; 6:100090. [PMID: 37927891 PMCID: PMC10622675 DOI: 10.1016/j.sleepx.2023.100090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/30/2023] [Accepted: 10/13/2023] [Indexed: 11/07/2023] Open
Abstract
Background Despite the considerable knowledge of Obstructive Sleep Apnea (OSA) implications for cardiac diseases, the evidence regarding cardiovascular complications across OSA phenotypes including Rapid Eye Movement OSA (REM-OSA) and Positional OSA (POSA) is limited. In this study, we aimed to evaluate the risk of cardiovascular diseases development and progression among patients with REM-OSA and POSA. Methods Based on a retrospective cohort analysis, we included polysomnography studies done in the sleep lab at the Jordan University Hospital. Regarding cardiovascular diseases, primary outcomes were Heart Failure, and 1-years Major Adverse Cardiac Events while secondary outcomes were atrial fibrillation, pulmonary hypertension, other arrhythmia, metabolic profile, and echocardiographic measurements of the heart. Results The total number of the included patients was 1,026 patients. POSA group had significantly lower percentage of patients with hypertension (P-value = 0.004). Additionally, systolic blood pressure and HbA1c were significantly lower among patients with POSA compared to the NPOSA group (P-value<0.050). Left ventricular end diastolic dimension was significantly higher among patients with POSA while ejection fraction was significantly lower (P-value<0.050). Patients with diabetes and mean HbA1c were significantly lower among patients with REM-OSA compared to patients with NREM-OSA (P-value = 0.015, P-value = 0.046). Multivariate regression analysis revealed that after adjusting for age, gender and preexisting comorbidities, POSA was significantly associated with lower ejection fraction and higher left ventricular diastolic diameter. Conclusion In conclusion, our findings indicate that POSA might be associated with huge and clinically significant heart strain and poor cardiac functions, yet it might not have a clinically significant atherogenic effect. This study should guide clinicians to identify OSA phenotypes to imply the best treatment plan to reduce its detrimental impact on cardiac muscle.
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Affiliation(s)
- Khaled Al Oweidat
- Department of Respiratory and Sleep Medicine, Department of Internal Medicine, School of Medicine, The University of Jordan, Amman, Jordan
| | | | | | - Rima A. Sinan
- Faculty of Medicine, The University of Jordan, Amman, Jordan
| | - Sara H. Mansour
- Faculty of Medicine, The University of Jordan, Amman, Jordan
| | - Hanna K. Makhamreh
- Department of Cardiology, Department of Internal Medicine, School of Medicine, The University of Jordan, Amman, Jordan
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Li Y, Miao Y, Tan J, Zhang Q. Association of modifiable risk factors with obstructive sleep apnea: a Mendelian randomization study. Aging (Albany NY) 2023; 15:14039-14065. [PMID: 38085646 PMCID: PMC10756101 DOI: 10.18632/aging.205288] [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: 07/06/2023] [Accepted: 10/16/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND The risk factors involved in obstructive sleep apnea (OSA) have not been clearly identified yet. We attempted to systematically investigate genetically predicted modifiable risk factors and lifestyle behaviors associated with OSA. METHODS The association between 34 risk factors and OSA was evaluated using the two-sample Mendelian randomization (MR). Genetic variants for risk factors were acquired from European-descent genome-wide studies. Data sources for OSA were extracted from FinnGen study with 16,761 cases and 201,194 controls. The primary analysis chosen was the inverse-variance weighted method. RESULTS MR analyses provide evidence of genetically predicted poor overall health rating (odds ratio (OR), 2.82; 95% confidence interval (CI), 1.95-4.08), nap during day (OR, 2.01; 95% CI, 1.37-2.93), high body mass index (BMI) (OR, 1.14; 95% CI, 1.09-1.19), increased body fat mass (OR, 1.83; 95% CI, 1.83-2.05), elevated body water mass (OR, 1.50; 95% CI, 1.31-1.70) and hypertension (OR, 1.81; 95% CI, 1.34-2.45) were associated with higher OSA risk, while high education level (OR, 0.55; 95% CI, 0.40-0.75) correlated with reduced OSA risk. Suggestive evidence was obtained for smoking and waist-to-hip ratio (WHR) with higher OSA odds, and vigorous physical activity, and HDL cholesterol with lower OSA odds. After adjusting for BMI using multivariable MR analysis, the effects of smoking, WHR, vigorous physical activity, and HDL-cholesterol were fully attenuated. CONCLUSIONS This MR study indicates that overall health rating, nap during day, BMI, body fat mass, body water mass, hypertension, and education are causally associated with the risk of OSA, which means that these modifiable risk factors are key targets for OSA prevention.
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Affiliation(s)
- Ye Li
- Department of Geriatrics, Tianjin Medical University General Hospital, Tianjin 300052, China
- Tianjin Geriatrics Institute, Tianjin 300052, China
| | - Yuyang Miao
- Department of Geriatrics, Tianjin Medical University General Hospital, Tianjin 300052, China
- Tianjin Geriatrics Institute, Tianjin 300052, China
| | - Jin Tan
- Department of Geriatrics, Tianjin Medical University General Hospital, Tianjin 300052, China
- Tianjin Geriatrics Institute, Tianjin 300052, China
| | - Qiang Zhang
- Department of Geriatrics, Tianjin Medical University General Hospital, Tianjin 300052, China
- Tianjin Geriatrics Institute, Tianjin 300052, China
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He Y, Liu WT, Lin S, Li Z, Qiu H, Yim SHL, Chuang HC, Ho KF. The joint association of ambient air pollution and different sleep posture with mild obstructive sleep apnea: A study conducted at Taipei Sleep Center. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 903:166531. [PMID: 37633386 DOI: 10.1016/j.scitotenv.2023.166531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/02/2023] [Accepted: 08/22/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Growing evidence suggests the detrimental impact of supine position and air pollution on obstructive sleep apnea (OSA), as well as the potential benefits of nonsupine positions. However, their interaction effects on OSA remain unclear. OBJECTIVES To evaluate the interaction effects of air pollution (NO2/PM2.5) and sleep position on OSA on additive and multiplicative scales. METHODS This study included 3330 individuals. Personal exposure to air pollution was assessed using a spatiotemporal model. OSA was diagnosed through polysomnography. The associations of supine and nonsupine positions and air pollutants with mild-OSA and their interaction effects on mild-OSA. were explored through generalized logistic regression. RESULTS Supine position and high NO2 level independently increased the risk of mild-OSA, while PM2.5 was not associated with mild-OSA. Significant interactions were observed between supine position and NO2 at different lag periods (0-7 days, 0-1 year, and 0-2 years) (P = 0.042, 0.013, and 0.010, respectively). The relative excess risks due to interactions on the additive scale for 1-week, 1-year, and 2-year NO2 exposure and supine position were 0.63 (95 % CI: 0.10-1.16), 0.56 (95 % CI: 0.13-0.99), and 0.64 (95 % CI: 0.18-1.10); the corresponding odds ratios for interactions on the multiplicative scale were 1.45 (95 % CI: 1.01-2.07), 1.55 (95 % CI: 1.09-2.22), and 1.60 (95 % CI: 1.12-2.28). The positive interactions persisted in men and participants with obesity. No interaction was observed between nonsupine position and NO2 levels; nevertheless, significant interactions were noted on both the negative additive and multiplicative scales in men. CONCLUSION Prolonged supine sleep significantly increased the risk of mild-OSA, particularly in men and individuals with obesity. Although the benefits of nonsupine position are considerably less than the risks of NO2 exposure, avoiding prolonged supine sleep may reduce the risk of mild-OSA caused by high levels of NO2 in men.
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Affiliation(s)
- Yansu He
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, HKSAR, China
| | - Wen-Te Liu
- Research Center of Sleep Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan; Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Shangyang Lin
- Research Center of Sleep Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Zhiyuan Li
- Institute of Environment, Energy and Sustainability, The Chinese University of Hong Kong, HKSAR, China
| | - Hong Qiu
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, HKSAR, China
| | - Steve Hung Lam Yim
- The Asian School of the Environment, Nanyang Technological University, Singapore
| | - Hsiao-Chi Chuang
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan; Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan; Cell Physiology and Molecular Image Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Kin Fai Ho
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, HKSAR, China; Institute of Environment, Energy and Sustainability, The Chinese University of Hong Kong, HKSAR, China.
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Mohammadi I, Adibparsa M, Najafi A, Sehat MS, Sadeghi M. A systematic review with meta-analysis to assess Alzheimer's disease biomarkers in adults with or without obstructive sleep apnoea. Int Orthod 2023; 21:100814. [PMID: 37776696 DOI: 10.1016/j.ortho.2023.100814] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/06/2023] [Accepted: 09/09/2023] [Indexed: 10/02/2023]
Abstract
INTRODUCTION The aim was to design a meta-analysis evaluating the positron emission tomography (PET) uptake and cerebrospinal fluid (CSF), circulating levels of amyloid-β (Aβ), and tau proteins OSA group versus control group, as well as the association of these biomarkers with the severity of OSA. MATERIAL AND METHODS Four databases were searched until April 17, 2023, without any restrictions. The effect sizes were the standardized mean difference (SMD) along with a 95% confidence interval (CI). RESULTS A total of 21 articles were entered into the meta-analysis. The pooled SMDs of the CSF levels in OSA adults compared to controls were: -0.82 (P=0.004) for Aβ42, -1.13 (P<0.001) for Aβ40, 0.17 (P=0.23) for p-tau, 0.04 (P=0.65) for t-tau, 0.08 (P=0.89) for Aβ42/Aβ40 ratio, and 0.81 (P=0.001) for t-tau/Aβ42 ratio. The pooled SMD for the PET uptake of Aβ burden in OSA adults compared to controls was 0.30 (P=0.03). The pooled SMDs of the circulating levels in OSA adults compared to controls were: 0.67 (P=0.002) for Aβ42, 0.11 (P=0.82) for Aβ40, 0.35 (P=0.06) for p-tau, and 1.41(P=0.005) for t-tau. The pooled SMDs for levels of Aβ42, Aβ40, total Aβ, p-tau, t-tau, and Aβ42/Aβ40 ratio in severe OSA adults compared to mild/moderate OSA adults were -0.15 (P=0.33), 0.25 (P=35), 0.04 (P=87), -2.53 (P=0.24), -0.24 (P=0.52), and -0.28 (P=0.30), respectively. CONCLUSIONS The results indicated that CSF levels of Aβ42 and Aβ40 in OSA adults were significantly lower, but the CSF level of t-tau/Aβ42 ratio and PET Aβ burden uptake in OSA adults significantly were higher than in controls.
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Affiliation(s)
- Iman Mohammadi
- Oral and Maxillofacial Surgery Department, School of Dentistry, Isfahan University of Medical Sciences, 81746-73461 Isfahan, Iran
| | - Mehrdad Adibparsa
- Department of Plastic Surgery, School of Medicine, Isfahan University of Medical Sciences, 81746-73461 Isfahan, Iran
| | - Amir Najafi
- Oral and Maxillofacial Surgery Department, School of Dentistry, Isfahan University of Medical Sciences, 81746-73461 Isfahan, Iran
| | - Mohammad Soroush Sehat
- Oral and Maxillofacial Surgery Department, School of Dentistry, Isfahan University of Medical Sciences, 81746-73461 Isfahan, Iran
| | - Masoud Sadeghi
- Medical Biology Research Center, Kermanshah University of Medical Sciences, 67144-15185 Kermanshah, Iran.
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Pereyra K, Las Heras A, Toledo C, Díaz-Jara E, Iturriaga R, Del Rio R. Chemogenetic inhibition of NTS astrocytes normalizes cardiac autonomic control and ameliorate hypertension during chronic intermittent hypoxia. Biol Res 2023; 56:57. [PMID: 37932867 PMCID: PMC10626729 DOI: 10.1186/s40659-023-00463-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 09/19/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is characterized by recurrent episodes of chronic intermittent hypoxia (CIH), which has been linked to the development of sympathoexcitation and hypertension. Furthermore, it has been shown that CIH induced inflammation and neuronal hyperactivation in the nucleus of the solitary tract (NTS), a key brainstem region involved in sympathetic and cardiovascular regulation. Since several studies have proposed that NTS astrocytes may mediate neuroinflammation, we aimed to determine the potential contribution of NTS-astrocytes on the pathogenesis of CIH-induced hypertension. RESULTS Twenty-one days of CIH induced autonomic imbalance and hypertension in rats. Notably, acute chemogenetic inhibition (CNO) of medullary NTS astrocytes using Designer Receptors Exclusively Activated by Designers Drugs (DREADD) restored normal cardiac variability (LF/HF: 1.1 ± 0.2 vs. 2.4 ± 0.2 vs. 1.4 ± 0.3, Sham vs. CIH vs. CIH + CNO, respectively) and markedly reduced arterial blood pressure in rats exposed to CIH (MABP: 82.7 ± 1.2 vs. 104.8 ± 4.4 vs. 89.6 ± 0.9 mmHg, Sham vs. CIH vs. CIH + CNO, respectively). In addition, the potentiated sympathoexcitation elicit by acute hypoxic chemoreflex activation in rats exposed to CIH was also completely abolished by chemogenetic inhibition of NTS astrocytes using DREADDs. CONCLUSION Our results support a role for NTS astrocytes in the maintenance of heightened sympathetic drive and hypertension during chronic exposure to intermittent hypoxia mimicking OSA.
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Affiliation(s)
- Katherin Pereyra
- Laboratory of Cardiorespiratory Control, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alexandra Las Heras
- Laboratory of Cardiorespiratory Control, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Camilo Toledo
- Laboratory of Cardiorespiratory Control, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
- Instituto de Fisiología, Universidad Austral de Chile, Valdivia, Chile
| | - Esteban Díaz-Jara
- Laboratory of Cardiorespiratory Control, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rodrigo Iturriaga
- Laboratory of Cardiorespiratory Control, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
- Centro de Investigación en Fisiología y Medicina en Altura, Facultad de Ciencias de la Salud, Universidad de Antofagasta, Antofagasta, Chile
| | - Rodrigo Del Rio
- Laboratory of Cardiorespiratory Control, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile.
- Centro de Excelencia en Biomedicina de Magallanes (CEBIMA), Universidad de Magallanes, Punta Arenas, Chile.
- Department of Cell Biology and Physiology, School of Medicine, University of Kansas Medical Center, Kansas City, KS, USA.
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Sinclair M, Alamdari HH, Paffile J, El-Sankary K, Lowe S, Driscoll S, Oore S, Tomson H, Begin G, Aristi G, Schmidt M, Roach D, Penzel T, Fietze I, Patel SR, Mehra R, Morrison D. The Beginning of the AI-Enabled Preventative PAP Therapy Era: A First-in-Human Proof of Concept Interventional Study. IEEE Trans Biomed Eng 2023; 70:2776-2787. [PMID: 37030831 DOI: 10.1109/tbme.2023.3263379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Abstract
Positive Airway Pressure (PAP) therapy is the most common and efficacious treatment for Obstructive Sleep Apnea (OSA). However, it suffers from poor patient adherence due to discomfort and may not fully alleviate all adverse consequences of OSA. Identifying abnormal respiratory events before they have occurred may allow for improved management of PAP levels, leading to improved adherence and better patient outcomes. Our previous work has resulted in the successful development of a Machine-Learning (ML) algorithm for the prediction of future apneic events using existing airflow and air pressure sensors available internally to PAP devices. Although researchers have studied the use of ML for the prediction of apneas, research to date has focused primarily on using external polysomnography sensors that add to patient discomfort and has not investigated the use of internal-to-PAP sensors such as air pressure and airflow to predict and prevent respiratory events. We hypothesized that by using our predictive software, OSA events could be proactively prevented while maintaining patients' sleep quality. An intervention protocol was developed and applied to all patients to prevent OSA events. Although the protocol's cool-down period limited the number of prevention attempts, analysis of 11 participants revealed that our system improved many sleep parameters, which included a statistically significant 31.6% reduction in Apnea-Hypopnea Index, while maintaining sleep quality. Most importantly, our findings indicate the feasibility of unobtrusive identification and unique prevention of each respiratory event as well as paving the path to future truly personalized PAP therapy by further training of ML models on individual patients.
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Loboda D, Stepanik M, Durmala J, Gardas R, Golba KS. Effect of Sleep-Disordered Breathing on Exercise Capacity after Myocardial Infarction - A Cross-Sectional Study. Rev Cardiovasc Med 2023; 24:299. [PMID: 39077562 PMCID: PMC11273161 DOI: 10.31083/j.rcm2410299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 08/15/2023] [Accepted: 08/21/2023] [Indexed: 07/31/2024] Open
Abstract
Background Exercise capacity reflects the cardiovascular risk after myocardial infarction (MI). The study aims to evaluate the impact of sleep-disordered breathing (SDB) on exercise capacity after MI. Methods Consecutive patients referring to outpatient cardiac rehabilitation up to 28 days after MI and participating in the Polish Managed Care after Acute Myocardial Infarction (MC-AMI) program were included. On admission, we assessed the presence and the severity of SDB using the home sleep apnea test (HSAT), patients' maximum exercise capacity on a treadmill exercise stress test (EST), and a 6-minute walk test (6MWT), as well as the effect of SDB on the results obtained. In the multivariate analysis, we verified the strength of the observed associations concerning age, anthropometric parameters, and left ventricular ejection fraction (LVEF). Results A total of 254 patients aged 60.00 (interquartile range 51.00-67.00), including 39 (15.4%) women, with technically adequate HSAT, constituted the study group. Mild SDB was found in 82 (32.3%), moderate in 54 (21.3%), and severe in 51 (20.1%) patients. Among those diagnosed with SDB, obstructive sleep apnea (OSA) was dominant in 167 (89.8%). With the worsening of SDB, the distance in 6MWT and the maximum physical exertion achieved in EST, expressed in metabolic equivalents (METs) and maximal heart rate (MHR), decreased. The linear regression analysis confirmed the following: (1) inversely proportional relationship between the respiratory event index and METs, MHR, and 6MWT distance (p = 0.005, p = 0.008, and p = 0.004), and the maximum apnea duration and MET and 6MWT distance (p = 0.042 and p = 0.002); and (2) directly proportional relationship between mean arterial oxygen saturation ( SpO 2 ) during sleep and MET, MHR, and 6MWT distance (p = 0.019, p = 0.006, and p = 0.013), and minimum SpO 2 and MET and MHR (p = 0.040 and p < 0.001). However, the independent risk factors for impaired exercise capacity, determined using multivariable regression analysis, were age, female sex, higher body mass index (BMI), and decreased LVEF, but not SDB parameters. Conclusions SDB negatively impacts exercise capacity after MI. However, the strength of this association may be less pronounced due to the interaction of risk factors common for SDB and impaired exercise capacity, e.g., sex, age, BMI, and LVEF.
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Affiliation(s)
- Danuta Loboda
- Department of Electrocardiology and Heart Failure, Medical University of Silesia in Katowice, 40-635 Katowice, Poland
| | - Michalina Stepanik
- Department of Rehabilitation, Medical University of Silesia in Katowice, 40-635 Katowice, Poland
| | - Jacek Durmala
- Department of Rehabilitation, Medical University of Silesia in Katowice, 40-635 Katowice, Poland
| | - Rafal Gardas
- Department of Electrocardiology and Heart Failure, Medical University of Silesia in Katowice, 40-635 Katowice, Poland
| | - Krzysztof S. Golba
- Department of Electrocardiology and Heart Failure, Medical University of Silesia in Katowice, 40-635 Katowice, Poland
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Vega-Jasso AL, Amezcua-Guerra LM, González-Pacheco H, Sandoval-Zárate J, González-Díaz CA, Escobar-Alvarado J, Manzano-Luna JD, Brianza-Padilla M. Adipokines and Inflammatory Markers in Acute Myocardial Infarction Patients with and without Obstructive Sleep Apnea: A Comparative Analysis. Int J Mol Sci 2023; 24:14674. [PMID: 37834123 PMCID: PMC10572714 DOI: 10.3390/ijms241914674] [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: 07/12/2023] [Revised: 09/25/2023] [Accepted: 09/26/2023] [Indexed: 10/15/2023] Open
Abstract
An association has been suggested between acute myocardial infarction (AMI) and obstructive sleep apnea (OSA). Considering the role of adipose-tissue-derived inflammatory mediators (adipokines) and the shared risk factor of obesity in OSA and AMI, this study aimed to investigate the involvement of adipokines in AMI patients with and without OSA. Serum levels of adipokines and inflammatory mediators were quantified, and home respiratory polygraphy was conducted. A total of 30 AMI patients and 25 controls were included. Patients with AMI exhibited elevated levels of resistin (7.4 vs. 3.7 ng/mL), interleukin-6 (8.8 vs. 1.3 pg/mL), and endothelin-1 (3.31 vs. 1.8 pg/mL). Remarkably, AMI patients with concomitant OSA exhibited higher levels of resistin (7.1 vs. 3.7 ng/mL), interleukin-6 (8.9 vs. 1.3 pg/mL), endothelin-1 (3.2 vs. 1.8 pg/mL), creatin kinase (1430 vs. 377 U/L), creatine kinase-MB (64.6 vs. 9.7 ng/mL), and troponin T (2298 vs. 356 pg/mL) than their non-OSA counterparts. Leptin showed a correlation with OSA severity markers. OSA was associated with greater cardiac damage in AMI patients. Our findings underscore that adipokines alone are not sufficient to discriminate the risk of AMI in the presence of OSA. Further research is necessary to determine the potential mechanisms contributing to exacerbated cardiac damage in patients with both conditions.
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Affiliation(s)
- Ana L. Vega-Jasso
- Master of Health Sciences, School of Medicine, Instituto Politécnico Nacional, Ciudad de México 07738, Mexico;
| | - Luis M. Amezcua-Guerra
- Department of Immunology, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México 14080, Mexico; (L.M.A.-G.); (J.S.-Z.)
| | - Héctor González-Pacheco
- Coronary Care Unit, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México 14080, Mexico;
| | - Julio Sandoval-Zárate
- Department of Immunology, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México 14080, Mexico; (L.M.A.-G.); (J.S.-Z.)
| | - César A. González-Díaz
- Postgraduate Studies and Research Section, School of Medicine, Instituto Politécnico Nacional, Ciudad de México 07738, Mexico;
| | - Jennifer Escobar-Alvarado
- Sleep Laboratory, UNAM-INC Translational Research Unit, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México 14080, Mexico;
| | - Jennifer D. Manzano-Luna
- Red MEDICI, Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlalnepantla 54090, Mexico;
| | - Malinalli Brianza-Padilla
- Department of Immunology, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México 14080, Mexico; (L.M.A.-G.); (J.S.-Z.)
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Al Amri A, Alshahrani MAA, Asiri MA, Abdulrahman MA, Alshehri AYA, Alqahtani MMM, Oraydan AAA, Summan SI, Alqahtani TS, Al Hunaif AM. Prevalence of Sleep Disorders Among Patients With Type 2 Diabetes Mellitus at Primary Healthcare Centers in the South Region of Abha City. Cureus 2023; 15:e44749. [PMID: 37809270 PMCID: PMC10556360 DOI: 10.7759/cureus.44749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2023] [Indexed: 10/10/2023] Open
Abstract
Background Type 2 diabetes is a chronic condition that affects the way the body processes blood sugar (glucose). This issue is of considerable importance in the field of public health, as it has a global impact on a substantial number of individuals. The primary emphasis in the management of type 2 diabetes is centered around achieving glycemic control, implementing lifestyle adjustments, and employing pharmaceutical therapies as preventive measures or for the purpose of managing problems that may arise as a result of the disease. Aim This research aimed to investigate the prevalence of sleep-belated issues among individuals diagnosed with type 2 diabetes. Methodology A total of 230 participants with type 2 diabetes patients of primary healthcare in Abha city whose age is ≥18 years were included in the study. The data collection process involved the distribution of a self-administered questionnaire that assessed various aspects of sleep disturbances, including difficulties in falling asleep, waking up during the night, excessive daytime sleepiness, and restless legs or leg muscle cramps. The questionnaire also collected demographic information and data on potential risk factors such as alcohol consumption, caffeine consumption, and smoking/tobacco product use. Data analysis was conducted using chi-square tests and significance levels were set at p < 0.05. Results The findings revealed a prevalence of sleep disturbances among individuals with type 2 diabetes. Difficulties in falling asleep and waking up during the night were reported by a substantial proportion of participants, and a notable number experienced excessive daytime sleepiness. Restless legs or leg muscle cramps that interrupted sleep were experienced occasionally by 16.5% and frequently by 8.7% of the participants. The study also found a significant association between the presence of sleep problems and lower sleep quality ratings. However, no significant associations were found between sleep disturbances and the duration of type 2 diabetes or the examined risk factors. Conclusion The findings from this study emphasize the detrimental effects of sleep disturbances on sleep quality and suggest that improving sleep quality can positively influence the overall health and well-being of individuals with type 2 diabetes.
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Affiliation(s)
- Ali Al Amri
- Family Medicine, Asir Central Hospital, Abha, SAU
| | | | - Mousa A Asiri
- Technician Pharmacy, Primary Care Center Al Mansak, Abha, SAU
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Gentina T, Gentina E, Douay B, Micoulaud-Franchi JA, Pépin JL, Bailly S. Investigating associations between social determinants, self-efficacy measurement of sleep apnea and CPAP adherence: the SEMSA study. Front Neurol 2023; 14:1148700. [PMID: 37528857 PMCID: PMC10390224 DOI: 10.3389/fneur.2023.1148700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 06/29/2023] [Indexed: 08/03/2023] Open
Abstract
Study objectives The prospective Self-Efficacy Measure for Sleep Apnea study (SEMSAS) is investigating thresholds for health literacy, self-efficacy and precariousness at obstructive sleep apnea (OSA) diagnosis to predict CPAP adherence. This paper describes the study protocol and presents baseline data from the ongoing study. Methods Eligible individuals had confirmed OSA and were referred to a homecare provider for continuous positive airway pressure (CPAP) therapy initiation. Data on patient characteristics and comorbidities were collected, along with baseline evaluations of self-efficacy [15-item Self-Efficacy Measure for Sleep Apnea tool (SEMSA-15)], precariousness [Deprivation in Primary Care Questionnaire (DipCareQ)], and health literacy (Health Literacy Questionnaire). CPAP adherence over 12 months of follow-up will be determined using remote monitoring of CPAP device data. The primary objective is to define an optimal SEMSA-15 score threshold to predict CPAP adherence at 3- and 12-month follow-up. Results Enrollment of 302 participants (71% male, median age 55 years, median body mass index 31.6 kg/m2) is complete. Low self-efficacy (SEMSA-15 score ≤ 2.78) was found in 93/302 participants (31%), and 38 (12.6%) reported precariousness (DipCareQ score > 1); precariousness did not differ significantly between individuals with a SEMSA-15 score ≤ 2.78 versus >2.78. Health literacy was generally good, but was significantly lower in individuals with versus without precariousness, and with low versus high self-efficacy. Conclusion SEMSAS is the first study using multidimensional baseline assessment of self-efficacy, health literacy and precariousness, plus other characteristics, to determine future adherence to CPAP, including CPAP adherence trajectories. Collection of follow-up data is underway.
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Affiliation(s)
- Thibaut Gentina
- Ramsey General Healthcare La Louviere Hospital, Lille, France
| | - Elodie Gentina
- IESEG School of Management, CNRS, UMR 9221 – LEM – Lille Economie Management, Univ. Lille, Lille, France
| | - Bernard Douay
- Ramsey General Healthcare La Louviere Hospital, Lille, France
| | - Jean-Arthur Micoulaud-Franchi
- SANPSY, UMR 6033, University of Bordeaux, Bordeaux, France
- Sleep Medicine Service, University Hospital, Bordeaux, France
| | - Jean-Louis Pépin
- HP2 Laboratory, INSERM U1300, Univ. Grenoble Alpes, Grenoble, France
- EFCR Laboratory, Grenoble Alpes University Hospital, Grenoble, France
| | - Sébastien Bailly
- HP2 Laboratory, INSERM U1300, Univ. Grenoble Alpes, Grenoble, France
- EFCR Laboratory, Grenoble Alpes University Hospital, Grenoble, France
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Wyszomirski K, Walędziak M, Różańska-Walędziak A. Obesity, Bariatric Surgery and Obstructive Sleep Apnea-A Narrative Literature Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1266. [PMID: 37512076 PMCID: PMC10385107 DOI: 10.3390/medicina59071266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 06/26/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023]
Abstract
The purpose of this review was to analyze the available literature on the subject of obesity and obstructive sleep apnea. We searched for available articles for the time period from 2013 to 2023. Obesity is listed as one of the most important health issues. Complications of obesity, with obstructive sleep apnea (OSA) listed among them, are common problems in clinical practice. Obesity is a well-recognized risk factor for OSA, but OSA itself may contribute to worsening obesity. Bariatric surgery is a treatment of choice for severely obese patients, especially with present complications, and remains the only causative treatment for patients with OSA. Though improvement in OSA control in patients after bariatric surgery is well-established knowledge, the complete resolution of OSA is achieved in less than half of them. The determination of subpopulations of patients in whom bariatric surgery would be especially advantageous is an important issue of OSA management. Increasing the potential of non-invasive strategies in obesity treatment requires studies that assess the efficacy and safety of combined methods.
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Affiliation(s)
- Krzysztof Wyszomirski
- Department of Human Physiology and Pathophysiology, Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszynski University in Warsaw, 01-938 Warsaw, Poland
| | - Maciej Walędziak
- Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine-National Research Institute, Szaserów 128 St., 04-141 Warsaw, Poland
| | - Anna Różańska-Walędziak
- Department of Human Physiology and Pathophysiology, Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszynski University in Warsaw, 01-938 Warsaw, Poland
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Bogan RK, Maynard JP, Neuwirth R, Faessel H, Swick T, Olsson T. Safety and pharmacodynamics of a single infusion of danavorexton in adults with obstructive sleep apnea experiencing excessive daytime sleepiness despite adequate use of CPAP. Sleep Med 2023; 107:229-235. [PMID: 37244138 DOI: 10.1016/j.sleep.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 04/06/2023] [Accepted: 05/01/2023] [Indexed: 05/29/2023]
Abstract
BACKGROUND Sleep disruptions experienced by patients with obstructive sleep apnea (OSA) can lead to excessive daytime sleepiness (EDS) and significantly impact patients' quality of life. EDS may persist despite use of continuous positive airway pressure (CPAP) therapy. Small molecules that target the orexin system, which has a known role in sleep-wake regulation, show therapeutic potential for the treatment of EDS in patients with hypersomnia. This randomized, placebo-controlled, phase 1b study aimed to investigate the safety of danavorexton, a small-molecule orexin-2 receptor agonist, and its effects on residual EDS in patients with OSA. METHODS Adults with OSA aged 18-67 years with adequate CPAP use were randomized to one of six treatment sequences of single IV infusions of danavorexton 44 mg, danavorexton 112 mg, and placebo. Adverse events were monitored throughout the study. Pharmacodynamic assessments included maintenance of wakefulness test (MWT), Karolinska Sleepiness Scale (KSS), and the psychomotor vigilance test (PVT). RESULTS AND CONCLUSION Among 25 randomized patients, 16 (64.0%) had treatment-emergent adverse events (TEAEs) and 12 (48.0%) had TEAEs considered related to treatment, all mild or moderate. Seven patients (28.0%) had urinary TEAEs: three, seven, and none while taking danavorexton 44 mg, danavorexton 112 mg, and placebo, respectively. There were no deaths or TEAEs leading to discontinuation. Improvements in mean MWT, KSS, and PVT scores were observed with danavorexton 44 mg and 112 mg vs placebo. These findings show that danavorexton can improve subjective and objective measures of EDS in patients with OSA and residual EDS despite adequate CPAP use.
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Affiliation(s)
- Richard K Bogan
- University of South Carolina School of Medicine, Columbia, SC, USA.
| | | | - Rachel Neuwirth
- Takeda Development Center Americas, Inc., Lexington, MA, USA.
| | - Hélène Faessel
- Takeda Development Center Americas, Inc., Lexington, MA, USA.
| | - Todd Swick
- Takeda Development Center Americas, Inc., Lexington, MA, USA.
| | - Tina Olsson
- Takeda Development Center Americas, Inc., Lexington, MA, USA.
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Velescu DR, Marc MS, Pescaru CC, Traila D, Vaștag E, Papava I, Motofelea AC, Ciuca IM, Manolescu D, Oancea C. Impact of CPAP Therapy Adherence on Global Cognition in Patients with Moderate to Severe Obstructive Sleep Apnea: A One-Year Follow-Up. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050846. [PMID: 37241079 DOI: 10.3390/medicina59050846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/18/2023] [Accepted: 04/25/2023] [Indexed: 05/28/2023]
Abstract
Background: Obstructive sleep apnea increases (OSA) cognitive impairment risk. The objective of this study was to determine the impact of continuous positive airway pressure (CPAP) adherence on global cognition using the Montreal Cognitive Assessment questionnaire (MoCA). Materials and Methods: Thirty-four new patients diagnosed with moderate or severe OSA (apnea-hypopnea index AHI ≥ 15 events/h) from the CPAP group were compared with thirty-one moderate to severe OSA patients from the no-CPAP group. In addition, all patients completed the MoCA test, a patient health questionnaire (PHQ-9) for depressive symptoms, and a generalized anxiety questionnaire (GAD-7) for anxiety symptoms, at baseline, after 6 months, and after 1 year. Results: At baseline, there were no significant differences between the two groups regarding total MoCA scores, 20.9 ± 3.5 CPAP group to 19.7 ± 2.9 no-CPAP group (p = 0.159), PHQ-9 (p = 0.651), and GAD-7 (p = 0.691). After one year, improvement was observed for a total MoCA score of 22.7 ± 3.5 (p < 0.001) for the CPAP group, and significant variance of score between groups was more accentuated for delayed recall and attention (p < 0.001) sub-topic. Moreover, PHQ-9, GAD-7 scores, and the Epworth Sleepiness Scale (ESS) decreased significantly (p < 0.001) after CPAP therapy. The MoCA score was significantly correlated with years of education (r = 0.74, p < 0.001) and had a negative correlation with body mass index (BMI) (r = -0.34), ESS (r = -0.30) and PHQ-9 (r = -0.34). Conclusions: One year of CPAP adherence improved global cognition associated with OSA.
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Affiliation(s)
- Diana Raluca Velescu
- Pulmonary Department, Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), 'Victor Babes' University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Monica Steluta Marc
- Pulmonary Department, Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), 'Victor Babes' University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Clinical Hospital of Infectious Diseases and Pneumophthisiology 'Dr. Victor Babes', 300173 Timisoara, Romania
| | - Camelia Corina Pescaru
- Pulmonary Department, Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), 'Victor Babes' University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Clinical Hospital of Infectious Diseases and Pneumophthisiology 'Dr. Victor Babes', 300173 Timisoara, Romania
| | - Daniel Traila
- Pulmonary Department, Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), 'Victor Babes' University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Clinical Hospital of Infectious Diseases and Pneumophthisiology 'Dr. Victor Babes', 300173 Timisoara, Romania
| | - Emanuela Vaștag
- Pulmonary Department, Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), 'Victor Babes' University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Clinical Hospital of Infectious Diseases and Pneumophthisiology 'Dr. Victor Babes', 300173 Timisoara, Romania
| | - Ion Papava
- Neuroscience Department, NEUROPSY-COG Center for Cognitive Research in Neuropsychiatric Pathology, 'Victor Babes', University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Alexandru Catalin Motofelea
- Internal Medicine Department, 'Victor Babes' University of Medicine and Pharmacy Timisoara, 2 Eftimie Murgu Sq, 300041 Timisoara, Romania
| | - Ioana Mihaiela Ciuca
- Pediatric Department, 'Victor Babes' University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania
| | - Diana Manolescu
- Pulmonary Department, Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), 'Victor Babes' University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Radiology and Medical Imaging Department, 'Victor Babes' University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania
| | - Cristian Oancea
- Pulmonary Department, Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), 'Victor Babes' University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Clinical Hospital of Infectious Diseases and Pneumophthisiology 'Dr. Victor Babes', 300173 Timisoara, Romania
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Ytzhaik N, Zur D, Goldstein C, Almoznino G. Obstructive Sleep Apnea, Metabolic Dysfunction, and Periodontitis-Machine Learning and Statistical Analyses of the Dental, Oral, Medical Epidemiological (DOME) Big Data Study. Metabolites 2023; 13:metabo13050595. [PMID: 37233636 DOI: 10.3390/metabo13050595] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/12/2023] [Accepted: 04/24/2023] [Indexed: 05/27/2023] Open
Abstract
This study aimed to analyze the associations of obstructive sleep apnea (OSA) with dental parameters while controlling for socio-demographics, health-related habits, and each of the diseases comprising metabolic syndrome (MetS), its consequences, and related conditions. We analyzed data from the dental, oral, and medical epidemiological (DOME) cross-sectional records-based study that combines comprehensive socio-demographic, medical, and dental databases of a nationally representative sample of military personnel for one year. Analysis included statistical and machine learning models. The study included 132,529 subjects; of these, 318 (0.2%) were diagnosed with OSA. The following parameters maintained a statistically significant positive association with OSA in the multivariate binary logistic regression analysis (descending order from highest to lowest OR): obesity (OR = 3.104 (2.178-4.422)), male sex (OR = 2.41 (1.25-4.63)), periodontal disease (OR = 2.01 (1.38-2.91)), smoking (OR = 1.45 (1.05-1.99)), and age (OR = 1.143 (1.119-1.168)). Features importance generated by the XGBoost machine learning algorithm were age, obesity, and male sex (located on places 1-3), which are well-known risk factors of OSA, as well as periodontal disease (fourth place) and delivered dental fillings (fifth place). The Area Under Curve (AUC) of the model was 0.868 and the accuracy was 0.92. Altogether, the findings supported the main hypothesis of the study, which was that OSA is linked to dental morbidity, in particular to periodontitis. The findings highlight the need for dental evaluation as part of the workup of OSA patients and emphasizes the need for dental and general medical authorities to collaborate by exchanging knowledge about dental and systemic morbidities and their associations. The study also highlights the necessity for a comprehensive holistic risk management strategy that takes systemic and dental diseases into account.
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Affiliation(s)
- Noya Ytzhaik
- In Partial Fulfillment DMD Thesis, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel
| | - Dorit Zur
- Medical Information Department, General Surgeon Headquarter, Medical Corps, 02149, Israel Defense Forces, Tel-Hashomer, Israel
| | - Chen Goldstein
- Faculty of Dental Medicine, Hebrew University of Jerusalem, Israel; Big Biomedical Data Research Laboratory; Dean's Office, Hadassah Medical Center, Jerusalem 91120, Israel
| | - Galit Almoznino
- Faculty of Dental Medicine, Hebrew University of Jerusalem, Israel; Big Biomedical Data Research Laboratory; Dean's Office, Hadassah Medical Center, Jerusalem 91120, Israel
- Faculty of Dental Medicine, Hebrew University of Jerusalem, Israel; Department of Endodontics, Hadassah Medical Center, Jerusalem 91120, Israel
- Faculty of Dental Medicine, Hebrew University of Jerusalem, Israel; Department of Oral Medicine, Sedation & Maxillofacial Imaging, Hadassah Medical Center, Jerusalem 91120, Israel
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Łoboda D, Stepanik M, Szajerska-Kurasiewicz A, Turski M, Urbanczyk-Świć D, Durmała J, Gołba KS. The Usefulness of Questionnaires in Assessing the Risk of Obstructive Sleep Apnea in Patients in the Managed Care after Acute Myocardial Infarction Program-The Results of a Cross-Sectional Study. J Pers Med 2023; 13:jpm13040642. [PMID: 37109027 PMCID: PMC10142237 DOI: 10.3390/jpm13040642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/02/2023] [Accepted: 04/04/2023] [Indexed: 04/29/2023] Open
Abstract
Obstructive sleep apnea (OSA) worsens prognosis after myocardial infarction (MI) but often remains undiagnosed. The study aimed to evaluate the usefulness of questionnaires in assessing the risk of OSA in patients participating in managed care after an acute myocardial infarction program. Study group: 438 patients (349 (79.7%) men) aged 59.92 ± 10.92, hospitalized in the day treatment cardiac rehabilitation department 7-28 days after MI. OSA risk assessment: A 4-variable screening tool (4-V), STOP-BANG questionnaire, Epworth sleepiness scale (ESS), and adjusted neck circumference (ANC). The home sleep apnea testing (HSAT) was performed on 275 participants. Based on four scales, a high risk of OSA was found in 283 (64.6%) responders, including 248 (56.6%) based on STOP-BANG, 163 (37.5%) based on ANC, 115 (26.3%) based on 4-V, and 45 (10.3%) based on ESS. OSA was confirmed in 186 (68.0%) participants: mild in 85 (30.9%), moderate in 53 (19.3%), and severe in 48 (17.5%). The questionnaires' sensitivity and specificity in predicting moderate-to-severe OSA were: for STOP-BANG-79.21% (95% confidence interval; CI 70.0-86.6) and 35.67% (95% CI 28.2-43.7); ANC-61.39% (95% CI 51.2-70.9) and 61.15% (95% CI 53.1-68.8); 4-V-45.54% (95% CI 35.6-55.8) and 68.79% (95% CI 60.9-75.9); ESS-16.83% (95% CI 10.1-25.6) and 87.90% (95% CI 81.7-92.6). OSA is common in post-MI patients. The ANC most accurately estimates the risk of OSA eligible for positive airway pressure therapy. The sensitivity of the ESS in the post-MI population is insufficient and limits this scale's usefulness in risk assessment and qualification for treatment.
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Affiliation(s)
- Danuta Łoboda
- Department of Electrocardiology and Heart Failure, Medical University of Silesia in Katowice, 40-635 Katowice, Poland
- Department of Electrocardiology, Upper-Silesian Medical Centre, 40-635 Katowice, Poland
| | - Michalina Stepanik
- Department of Rehabilitation, Medical University of Silesia in Katowice, 40-635 Katowice, Poland
| | | | - Maciej Turski
- Day Treatment Cardiac Rehabilitation Ward, Upper-Silesian Medical Centre, 40-635 Katowice, Poland
| | - Dagmara Urbanczyk-Świć
- Day Treatment Cardiac Rehabilitation Ward, Upper-Silesian Medical Centre, 40-635 Katowice, Poland
| | - Jacek Durmała
- Department of Rehabilitation, Medical University of Silesia in Katowice, 40-635 Katowice, Poland
| | - Krzysztof S Gołba
- Department of Electrocardiology and Heart Failure, Medical University of Silesia in Katowice, 40-635 Katowice, Poland
- Department of Electrocardiology, Upper-Silesian Medical Centre, 40-635 Katowice, Poland
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Alshehri AA, Hakami F, Gadi W, Darraj H, Hamdi S, Awaf M, Hakami A, Zogel B. Nasal Blockage and Academic Performance Among Medical College Students in the Kingdom of Saudi Arabia. Cureus 2023; 15:e36135. [PMID: 37065372 PMCID: PMC10101197 DOI: 10.7759/cureus.36135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2023] [Indexed: 03/15/2023] Open
Abstract
Objectives The most frequent otolaryngological complaint is nasal obstruction. We aimed to determine if there is a relationship between nasal blockage and academic performance among medical college students in Saudi Arabia. Methods This cross-sectional survey carried out from August to December 2022, included 860 medical students determining the risk of obstructive sleep apnea (OSA) on the participants using the Berlin Sleep Questionnaire Risk Probability, then comparing it to their socio-demographic characteristics, while the Chi-square test was used for the comparison of categorical variables. Result The average age of the participants in our study was 21.52 years; 60% were females and 40% were males. The risk of obstructive sleep apnea was found to be two times higher in females than in males (95% CI: 1.195- 3.345; p-value 0.008). The hypertensive participants had a 27-fold increased risk of OSA compared to non-hypertensives. Grade Point Average (GPA) and snoring had a statistically significant relationship, however, a fifth of the participants reported snoring (79.8% reported not snoring). We also found that 14.8% of the participants with snoring had a GPA between 2-4.49 compared to 44.6% of participants without snoring. Conclusion Female students had a two-fold higher chance of developing OSA than males. While a GPA of 4.5 and above was more often associated with participants without snoring, the number of individuals with a GPA of 2-4.49 was greater among participants with snoring. To aid in the prevention of illness complications and the management of risk factors, additional efforts should be made to increase disease knowledge among students, primary healthcare practitioners, and specialty doctors.
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Zhang C, Wei S, Wang Y, Yu K, Jin Z, Zhang M, Ma X, Zhang C, Zhang Q, Sun K, Zhou P, Zhong Y, Ma J, Liao J, Wang G. Association between preserved ratio impaired spirometry and sleep apnea in a Chinese community. Curr Med Res Opin 2023; 39:621-626. [PMID: 36847254 DOI: 10.1080/03007995.2023.2182531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
OBJECTIVE This study investigated the association between obstructive sleep apnea (OSA) and preserved ratio impaired spirometry (PRISm) in a community population. METHODS Baseline data from a prospective cohort study, the Predictive Value of Combining Inflammatory Biomarkers and Rapid Decline of FEV1 for COPD (PIFCOPD), were used for cross-sectional analysis. Participants aged 40-75 years were recruited from the community and their demographic information and medical history were collected. The STOP-Bang questionnaire (SBQ) was used to assess the risk of OSA. Pulmonary function tests were performed using a portable spirometer (COPD-6) and forced expiratory volume in 1 s (FEV1) and 6 s (FEV6) were measured. Routine blood, biochemical, high-sensitivity C-reactive protein (hs-CRP), and interleukin-6 tests were also performed. The pH of the exhaled breath condensate was determined. RESULTS A total of 1183 participants were enrolled, of which 221 with PRISm and 962 with normal lung function. The neck circumference, waist-to-hip ratio, hs-CRP concentration, proportion of males, cigarette exposure, number of current smoker, high risk of OSA, and prevalence of nasal and ocular allergy symptoms were significantly higher in the PRISm group than in the non-PRISm group (p < .05). Logistic regression showed that the risk of OSA (odds ratio, 1.883; 95% confidence interval, 1.245-2.848), waist-to-hip ratio, current smoking, and prevalence of nasal allergy symptoms were independently associated with PRISm after correcting for age and sex. CONCLUSION These findings showed that OSA prevalence is independently associated with PRISm prevalence. Further studies should confirm the relationship between systemic inflammation in OSA, localized inflammation of the airways, and impaired lung function.
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Affiliation(s)
- Cheng Zhang
- The Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Shanshan Wei
- The Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Yunxia Wang
- The Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Kunyao Yu
- The Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Zhe Jin
- The Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Meng Zhang
- The Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Xiaoyu Ma
- The Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Chunbo Zhang
- The Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Qi Zhang
- The Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Kunyan Sun
- The Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Peining Zhou
- The Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Yijue Zhong
- The Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Jing Ma
- The Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Jiping Liao
- The Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Guangfa Wang
- The Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
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Ludwig K, Malatantis-Ewert S, Huppertz T, Bahr-Hamm K, Seifen C, Pordzik J, Matthias C, Simon P, Gouveris H. Central Apneic Event Prevalence in REM and NREM Sleep in OSA Patients: A Retrospective, Exploratory Study. BIOLOGY 2023; 12:298. [PMID: 36829574 PMCID: PMC9953334 DOI: 10.3390/biology12020298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/01/2023] [Accepted: 02/10/2023] [Indexed: 02/16/2023]
Abstract
Patients with sleep-disordered breathing show a combination of different respiratory events (central, obstructive, mixed), with one type being predominant. We observed a reduced prevalence of central apneic events (CAEs) during REM sleep compared to NREM sleep in patients with predominant obstructive sleep apnea (OSA). The aim of this retrospective, exploratory study was to describe this finding and to suggest pathophysiological explanations. The polysomnography (PSG) data of 141 OSA patients were assessed for the prevalence of CAEs during REM and NREM sleep. On the basis of the apnea-hypopnea index (AHI), patients were divided into three OSA severity groups (mild: AHI < 15/h; moderate: AHI = 15-30/h; severe: AHI > 30/h). We compared the frequency of CAEs adjusted for the relative length of REM and NREM sleep time, and a significantly increased frequency of CAEs in NREM was found only in severely affected OSA patients. Given that the emergence of CAEs is strongly associated with the chemosensitivity of the brainstem nuclei regulating breathing mechanics in humans, a sleep-stage-dependent chemosensitivity is proposed. REM-sleep-associated neuronal circuits in humans may act protectively against the emergence of CAEs, possibly by reducing chemosensitivity. On the contrary, a significant increase in the chemosensitivity of the brainstem nuclei during NREM sleep is suggested.
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Affiliation(s)
- Katharina Ludwig
- Sleep Medicine Center, Department of Otorhinolaryngology, University Medical Center, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
| | - Sebastian Malatantis-Ewert
- Sleep Medicine Center, Department of Otorhinolaryngology, University Medical Center, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
| | - Tilman Huppertz
- Sleep Medicine Center, Department of Otorhinolaryngology, University Medical Center, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
| | - Katharina Bahr-Hamm
- Sleep Medicine Center, Department of Otorhinolaryngology, University Medical Center, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
| | - Christopher Seifen
- Sleep Medicine Center, Department of Otorhinolaryngology, University Medical Center, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
| | - Johannes Pordzik
- Sleep Medicine Center, Department of Otorhinolaryngology, University Medical Center, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
| | - Christoph Matthias
- Sleep Medicine Center, Department of Otorhinolaryngology, University Medical Center, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
| | - Perikles Simon
- Department of Sport Medicine, Rehabilitation and Disease Prevention, Faculty of Social Science, Media and Sport, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
| | - Haralampos Gouveris
- Sleep Medicine Center, Department of Otorhinolaryngology, University Medical Center, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
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Tsai CY, Liu WT, Hsu WH, Majumdar A, Stettler M, Lee KY, Cheng WH, Wu D, Lee HC, Kuan YC, Wu CJ, Lin YC, Ho SC. Screening the risk of obstructive sleep apnea by utilizing supervised learning techniques based on anthropometric features and snoring events. Digit Health 2023; 9:20552076231152751. [PMID: 36896329 PMCID: PMC9989412 DOI: 10.1177/20552076231152751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 01/04/2023] [Indexed: 03/08/2023] Open
Abstract
Objectives Obstructive sleep apnea (OSA) is typically diagnosed by polysomnography (PSG). However, PSG is time-consuming and has some clinical limitations. This study thus aimed to establish machine learning models to screen for the risk of having moderate-to-severe and severe OSA based on easily acquired features. Methods We collected PSG data on 3529 patients from Taiwan and further derived the number of snoring events. Their baseline characteristics and anthropometric measures were obtained, and correlations among the collected variables were investigated. Next, six common supervised machine learning techniques were utilized, including random forest (RF), extreme gradient boosting (XGBoost), k-nearest neighbor (kNN), support vector machine (SVM), logistic regression (LR), and naïve Bayes (NB). First, data were independently separated into a training and validation dataset (80%) and a test dataset (20%). The approach with the highest accuracy in the training and validation phase was employed to classify the test dataset. Next, feature importance was investigated by calculating the Shapley value of every factor, which represented the impact on OSA risk screening. Results The RF produced the highest accuracy (of >70%) in the training and validation phase in screening for both OSA severities. Hence, we employed the RF to classify the test dataset, and results showed a 79.32% accuracy for moderate-to-severe OSA and 74.37% accuracy for severe OSA. Snoring events and the visceral fat level were the most and second most essential features of screening for OSA risk. Conclusions The established model can be considered for screening for the risk of having moderate-to-severe or severe OSA.
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Affiliation(s)
- Cheng-Yu Tsai
- Department of Civil and Environmental Engineering, Imperial College London, London, UK
| | - Wen-Te Liu
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Sleep Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Research Center of Artificial Intelligence in Medicine, Taipei Medical University, Taipei, Taiwan
| | - Wen-Hua Hsu
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Arnab Majumdar
- Department of Civil and Environmental Engineering, Imperial College London, London, UK
| | - Marc Stettler
- Department of Civil and Environmental Engineering, Imperial College London, London, UK
| | - Kang-Yun Lee
- Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Wun-Hao Cheng
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Dean Wu
- Sleep Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan.,Dementia Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Hsin-Chien Lee
- Department of Psychiatry, Taipei Medical University Hospital, Taipei, Taiwan
| | - Yi-Chun Kuan
- Sleep Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan.,Dementia Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Cheng-Jung Wu
- Department of Otolaryngology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Yi-Chih Lin
- Department of Otolaryngology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Shu-Chuan Ho
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
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Chiang JK, Lin YC, Lu CM, Kao YH. Snoring Index and Neck Circumference as Predictors of Adult Obstructive Sleep Apnea. Healthcare (Basel) 2022; 10:healthcare10122543. [PMID: 36554066 PMCID: PMC9778532 DOI: 10.3390/healthcare10122543] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
Background. Snoring is the cardinal symptom of obstructive sleep apnea (OSA). The acoustic features of snoring sounds include intra-snore (including snoring index [SI]) and inter-snore features. However, the correlation between snoring sounds and the severity of OSA according to the apnea−hypopnea index (AHI) is still unclear. We aimed to use the snoring index (SI) and the Epworth Sleepiness Scale (ESS) to predict OSA and its severity according to the AHI among middle-aged participants referred for polysomnography (PSG). Methods. In total, 50 participants (mean age, 47.5 ± 12.6 years; BMI: 29.2 ± 5.6 kg/m2) who reported snoring and were referred for a diagnosis of OSA and who underwent a whole night of PSG were recruited. Results. The mean AHI was 30.2 ± 27.2, and the mean SI was 87.9 ± 56.3 events/hour. Overall, 11 participants had daytime sleepiness (ESS > 10). The correlation between SI and AHI (r = 0.33, p = 0.021) was significant. Univariate linear regression analysis showed that male gender, body mass index, neck circumference, ESS, and SI were associated with AHI. SI (β = 0.18, p = 0.004) and neck circumference (β = 2.40, p < 0.001) remained significantly associated with AHI by the multivariate linear regression model. Conclusion. The total number of snores per hour of sleep and neck circumference were positively associated with OSA among adults referred for PSG.
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Affiliation(s)
- Jui-Kun Chiang
- Department of Family Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi 622, Taiwan
| | | | - Chih-Ming Lu
- Department of Urology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi 622, Taiwan
| | - Yee-Hsin Kao
- Department of Family Medicine, Tainan Municipal Hospital (Managed by Show Chwan Medical Care Corporation), Tainan 701, Taiwan
- Correspondence: ; Tel.: +886-6-2609926 (ext. 23104)
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Patient-Reported Outcome Measurements in Patients with COPD-Obstructive Sleep Apnea Overlap Syndrome: Time for Action? J Pers Med 2022; 12:jpm12121951. [PMID: 36556172 PMCID: PMC9783659 DOI: 10.3390/jpm12121951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 11/04/2022] [Accepted: 11/14/2022] [Indexed: 11/26/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea syndrome (OSA) are common conditions that often coexist [Overlap syndrome (OS)]. OS has important implications in the diagnosis, treatment, and patient outcome of both disorders. Patient-reported outcomes (PROs) are essential to evaluate symptoms, impact of symptoms on activities of daily living, and treatment response. The present review aims to display the potential usefulness of PROs measurements (PROMs) regarding the initial evaluation and treatment of both conditions (COPD and OSA) in OS patients. More specifically, we review PROMs regarding symptoms, mental health indices and health-related quality of life in patients with OS. These PROMs have the potential to add value to clinical research and daily practice in certain aspects that are important to patients.
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Tsai CY, Huang HT, Cheng HC, Wang J, Duh PJ, Hsu WH, Stettler M, Kuan YC, Lin YT, Hsu CR, Lee KY, Kang JH, Wu D, Lee HC, Wu CJ, Majumdar A, Liu WT. Screening for Obstructive Sleep Apnea Risk by Using Machine Learning Approaches and Anthropometric Features. SENSORS (BASEL, SWITZERLAND) 2022; 22:s22228630. [PMID: 36433227 PMCID: PMC9694257 DOI: 10.3390/s22228630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 10/26/2022] [Accepted: 11/05/2022] [Indexed: 05/14/2023]
Abstract
Obstructive sleep apnea (OSA) is a global health concern and is typically diagnosed using in-laboratory polysomnography (PSG). However, PSG is highly time-consuming and labor-intensive. We, therefore, developed machine learning models based on easily accessed anthropometric features to screen for the risk of moderate to severe and severe OSA. We enrolled 3503 patients from Taiwan and determined their PSG parameters and anthropometric features. Subsequently, we compared the mean values among patients with different OSA severity and considered correlations among all participants. We developed models based on the following machine learning approaches: logistic regression, k-nearest neighbors, naïve Bayes, random forest (RF), support vector machine, and XGBoost. Collected data were first independently split into two data sets (training and validation: 80%; testing: 20%). Thereafter, we adopted the model with the highest accuracy in the training and validation stage to predict the testing set. We explored the importance of each feature in the OSA risk screening by calculating the Shapley values of each input variable. The RF model achieved the highest accuracy for moderate to severe (84.74%) and severe (72.61%) OSA. The level of visceral fat was found to be a predominant feature in the risk screening models of OSA with the aforementioned levels of severity. Our machine learning models can be employed to screen for OSA risk in the populations in Taiwan and in those with similar craniofacial structures.
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Affiliation(s)
- Cheng-Yu Tsai
- Centre for Transport Studies, Department of Civil and Environmental Engineering, Imperial College London, London SW7 2AZ, UK
| | - Huei-Tyng Huang
- Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 6BT, UK
| | - Hsueh-Chien Cheng
- Parasites and Microbes Programme, Wellcome Sanger Institute, Hinxton CB10 1RQ, UK
| | - Jieni Wang
- Chemical Engineering and Biotechnology, University of Cambridge, Cambridge CB3 0AS, UK
| | - Ping-Jung Duh
- Cognitive Neuroscience, Division of Psychology and Language Science, University College London, London WC1H 0AP, UK
| | - Wen-Hua Hsu
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan
| | - Marc Stettler
- Centre for Transport Studies, Department of Civil and Environmental Engineering, Imperial College London, London SW7 2AZ, UK
| | - Yi-Chun Kuan
- Sleep Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235041, Taiwan
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235041, Taiwan
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan
- Taipei Neuroscience Institute, Taipei Medical University, Taipei 110301, Taiwan
- Dementia Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235041, Taiwan
| | - Yin-Tzu Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan 33305, Taiwan
| | - Chia-Rung Hsu
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235041, Taiwan
| | - Kang-Yun Lee
- Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235041, Taiwan
| | - Jiunn-Horng Kang
- Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei 110301, Taiwan
- Research Center of Artificial Intelligence in Medicine, Taipei Medical University, Taipei 110301, Taiwan
- Graduate Institute of Nanomedicine and Medical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei 110301, Taiwan
| | - Dean Wu
- Sleep Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235041, Taiwan
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235041, Taiwan
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan
- Taipei Neuroscience Institute, Taipei Medical University, Taipei 110301, Taiwan
- Dementia Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235041, Taiwan
| | - Hsin-Chien Lee
- Department of Psychiatry, Taipei Medical University Hospital, Taipei 110301, Taiwan
| | - Cheng-Jung Wu
- Department of Otolaryngology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235041, Taiwan
| | - Arnab Majumdar
- Centre for Transport Studies, Department of Civil and Environmental Engineering, Imperial College London, London SW7 2AZ, UK
- Correspondence: (A.M.); (W.-T.L.)
| | - Wen-Te Liu
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan
- Sleep Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235041, Taiwan
- Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235041, Taiwan
- Research Center of Artificial Intelligence in Medicine, Taipei Medical University, Taipei 110301, Taiwan
- Correspondence: (A.M.); (W.-T.L.)
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Gutlapalli SD, Pu J, Zaidi MF, Patel M, Atluri LM, Gonzalez NA, Sakhamuri N, Athiyaman S, Randhi B, Penumetcha SS. The Significance of Sleep Disorders in Post-myocardial Infarction Depression. Cureus 2022; 14:e30899. [DOI: 10.7759/cureus.30899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022] Open
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CPAP Therapy on Depressive and Anxiety Symptoms in Patients with Moderate to Severe Obstructive Sleep Apnea Syndrome. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58101402. [PMID: 36295563 PMCID: PMC9609270 DOI: 10.3390/medicina58101402] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/01/2022] [Accepted: 10/03/2022] [Indexed: 11/16/2022]
Abstract
Backgrounds and Objectives: There is a link between sleep apnea syndrome (OSA) and depressive and anxiety symptoms, but the underlying mechanisms are not fully understood. The study aimed to determine the prevalence of these symptoms in patients with OSA and to evaluate the impact of continuous positive airway pressure (CPAP) on depression and anxiety scores. Materials and Methods: Ninety-nine consecutive new patients diagnosed with moderate or severe (apnea-hypopnea index AHI ≥ 15 events/h) OSA were accepted for the CPAP therapy. Patients completed a patient health questionnaire (PHQ-9) for depressive symptoms and a generalized anxiety questionnaire (GAD-7) for anxiety symptoms before the CPAP treatment, after 6 months, and after 1 year of CPAP therapy with compliance. For both scores (PHQ-9 and GAD-7), a cut point ≥10 was used to indicate the presence of clinically depressive and anxiety symptoms. Results: Forty-eight individuals (48.48%) had PHQ-9 scores above the cut-off point ≥ 10, and twenty-seven participants (27.27%) had GAD-7 scores above the cut-off point ≥10. A significant correlation has been shown between PHQ-9 score and BMI (p < 0.0001), AHI (p < 0.0001), ODI (p < 0.001), ESS (p < 0.001), GAD-7 score (p < 0.0001), and [t90] (p < 0.0001), while GAD-7 was correlated with AHI (p < 0.030), ODI (p < 0.006), and [t90] (p < 0.001). The PHQ-9 and GAD-7 scores decreased significantly after 6 months of CPAP therapy in all groups and after 1 year of CPAP use. Conclusions: OSA patients should be screened for depression and anxiety. Furthermore, CPAP should be the first choice of treatment before starting other treatments for depression and anxiety symptoms.
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Maino G, Cremonini F, Pettinato G, Paoletto E, Lombardo L. Obstructive sleep apnoea syndrome and anatomical factors: possible correlations. Sleep Sci 2022; 15:429-435. [PMID: 36419816 PMCID: PMC9670767 DOI: 10.5935/1984-0063.20220074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/05/2022] [Indexed: 07/30/2023] Open
Abstract
OBJECTIVES The following retrospective study was devised with the aim of evaluating the correlation between OSAS and various anatomical factors. MATERIAL AND METHODS Thirty-seven patients over the age of 40 were analyzed, of which 19 were classified as OSAS cases and 18 as control cases. For each, 17 anatomical variables were identified and examined using Invivo Dental software on CBCT scans, WebCeph software on laterolateral teleradiographs, and Rhinoceros 6.0 software on dental casts. RESULTS A generalized linear model of all the anatomical factors identified only two statistically significant variables. Specifically, the total volume of the palate displayed a inverse correlation with OSAS, while the distance between the S point and the Go point (S-Go) exhibited a direct correlation with the disease. CONCLUSION The likelihood of an individual having OSAS appears to decrease as the volume of the palate increases but increase as the lingual measure S-Go increases.
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Affiliation(s)
- Giovanna Maino
- University of Ferrara, Postgraduate School of Orthodontics - Ferrara -
Italy
| | - Francesca Cremonini
- University of Ferrara, Postgraduate School of Orthodontics - Ferrara -
Italy
| | - Giulia Pettinato
- University of Ferrara, Postgraduate School of Orthodontics - Ferrara -
Italy
| | - Emanuele Paoletto
- University of Ferrara, Postgraduate School of Orthodontics - Ferrara -
Italy
| | - Luca Lombardo
- University of Ferrara, Postgraduate School of Orthodontics - Ferrara -
Italy
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