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Kim K, Kim HJ, Lee S, Lee W. Association and interaction effect of shift work and the risk for obstructive sleep apnea on diabetes mellitus in middle-aged Korean workers. Sleep Breath 2024:10.1007/s11325-024-03160-8. [PMID: 39259440 DOI: 10.1007/s11325-024-03160-8] [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: 04/15/2024] [Revised: 08/28/2024] [Accepted: 09/06/2024] [Indexed: 09/13/2024]
Abstract
PURPOSE To investigate the association of shift work and the risk for obstructive sleep apnea (OSA) with diabetes mellitus (DM), and the interaction effect of shift work and the risk for OSA on DM. METHODS Data from the Korea National Health and Nutrition Examination Survey (KNHANES) 2019-2021 were used. The participants were 3012 employees aged 40 to 59 years. Shift work was assessed using self-reporting questionnaires. The risk for OSA was assessed by STOP-BANG score. The distribution of demographic factors was calculated using the chi-square test. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were calculated using multivariable logistic regression. An interaction effect between shift work and the risk for OSA on DM was evaluated using relative excess risk owing to interaction (RERI) and attributable proportion (AP) with 95% CIs. The synergic index (SI) was also calculated. RESULTS Shift work and the risk for OSA were each significantly associated with DM. There was also a significant interaction effect between shift work and the risk for OSA on DM. The RERI was 0.543 (95% CI 0.205-1.361) and the AP was 0.230 (95% CI 0.145-0.342). The SI was 1.662 (95% CI 1.481-1.843). CONCLUSIONS There was an association and a significant interaction effect of shift work and the risk for OSA on DM. The management of OSA in shift workers should be implemented to prevent DM.
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Affiliation(s)
- Kyusung Kim
- Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Medical Humanities and Social Sciences, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hi-Ju Kim
- Department of Psychiatry, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Seunghyun Lee
- Department of Convergence Medicine, School of Medicine, Pusan National University, Yangsan, Republic of Korea
| | - Wanhyung Lee
- Department of Preventive Medicine, College of Medicine, Chung-Ang University, Heukseouk- Ro, DongJak-Gu, Seoul, 06974, Republic of Korea.
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2
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Leff LE, Koperwas ML. Calculated Medicine: Seven Decades of Accelerating Growth. Am J Med 2024; 137:582-588. [PMID: 38556036 DOI: 10.1016/j.amjmed.2024.03.025] [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: 03/04/2024] [Revised: 03/11/2024] [Accepted: 03/11/2024] [Indexed: 04/02/2024]
Abstract
The field of Calculated Medicine has grown substantially over the last 7 decades. Comprised of objective, evidence-based medical decision tools, Calculated Medicine has broad application in medical practice, medical research, and health care management. This article reviews the history and varied methodologies of Calculated Medicine, starting with the 1953 Apgar score and concluding with a look into modern computational tools of the field: machine learning, natural language processing, artificial intelligence, and in silico research techniques. We'll also review and quantify the rapidly accelerating growth of Calculated Medicine in the medical literature. Our database of journal articles referring to the field has accumulated over 1.8 million citations, with more than 460 new citations (on average) posted every day. Using natural language processing, we examine and analyze this burgeoning database. Lastly, we examine an important new direction of Calculated Medicine: self-reflection on its potential effect on racial and ethnic disparities in health care. Our field is making great strides promoting health care egality, and some of the most prominent contributions will be reviewed.
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Affiliation(s)
- Louis E Leff
- University of Pittsburgh School of Medicine, Pa.
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3
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Abd-Ellah ME, Mohamed FS, Khamis MM, Abdel Wahab NH. Modified biblock versus monoblock mandibular advancement appliances for treatment of obstructive sleep apnea: A randomized controlled trial. J Prosthet Dent 2024; 131:633-642. [PMID: 35379469 DOI: 10.1016/j.prosdent.2022.02.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 02/20/2022] [Accepted: 02/21/2022] [Indexed: 11/19/2022]
Abstract
STATEMENT OF PROBLEM The high prevalence of obstructive sleep apnea represents a serious public health problem. Oral appliances have gained wide acceptance among patients diagnosed with obstructive sleep apnea, who should wear them every night. A comfortable oral appliance is mandatory for successful treatment outcomes. PURPOSE The purpose of this randomized controlled trial was the assessment of the influence of 2 different designs of the mandibular advancement appliance (MAA), modified biblock and monoblock, for the management of obstructive sleep apnea. MATERIAL AND METHODS The study was designed as a prospective 2-arm randomized controlled clinical trial conducted in parallel. Twenty participants (aged 40 ±7.5 years) diagnosed with moderate obstructive sleep apnea were randomly assigned to a control group (n=10), receiving monoblock MAA, and a study group (n=10), receiving modified biblock MAA with elastics. Both appliances were fabricated by using computer-aided design and computer-aided manufacture (CAD-CAM) technology at different mandibular advancement levels (MALs): 50% and 75% of maximum MAL. A total of 60 cone beam computed tomography scans, 60 overnight full polysomnography sleep tests, 60 STOP-Bang questionnaires, and 40 Usability of Sleep Apnea Equipment-Oral Appliance (USE-OA) questionnaires were collected and analyzed blindly at baseline (initial visit), 50% MAL (3 months), and 75% MAL (6 months). The main outcome measures were the upper airway volume, linear anteroposterior and cross-sectional airway measurements, Apnea Hypopnea Index, Respiratory Disturbance Index, STOP-Bang questionnaire scoring, and USE-OA questionnaire scoring. Nonparametric statistical analysis was performed by using a statistical software program (α=.05). With a beta error accepted of up to 20%, the power of the study was 80%. RESULTS At 75% MAL, the percentage change in upper airway volumetric measurements showed a favorable increase: biblock group (115%) and monoblock group (42%), with a statistically significant difference (P=.001). The linear anteroposterior airway measurements and the percentage change in cross-sectional airway measurements were statistically similar: biblock group (80%) and (75%) monoblock group (60%), (54%) (P=.450, P=.151, respectively). The percentage change in the Apnea Hypopnea Index significantly decreased: biblock group (-89%) and monoblock group (-54%) (P<.001). The percentage change in the Respiratory Disturbance Index decreased: biblock group (-78%) and monoblock group (-62%) (P<.023). From the STOP-Bang questionnaire scoring, 100% of both groups showed low risk for obstructive sleep apnea at 75% MAL. From the satisfaction scoring on the USE-OA questionnaire, the biblock group was 100% strong satisfaction and the monoblock group was 50% satisfaction and 50% fairly satisfied. CONCLUSIONS The modified biblock MAA with elastics showed significant improvements in patients diagnosed with obstructive sleep apnea regarding upper airway measurements and full polysomnography vital parameters when compared with monoblock MAA.
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Affiliation(s)
- Mervat E Abd-Ellah
- Lecturer, Department of Prosthodontics, Faculty of Dentistry, Alexandria University, Alexandria, Egypt.
| | - Faten S Mohamed
- Professor, Department of Prosthodontics, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Mohamed M Khamis
- Professor and Chairman, Department of Prosthodontics, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Nashwa H Abdel Wahab
- Professor, Department of Chest Diseases, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Filardi M, Gnoni V, Tamburrino L, Nigro S, Urso D, Vilella D, Tafuri B, Giugno A, De Blasi R, Zoccolella S, Logroscino G. Sleep and circadian rhythm disruptions in behavioral variant frontotemporal dementia. Alzheimers Dement 2024; 20:1966-1977. [PMID: 38183333 PMCID: PMC10984421 DOI: 10.1002/alz.13570] [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: 06/29/2023] [Revised: 10/09/2023] [Accepted: 11/09/2023] [Indexed: 01/08/2024]
Abstract
INTRODUCTION Sleep and rest-activity rhythm alterations are common in neurodegenerative diseases. However, their characterization in patients with behavioral variant frontotemporal dementia (bvFTD) has proven elusive. We investigated rest-activity rhythm alterations, sleep disturbances, and their neural correlates in bvFTD. METHODS Twenty-seven bvFTD patients and 25 healthy controls completed sleep questionnaires and underwent 7 days of actigraphy while concurrently maintaining a sleep diary. Cortical complexity and thickness were calculated from T1-weighted magnetic resonance (MR) images. RESULTS Compared to controls, bvFTD patients showed longer time in bed (95% confidence interval [CI]: 79.31, 321.83) and total sleep time (95% CI: 24.38, 321.88), lower sleep efficiency (95% CI: -12.58, -95.54), and rest-activity rhythm alterations in the morning and early afternoon. Increased sleep duration was associated with reduced cortical thickness in frontal regions. DISCUSSION Patients with bvFTD showed longer sleep duration, lower sleep quality, and rest-activity rhythm alterations. Actigraphy could serve as a cost-effective and accessible tool for ecologically monitoring changes in sleep duration in bvFTD patients. HIGHLIGHTS We assessed sleep and circadian rhythms in behavioral variant frontotemporal dementia (bvFTD) using actigraphy. Patients with bvFTD show increased sleep duration and reduced sleep quality. Patients with bvFTD show rest-activity alterations in the morning and early afternoon. Sleep duration is associated with reduced cortical thickness in frontal regions. These alterations may represent an early sign of neurodegeneration.
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Affiliation(s)
- Marco Filardi
- Department of Translational Biomedicine and Neurosciences (DiBraiN)University of Bari Aldo MoroBariItaly
- Center for Neurodegenerative Diseases and the Aging BrainUniversity of Bari Aldo Moro at Pia Fondazione “Card. G. Panico”TricaseItaly
| | - Valentina Gnoni
- Center for Neurodegenerative Diseases and the Aging BrainUniversity of Bari Aldo Moro at Pia Fondazione “Card. G. Panico”TricaseItaly
| | - Ludovica Tamburrino
- Department of Translational Biomedicine and Neurosciences (DiBraiN)University of Bari Aldo MoroBariItaly
- Center for Neurodegenerative Diseases and the Aging BrainUniversity of Bari Aldo Moro at Pia Fondazione “Card. G. Panico”TricaseItaly
| | - Salvatore Nigro
- Center for Neurodegenerative Diseases and the Aging BrainUniversity of Bari Aldo Moro at Pia Fondazione “Card. G. Panico”TricaseItaly
| | - Daniele Urso
- Center for Neurodegenerative Diseases and the Aging BrainUniversity of Bari Aldo Moro at Pia Fondazione “Card. G. Panico”TricaseItaly
| | - Davide Vilella
- Center for Neurodegenerative Diseases and the Aging BrainUniversity of Bari Aldo Moro at Pia Fondazione “Card. G. Panico”TricaseItaly
| | - Benedetta Tafuri
- Department of Translational Biomedicine and Neurosciences (DiBraiN)University of Bari Aldo MoroBariItaly
- Center for Neurodegenerative Diseases and the Aging BrainUniversity of Bari Aldo Moro at Pia Fondazione “Card. G. Panico”TricaseItaly
| | - Alessia Giugno
- Center for Neurodegenerative Diseases and the Aging BrainUniversity of Bari Aldo Moro at Pia Fondazione “Card. G. Panico”TricaseItaly
| | - Roberto De Blasi
- Center for Neurodegenerative Diseases and the Aging BrainUniversity of Bari Aldo Moro at Pia Fondazione “Card. G. Panico”TricaseItaly
- Department of Diagnostic ImagingPia Fondazione “Card. G. Panico”TricaseItaly
| | - Stefano Zoccolella
- Center for Neurodegenerative Diseases and the Aging BrainUniversity of Bari Aldo Moro at Pia Fondazione “Card. G. Panico”TricaseItaly
- Neurology Unit, San Paolo HospitalAzienda Sanitaria Locale (ASL) BariBariItaly
| | - Giancarlo Logroscino
- Department of Translational Biomedicine and Neurosciences (DiBraiN)University of Bari Aldo MoroBariItaly
- Center for Neurodegenerative Diseases and the Aging BrainUniversity of Bari Aldo Moro at Pia Fondazione “Card. G. Panico”TricaseItaly
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Lee PL, Wu YW, Cheng HM, Wang CY, Chuang LP, Lin CH, Hang LW, Yu CC, Hung CL, Liu CL, Chou KT, Su MC, Cheng KH, Huang CY, Hou CJY, Chiu KL. Recommended assessment and management of sleep disordered breathing in patients with atrial fibrillation, hypertension and heart failure: Taiwan Society of Cardiology/Taiwan Society of sleep Medicine/Taiwan Society of pulmonary and Critical Care Medicine joint consensus statement. J Formos Med Assoc 2024; 123:159-178. [PMID: 37714768 DOI: 10.1016/j.jfma.2023.08.024] [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: 04/16/2023] [Revised: 07/23/2023] [Accepted: 08/23/2023] [Indexed: 09/17/2023] Open
Abstract
Sleep disordered breathing (SDB) is highly prevalent and may be linked to cardiovascular disease in a bidirectional manner. The Taiwan Society of Cardiology, Taiwan Society of Sleep Medicine and Taiwan Society of Pulmonary and Critical Care Medicine established a task force of experts to evaluate the evidence regarding the assessment and management of SDB in patients with atrial fibrillation (AF), hypertension and heart failure with reduced ejection fraction (HFrEF). The GRADE process was used to assess the evidence associated with 15 formulated questions. The task force developed recommendations and determined strength (Strong, Weak) and direction (For, Against) based on the quality of evidence, balance of benefits and harms, patient values and preferences, and resource use. The resulting 11 recommendations are intended to guide clinicians in determining which the specific patient-care strategy should be utilized by clinicians based on the needs of individual patients.
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Affiliation(s)
- Pei-Lin Lee
- Center of Sleep Disorder, National Taiwan University Hospital, Taipei, Taiwan; School of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yen-Wen Wu
- Division of Cardiology, Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hao-Min Cheng
- Division of Faculty Development, Taipei Veterans General Hospital, Taipei, Taiwan; PhD Program of Interdisciplinary Medicine (PIM), National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan
| | - Cheng-Yi Wang
- Department of Internal Medicine, Cardinal Tien Hospital and School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Li-Pang Chuang
- Sleep Center, Department of Thoracic Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan; School of Medicine, Chang Gung University, Tauyan, Taiwan
| | - Chou-Han Lin
- Division of Respirology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Liang-Wen Hang
- School of Nursing & Graduate Institute of Nursing, China Medical University, Taichung, Taiwan; Sleep Medicine Center, China Medical University Hospital, Taichung, Taiwan
| | - Chih-Chieh Yu
- School of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chung-Lieh Hung
- Cardiovascular Center, MacKay Memorial Hospital, Taipei, Taiwan; Institute of Biomedical Sciences, Mackay Medical College, Taipei, Taiwan
| | - Ching-Lung Liu
- Division of Chest, Departments of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan; MacKay Medical College, New Taipei City, Taiwan
| | - Kun-Ta Chou
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Division of Clinical Respiratory Physiology, Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Mao-Chang Su
- Sleep Center, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan
| | - Kai-Hung Cheng
- Kao-Ho Hospital, Kaohsiung, Taiwan; Division of Cardiology, Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan
| | - Chun-Yao Huang
- Division of Cardiology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan; Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Charles Jia-Yin Hou
- Cardiovascular Center, MacKay Memorial Hospital, Taipei, Taiwan; MacKay Medical College, New Taipei City, Taiwan.
| | - Kuo-Liang Chiu
- Division of Chest Medicine, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan; School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien, Taiwan.
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Pisano A, Zoccali C, Bolignano D, D'Arrigo G, Mallamaci F. Sleep apnoea syndrome prevalence in chronic kidney disease and end-stage kidney disease patients: a systematic review and meta-analysis. Clin Kidney J 2024; 17:sfad179. [PMID: 38186876 PMCID: PMC10768783 DOI: 10.1093/ckj/sfad179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Indexed: 01/09/2024] Open
Abstract
Background Several studies have examined the frequency of sleep apnoea (SA) in patients with chronic kidney disease (CKD), reporting different prevalence rates. Our systematic review and meta-analysis aimed to define the clinical penetrance of SA in CKD and end-stage kidney disease (ESKD) patients. Methods Ovid-MEDLINE and PubMed databases were explored up to 5 June 2023 to identify studies providing SA prevalence in CKD and ESKD patients assessed by different diagnostic methods, either sleep questionnaires or respiration monitoring equipment [such as polysomnography (PSG), type III portable monitors or other diagnostic tools]. Single-study data were pooled using the random-effects model. The Chi2 and Cochrane-I2 tests were used to assess the presence of heterogeneity, which was explored performing sensitivity and/or subgroup analyses. Results A cumulative analysis from 32 single-study data revealed a prevalence of SA of 57% [95% confidence interval (CI) 42%-71%] in the CKD population, whereas a prevalence of 49% (95% CI 47%-52%) was found pooling data from 91 studies in ESKD individuals. The prevalence of SA using instrumental sleep monitoring devices, including classical PSG and type III portable sleep monitors, was 62% (95% CI 52%-72%) and 56% (95% CI 42%-69%) in CKD and ESKD populations, respectively. Sleep questionnaires revealed a prevalence of 33% (95% CI 16%-49%) and 39% (95% CI 30%-49%). Conclusions SA is commonly seen in both non-dialysis CKD and ESKD patients. Sleep-related questionnaires underestimated the presence of SA in this population. This emphasizes the need to use objective diagnostic tools to identify such a syndrome in kidney disease.
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Affiliation(s)
- Anna Pisano
- CNR-Institute of Clinical Physiology; Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, Reggio Calabria, Italy
| | - Carmine Zoccali
- Renal Research Institute, NY, USA
- Institute of Molecular Biology and Genetics (BIOGEM), Ariano Irpino, Italy
- Associazione Ipertensione Nefrologia e Trapianto Renale (IPNET), Reggio Calabria, Italy
| | - Davide Bolignano
- Department of Surgical and Medical Sciences-Magna Graecia, University of Catanzaro, Catanzaro, Italy
| | - Graziella D'Arrigo
- CNR-Institute of Clinical Physiology; Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, Reggio Calabria, Italy
| | - Francesca Mallamaci
- CNR-Institute of Clinical Physiology; Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, Reggio Calabria, Italy
- Nephology and Transplantation Unit, Grande Ospedale Metropolitano, Reggio Calabria, Italy
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Spiteri G, Monaco MGL, Carta A, Taus F, Torroni L, Verlato G, Porru S. Risk of obstructive sleep apnea among health workers: results of a screening in a large Italian University Hospital. Int Arch Occup Environ Health 2024; 97:101-108. [PMID: 38085278 DOI: 10.1007/s00420-023-02029-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 11/12/2023] [Indexed: 01/18/2024]
Abstract
PURPOSE Obstructive sleep apnea (OSA) is a common respiratory sleep disorder, related to increased mortality, poor quality of life, and higher risk of work accidents and injuries. Studies on the risk of OSA (rOSA) among health workers (HW) are scant. The aims of this study were to investigate this issue in a large University Hospital and to assess the effectiveness of a screening program. METHODS The STOP-BANG questionnaire (SBQ) was sent via e-mail to the 5031 HW employed at the University Hospital of Verona. HW who completed the SBQ were classified at low, moderate, and high rOSA. HW at high rOSA were invited to undergo nocturnal polygraphy. The determinants of rOSA were studied by non-parametric Kruskal-Wallis test, Pearson's chi-squared, and multinomial logistic model. RESULTS Of 5031 HW, 1564 (31.1%) completed the online questionnaire. Responders with low, moderate, and high rOSA were 72.7%, 13.7%, and 13.6%. Male gender, older age, and higher body mass index (BMI) were significant predictors of high rOSA, as expected. Physicians had the lowest probability of being in the high-risk category. Polygraphy was performed in 64 subjects. The positive predictive value of the self-administered SBQ was 68.8% (95%C.I. 55.9-79.8%) but raised to 96.9% (95%C.I. 89.2-99.6%) when re-administered by medical staff. CONCLUSION SBQ showed its effectiveness as a screening tool in detecting undiagnosed OSA in HW. Systematic screening for OSA in work settings could allow early diagnosis and treatment, reducing short- and long-term health effects of OSA.
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Affiliation(s)
- Gianluca Spiteri
- Occupational Medicine Unit, University Hospital of Verona, 37134, Verona, Italy
| | | | - Angela Carta
- Occupational Medicine Unit, University Hospital of Verona, 37134, Verona, Italy
- Section of Occupational Health, Department of Diagnostics and Public Health, University of Verona, 37134, Verona, Italy
| | - Francesco Taus
- Section of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, 37134, Verona, Italy
- Unit of Forensic Medicine, Department of Diagnostics and Public Health, University of Verona, 37134, Verona, Italy
| | - Lorena Torroni
- Section of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, 37134, Verona, Italy
| | - Giuseppe Verlato
- Section of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, 37134, Verona, Italy
| | - Stefano Porru
- Occupational Medicine Unit, University Hospital of Verona, 37134, Verona, Italy
- Section of Occupational Health, Department of Diagnostics and Public Health, University of Verona, 37134, Verona, Italy
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Menezes-Júnior LAAD, Fajardo VC, Neto RMDN, Freitas SND, Oliveira FLPD, Pimenta FAP, Machado-Coelho GLL, Meireles AL. The predictive values of BOAH and No-apnea score for screening obstructive sleep apnea in rotating shift worker drivers. Sleep Med X 2023; 6:100084. [PMID: 37711594 PMCID: PMC10497842 DOI: 10.1016/j.sleepx.2023.100084] [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: 05/17/2023] [Revised: 08/31/2023] [Accepted: 09/03/2023] [Indexed: 09/16/2023] Open
Abstract
Objective To evaluate the BOAH (Body mass index, Observed apnea, Age, and Hypertension) and No-apnea score's diagnostic values for detecting obstructive sleep apnea (OSA) risk in shift workers. Methods Cross-sectional study with male rotating shift workers and drivers of heavy off-road machinery. The BOAH score is based on body mass index, witnessed apneas during sleep, age, and hypertension. The No-apnea score is based on neck circumference and age. Based on the apnea-hypopnea index (AHI), the severity of OSA was categorized as least mild OSA (AHI ≥5/h), moderate to severe OSA (AHI ≥15/h), and severe OSA (AHI ≥30/h). Sensitivity, specificity, positive predictive value, negative predictive value, and areas under the curve (AUC) were calculated. Results Among 119 workers evaluated, 84.0% had AHI ≥5, 46.2% had AHI ≥15, and 14.3% had AHI ≥30. BOAH score with 2 points for AHI ≥5, the AUC was 0.679, and sensitivity and specificity were 41.0% and 94.7%, respectively. No-apnea score with 3 points AHI ≥5, the AUC was 0.692, and sensitivity and specificity were 70.0% and 68.4%, respectively. Furthermore, using at least one of the positive scores, the AUC was higher when compared to the single tests for AHI ≥5 (AUC = 0.727). And when both scores were positive, the AUC was higher for AHI ≥30 (AUC = 0.706). Conclusion In rotating shift workers and drivers of heavy off-road machinery, BOAH, and No-apnea scores can be helpful tools in identifying individuals at risk for sleep apnea. In addition, matching the scores may increase the prediction of OSA.
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Affiliation(s)
| | - Virgínia Capistrano Fajardo
- Post-Graduate in Applied Sciences in Adult Health, Federal University of Minas Gerais, Belo Horizonte, MG, 30130-100, Brazil
| | | | | | | | | | - George Luiz Lins Machado-Coelho
- Post-Graduate in Health and Nutrition, Federal University of Ouro Preto, Ouro Preto, MG, 35400-000, Brazil
- School of Medicine, Federal University of Ouro Preto, Ouro Preto, MG, 35400-000, Brazil
| | - Adriana Lúcia Meireles
- Post-Graduate in Health and Nutrition, Federal University of Ouro Preto, Ouro Preto, MG, 35400-000, Brazil
- School of Nutrition, Federal University of Ouro Preto, Ouro Preto, MG, 35400-000, Brazil
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Murray AM, Ramar K, Morgenthaler TI. Guidance, not screening. J Clin Sleep Med 2023; 19:2145-2146. [PMID: 38041535 PMCID: PMC10692935 DOI: 10.5664/jcsm.10792] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 08/18/2023] [Accepted: 08/18/2023] [Indexed: 12/03/2023]
Affiliation(s)
- Ann M. Murray
- Center for Sleep Medicine, Mayo Clinic, Rochester, Minnesota
- Mayo Clinic School of Graduate Medical Education, Mayo Clinic, Rochester, Minnesota
| | - Kannan Ramar
- Center for Sleep Medicine, Mayo Clinic, Rochester, Minnesota
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota
| | - Timothy I. Morgenthaler
- Center for Sleep Medicine, Mayo Clinic, Rochester, Minnesota
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota
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Reutrakul S, Irsheed GA, Park M, Steffen AD, Burke L, Pratuangtham S, Baron KG, Duffecy J, Perez R, Quinn L, Withington MHC, Saleh AH, Loiacono B, Mihailescu D, Martyn-Nemeth P. Association between sleep variability and time in range of glucose levels in patients with type 1 diabetes: Cross-sectional study. Sleep Health 2023; 9:968-976. [PMID: 37709596 PMCID: PMC10840618 DOI: 10.1016/j.sleh.2023.07.007] [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: 02/23/2023] [Revised: 06/16/2023] [Accepted: 07/10/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVE Sleep and circadian disturbances emerge as novel factors influencing glycemic control in type 1 diabetes (T1D). We aimed to explore the associations among sleep, behavioral circadian parameters, self-care, and glycemic parameters in T1D. METHODS Seventy-six non-shift-working adult T1D patients participated. Blinded 7-day continuous glucose monitoring (CGM) and hemoglobin A1C (A1C) were collected. Percentages of time-in-range (glucose levels 70-180 mg/dL) and glycemic variability (measured by the coefficient of variation [%CV]) were calculated from CGM. Sleep (duration and efficiency) was recorded using 7-day actigraphy. Variability (standard deviation) of midsleep time was used to represent sleep variability. Nonparametric behavioral circadian variables were derived from actigraphy activity recordings. Self-care was measured by diabetes self-management questionnaire-revised. Multiple regression analyses were performed to identify independent predictors of glycemic parameters. RESULTS Median (interquartile range) age was 34.0 (27.2, 43.1) years, 48 (63.2%) were female, and median (interquartile range) A1C was 6.8% (6.2, 7.4). Sleep duration, efficiency, and nonparametric behavioral circadian variables were not associated with glycemic parameters. After adjusting for age, sex, insulin delivery mode/CGM use, and ethnicity, each hour increase in sleep variability was associated with 9.64% less time-in-range (B = -9.64, 95% confidence interval [-16.29, -2.99], p ≤ .001). A higher diabetes self-management questionnaire score was an independent predictor of lower A1C (B = -0.18, 95% confidence interval [-0.32, -0.04]). CONCLUSION Greater sleep timing variability is independently associated with less time spent in the desirable glucose range in this T1D cohort. Reducing sleep timing variability could potentially lead to improved metabolic control and should be explored in future research. DATA AVAILABILITY STATEMENT Data are available upon a reasonable request to the corresponding author.
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Affiliation(s)
- Sirimon Reutrakul
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Illinois Chicago, Chicago, Illinois, USA.
| | - Ghada Abu Irsheed
- College of Nursing, Department of Biobehavioral Nursing Science, University of Illinois Chicago, Chicago, Illinois, USA
| | - Minsun Park
- College of Nursing, Department of Biobehavioral Nursing Science, University of Illinois Chicago, Chicago, Illinois, USA
| | - Alana D Steffen
- College of Nursing, Department of Population Health Nursing Science, University of Illinois Chicago, Chicago, Illinois, USA
| | - Larisa Burke
- Office of Research Facilitation, College of Nursing, University of Illinois Chicago, Chicago, Illinois, USA
| | - Sarida Pratuangtham
- Department of Bioengineering, University of California San Diego, San Diego, California, USA
| | - Kelly Glazer Baron
- Division of Public Health, Department of Family and Preventive Medicine, The University of Utah, Salt Lake City, Utah, USA
| | - Jennifer Duffecy
- Department of Psychiatry, College of Medicine, University of Illinois Chicago, Chicago, llinois, USA
| | - Rose Perez
- College of Nursing, Department of Biobehavioral Nursing Science, University of Illinois Chicago, Chicago, Illinois, USA
| | - Laurie Quinn
- College of Nursing, Department of Biobehavioral Nursing Science, University of Illinois Chicago, Chicago, Illinois, USA
| | - Margaret H Clark Withington
- College of Nursing, Department of Biobehavioral Nursing Science, University of Illinois Chicago, Chicago, Illinois, USA
| | - Adam Hussain Saleh
- College of Nursing, Department of Biobehavioral Nursing Science, University of Illinois Chicago, Chicago, Illinois, USA
| | - Bernardo Loiacono
- College of Nursing, Department of Biobehavioral Nursing Science, University of Illinois Chicago, Chicago, Illinois, USA
| | - Dan Mihailescu
- Division of Endocrinology, Cook County Health, Chicago, Illinois, USA
| | - Pamela Martyn-Nemeth
- College of Nursing, Department of Biobehavioral Nursing Science, University of Illinois Chicago, Chicago, Illinois, USA
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11
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Orbell SL, Scott PW, Baniak LM, Chasens ER, Godzik C, Jeon B, Morris JL, Luyster FS. Patient-level factors associated with the self-report of trouble sleeping to healthcare providers in adults at high risk for obstructive sleep apnea. Sleep Health 2023; 9:984-990. [PMID: 37821259 DOI: 10.1016/j.sleh.2023.08.007] [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: 02/23/2023] [Revised: 06/15/2023] [Accepted: 08/15/2023] [Indexed: 10/13/2023]
Abstract
INTRODUCTION In adults at risk for obstructive sleep apnea, it is unclear what patient-level factors and symptoms may influence communication with healthcare providers regarding sleep difficulties. This analysis examined associations between sociodemographic characteristics, comorbidities, and obstructive sleep apnea-related symptoms and whether adults at high risk for obstructive sleep apnea reported trouble sleeping to an healthcare provider. METHODS The sample included participants from the 2015-2018 National Health and Nutrition Examination Survey determined by a modified STOP-Bang to be at high risk for obstructive sleep apnea (n = 2009). Participants were asked if they had ever reported trouble sleeping to an healthcare provider. Self-reported comorbidities and obstructive sleep apnea-related symptoms (ie, snoring, snorting, gasping, or breathing cessation during sleep, daytime sleepiness, fatigue, insomnia, and nocturia) were assessed. RESULTS Half of the sample (50.8%) never reported trouble sleeping to an healthcare provider. Factors associated with an increased likelihood of reporting trouble sleeping included female sex, former smoker, and prediabetes or diabetes, obstructive lung disease, daytime sleepiness, insomnia, nocturia, and symptoms of snorting, gasping, and/or breathing cessation during sleep. Factors associated with a decreased likelihood of reporting trouble sleeping included Mexican American background or Asian race and having less than a high school education. CONCLUSION Differences in sex, race, education, comorbidities, and obstructive sleep apnea-related symptoms exist between adults at high risk for obstructive sleep apnea who have and have not reported trouble sleeping to an healthcare provider. It is important for healthcare providers to ask all adults about sleep problems, recognizing that men, minorities, and persons with lower educational attainment may be less likely to report trouble sleeping.
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Affiliation(s)
- Staci L Orbell
- Department of Health and Community Systems, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
| | - Paul W Scott
- Department of Health and Community Systems, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Lynn M Baniak
- Department of Health and Community Systems, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Veteran Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Eileen R Chasens
- Department of Health and Community Systems, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Cassandra Godzik
- Department of Psychiatry, Dartmouth College and Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Bomin Jeon
- College of Nursing, University of Iowa, Iowa City, Iowa, USA
| | - Jonna L Morris
- Department of Health and Community Systems, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Faith S Luyster
- Department of Health and Community Systems, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Veteran Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
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12
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Ozen V, Ozen N. Obstructive sleep apnea in surgical patients and its relationship with difficult intubation: two years of experience from a single center. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2023; 73:563-569. [PMID: 34560116 PMCID: PMC10533974 DOI: 10.1016/j.bjane.2021.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 08/10/2021] [Accepted: 08/28/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVES In this study, we aimed to determine the risk of obstructive sleep apnea (OSA) in patients undergoing elective surgery and its relationship with difficult intubation (DI). METHODS This prospective, descriptive, cross-sectional study was conducted between December 2018 and February 2020 in the anesthesiology and reanimation service of a training and research hospital. The study included patients who were ASA I...II, 18 years of age, and older who underwent elective surgery under general anesthesia. A form regarding the baseline characteristics of the participants as well as STOP-Bang score, Mallampati, and Cormack-Lehane classification was used to collect the data. RESULTS The study included 307 patients. It was determined that 64.2% of patients had a high risk of OSA. The presence of DI (determined by repeated attempts at intubation) was 28.6% in the high-risk OSA group, while there was no DI in the low-risk OSA group. A statistically significant difference was found between the groups in terms of OSA risk according to the presence of DI according to repeated attempts, Cormack-Lehane classification, and Mallampati classification (p...<...0.001). CONCLUSION Due to the high rate of DI in patients with a high risk of OSA, the security of the airway in these patients is endangered. Early clinical recognition of OSA can help in designing a safer care plan.
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Affiliation(s)
- Volkan Ozen
- Prof. Dr. Cemil Tascioglu City Hospital, Department of Anesthesiology and Reanimation, Istanbul, Turkey.
| | - Nurten Ozen
- Demiroglu Bilim University Florence Nightingale Hospital School of Nursing, Istanbul, Turkey.
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13
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Wang Y, Fietze I, Salanitro M, Penzel T. Comparison of the value of the STOP-BANG questionnaire with oxygen desaturation index in screening obstructive sleep apnea in Germany. Sleep Breath 2023; 27:1315-1323. [PMID: 36269514 PMCID: PMC10427704 DOI: 10.1007/s11325-022-02727-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 09/28/2022] [Accepted: 10/07/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE Despite polysomnography being the gold standard method of diagnosing obstructive sleep apnea (OSA), it is time-consuming and has long waiting lists. Alternative methods including questionnaires and portable sleep devices have been developed to increase the speed of diagnosis. However, most questionnaires such as the STOP-BANG questionnaire (SBQ) are limited due to low specificity. This study evaluated the value of SBQ to screen for OSA and compared it with the oxygen desaturation index (ODI) and their combination. METHODS This retrospective study included patients who completed the SBQ and underwent a night at the sleep lab or home sleep testing. The ODI was extracted from these sleep study reports. The combination of SBQ with ODI and their individual scores were compared with apnea-hypopnea index (AHI) in terms of their accuracy in diagnosing OSA. Sensitivity, specificity, and area under the curve (AUC) for different severities of OSA were calculated and compared. RESULTS Among 132 patients, SBQ showed a sensitivity of 0.9 and a specificity of 0.3 to screen for OSA. As the severity of OSA increased, the sensitivity increased whilst specificity decreased for both measurements. ODI achieved an increased specificity of 0.8 and could correctly diagnose OSA 86% of the time which was better than SBQ's 60%. For all severities of OSA, ODI alone displayed a larger AUC than SBQ and similar AUC to their combination. CONCLUSION ODI produced a higher specificity and AUC than SBQ. Furthermore, ODI combined with SBQ failed to increase diagnostic value. Therefore, ODI may be the preferred way to initially screen patients for OSA as an easy-to-use alternative compared to SBQ.
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Affiliation(s)
- Yan Wang
- Interdisciplinary Sleep Medicine Center, Charité–Universitätsmedizin Berlin, Luisenstrasse 13, 10117 Berlin, Germany
| | - Ingo Fietze
- Interdisciplinary Sleep Medicine Center, Charité–Universitätsmedizin Berlin, Luisenstrasse 13, 10117 Berlin, Germany
- The Federal State Autonomous Educational Institution of Higher Education, I.M Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Matthew Salanitro
- Interdisciplinary Sleep Medicine Center, Charité–Universitätsmedizin Berlin, Luisenstrasse 13, 10117 Berlin, Germany
| | - Thomas Penzel
- Interdisciplinary Sleep Medicine Center, Charité–Universitätsmedizin Berlin, Luisenstrasse 13, 10117 Berlin, Germany
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14
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Jagielski JT, Bibi N, Gay PC, Junna MR, Carvalho DZ, Williams JA, Morgenthaler TI. Evaluating an under-mattress sleep monitor compared to a peripheral arterial tonometry home sleep apnea test device in the diagnosis of obstructive sleep apnea. Sleep Breath 2023; 27:1433-1441. [PMID: 36441446 DOI: 10.1007/s11325-022-02751-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 11/07/2022] [Accepted: 11/17/2022] [Indexed: 11/29/2022]
Abstract
STUDY OBJECTIVES To evaluate whether or not the apnea-hypopnea index (AHI) from a peripheral arterial tonometry (PAT) home sleep apnea test (HSAT) is equivalent to the AHI provided by the mean of one, three, or seven nights from the Withings Sleep Analyzer (WSA) under-mattress device. METHODS We prospectively enrolled patients with suspected OSA in whom a PAT-HSAT was ordered. Eligible patients used the WSA for seven to nine nights. PAT data were scored using the device's intrinsic machine learning algorithms to arrive at the AHI using both 3% and 4% desaturation criteria for hypopnea estimations (PAT3%-AHI and PAT4%-AHI, respectively). These were then compared with the WSA-estimated AHI (WSA-AHI). RESULTS Of 61 patients enrolled, 35 completed the study with valid PAT and WSA data. Of the 35 completers 16 (46%) had at least moderately severe OSA (PAT3%-AHI ≥ 15). The seven-night mean WSA-AHI was 2.13 (95%CI = - 0.88, 5.14) less than the PAT3%-AHI, but 5.64 (95%CI = 2.54, 8.73) greater than the PAT4%-AHI. The accuracy and area under the receiver operating curve (AUC) using the PAT3%-AHI ≥ 15 were 77% and 0.87 and for PAT4%-AHI ≥ 15 were 77% and 0.85, respectively. The one-, three-, or seven-night WSA-AHI were not equivalent to either the 3% or 4% PAT-AHI (equivalency threshold of ± 2.5 using the two one-sided t-test method). CONCLUSIONS The WSA derives estimates of the AHI unobtrusively over many nights, which may prove to be a valuable clinical tool. However, the WSA-AHI over- or underestimates the PAT-AHI in clinical use, and the appropriate use of the WSA in clinical practice will require further evaluation. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04778748.
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Affiliation(s)
- Jack T Jagielski
- Neurology Clinical Research Unit, Mayo Clinic, Rochester, MN, USA
| | - Noor Bibi
- Neurology Clinical Research Unit, Mayo Clinic, Rochester, MN, USA
| | - Peter C Gay
- Center for Sleep Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Mithri R Junna
- Center for Sleep Medicine, Mayo Clinic, Rochester, MN, USA
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Diego Z Carvalho
- Center for Sleep Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Julie A Williams
- Center for Sleep Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Timothy I Morgenthaler
- Center for Sleep Medicine, Mayo Clinic, Rochester, MN, USA.
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA.
- Mayo Clinic Center for Sleep Medicine, 200 First Street SW, Rochester, MN, 55905, USA.
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15
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Ma X, Zhang C, Feng L, Shen Y, Ma J, Wang G. Modified STOP-bang questionnaire incorporating morning dry mouth and BMI adjustment in China: a retrospective study of 590 patients. Expert Rev Respir Med 2023; 17:1041-1048. [PMID: 38147000 DOI: 10.1080/17476348.2023.2292136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 12/04/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUND Morning dry mouth (MDM) is a common symptom of Obstructive Sleep Apnea (OSA) yet current OSA screening tools overlook it. OBJECTIVE To enhance the specificity of the Stop-Bang questionnaire (SBQ) by adding an MDM symptom. METHOD A retrospective analysis on 590 patients from Peking University First Hospital (2013-2018) suspected of OSA was conducted. They underwent polysomnography. The research incorporated the MDM symptom into SBQ and adjusted the body mass index (BMI) threshold to 28 kg/m2. Predictive parameters were then calculated. RESULTS 83.1% patients were diagnosed with OSA, with 61.4% reporting MDM. Multivariate regression confirmed MDM significantly influenced Apnea-Hypopnea Index (AHI). Adjusted SBQ with MDM showed a slight decrease in sensitivity but improved specificity, especially when using a BMI threshold of > 28 kg/m2. For AHI ≥ 5 events/h and AHI ≥ 15 events/h, adjusted SBQ with MDM (BMI >28 kg/m2) obtained the highest Youden index. CONCLUSION Incorporating the MDM symptom into SBQ and adjusting the BMI threshold enhances the diagnostic specificity for OSA.
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Affiliation(s)
| | | | - Liping Feng
- First Hospital, Department of Respiratory and Critical Care Medicine, Peking University, Beijing, China
| | - Yane Shen
- First Hospital, Department of Respiratory and Critical Care Medicine, Peking University, Beijing, China
| | - Jing Ma
- First Hospital, Department of Respiratory and Critical Care Medicine, Peking University, Beijing, China
| | - Guangfa Wang
- First Hospital, Department of Respiratory and Critical Care Medicine, Peking University, Beijing, China
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16
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Dai Y, Wu Z, Zhang X, Cai Y, Ji S, Lin J, Li L, Lin Y, Guo P, Cai F, Hou X, Zhang J. STOP-Bang Questionnaire Is Associated With Aortic Remodeling in Patients With Acute Type B Aortic Dissection Undergoing Standard Thoracic Endovascular Aortic Repair. J Endovasc Ther 2023:15266028231179425. [PMID: 37300399 DOI: 10.1177/15266028231179425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE To determine whether the STOP-Bang questionnaire, which is a tool for evaluating obstructive sleep apnea, is associated with aortic remodeling after thoracic endovascular aortic repair (TEVAR) in patients with type B aortic dissection (TBAD). METHODS Patients with TBAD who underwent standard TEVAR at our center from January 2015 to December 2020 were enrolled. For the included patients, we recorded baseline characteristics, comorbidities, preoperative computed tomographic angiography findings, procedure details, and complications. The STOP-Bang questionnaire was administered to each patient. Total scores comprised points for 4 yes/no questions and 4 clinical measurements. STOP-Bang ≥5 and STOP-Bang <5 groups were then created using the STOP-Bang total scores. We evaluated aortic remodeling 1 year after discharge and the reintervention rate, as well as false lumen complete thrombosis (FLCT) and non-FLCT length. RESULTS Fifty-five patients were enrolled in the study; STOP-Bang <5, n=36, and STOP-Bang ≥5, n=19. Compared with the STOP-Bang ≥5 group, the STOP-Bang <5 group achieved statistically significantly higher descending aorta positive aortic remodeling (PAR) rates in zones 3 to 5 (zone 3: p=0.002; zone 4: p=0.039; zone 5: p=0.023), higher total descending aorta-PAR rate (66.7% vs 36.8%, respectively; p=0.004), and lower reintervention rate (8.1% vs 38.9%, respectively; p=0.005). In the logistic regression analysis, STOP-Bang ≥5 had an odds ratio of 0.12 (95% confidence interval: 0.03-0.58; p=0.008). There was no significant difference in overall survival between the groups. CONCLUSION STOP-Bang questionnaire scores were associated with aortic remodeling after TEVAR in patients with TBAD. Increasing the frequency of surveillance after TEVAR might be beneficial in these patients. CLINICAL IMPACT We analysed aortic remodelling 1 year after thoracic endovascular aortic repair (TEVAR) in acute type B aortic dissection (TBAD) patients with STOP-Bang < 5 and STOP-Bang ≥ 5. Aortic remodelling was better, and the reintervention rate was higher in patients with STOP-Bang < 5 compared with patients with STOP-Bang ≥ 5. In patients with STOP-Bang ≥ 5, aortic remodelling was worse in zones 3-5 compared with zones 6-9. This study suggests that the STOP-Bang questionnaire results is associated with aortic remodelling after TEVAR in patients with TBAD.
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Affiliation(s)
- Yiquan Dai
- Departments of Vascular and Endovascular Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Vascular Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Zhiye Wu
- Departments of Vascular and Endovascular Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Xunliang Zhang
- Departments of Vascular and Endovascular Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Yihang Cai
- Departments of Vascular and Endovascular Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Shiping Ji
- Departments of Vascular and Endovascular Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Vascular Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Jie Lin
- Departments of Vascular and Endovascular Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Vascular Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Luyao Li
- Departments of Vascular and Endovascular Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Yichen Lin
- Departments of Vascular and Endovascular Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Vascular Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Pingfan Guo
- Departments of Vascular and Endovascular Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Vascular Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Fanggang Cai
- Departments of Vascular and Endovascular Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Vascular Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Xinhuang Hou
- Departments of Vascular and Endovascular Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Vascular Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Jinchi Zhang
- Departments of Vascular and Endovascular Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Vascular Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
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Jang YS, Nerobkova N, Hurh K, Park EC, Shin J. Association between smoking and obstructive sleep apnea based on the STOP-Bang index. Sci Rep 2023; 13:9085. [PMID: 37277416 DOI: 10.1038/s41598-023-34956-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 05/10/2023] [Indexed: 06/07/2023] Open
Abstract
Smoking is a risk factor for respiratory diseases, and it worsens sleep quality due to nicotine stimulation and sudden nicotine withdrawal during sleep. This can increase the severity of OSA through alterations upper airway inflammation and neuromuscular function, arousal mechanisms, and sleep architecture. Therefore, it may lead to sleep-disrupted breathing, particularly obstructive sleep apnea (OSA). Herein, this study aims to research the association between smoking and OSA through the STOP-Bang index. In this study, total sample of 3442 participants (1465 men and 1977 women) were analyzed. We used data from the Korea National Health and Nutrition Examination Survey in 2020 by classifying adults into current, ex-, and non-smokers. A multiple logistic regression analysis was used to investigate the association between smoking and OSA. Furthermore, multinomial regression analysis was used to investigate the effect of smoking cessation. For males, compared to the non-smokers, the odds ratios (OR) for the OSA were significantly higher in the ex-smokers (OR: 1.53, 95% confidence interval(CI) 1.01-2.32) and current smokers (OR: 1.79, 95% CI 1.10-2.89). In females, higher ORs were observed for OSA risk, similar to the non-smokers, smoking cessation, and pack-years. Among men, OSA was significantly associated with a moderate risk for ex-smokers (OR: 1.61, 95% CI 1.05-2.48) and a severe risk for current smokers (OR: 1.88, 95% CI 1.07-3.29). This study observed that smoking might contribute to OSA risk among adults. Smoking cessation can help to manage sleep quality properly.
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Affiliation(s)
- Yun Seo Jang
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
- Institute of Health Services Research, Yonsei University, 50 Yonsei-to, Seodaemun-Gu, Seoul, 03722, Republic of Korea
| | - Nataliya Nerobkova
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
- Institute of Health Services Research, Yonsei University, 50 Yonsei-to, Seodaemun-Gu, Seoul, 03722, Republic of Korea
| | - Kyungduk Hurh
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
- Institute of Health Services Research, Yonsei University, 50 Yonsei-to, Seodaemun-Gu, Seoul, 03722, Republic of Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University, 50 Yonsei-to, Seodaemun-Gu, Seoul, 03722, Republic of Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jaeyong Shin
- Institute of Health Services Research, Yonsei University, 50 Yonsei-to, Seodaemun-Gu, Seoul, 03722, Republic of Korea.
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
- Department of Policy Analysis and Management, College of Human Ecology, Cornell University, Ithaca, NY, USA.
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18
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Katz P, Pedro S, Michaud K. Sleep Disorders Among Individuals With Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2023; 75:1250-1260. [PMID: 35997482 DOI: 10.1002/acr.24999] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/03/2022] [Accepted: 08/16/2022] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Self-reported sleep problems are common in rheumatoid arthritis (RA), with potential negative health implications, yet relatively little research has focused on sleep in RA. We examined the prevalence of obstructive sleep apnea (OSA) risk, restless legs syndrome (RLS) symptoms, and short sleep (SS) in a large RA cohort (n = 4,200) and factors associated with each. METHODS Data are from FORWARD, The National Databank for Rheumatic Diseases. Validated screening measures assessed OSA risk and RLS symptoms. SS was based on self-reported average sleep time (<6 hours). The Medical Outcomes Study Sleep Problems Index I measured self-reported sleep quality. Multivariable logistic regression models identified independent predictors of sleep disorders and sleep quality and the independent association of OSA risk, RLS symptoms, and SS with self-reported poor sleep quality. RESULTS Twenty-one percent (n = 899) had OSA diagnosis or risk, 30% (n = 1,272) had RLS symptoms or diagnosis, and 43% (n = 1,737) reported SS, and RA disease activity was associated with each sleep disorder. Abatacept use was associated with lower odds of RLS and SS. Use of conventional disease-modifying antirheumatic drugs or abatacept was less frequent in the SS group. No medications were associated with OSA in multivariable analyses. Both RLS and SS was associated with worse perceived sleep quality. DISCUSSION Almost two-thirds met criteria for at least one sleep disorder. RA disease activity and pain were significantly associated with each sleep condition. Additional research is needed to identify the causal pathway between sleep disorders and RA disease activity and pain and the long-term consequences of sleep disorders in RA.
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Affiliation(s)
| | - Sofia Pedro
- FORWARD, The National Databank for Rheumatic Diseases, Wichita, Kansas
| | - Kaleb Michaud
- FORWARD, The National Databank for Rheumatic Diseases, Wichita, Kansas, and University of Nebraska Medical Center, Omaha
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19
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Fang WY, Rama Raj P, Wu Z, Abbott C, Luu CD, Naughton M, Guymer RH. Role of sleep-disordered breathing in age-related macular degeneration. BMJ Open Ophthalmol 2023; 8:bmjophth-2022-001203. [PMID: 37278414 DOI: 10.1136/bmjophth-2022-001203] [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: 11/07/2022] [Accepted: 04/26/2023] [Indexed: 06/07/2023] Open
Abstract
AIMS To examine the association between obstructive sleep apnoea (OSA) and age-related macular degeneration (AMD), and the subphenotype of AMD with reticular pseudodrusen (RPD). METHODS Case-control study with 351 participants (211 AMD and 140 controls) using the Epworth Sleepiness Scale (ESS) and the STOP-BANG Questionnaire (SBQ) validated sleep questionnaires. Participant risk of having moderate-to-severe OSA was determined using a binary risk scale based on the ESS and SBQ combined and an ordinal risk scale based on the SBQ. A prior diagnosis of OSA and whether receiving assisted breathing treatment was also ascertained. Retinal imaging allowed AMD and RPD determination. RESULTS Higher risk of moderate-to-severe OSA according to the binary and ordinal scales was not associated with the presence of AMD (p≥0.519) nor AMD with RPD (p≥0.551). Per point increase in ESS or SBQ questionnaire score was also not associated with AMD nor AMD with RPD (p≥0.252). However, being on assisted breathing treatment for diagnosed OSA was significantly associated with a higher likelihood of having AMD with RPD, but not all AMD, (OR 3.70; p=0.042 and OR 2.70; p=0.149, respectively), when compared with those without diagnosed OSA on treatment. CONCLUSIONS Formally diagnosed OSA undergoing treatment, increased the likelihood of having AMD with RPD, but not overall AMD compared with those who were not undergoing treatment. Risk-based OSA questionnaires showed no difference in risk for all AMD or AMD with RPD. Future research, using formal sleep studies could further explore the potential role of nocturnal hypoxia in AMD.
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Affiliation(s)
- Wendy Ying Fang
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
- Department of Surgery (Ophthalmology), The University of Melbourne, Melbourne, Victoria, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Palaniraj Rama Raj
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
- Discipline of Clinical Ophthalmology and Eye Health/Save Sight Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Zhichao Wu
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
- Department of Surgery (Ophthalmology), The University of Melbourne, Melbourne, Victoria, Australia
| | - Carla Abbott
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
- Department of Surgery (Ophthalmology), The University of Melbourne, Melbourne, Victoria, Australia
| | - Chi D Luu
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
- Department of Surgery (Ophthalmology), The University of Melbourne, Melbourne, Victoria, Australia
| | - Matthew Naughton
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
- Department of Respiratory and Sleep Medicine, Alfred Hospital, Melbourne, Victoria, Australia
| | - Robyn H Guymer
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
- Department of Surgery (Ophthalmology), The University of Melbourne, Melbourne, Victoria, Australia
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20
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Nair AS, Vaze V, Vaid N. Comparative Study of Subjective and Objective Analysis in Diagnosis of Obstructive Sleep Apnea. Indian J Otolaryngol Head Neck Surg 2023; 75:715-722. [PMID: 37206851 PMCID: PMC10188680 DOI: 10.1007/s12070-022-03264-1] [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: 06/24/2022] [Accepted: 10/23/2022] [Indexed: 11/15/2022] Open
Abstract
The gold standard for diagnosis of Obstructive sleep apnea (OSA) is an overnight polysomnography (PSG). However, PSG is time consuming, labour intensive and expensive. In our country PSG is not available everywhere. Therefore, a simple and reliable method of identifying patients of OSA is important for its prompt diagnosis and treatment. This study looks at the efficacy of three questionnaires to serve as a screening test for the diagnosis of OSA in the Indian population. For the first time in India, a prospective study was conducted wherein patients with history of OSA underwent PSG and were asked to fill three questionnaires-Epworth Sleepiness Score (ESS), Berlin Questionnaire (BQ) and Stop Bang Questionnaire (SBQ). The scoring of these questionnaires were compared with the PSG results. SBQ had a high negative predictive value (NPV) and the probability of moderate and severe OSA steadily increases with higher SBQ scores. In comparison, ESS and BQ had low NPV. SBQ is a useful clinical tool to identify patients at high risk of OSA and can facilitate in the diagnosis of unrecognised OSA.
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Affiliation(s)
- Aathira S. Nair
- ENT Department, KEM Hospital, Pune, Maharashtra India
- Navi Mumbai, India
| | - Varada Vaze
- ENT Department, KEM Hospital, Pune, Maharashtra India
| | - Neelam Vaid
- ENT Department, KEM Hospital, Pune, Maharashtra India
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21
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Braley TJ, Shieu MM, Zaheed AB, Dunietz GL. Pathways between multiple sclerosis, sleep disorders, and cognitive function: Longitudinal findings from The Nurses' Health Study. Mult Scler 2023; 29:436-446. [PMID: 36633265 PMCID: PMC9991978 DOI: 10.1177/13524585221144215] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND The potential mediating and moderating effects of sleep disorders on cognitive outcomes in multiple sclerosis (MS) have been insufficiently studied. OBJECTIVES To determine direct and indirect longitudinal associations between sleep disorders and perceived cognitive dysfunction in women with MS. METHODS The 2013 and 2017 waves of the Nurses' Health Study (n = 63,866) were utilized. All diagnoses and symptoms including MS (n = 524) were self-reported. Subjective cognitive function was measured using a composite score of four memory items and three binary outcomes that assessed difficulty following instructions, conversations/plots, and street navigation. Moderating and mediating effects of diagnosed/suspected obstructive sleep apnea (OSA), sleepiness, and insomnia between MS and cognition were estimated using the four-way decomposition method. RESULTS Prevalence of diagnosed/suspected OSA, sleepiness, and insomnia in 2013 were higher for nurses with MS (NwMS). NwMS were more likely to report cognitive difficulties in 2017. Insomnia mediated 5.4%-15.1% of the total effect between MS and following instructions, conversations/plots, and memory impairment, while sleepiness mediated 8.6%-12.3% of the total effect for these outcomes. In interaction analyses, OSA significantly accounted for 34% of the total effect between MS and following instructions. CONCLUSION Prevalent OSA, insomnia, and sleepiness could differentially moderate or mediate the effect of MS on cognition in women with MS.
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Affiliation(s)
- Tiffany J Braley
- Division of Multiple Sclerosis and Clinical Neuroimmunology, Department of Neurology, University of Michigan, Ann Arbor, MI, USA/Division of Sleep Medicine, Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Monica M Shieu
- Division of Sleep Medicine, Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Afsara B Zaheed
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Galit Levi Dunietz
- Division of Sleep Medicine, Department of Neurology, University of Michigan, Ann Arbor, MI, USA
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22
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Ariza-Serrano J, Santana-Vargas D, Millan-Rosas G, Santana-Miranda R, Rosenthal L, Poblano A. Parasomnias related to shift work disorder among medical residents during the first year of training in Mexico. Sleep Biol Rhythms 2023; 21:105-111. [PMID: 38468903 PMCID: PMC10899934 DOI: 10.1007/s41105-022-00422-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/18/2022] [Indexed: 11/29/2022]
Abstract
Shift work disorder (SWD) may affect medical residents because their workload, academic demands and extended work hours. This condition set residents at risk of more sleep disorders. The study compared parasomnias among residents with and without shift work disorder (SWD) and weighed their relative risk (RR) for each parasomnia. One hundred twenty-six residents participated in the study. The Munich Parasomnia Screening questionnaire and the Barger Questionnaire for SWD were used for the screening of parasomnias and SWD, respectively. Means and percentages of studied variables were compared between groups. Relative risk (RR) was calculated for each type of parasomnia. The more frequent parasomnias in residents with SWD the RR (and 95% confidence intervals) were: sleep terrors, 5.60 (1.84-17.01); confusional arousals, 3.73 (1.84-7.56); sleep paralysis, 3.27 (1.53-6.93); hypnagogic/hypnopompic hallucinations, 2.55 (1.03-6.28); somniloquies, 2.45 (1.21-4.92); and nightmares, 2.01 (1.54-2.62). Our data suggest that residents who experience SWD may be at risk of having lower threshold for the occurrence of rapid eye movement (REM) and non-REM (NREM) sleep parasomnias. Additional research is needed to confirm these results, and to further identify the contribution to this association.
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Affiliation(s)
- Jaime Ariza-Serrano
- Clinic of Sleep Disorders at General Hospital of Mexico, National University of Mexico (UNAM), Dr. Balmis 146, Col. Doctores, Cuauhtémoc, 06726 Mexico City, Mexico
- Clinic of Sleep Disorders Somnos, Bogotá, Colombia
| | - Daniel Santana-Vargas
- Clinic of Sleep Disorders at General Hospital of Mexico, National University of Mexico (UNAM), Dr. Balmis 146, Col. Doctores, Cuauhtémoc, 06726 Mexico City, Mexico
- Department of Research, General Hospital of Mexico, Mexico City, Mexico
| | - Gabriela Millan-Rosas
- Clinic of Sleep Disorders at General Hospital of Mexico, National University of Mexico (UNAM), Dr. Balmis 146, Col. Doctores, Cuauhtémoc, 06726 Mexico City, Mexico
| | - Rafael Santana-Miranda
- Clinic of Sleep Disorders at General Hospital of Mexico, National University of Mexico (UNAM), Dr. Balmis 146, Col. Doctores, Cuauhtémoc, 06726 Mexico City, Mexico
| | | | - Adrián Poblano
- Clinic of Sleep Disorders at General Hospital of Mexico, National University of Mexico (UNAM), Dr. Balmis 146, Col. Doctores, Cuauhtémoc, 06726 Mexico City, Mexico
- Laboratory of Cognitive Neurophysiology, National Institute of Rehabilitation, Mexico City, Mexico
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23
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Iwasaki Y. Mechanism and management of atrial fibrillation in the patients with obstructive sleep apnea. J Arrhythm 2022; 38:974-980. [PMID: 36524043 PMCID: PMC9745489 DOI: 10.1002/joa3.12784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 09/10/2022] [Accepted: 09/16/2022] [Indexed: 11/10/2022] Open
Abstract
Obstructive sleep apnea (OSA) is a highly prevalent disorder in patients with atrial fibrillation (AF). Although there has been an increase in the incidence of AF due to the aging population, it has been reported that OSA is still underdiagnosed because many patients remain asymptomatic or unaware of the symptoms associated with OSA, such as daytime sleepiness. Untreated OSA reduces the effectiveness of AF treatment, regardless of pharmacological or non-pharmacological modes of therapy, such as catheter ablation. Experimental and clinical studies have shown that OSA pathophysiology is multifactorial, comprising of hypoxemia, hypercapnia, autonomic dysfunction, negative intrathoracic pressure changes, and arousals of OSA, and lead to AF. Both the acute and long-term effects of obstructive apnea episodes are involved in the development of an arrhythmogenic substrate of AF. Undiagnosed OSA causes underutilized opportunities for more effective AF management. Therefore, it is important to screen for OSA in all patients being considered for rhythm control therapy. However, regardless of the growing evidence of the negative prognostic impact of OSA, there is a lack of awareness regarding this connection not only among patients but also among cardiologists and arrhythmia specialists. There is a barrier to performing a systemic screening for OSA in clinical practice. Therefore, it is important to establish a comprehensive OSA care team for the efficient diagnosis and treatment of OSA. This review provides the current understanding of OSA and its relationship to AF and the importance of the diagnosis and management of OSA in AF.
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Affiliation(s)
- Yu‐ki Iwasaki
- Department of Cardiovascular MedicineNippon Medical SchoolTokyoJapan
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24
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Chiu HY, Chou KT, Su KC, Lin FC, Liu YY, Shiao TH, Chen YM. Obstructive sleep apnea in young Asian adults with sleep-related complaints. Sci Rep 2022; 12:20582. [PMID: 36447027 PMCID: PMC9708676 DOI: 10.1038/s41598-022-25183-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/25/2022] [Indexed: 12/03/2022] Open
Abstract
This study aimed to investigate the proportion of young OSA adults with sleep-related complaints in a sleep center, affiliated with a tertiary medical center for over a decade. This study presents a chronicle change in the numbers of young adults receiving polysomnography (PSG) and young patients with OSA from 2000 to 2017. We further analyzed 371 young patients with OSA among 2378 patients receiving PSG in our sleep center from 2016 to 2017 to capture their characteristics. Young adults constituted a substantial and relatively steady portion of examinees of PSG (25.1% ± 2.8%) and confirmed OSA cases (19.8 ± 2.4%) even though the total numbers increased with the years. Young adults with OSA tend to be sleepier, have a greater body mass index, and have a higher percentage of cigarette smoking and alcohol consumption. They also complained more about snoring and daytime sleepiness. They had a higher apnea-hypopnea index on average and experienced more hypoxemia during their sleep, both in terms of duration and the extent of desaturation. Even though the prevalence of comorbidities increased with age, hypertension in young male adults carried higher risks for OSA. Young adults with OSA have constituted a relatively constant portion of all confirmed OSA cases across time. The young adults with OSA were heavier, more symptomatic, and with more severe severity.Clinical trial: The Institutional Review Board of Taipei Veterans General Hospital approved the study (VGHIRB No. 2018-10-002CC). The study is registered with ClinicalTrials.gov, number NCT03885440.
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Affiliation(s)
- Hwa-Yen Chiu
- grid.278247.c0000 0004 0604 5314Center of Sleep Medicine, Taipei Veterans General Hospital, 14F, No. 201, Sec. 2, Shih-Pai Road, Taipei, 112 Taiwan ,grid.278247.c0000 0004 0604 5314Division of Clinical Respiratory Physiology, Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan ,grid.278247.c0000 0004 0604 5314Department of Internal Medicine, Taipei Veterans General Hospital Hsinchu Branch, Zhudong, Hsinchu County Taiwan ,grid.260539.b0000 0001 2059 7017Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan ,grid.260539.b0000 0001 2059 7017Institute of Biophotonics, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Kun-Ta Chou
- grid.278247.c0000 0004 0604 5314Center of Sleep Medicine, Taipei Veterans General Hospital, 14F, No. 201, Sec. 2, Shih-Pai Road, Taipei, 112 Taiwan ,grid.278247.c0000 0004 0604 5314Division of Clinical Respiratory Physiology, Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan ,grid.260539.b0000 0001 2059 7017Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Kang-Cheng Su
- grid.278247.c0000 0004 0604 5314Center of Sleep Medicine, Taipei Veterans General Hospital, 14F, No. 201, Sec. 2, Shih-Pai Road, Taipei, 112 Taiwan ,grid.278247.c0000 0004 0604 5314Division of Clinical Respiratory Physiology, Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan ,grid.260539.b0000 0001 2059 7017Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Fang-Chi Lin
- grid.278247.c0000 0004 0604 5314Center of Sleep Medicine, Taipei Veterans General Hospital, 14F, No. 201, Sec. 2, Shih-Pai Road, Taipei, 112 Taiwan ,grid.278247.c0000 0004 0604 5314Division of Clinical Respiratory Physiology, Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan ,grid.260539.b0000 0001 2059 7017Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yung-Yang Liu
- grid.278247.c0000 0004 0604 5314Center of Sleep Medicine, Taipei Veterans General Hospital, 14F, No. 201, Sec. 2, Shih-Pai Road, Taipei, 112 Taiwan ,grid.278247.c0000 0004 0604 5314Division of Clinical Respiratory Physiology, Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan ,grid.260539.b0000 0001 2059 7017Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tsu-Hui Shiao
- grid.278247.c0000 0004 0604 5314Center of Sleep Medicine, Taipei Veterans General Hospital, 14F, No. 201, Sec. 2, Shih-Pai Road, Taipei, 112 Taiwan ,grid.278247.c0000 0004 0604 5314Division of Clinical Respiratory Physiology, Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan ,grid.260539.b0000 0001 2059 7017Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yuh-Min Chen
- grid.278247.c0000 0004 0604 5314Center of Sleep Medicine, Taipei Veterans General Hospital, 14F, No. 201, Sec. 2, Shih-Pai Road, Taipei, 112 Taiwan ,grid.260539.b0000 0001 2059 7017Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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25
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Wang L, Zhao W, Liang C, Yan X, Zhang H, Dai H, Yu H, Zhang H, An H, Zhao Y. Accuracy and modification of the
STOP
‐bang questionnaire for screening patients with obstructive sleep apnea in China. J Sleep Res 2022; 32:e13781. [PMID: 36372957 DOI: 10.1111/jsr.13781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 10/21/2022] [Accepted: 10/24/2022] [Indexed: 11/16/2022]
Abstract
Despite the high sensitivity of the STOP-Bang questionnaire [snoring, tiredness, observed apneas, high blood pressure, body mass index, age, neck size, gender] questionnaire (SBQ), which is widely used to screen individuals at high risk of obstructive sleep apnea (OSA), few studies have evaluated the discrimination related to sex in the SBQ. Therefore, our study aimed to assess whether SBQ performance is gender-related and modified by changing body mass index (BMI) and neck circumference (NC) cut-off values. A total of 470 patients attended the sleep centres. They were divided into moderate-to-severe OSA and non-moderate-to-severe OSA groups based on the apnea-hypopnea index (AHI) and the results of the SBQ screening. The predictive performance of the SBQ screening instrument was evaluated by 2 × 2 contingency tables and discriminatory ability, which was estimated from the area under the curve (AUC) obtained from receiver operating characteristic curve. Our results suggest that when screening for moderate-to-severe OSA, the original SBQ has higher sensitivity and lower specificity for men; however, women have higher specificity and lower sensitivity. The SBQ achieved the maximum AUC of 0.783 for men and 0.634 for women when the BMI cut-off value was established at 30 kg/m2 and the NC cut-off value was established at 38 cm in men, and the BMI cut-off value was established at 25 kg/m2 and the NC cut-off value at 36 cm in women. Balancing the optimal sensitivity and specificity, the cut-off value of the optimal modified SBQ total scores for men was determined to be ≥4 and ≥3 for women.
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Affiliation(s)
- Liying Wang
- Department of Nursing Jinzhou Medical University Jinzhou China
| | - Weilan Zhao
- Department of Nursing Jinzhou Medical University Jinzhou China
| | - Chunguang Liang
- Department of Nursing Jinzhou Medical University Jinzhou China
| | - Xiangru Yan
- Department of Nursing Jinzhou Medical University Jinzhou China
| | - Huiying Zhang
- Sleep Monitoring Center The First Hospital of Jinzhou Medical University Jinzhou China
| | - Hongliang Dai
- Department of Nursing Jinzhou Medical University Jinzhou China
| | - Haitao Yu
- Department of Nursing Jinzhou Medical University Jinzhou China
| | - Hui Zhang
- Department of Nursing Jinzhou Medical University Jinzhou China
| | - Hui An
- Sleep Monitoring Center The First Hospital of Jinzhou Medical University Jinzhou China
| | - Ying Zhao
- Department of Nursing Jinzhou Medical University Jinzhou China
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26
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Obesity in Primary Care: A Case of Endocrine-Associated Conditions. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2022.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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27
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De Camilli AR, Cadwell JB, Weiss H, Tollinche LE, McFarlane D, Broach V, Leitao MM, Kitzler R, Afonso AM. Perioperative considerations for cancer patients with obesity: A narrative review. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2022; 46:33-41. [PMID: 38741664 PMCID: PMC11090210 DOI: 10.1016/j.tacc.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Cancer in patients with obesity has become increasingly common throughout much of the world. Based on our experiences in a specialized cancer center, we have developed a set of standards and expectations that should streamline the surgical journey for this patient population. These recommendations should inform the perioperative management of oncology patients with obesity and help raise awareness of this critical and under-discussed topic.
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Affiliation(s)
- Alessandro R. De Camilli
- Department of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medicine, New York, NY, USA
| | - Joshua B. Cadwell
- Department of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hallie Weiss
- Department of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medicine, New York, NY, USA
| | - Luis E. Tollinche
- Department of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medicine, New York, NY, USA
| | - Dianne McFarlane
- Perioperative Nursing, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Vance Broach
- Weill Cornell Medicine, New York, NY, USA
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mario M. Leitao
- Weill Cornell Medicine, New York, NY, USA
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Robina Kitzler
- Clinical Nursing, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anoushka M. Afonso
- Department of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medicine, New York, NY, USA
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28
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Varbanova M, Maggard B, Lenhardt R. Preoperative preparation and premedication of bariatric surgical patient. Saudi J Anaesth 2022; 16:287-298. [PMID: 35898527 PMCID: PMC9311181 DOI: 10.4103/sja.sja_140_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 02/13/2022] [Indexed: 12/02/2022] Open
Abstract
The prevalence of obesity has tripled worldwide over the past four decades. The United States has the highest rates of obesity, with 88% of the population being overweight and 36% obese. The UK has the sixth highest prevalence of obesity. The problem of obesity is not isolated to the developed world and has increasingly become an issue in the developing world as well. Obesity carries an increased risk of many serious diseases and health conditions, including type 2 diabetes, heart disease, stroke, sleep apnea, and certain cancers. Our ability to take care of this population safely throughout the perioperative period begins with a thorough and in-depth preoperative assessment and meticulous preparation. The preoperative assessment begins with being able to identify patients who suffer from obesity by using diagnostic criteria and, furthermore, being able to identify patients whose obesity is causing pathologic and physiologic changes. A detailed and thorough anesthesia assessment should be performed, and the anesthesia plan individualized and tailored to the specific patient's risk factors and comorbidities. The important components of the preoperative anesthesia assessment and patient preparation in the patient suffering from obesity include history and physical examination, airway assessment, medical comorbidities evaluation, functional status determination, risk assessment, preoperative testing, current weight loss medication, and review of any prior weight loss surgeries and their implications on the upcoming anesthetic. The preoperative evaluation of this population should occur with sufficient time before the planned operation to allow for modifications of the preoperative management without needing to delay surgery as the perioperative management of patients suffering from obesity presents significant practical and organizational challenges.
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Affiliation(s)
- Marina Varbanova
- Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, Kentucky, United States
| | - Brittany Maggard
- Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, Kentucky, United States
| | - Rainer Lenhardt
- Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, Kentucky, United States
- International Society for the Care of the Obese Patient, University of Louisville, Louisville, Kentucky, United States
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29
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de Heide J, Kock-Cordeiro DB, Bhagwandien RE, Hoogendijk MG, van der Meer KC, Wijchers SA, Szili-Torok T, Zijlstra F, Lenzen MJ, Yap SC. Impact of undiagnosed obstructive sleep apnea on atrial fibrillation recurrence following catheter ablation (OSA-AF study). IJC HEART & VASCULATURE 2022; 40:101014. [PMID: 35663451 PMCID: PMC9157450 DOI: 10.1016/j.ijcha.2022.101014] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/15/2022] [Accepted: 03/20/2022] [Indexed: 12/14/2022]
Abstract
Background Sleep-disordered breathing (SDB) may hamper the outcome of catheter ablation of atrial fibrillation (AF). However, SDB is underdiagnosed in clinical practice and the relevancy of undiagnosed SDB on the outcome of catheter ablation is unclear. Objective To evaluate if undiagnosed SDB has an impact on AF recurrence after catheter ablation. Methods In this single-center cohort study we enrolled patients who had a catheter ablation of AF 12 to 18 months prior to enrolment. Patients with diagnosed SDB at the time of catheter ablation were excluded. Enrolled patients underwent screening using WatchPAT (WP). SDB was defined as an apnea-hypopnea index (AHI) ≥ 15. Results A total of 164 patients were screened for eligibility. After exclusion of patients with previously diagnosed SDB (n = 30), 104 of 134 eligible patients were enrolled and underwent SDB screening. The median AHI was 11.5 (interquartile range 6.8-21.9) and 39 patients (38%) had SDB which was undiagnosed during the first year after ablation. AF recurrence in the first year after catheter ablation occurred in 40 patients (38%). The risk of AF recurrence was higher in the group with undiagnosed SDB in comparison to those without SDB (51% versus 31%, P = 0.04). Interestingly, the prevalence of AF recurrence was similar between patients with previously diagnosed and undiagnosed SDB (51% versus 50%, P = 0.92). Conclusion A significant proportion of patients undergoing catheter ablation of AF have undiagnosed SDB which is associated with a twofold higher risk of AF recurrence. SDB screening may improve patient counselling regarding the efficacy of catheter ablation.
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Affiliation(s)
- John de Heide
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Danielle B.M. Kock-Cordeiro
- Department of Intensive Care/Home Mechanical Ventilation and Pulmonology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Rohit E. Bhagwandien
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Mark G. Hoogendijk
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Koen C. van der Meer
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Sip A. Wijchers
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Tamas Szili-Torok
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Felix Zijlstra
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Mattie J. Lenzen
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Sing-Chien Yap
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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Henríquez-Beltrán M, Labarca G, Cigarroa I, Enos D, Lastra J, Nova-Lamperti E, Targa A, Barbe F. Sleep health and the circadian rest-activity pattern four months after COVID-19. JORNAL BRASILEIRO DE PNEUMOLOGIA : PUBLICACAO OFICIAL DA SOCIEDADE BRASILEIRA DE PNEUMOLOGIA E TISILOGIA 2022; 48:e20210398. [PMID: 35508066 PMCID: PMC9064633 DOI: 10.36416/1806-3756/e20210398] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 02/19/2022] [Indexed: 01/02/2023]
Abstract
Objective: To describe the prevalence and severity of sleep disorders and circadian alterations in COVID-19 patients four months after the acute phase of the disease. Methods: This was a cross-sectional observational prospective study of patients with mild COVID-19, moderate COVID-19 (requiring hospitalization but no mechanical ventilation), or severe COVID-19 (with ARDS) four months after the acute phase of the disease. All patients underwent a home sleep apnea test and seven-day wrist actigraphy, as well as completing questionnaires to assess sleep quality and mental health. Differences among the three groups of patients were evaluated by ANOVA and the chi-square test. Results: A total of 60 patients were included in the study. Of those, 17 were in the mild COVID-19 group, 18 were in the moderate COVID-19 group, and 25 were in the severe COVID-19 group. Sleep quality, as assessed by satisfaction, alertness, timing, efficiency, and duration scale scores, was found to be impaired in all three groups, which also had a high prevalence of unhealthy sleep, as assessed by the Pittsburgh Sleep Quality Index. The prevalence of insomnia was increased in all three groups, as assessed by the Insomnia Severity Index. The home sleep apnea test showed that the overall prevalence of obstructive sleep apnea was 60%, and seven-day wrist actigraphy showed that total sleep time was < 7 h in all three groups. Changes in quality of life and in the circadian rest-activity pattern were observed in all three groups. Conclusions: Sleep-related symptoms, changes in the circadian rest-activity pattern, and impaired mental health appear to be common in COVID-19 patients four months after the acute phase of the disease, severe COVID-19 being associated with a higher prevalence of obstructive sleep apnea.
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Affiliation(s)
| | - Gonzalo Labarca
- . Laboratorio de Inmunología Traslacional, Departamento de Bioquímica Clínica e Inmunología, Facultad de Farmacia, Universidad de Concepción, Concepción, Chile.,. Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston (MA) USA
| | - Igor Cigarroa
- . Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Chile
| | - Daniel Enos
- . Facultad de Medicina, Universidad de Concepción, Concepción, Chile
| | - Jaime Lastra
- . Facultad de Medicina, Universidad de Concepción, Concepción, Chile
| | - Estefania Nova-Lamperti
- . Laboratorio de Inmunología Traslacional, Departamento de Bioquímica Clínica e Inmunología, Facultad de Farmacia, Universidad de Concepción, Concepción, Chile
| | - Adriano Targa
- . Translational Research in Respiratory Medicine (TRRM) Group, Hospital Universitari Arnau de Vilanova-Santa Maria, IRBLleida, Lleida, España
| | - Ferran Barbe
- . Translational Research in Respiratory Medicine (TRRM) Group, Hospital Universitari Arnau de Vilanova-Santa Maria, IRBLleida, Lleida, España.,. Centro de Investigación Biomedica En Red de Enfermedades Respiratorias - CIBERES - Madrid, España
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Sleep Disturbances Following Traumatic Brain Injury. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2022. [DOI: 10.1007/s40141-022-00351-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Naghshtabrizi N, Alizadeh S, Naghshtabrizi B, Jalali A, Salarifar M. Relationship between Severity and Complexity of Coronary Artery Involvement and Obstructive Sleep Apnea Based on STOP-BANG Questionnaire. Int J Prev Med 2022; 13:34. [PMID: 35392318 PMCID: PMC8980830 DOI: 10.4103/ijpvm.ijpvm_443_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 04/16/2020] [Indexed: 01/12/2023] Open
Abstract
Background: Obstructive sleep apnea (OSA), which has a known correlation with cardiovascular disease, is a possible risk factor of coronary artery disease (CAD) that is preventable. Aims: We sought to put lights on the relationship between OSA based on the STOP-BANG questionnaire (SBQ) and the severity and complexity of coronary artery involvement. Methods: This cross-sectional, single-center, retrospective study was conducted among 145 patients who underwent selective coronary angiography (SCA) between October 2018 and March 2019, admitted to the Tehran Heart Center, Tehran, Iran. OSA risk was assessed in patients based on SBQ categories. Also, the severity and complexity of coronary artery involvement calculated according to SYNTAX and Gensini scores. Analysis performed by statistical software SPSS 25. Results: Based on SBQ risk assessment categories, 22 (15.2%), 64 (44.1%), and 59 (40.7%) of the patients were low, intermediate, and high-risk for OSA, respectively. By comparing the means of coronary artery involvement, there was no significant difference in SYNTAX score 17.15 ± 13.67 (10.56–23.74) in low, 15.67 ± 9.78 (13.19–18.16) in intermediate, and 16.93 ± 9.21 (14.42–19.45) in high-risk groups; P value: 0.754, and Gensini score 66.4 ± 70.75 (35.04–97.77) in low, 66.21 ± 55.05 (52.45–79.96) in intermediate, 74.61 ± 56.33 (59.93–89.3) iin high risk groups; P value: 0.697 with groups of OSA risks. Also, after adjusting confounding factors, there was still no statistically significant difference in terms of coronary involvement scores. Conclusions: There was no statistically significant difference in SYNTAX and Gensini scores of different groups of OSA risk categories based on the SBQ. However, our results can't be extended into the connection between OSA and CAD.
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Affiliation(s)
- Nima Naghshtabrizi
- Department of Cardiology, Tehran University of Medical Science, Tehran, Iran
| | - Soroosh Alizadeh
- Department of Cardiology, Tehran University of Medical Science, Tehran, Iran
| | | | - Arash Jalali
- Department of Epidemiology and Biostatistics, Tehran University of Medical Science, Tehran, Iran
| | - Mojtaba Salarifar
- Department of Cardiology, Tehran University of Medical Science, Tehran, Iran
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Joffe A, Barnes CR. Extubation of the potentially difficult airway in the intensive care unit. Curr Opin Anaesthesiol 2022; 35:122-129. [PMID: 35191402 DOI: 10.1097/aco.0000000000001119] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Extubation in the intensive care unit (ICU) is associated with a failure rate requiring reintubation in 10-20% patients further associated with significant morbidity and mortality. This review serves to highlight recent advancements and guidance on approaching extubation for patients at risk for difficult or failed extubation (DFE). RECENT FINDINGS Recent literature including closed claim analysis, meta-analyses, and national society guidelines demonstrate that extubation in the ICU remains an at-risk time for patients. Identifiable strategies aimed at optimizing respiratory mechanics, patient comorbidities, and airway protection, as well as preparing an extubation strategy have been described as potential methods to decrease occurrence of DFE. SUMMARY Extubation in the ICU remains an elective decision and patients found to be at risk should be further optimized and planning undertaken prior to proceeding. Extubation for the at-risk patient should be operationalized utilizing easily reproducible strategies, with airway experts present to guide decision making and assist in reintubation if needed.
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Affiliation(s)
- Aaron Joffe
- Department of Anesthesiology & Pain Medicine, Harborview Medical Center, Seattle, Washington
- Banner MD Anderson Cancer Center, Gilbert, Arizona, USA
| | - Christopher R Barnes
- Department of Anesthesiology & Pain Medicine, Harborview Medical Center, Seattle, Washington
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Parveen N, Parganiha A. Consequences and factors associated with OSA: a brief review. BIOL RHYTHM RES 2022. [DOI: 10.1080/09291016.2022.2054558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Noorshama Parveen
- School of Studies in Life Science, Pandit Ravishankar Shukla University, Raipur, India
| | - Arti Parganiha
- School of Studies in Life Science, Pandit Ravishankar Shukla University, Raipur, India
- Center for Translational Chronobiology, Pandit Ravishankar Shukla University, Raipur, India
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Do TQP, MacKay SG, Lam ME, Sideris AW, Jones AC, Chan LS. Precision Medicine in Adult Obstructive Sleep Apnea and Home Diagnostic Testing: Caution in Interpretation of Home Studies Without Clinician Input Is Necessary. Front Neurol 2022; 13:825708. [PMID: 35265029 PMCID: PMC8898897 DOI: 10.3389/fneur.2022.825708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 01/25/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose To assess the validity of home sleep apnea test directed diagnosis and treatment of obstructive sleep apnea (OSA) in a real-life clinical setting and establish the extent to which clinical evaluation alters diagnosis and therapeutic intervention, in the context of the evolving realm of precision medicine. Methods Retrospective consecutive cohort study of 505 patients referred to a single center between 15th September 2015 to 14th September 2016, multidisciplinary specialist sleep clinic presenting with a home sleep apnea test prior to referral. We evaluated the effect of sleep medicine practitioner (SMP) and ear, nose, and throat surgeon (ENTS) review on patient diagnoses, disease severity, and management options in OSA. Results Hundred and fifteen patients were included. Repeat evaluation with in-lab polysomnogram (PSG) was required in 46/115 (40.0%) of patients, of which 20/46 (43.5%) had OSA severity changed. Sleep medicine practitioner review decreased the need for repeat testing with formal in-lab PSG (p < 0.05) and increased patient acceptance of continuous positive airway pressure (CPAP) as a long-term management option for OSA. Sleep medicine practitioner/ENTS review resulted in discovery of a non-OSA related sleep disorder or change in OSA severity in 47.8% (55/115). Ear, nose, and throat surgeon review resulted in additional or changed diagnosis in 75.7% (87/115) of patients. Conclusion In the clinical assessment and diagnosis of OSA, patients should be reviewed by medical practitioners with an interest in sleep disorders to better navigate the complexities of assessment, as well as the identification of co-morbid conditions.
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Affiliation(s)
- Timothy Quy-Phong Do
- Illawarra ENT Head and Neck Clinic, Wollongong, NSW, Australia.,Department of Otolaryngology, Head and Neck Surgery, Wollongong Hospital, Wollongong, NSW, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - Stuart Grayson MacKay
- Illawarra ENT Head and Neck Clinic, Wollongong, NSW, Australia.,Department of Otolaryngology, Head and Neck Surgery, Wollongong Hospital, Wollongong, NSW, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - Matthew Eugene Lam
- Illawarra ENT Head and Neck Clinic, Wollongong, NSW, Australia.,Department of Otolaryngology, Head and Neck Surgery, Wollongong Hospital, Wollongong, NSW, Australia
| | - Anders William Sideris
- Illawarra ENT Head and Neck Clinic, Wollongong, NSW, Australia.,Department of Otolaryngology, Head and Neck Surgery, Wollongong Hospital, Wollongong, NSW, Australia
| | - Andrew Christopher Jones
- Department of Respiratory Medicine, Wollongong Hospital, Wollongong, NSW, Australia.,Illawarra Sleep Medicine Centre, Wollongong, NSW, Australia
| | - Lyndon Sidney Chan
- Illawarra ENT Head and Neck Clinic, Wollongong, NSW, Australia.,Department of Otolaryngology, Head and Neck Surgery, Wollongong Hospital, Wollongong, NSW, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
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Mackey TA. Results of a 1-Year Follow-Up Sleep Apnea Screening and Referral Initiative During Routine Yearly Examination of Environmental Inspection Workers. Workplace Health Saf 2022; 70:188-195. [PMID: 35073812 DOI: 10.1177/21650799211045720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There are strong links between obstructive sleep apnea (OSA), chronic disease, mental health, job performance, and motor vehicle accidents. Corporate wellness clinics and health monitoring programs present ideal settings to educate and screen employees for OSA. METHODS In January 2020, the Stop-Bang Sleep Apnea Questionnaire was added to the yearly health monitoring program of 571 State of Texas air, water, and hazardous waste workers as part of routine care. Medium- and high-risk (HR) scoring employees were counseled to seek follow-up care from a primary-care provider (PCP). The January 2021 exams provided an opportunity to determine the success of counseling efforts. FINDINGS Of the 479 returning employees in 2021, 24 (49%) of HR and 17 (21.8%) of intermediate risk (IR) had discussed OSA with a PCP. Seven (14.3%) HR and 1 (<1%) IR employee underwent a sleep study and 4 (8.2%) were prescribed continuous positive airway pressure (CPAP). CONCLUSIONS/APPLICATION TO PRACTICE Screening for OSA at the workplace was inexpensive and, when diagnosed and treated, can mitigate associated chronic disease, improve worker productivity, and reduce associated accidents and injuries. The described OSA screening delivered value to the employer and employees. The screening was performed at a very low cost, involved little time on the part of the nurse practitioner and employees, brought signs and symptoms of OSA to the consciousness level of 571 employees, encouraged at-risk participants to discuss OSA with a PCP and led to 4 (8.2%) being prescribed CPAP.
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Gumidyala R, Selzer A. Preoperative optimization of obstructive sleep apnea. Int Anesthesiol Clin 2022; 60:24-32. [PMID: 34897219 DOI: 10.1097/aia.0000000000000353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Felix M, Intriago Alvarez MB, Vanegas E, Farfán Bajaña MJ, Sarfraz Z, Sarfraz A, Michel J, Cherrez-Ojeda I. Risk of obstructive sleep apnea and traffic accidents among male bus drivers in Ecuador: Is there a significant relationship? Ann Med Surg (Lond) 2022; 74:103296. [PMID: 35145670 PMCID: PMC8818532 DOI: 10.1016/j.amsu.2022.103296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/17/2022] [Accepted: 01/22/2022] [Indexed: 11/18/2022] Open
Abstract
Background Obstructive sleep apnea (OSA) represents an important occupational health concern in the transportation industry, affecting a substantial percentage of transportation operators. Our study aims to determine the frequency of individuals at high risk of obstructive sleep apnea, and excessive daytime sleepiness, as well as any potential association between these conditions and traffic accidents among a sample of Ecuadorian bus drivers. Methods We conducted a cross-sectional study involving 340 commercial bus drivers from Ecuador. Descriptive statistics were used to determine frequency and proportions for demographic and clinical variables. A Kendall's tau-b was performed to ascertain the relationship between the STOP-Bang score towards the Epworth Sleepiness Scale (ESS) score and the number of accidents and near accidents. Results In general, 18.5% (n = 63) of participants were found to be at high-risk for OSA. There was a weak positive correlation between STOP-Bang score and ESS score (τb = 0.244, p = .000). We also found a statistically significant, although negligible, correlation between the STOP-Bang score and the number of accidents (τb = 0.096, p = .039) and near accidents (τb = 0.120, p = .008). Conclusion Our results suggest that a considerable proportion of Ecuadorian bus drivers were at high-risk for obstructive sleep apnea. Higher STOP-Bang scores were correlated with an increased number of accidents and near accidents. Additional studies are needed to determine whether additional interventions could increase road safety by taking care of undiagnosed and untreated OSA cases in a timely manner. Untreated obstructive sleep apnea is a significant contributor to motor vehicle crashes. The main consequence related to OSA is excessive daytime sleepiness, which is associated with increased risk of accidents. A considerable proportion of Ecuadorian bus drivers were at high-risk for obstructive sleep apnea. Higher STOP-Bang scores were correlated with an increased number of accidents and near accidents.
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Shieu MM, Dunietz GL, Paulson HL, Chervin RD, Braley TJ. The association between obstructive sleep apnea risk and cognitive disorders: a population-based study. J Clin Sleep Med 2021; 18:1177-1185. [PMID: 34913866 DOI: 10.5664/jcsm.9832] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To examine the association between OSA risk and cognitive disorders among US adults. METHODS Data from the 2016 wave of the Health and Retirement Study (HRS) were utilized. Probable OSA cases were identified with survey items that resembled critical elements of a clinically validated OSA screen (STOP-Bang questionnaire). Weighted prevalence of cognitive impairment not dementia (CIND) and dementia among individuals with and without probable OSA were assessed. Cross-sectional analyses of associations between OSA risk and cognitive outcomes, along with effect modification by race and ethnicity, were estimated using imputed data. RESULTS Of the 20,910 HRS participants, 60% had probable OSA. CIND and dementia were more common among adults with probable OSA as compared to those without (12.7% vs. 8.0% for CIND; 3.2% vs 2.0% for dementia). Probable OSA was associated with CIND (OR=1.22, 1.08-1.37) and dementia (OR=1.27, 1.04-1.54). Race/ethnicity significantly modified the association between probable OSA and CIND, with a higher risk for CIND in Whites (OR=1.35, 1.17-1.57) as compared to non-Whites (OR=0.98, 0.81-1.19). CONCLUSIONS CIND and dementia are more common among older adults who are at high risk for OSA, as compared to low-risk individuals. These data highlight the importance of consideration of OSA risk in large-scale studies of OSA and cognitive disorders.
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Affiliation(s)
- Monica M Shieu
- University of Michigan, Department of Neurology, Division of Sleep Medicine
| | - Galit L Dunietz
- University of Michigan, Department of Neurology, Division of Sleep Medicine
| | | | - Ronald D Chervin
- University of Michigan, Department of Neurology, Division of Sleep Medicine
| | - Tiffany J Braley
- University of Michigan, Department of Neurology, Division of Sleep Medicine
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Moderie C, Carrier J, Dang-Vu TT. [Sleep disorders in patients with a neurocognitive disorder]. Encephale 2021; 48:325-334. [PMID: 34916075 DOI: 10.1016/j.encep.2021.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/24/2021] [Accepted: 08/29/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Sleep disorders are prevalent in patients with a neurocognitive disorder, and diagnosis and treatment in these patients remain challenging in clinical practice. METHODS This narrative review offers a systematic approach to diagnose and treat sleep disorders in neurocognitive disorders. RESULTS Alzheimer's disease is often associated with circadian rhythm disorders, chronic insomnia, and sleep apnea-hypopnea syndrome. Alpha-synucleinopathies (e.g., Parkinson's disease and Lewy body dementia) are often associated with a rapid eye movement sleep behavior disorder, restless legs syndrome, chronic insomnia, and sleep apnea-hypopnea syndrome. A focused history allows to diagnose most sleep disorders. Clinicians should ensure to gather the following information in all patients with a neurocognitive disorder: (1) the presence of difficulties falling asleep or staying asleep, (2) the impact of sleep disturbances on daily functioning (fatigue, sleepiness and other daytime consequences), and (3) abnormal movements in sleep. Sleep diaries and questionnaires can assist clinicians in screening for specific sleep disorders. Polysomnography is recommended if a rapid eye movement sleep behavior disorder or a sleep apnea-hypopnea syndrome are suspected. Sleep complaints should prompt clinicians to ensure that comorbidities interfering with sleep are properly managed. The main treatment for moderate to severe obstructive sleep apnea-hypopnea syndrome remains continuous positive airway pressure, as its efficacy has been demonstrated in patients with neurocognitive disorders. Medications should also be reviewed, and time of administration should be optimized (diuretics and stimulating medications in the morning, sedating medications in the evening). Importantly, cholinesterase inhibitors (especially donepezil) may trigger insomnia. Switching to morning dosing or to an alternative drug may help. Cognitive-behavioral therapy for insomnia is indicated to treat chronic insomnia in neurocognitive disorders. False beliefs regarding sleep should be addressed with the patient and their caregiver. The sleep environment should be optimized (decrease light exposure at night, minimize noise, avoid taking vital signs, etc.). Sleep restriction can be considered as patients with a neurocognitive disorder often spend too much time in bed. The need for naps should be assessed case by case as naps may contribute to insomnia in some patients but allow others to complete their diurnal activities. Trazodone (50mg) may also be used under certain circumstances in chronic insomnia. Recent evidence does not support a role for exogenous melatonin in patients with a neucognitive disorder and insomnia. Patients in long-term care facilities are often deprived of an adequate diurnal exposure to light. Increasing daytime exposure to light may improve sleep and mood. Patients with circadian rhythm disorders can also benefit from light therapy (morning bright light therapy in case of phase delay and evening bright light therapy in case of phase advance). Rapid eye movement sleep behavior disorder can lead to violent behaviors, and the sleeping environment should be secured (e.g., mattress on the floor, remove surrounding objects). Medication exacerbating this disorder should be stopped if possible. High dose melatonin (6 to 18mg) or low dose clonazepam (0.125-0.25mg) at bedtime may be used to reduce symptoms. Melatonin is preferred in first-line as it is generally well tolerated with few side effects. Patients with restless legs syndrome should be investigated for iron deficiency. Medication decreasing dopaminergic activity should be reduced or stopped if possible. Behavioral strategies such as exercise and leg massages may be beneficial. Low-dose dopamine agonists (such as pramipexole 0.125mg two hours before bedtime) can be used to treat the condition, but a prolonged treatment may paradoxically worsen the symptoms. Alpha-2-delta calcium channel ligands can also be used while monitoring for the risk of falls. CONCLUSION Multiple and sustained nonpharmacological approaches are recommended for the treatment of sleep disturbances in patients with neurocognitive disorder. Pharmacological indications remain limited, and further randomized clinical trials integrating a multimodal approach are warranted to evaluate the treatment of sleep disorders in specific neurocognitive disorders.
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Affiliation(s)
- C Moderie
- Département de psychiatrie, université McGill, Montréal, Québec, Canada
| | - J Carrier
- Centre de recherche de l'institut universitaire de gériatrie de Montréal, Montréal, Québec, Canada; Département de psychologie, université de Montréal, Montréal, Québec, Canada; Centre d'études avancées en médecine du sommeil, Montréal, Québec, Canada
| | - T T Dang-Vu
- Centre de recherche de l'institut universitaire de gériatrie de Montréal, Montréal, Québec, Canada; Département de psychologie, université de Montréal, Montréal, Québec, Canada; Département de santé, kinésiologie et physiologie appliquée, centre d'études en neurobiologie comportementale et centre PERFORM, université Concordia, Montréal, Québec, Canada.
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Szlejf C, Suemoto CK, Drager LF, Griep RH, Fonseca MJM, Diniz MFHS, Lotufo PA, Benseãor IM. Association of sleep disturbances with sarcopenia and its defining components: the ELSA-Brasil study. Braz J Med Biol Res 2021; 54:e11539. [PMID: 34878063 PMCID: PMC8647897 DOI: 10.1590/1414-431x2021e11539] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 09/21/2021] [Indexed: 11/22/2022] Open
Abstract
Sarcopenia and sleep problems share common physiopathology. We aimed to investigate the association of sleep disturbances with sarcopenia and its defining components in Brazilian middle-aged and older adults. In this cross-sectional analysis of the second wave of the ELSA-Brasil study, we included data from 7948 participants aged 50 years and older. Muscle mass was evaluated by bioelectrical impedance analysis and muscle strength by hand-grip strength. Sarcopenia was defined according to the Foundation for the National Institutes of Health criteria. Sleep duration and insomnia complaint were self-reported. Short sleep duration was considered as ≤6 h/night and long sleep duration as >8 h/night. High risk of obstructive sleep apnea (OSA) was assessed using the STOP-Bang questionnaire. Possible confounders included socio-demographic characteristics, lifestyle, clinical comorbidities, and use of sedatives and hypnotics. The frequencies of sarcopenia, low muscle mass, and low muscle strength were 1.6, 21.1, and 4.1%, respectively. After adjustment for possible confounders, high risk of OSA was associated with low muscle mass (OR=2.17, 95%CI: 1.92-2.45). Among obese participants, high risk of OSA was associated with low muscle strength (OR=1.68, 95%CI: 1.07-2.64). However, neither short nor long sleep duration or frequent insomnia complaint were associated with sarcopenia or its defining components. In conclusion, high risk of OSA was associated with low muscle mass in the whole sample and with low muscle strength among obese participants. Future studies are needed to clarify the temporal relationship between both conditions.
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Affiliation(s)
- C Szlejf
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil
| | - C K Suemoto
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil.,Divisão de Geriatria, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - L F Drager
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil.,Unidade de Hipertensão, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - R H Griep
- Laboratório de Educação em Ambiente e Saúde, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
| | - M J M Fonseca
- Departamento de Epidemiologia e Métodos Quantitativos em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
| | - M F H S Diniz
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
| | - P A Lotufo
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil.,Departamento de Medicina Interna, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - I M Benseãor
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil.,Departamento de Medicina Interna, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
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Adeleke I, Chae C, Okocha O, Sweitzer B. Risk assessment and risk stratification for perioperative complications and mitigation: Where should the focus be? How are we doing? Best Pract Res Clin Anaesthesiol 2021; 35:517-529. [PMID: 34801214 DOI: 10.1016/j.bpa.2020.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 10/07/2020] [Accepted: 11/12/2020] [Indexed: 02/06/2023]
Abstract
Various risk stratification tools are used to predict patients' risk of adverse outcomes. Most of these tools are based on type of surgery and patient comorbidities. Accuracy of risk prediction is improved when additional factors such as functional capacity are included. However, these tools are limited because data are obtained from specific patient populations, are simplified to aid ease of use, and do not account for improved treatment modalities that occur over time. Risk estimation allows for shared decision-making among the perioperative care team and the patient, for perioperative planning, and for opportunity for risk mitigation. Technological advancement in data collection will likely improve existing risk assessment and allow development of new options. Future research should focus on establishing and standardizing perioperative outcomes that include meaningful patient-centric considerations such as quality of life. We review available stratification tools and important risk assessment biomarkers that address the most common causes of adverse outcomes.
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Affiliation(s)
- Ibukun Adeleke
- Department of Anesthesiology, Northwestern University, Feinberg School of Medicine, Feinberg 5-704, 251 East Huron Street Chicago 60611, IL, USA.
| | - Christina Chae
- Department of Anesthesiology, Northwestern University, Feinberg School of Medicine, Feinberg 5-704, 251 East Huron Street Chicago 60611, IL, USA.
| | - Obianuju Okocha
- Department of Anesthesiology, Northwestern University, Feinberg School of Medicine, Feinberg 5-704, 251 East Huron Street Chicago 60611, IL, USA.
| | - BobbieJean Sweitzer
- Department of Anesthesiology, Northwestern University, Feinberg School of Medicine, Feinberg 5-704, 251 East Huron Street Chicago 60611, IL, USA.
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Anesthesia preoperative clinics: redefining the value proposition. Int Anesthesiol Clin 2021; 59:59-72. [PMID: 34433183 DOI: 10.1097/aia.0000000000000341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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44
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Cherrez-Ojeda I, Maurer M, Felix M, Bernstein JA, Ramon GD, Jardim Criado RF, Mata VL, Cherrez A, Morfin-Maciel BM, Larco JI, Tinoco IO, Chorzepa GF, Gómez RM, Raad RJ, Thomsen SF, Schmid-Grendelmeier P, Guillet C, Cherrez S, Vanegas E. "Chronic urticaria and obstructive sleep apnea: Is there a significant association?". World Allergy Organ J 2021; 14:100577. [PMID: 34471460 PMCID: PMC8387911 DOI: 10.1016/j.waojou.2021.100577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/07/2021] [Accepted: 08/03/2021] [Indexed: 11/28/2022] Open
Abstract
Background Few studies have explored the association between obstructive sleep apnea (OSA) and chronic urticaria (CU). Our study aims to fill this gap by determining the frequency of the risk categories for OSA and how they might correlate with the specific CU patient reported outcome measures urticaria activity score (UAS7), urticaria control test (UCT) and CU quality of life questionnaire (CU-Q2oL). Methods We conducted a cross-sectional study involving a cohort of 171 Latin American CU patients. Descriptive statistics were used to determine frequency and proportions for demographic and clinical variables, while a chi-squared test for association between STOP-Bang OSA questionnaire categories and both UAS7 and UCT categories was performed to analyze how such variables interact. To further assess the strength of the correlation a Cramer's V coefficient was reported. Finally, a Kendall-Tau b correlation coefficient was performed to measure the correlation between the STOP-Bang score and other independent continuous variables. Results The average STOP-Bang score was 2.5, with 24% and 21% of patients falling into the intermediate and high-risk category for moderate-to-severe OSA, respectively. There was a strong statistically significant association (Cramer's V = 0.263; p = .000) between UAS-7 categories and STOP-Bang risk categories. A similar pattern of strong significant association (Cramer's V = .269; p = .002) was observed between UCT categories and STOP-Bang risk categories. A weak positive correlation between the STOP-Bang score and the CU-Q2oL average score (τb = 0.188, p = .001) was identified. Overall, 72.5% patients reported limitations with respect to sleep in a varied degree according to the CU-Q2oL. Conclusions Our results suggest that a considerable proportion of patients with CU are at intermediate to high risk for OSA. Higher disease activity, poor CU control, and worse quality of life were all found to be associated with an increased risk. Additional studies are needed to determine the exact link between these conditions, and to determine whether screening and treatment for OSA might benefit patients with CU.
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Affiliation(s)
- Ivan Cherrez-Ojeda
- Universidad Espíritu Santo, Samborondón, Ecuador.,Respiralab, Respiralab Research Group, Guayaquil, Ecuador
| | - Marcus Maurer
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Germany
| | - Miguel Felix
- Universidad Espíritu Santo, Samborondón, Ecuador.,Respiralab, Respiralab Research Group, Guayaquil, Ecuador
| | - Jonathan A Bernstein
- University of Cincinnati College of Medicine, Department of Internal Medicine, Division of Immunology/Allergy Section, Cincinnati, OH, United States
| | - German D Ramon
- Instituto de Alergia e Inmunología del Sur, Bahía Blanca, Argentina
| | | | - Valeria L Mata
- Universidad Espíritu Santo, Samborondón, Ecuador.,Respiralab, Respiralab Research Group, Guayaquil, Ecuador
| | - Annia Cherrez
- Respiralab, Respiralab Research Group, Guayaquil, Ecuador.,Clinic and Policlinic for Dermatology and Venereology, University Medical Center Rostock, Rostock, Germany
| | | | | | | | | | | | - Rodolfo Jaller Raad
- Departamento de Alergias del Centro de Asma Alergia e Inmunología Barranquilla, Colombia
| | - Simon Francis Thomsen
- Department of Dermatology, Bispebjerg Hospital and Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Carole Guillet
- Allergy Unit, Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Department of Dermatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Sofia Cherrez
- Respiralab, Respiralab Research Group, Guayaquil, Ecuador.,Department of Dermatology, SRH Zentralklinikum Suhl, Germany
| | - Emanuel Vanegas
- Universidad Espíritu Santo, Samborondón, Ecuador.,Respiralab, Respiralab Research Group, Guayaquil, Ecuador
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45
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Horacio Rojas Mendiola R, Smurra M, Khoury M. [Clinical profile of patients suspected of sleep apnea]. REVISTA DE LA FACULTAD DE CIENCIAS MÉDICAS 2021. [PMID: 34617716 PMCID: PMC8760919 DOI: 10.3105310.31053/1853.0605.v78.n3.25531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Obstructive Sleep Apnea Syndrome is a disease with a growing prevalence worldwide that significantly affects quality of life and increases cardiovascular morbidity and mortality. OBJECTIVES To describe symptoms, comorbidities and anthropometry of patients who were clinically evaluated and underwent sleep studies to identify variables associated with a Respiratory Disturbance Index (RDI) equal or greater than 15. MATERIAL AND METHODS We reviewed data from a self-administered questionary, anthropometry, comorbidities and sleep studies of patients who consulted for the first time at a sleep medicine practice from June 2012 through May 2016. RESULTS Among 366 patients included we found 47.5% with a RDI>30, 21.9% with a RDI 15 – 29.9, 22.1% with a RDI 5 – 14.9 and 8.5% with a RDI<5. A multivariate model was built using RDI≥15 as the dependent variable. It showed that snoring more than 3 nights per week (OR 2.89, 95%CI 1.66 – 5.05), BMI ≥ 35 Kg/m2 (OR 2.53, 95%CI 1.35 – 4.72), witnessed apneas almost every night or every night (OR 1.95, 95%CI 1.09 – 3.49), male sex (OR 1.81, 95%CI 1.10 – 2.97) and the presence of high blood pressure (OR 1.67, 95%CI 1.02 – 2.74) were the most significant clinical factors. CONCLUSIONS In our sample, the most significant predictors of a RDI >15 were: snoring more than 3 nights per week, BMI ≥ 35 Kg/m2, witnessed apneas almost every night or every night, male sex and the presence of high blood pressure.
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Affiliation(s)
| | | | - Marina Khoury
- Instituto de Investigaciones Médicas Alfredo LanariArgentina
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Diagnostic accuracy of screening questionnaires for obstructive sleep apnoea in adults in different clinical cohorts: a systematic review and meta-analysis. Sleep Breath 2021; 26:1053-1078. [PMID: 34406554 PMCID: PMC8370860 DOI: 10.1007/s11325-021-02450-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/02/2021] [Accepted: 07/20/2021] [Indexed: 02/08/2023]
Abstract
PURPOSE The majority of individuals with clinically significant obstructive sleep apnoea (OSA) are undiagnosed and untreated. A simple screening tool may support risk stratification, identification, and appropriate management of at-risk patients. Therefore, this systematic review and meta-analysis evaluated and compared the accuracy and clinical utility of existing screening questionnaires for identifying OSA in different clinical cohorts. METHODS We conducted a systematic review and meta-analysis of observational studies assessing the diagnostic value of OSA screening questionnaires. We identified prospective studies, validated against polysomnography, and published to December 2020 from online databases. To pool the results, we used random effects bivariate binomial meta-analysis. RESULTS We included 38 studies across three clinical cohorts in the meta-analysis. In the sleep clinic cohort, the Berlin questionnaire's pooled sensitivity for apnoea-hypopnoea index (AHI) ≥ 5, ≥ 15, and ≥ 30 was 85%, 84%, and 89%, and pooled specificity was 43%, 30%, and 33%, respectively. The STOP questionnaire's pooled sensitivity for AHI ≥ 5, ≥ 15, and ≥ 30 was 90%, 90%, and 95%, and pooled specificity was 31%, 29%, and 21%. The pooled sensitivity of the STOP-Bang questionnaire for AHI ≥ 5, ≥ 15, and ≥ 30 was 92%, 95%, and 96%, and pooled specificity was 35%, 27%, and 28%. In the surgical cohort (AHI ≥ 15), the Berlin and STOP-Bang questionnaires' pooled sensitivity were 76% and 90% and pooled specificity 47% and 27%. CONCLUSION Among the identified questionnaires, the STOP-Bang questionnaire had the highest sensitivity to detect OSA but lacked specificity. Subgroup analysis considering other at-risk populations was not possible. Our observations are limited by the low certainty level in available data.
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47
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Arnardottir ES, Islind AS, Óskarsdóttir M. The Future of Sleep Measurements: A Review and Perspective. Sleep Med Clin 2021; 16:447-464. [PMID: 34325822 DOI: 10.1016/j.jsmc.2021.05.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
This article provides an overview of the current use, limitations, and future directions of the variety of subjective and objective sleep assessments available. This article argues for various ways and sources of collecting, combining, and using data to enlighten clinical practice and the sleep research of the future. It highlights the prospects of digital management platforms to store and present the data, and the importance of codesign when developing such platforms and other new instruments. It also discusses the abundance of opportunities that data science and machine learning open for the analysis of data.
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Affiliation(s)
- Erna Sif Arnardottir
- Reykjavik University Sleep Institute, School of Technology, Reykjavik University, Menntavegi 1, 102 Reykjavik, Iceland; Internal Medicine Services, Landspitali University Hospital, E7 Fossvogi, 108 Reykjavik, Iceland.
| | - Anna Sigridur Islind
- Reykjavik University Sleep Institute, School of Technology, Reykjavik University, Menntavegi 1, 102 Reykjavik, Iceland; Department of Computer Science, Reykjavik University, Menntavegi 1, 102 Reykjavik, Iceland
| | - María Óskarsdóttir
- Reykjavik University Sleep Institute, School of Technology, Reykjavik University, Menntavegi 1, 102 Reykjavik, Iceland; Department of Computer Science, Reykjavik University, Menntavegi 1, 102 Reykjavik, Iceland
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48
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Khan MN, Ahmed A. Accuracy of STOP-Bang Questionnaire in Predicting Difficult Mask Ventilation: An Observational Study. Cureus 2021; 13:e15955. [PMID: 34336451 PMCID: PMC8314963 DOI: 10.7759/cureus.15955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction Difficulty with bag-mask ventilation after the induction of general anesthesia and muscle relaxation places the patient at risk for a prolonged period of apnea and hypoxia and thus, at an increased risk of morbidity and mortality. This study was designed to assess the accuracy of the STOP-Bang questionnaire in predicting difficult mask ventilation (DMV) in patients receiving general anesthesia for elective surgical procedures. Methods It was a prospective cross-sectional, observational study conducted at a university teaching hospital. A total of 530 patients undergoing surgery under general anesthesia with endotracheal intubation were enrolled. STOP-Bang questionnaire was filled at pre-operative anesthesia assessment. Ease or difficulty of mask ventilation was assessed and documented by a senior resident responsible for intraoperative anesthetic management. Results Out of 530 patients, 139 (26.22%) had a STOP-Bang score of ≥ 3, of whom 55 (39.5%) were found to have DMV. Out of 391 patients with a STOP-Bang score of < 3, only 29 patients (7.5%) had DMV (P ≤0.001). Snoring, high blood pressure, BMI more than 35 kg/m2, age more than 50 years, neck circumference more than 40 cm, and male gender were significantly associated with DMV. The accuracy of the STOP-Bang questionnaire in predicting difficult mask ventilation was 78.68% (95% CI 74.99-81.95) with a negative predictive value of 92.58%. The sensitivity and specificity were found to be 65.48% and 81.17% respectively. Conclusion STOP-Bang score has a high negative predictive value and can be very useful in ruling out the possibility of difficult mask ventilation.
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Affiliation(s)
- Marium N Khan
- Anaesthetics, Blackpool Victoria Teaching Hospital, Blackpool, GBR
| | - Aliya Ahmed
- Anaesthesiology, Aga Khan University, Karachi, PAK
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49
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Ferreira-Santos D, Rodrigues PP. Enhancing Obstructive Sleep Apnea Diagnosis With Screening Through Disease Phenotypes: Algorithm Development and Validation. JMIR Med Inform 2021; 9:e25124. [PMID: 34156340 PMCID: PMC8277326 DOI: 10.2196/25124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/22/2021] [Accepted: 03/16/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The American Academy of Sleep Medicine guidelines suggest that clinical prediction algorithms can be used in patients with obstructive sleep apnea (OSA) without replacing polysomnography, which is the gold standard. OBJECTIVE This study aims to develop a clinical decision support system for OSA diagnosis according to its standard definition (apnea-hypopnea index plus symptoms), identifying individuals with high pretest probability based on risk and diagnostic factors. METHODS A total of 47 predictive variables were extracted from a cohort of patients who underwent polysomnography. A total of 14 variables that were univariately significant were then used to compute the distance between patients with OSA, defining a hierarchical clustering structure from which patient phenotypes were derived and described. Affinity from individuals at risk of OSA phenotypes was later computed, and cluster membership was used as an additional predictor in a Bayesian network classifier (model B). RESULTS A total of 318 patients at risk were included, of whom 207 (65.1%) individuals were diagnosed with OSA (111, 53.6% with mild; 50, 24.2% with moderate; and 46, 22.2% with severe). On the basis of predictive variables, 3 phenotypes were defined (74/207, 35.7% low; 104/207, 50.2% medium; and 29/207, 14.1% high), with an increasing prevalence of symptoms and comorbidities, the latter describing older and obese patients, and a substantial increase in some comorbidities, suggesting their beneficial use as combined predictors (median apnea-hypopnea indices of 10, 14, and 31, respectively). Cross-validation results demonstrated that the inclusion of OSA phenotypes as an adjusting predictor in a Bayesian classifier improved screening specificity (26%, 95% CI 24-29, to 38%, 95% CI 35-40) while maintaining a high sensitivity (93%, 95% CI 91-95), with model B doubling the diagnostic model effectiveness (diagnostic odds ratio of 8.14). CONCLUSIONS Defined OSA phenotypes are a sensitive tool that enhances our understanding of the disease and allows the derivation of a predictive algorithm that can clearly outperform symptom-based guideline recommendations as a rule-out approach for screening.
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Affiliation(s)
- Daniela Ferreira-Santos
- MEDCIDS-FMUP - Community Medicine, Information and Decision Sciences, Faculty of Medicine of the University of Porto, Porto, Portugal.,CINTESIS - Center for Health Technology and Services Research, Porto, Portugal
| | - Pedro Pereira Rodrigues
- MEDCIDS-FMUP - Community Medicine, Information and Decision Sciences, Faculty of Medicine of the University of Porto, Porto, Portugal.,CINTESIS - Center for Health Technology and Services Research, Porto, Portugal
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50
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Singh M, Gavidia R, Dunietz GL, Washnock-Schmid E, Romeo AR, Hershner S, Chervin RD, Braley TJ. Validation of an obstructive sleep apnea symptom inventory in persons with multiple sclerosis. Mult Scler 2021; 28:280-288. [PMID: 34048308 DOI: 10.1177/13524585211013014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Improved screening for obstructive sleep apnea (OSA) could enhance multiple sclerosis (MS) clinical care; yet the utility of current screening tools for OSA have yet to be evaluated in persons with multiple sclerosis (PwMS). OBJECTIVES The STOP-Bang Questionnnaire is an 8-item screening tool for OSA that is commonly used in non-MS samples. The aim of this study was to assess the validity of the STOP-Bang in PwMS. METHODS STOP-Bang and polysomnography data were analyzed from n = 200 PwMS. Sensitivity, specificity, positive-, and negative-predictive value (PPV and NPV) were calculated, with receiving operating characteristic (ROC) curves, for each STOP-Bang threshold score, against polysomnography-confirmed OSA diagnosis at three apnea severity thresholds (mild, moderate, and severe). RESULTS Nearly 70% had a STOP-Bang score of ⩾3% and 78% had OSA. The STOP-Bang at a threshold score of 3 provided sensitivities of 87% and 91% to detect moderate and severe OSA, respectively; and NPV of 84% and 95% to identify PwMS without moderate or severe OSA, respectively. Sensitivity to detect milder forms of OSA was 76%. The NPV to identify persons without milder forms of OSA was 40%. CONCLUSION The STOP-Bang Questionnaire is an effective tool to screen for moderate and severe OSA in PwMS, but may be insufficient to exclude mild OSA.
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Affiliation(s)
- Mini Singh
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
| | - Ronald Gavidia
- Division of Sleep Medicine, Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Galit Levi Dunietz
- Division of Sleep Medicine, Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Elizabeth Washnock-Schmid
- Division of Multiple Sclerosis and Clinical Neuroimmunology, Department of Neurology, University of Michigan, Ann Arbor, MI, USA/VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Andrew R Romeo
- Division of Multiple Sclerosis and Clinical Neuroimmunology, Department of Neurology, University of Michigan, Ann Arbor, MI, USA/VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Shelley Hershner
- Division of Sleep Medicine, Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Ronald D Chervin
- Division of Sleep Medicine, Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Tiffany J Braley
- Divisions of Multiple Sclerosis, Clinical Neuroimmunology and Sleep Medicine, Department of Neurology, University of Michigan, Ann Arbor, MI, USA/Division of Multiple Sclerosis and Clinical Neuroimmunology, Department of Neurology, University of Michigan, Ann Arbor, MI, USA/VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
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