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Boppana TK, Mittal S, Madan K, Tiwari P, Mohan A, Hadda V. Antioxidant therapies for obstructive sleep apnea: A systematic review and meta-analysis. Sleep Breath 2024; 28:1513-1522. [PMID: 38740632 DOI: 10.1007/s11325-024-03050-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 04/28/2024] [Accepted: 05/03/2024] [Indexed: 05/16/2024]
Abstract
PURPOSE Obstructive sleep apnea (OSA) is a common clinical problem that is associated with adverse cardiovascular outcomes attributed to the oxidative stress due to sympathetic overstimulation. Treatment approaches targeting oxidative stress have been tried by multiple investigators. This systematic review and meta-analysis evaluated the efficacy and safety of such approaches. METHODS Pubmed and Embase databases were searched for human studies evaluating the utility of antioxidant therapies in patients with OSA. RESULTS A total of six studies (five randomized trials and one case-control study) were included, including 160 patients with OSA using N-acetyl cysteine, vitamin C, carbocysteine, superoxide dismutase, vitamin E, allopurinol, and their combinations. There was a significant improvement in flow-mediated dilatation (FMD) following antioxidants, with the pooled effect being 2.16 % (95% CI 1.65-2.67) using the random-effects model (I2 = 0% and p<0.001). It was also associated with a significant reduction in malondialdehyde levels and an increase in reduced glutathione (GSH) levels. There was also a significant improvement in the Epworth sleepiness scale, oxygen desaturation index, and minimum oxygen saturation during sleep without any significant adverse effects. CONCLUSION Antioxidant therapy in patients with OSA is associated with improved endothelial function, reduced oxidative stress, and improved sleep parameters. These results call for future multicentre studies with longer follow-ups to assess the utility of antioxidant therapy in patients with OSA.
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Affiliation(s)
- Tarun Krishna Boppana
- Department of Pulmonary, Critical Care, and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, India, 110029
| | - Saurabh Mittal
- Department of Pulmonary, Critical Care, and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, India, 110029.
| | - Karan Madan
- Department of Pulmonary, Critical Care, and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, India, 110029
| | - Pawan Tiwari
- Department of Pulmonary, Critical Care, and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, India, 110029
| | - Anant Mohan
- Department of Pulmonary, Critical Care, and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, India, 110029
| | - Vijay Hadda
- Department of Pulmonary, Critical Care, and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, India, 110029
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Martin JL, Rowley JA, Goel N, Heller HC, Gurubhagavatula I, DelRosso LM, Rodriguez A, Clark M, Rice-Conboy L. "Count on Sleep": an OSA awareness project update. J Clin Sleep Med 2024; 20:303-307. [PMID: 37861414 PMCID: PMC10835781 DOI: 10.5664/jcsm.10864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
Obstructive sleep apnea (OSA) is a common, chronic sleep-related breathing disorder that affects approximately 12% of the US adult population. Greater public awareness of OSA is necessary to decrease the number of people with undiagnosed or untreated OSA and reduce the negative health consequences of unrecognized OSA. In 2021, the American Academy of Sleep Medicine initiated the "Count on Sleep" project in partnership with key stakeholders with the objective of raising the awareness of OSA among the public, health care providers, and public health officials. Four workgroups implemented strategies and completed tasks focused on increasing OSA awareness in their targeted areas to address the objectives of the project including (1) Public Awareness and Communications, (2) Provider Education, (3) Tool Development and Surveillance, and (4) a Strategic Planning workgroup that coordinated efforts across the project. Over the first 2 years, workgroups made substantial progress toward project goals including holding "listening sessions" with representatives of communities disproportionately affected by OSA and its consequences, developing resources for primary care providers that can be easily accessed and used in practice, and developing a brief survey for use in estimating and tracking OSA risk across the population. Over the first 2 project years, workgroups made significant progress in advancing efforts to increase awareness of OSA in US communities. The third year of the project will focus on dissemination of campaign materials and resources for all targeted groups, including the public, health care professionals, and public health professionals. CITATION Martin JL, Rowley J, Goel N, et al. "Count on Sleep": an OSA awareness project update. J Clin Sleep Med. 2024;20(2):303-307.
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Affiliation(s)
- Jennifer L Martin
- Veteran Affairs Greater Los Angeles Healthcare System, North Hills, California
- David Geffen School of Medicine at the University of California, Los Angeles, California
| | | | - Namni Goel
- Biological Rhythms Research Laboratory, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois
| | - H Craig Heller
- Biology Department, Stanford University, Palo Alto, California
| | - Indira Gurubhagavatula
- Division of Sleep Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
| | | | - Alcibiades Rodriguez
- New York University Langone Health Comprehensive Epilepsy Center-Sleep Center, Department of Neurology, New York University Grossman School of Medicine, New York, New York
| | - Melissa Clark
- American Academy of Sleep Medicine, Darien, Illinois
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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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Casal-Guisande M, Ceide-Sandoval L, Mosteiro-Añón M, Torres-Durán M, Cerqueiro-Pequeño J, Bouza-Rodríguez JB, Fernández-Villar A, Comesaña-Campos A. Design of an Intelligent Decision Support System Applied to the Diagnosis of Obstructive Sleep Apnea. Diagnostics (Basel) 2023; 13:diagnostics13111854. [PMID: 37296707 DOI: 10.3390/diagnostics13111854] [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: 02/07/2023] [Revised: 05/07/2023] [Accepted: 05/22/2023] [Indexed: 06/12/2023] Open
Abstract
Obstructive sleep apnea (OSA), characterized by recurrent episodes of partial or total obstruction of the upper airway during sleep, is currently one of the respiratory pathologies with the highest incidence worldwide. This situation has led to an increase in the demand for medical appointments and specific diagnostic studies, resulting in long waiting lists, with all the health consequences that this entails for the affected patients. In this context, this paper proposes the design and development of a novel intelligent decision support system applied to the diagnosis of OSA, aiming to identify patients suspected of suffering from the pathology. For this purpose, two sets of heterogeneous information are considered. The first one includes objective data related to the patient's health profile, with information usually available in electronic health records (anthropometric information, habits, diagnosed conditions and prescribed treatments). The second type includes subjective data related to the specific OSA symptomatology reported by the patient in a specific interview. For the processing of this information, a machine-learning classification algorithm and a set of fuzzy expert systems arranged in cascade are used, obtaining, as a result, two indicators related to the risk of suffering from the disease. Subsequently, by interpreting both risk indicators, it will be possible to determine the severity of the patients' condition and to generate alerts. For the initial tests, a software artifact was built using a dataset with 4400 patients from the Álvaro Cunqueiro Hospital (Vigo, Galicia, Spain). The preliminary results obtained are promising and demonstrate the potential usefulness of this type of tool in the diagnosis of OSA.
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Affiliation(s)
- Manuel Casal-Guisande
- Department of Design in Engineering, University of Vigo, 36208 Vigo, Spain
- Design, Expert Systems and Artificial Intelligent Solutions Group (DESAINS), Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, 36213 Vigo, Spain
| | - Laura Ceide-Sandoval
- Design, Expert Systems and Artificial Intelligent Solutions Group (DESAINS), Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, 36213 Vigo, Spain
| | - Mar Mosteiro-Añón
- Pulmonary Department, Hospital Álvaro Cunqueiro, 36213 Vigo, Spain
- NeumoVigo I+i Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, 36213 Vigo, Spain
| | - María Torres-Durán
- Pulmonary Department, Hospital Álvaro Cunqueiro, 36213 Vigo, Spain
- NeumoVigo I+i Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, 36213 Vigo, Spain
| | - Jorge Cerqueiro-Pequeño
- Department of Design in Engineering, University of Vigo, 36208 Vigo, Spain
- Design, Expert Systems and Artificial Intelligent Solutions Group (DESAINS), Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, 36213 Vigo, Spain
| | - José-Benito Bouza-Rodríguez
- Department of Design in Engineering, University of Vigo, 36208 Vigo, Spain
- Design, Expert Systems and Artificial Intelligent Solutions Group (DESAINS), Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, 36213 Vigo, Spain
| | - Alberto Fernández-Villar
- Pulmonary Department, Hospital Álvaro Cunqueiro, 36213 Vigo, Spain
- NeumoVigo I+i Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, 36213 Vigo, Spain
| | - Alberto Comesaña-Campos
- Department of Design in Engineering, University of Vigo, 36208 Vigo, Spain
- Design, Expert Systems and Artificial Intelligent Solutions Group (DESAINS), Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, 36213 Vigo, Spain
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Berg KA, Marbury M, Whaley MA, Perzynski AT, Patel SR, Thornton JD. Experiences with Continuous Positive Airway Pressure Among African American Patients and their Bed Partners. Behav Sleep Med 2023; 21:242-253. [PMID: 35583497 PMCID: PMC9672138 DOI: 10.1080/15402002.2022.2075365] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
RATIONALE Despite having a higher prevalence and severity of obstructive sleep apnea (OSA), African Americans have lower adherence to continuous positive airway pressure (CPAP) compared to other groups. Information regarding challenges faced by African Americans prescribed CPAP are lacking. OBJECTIVES To determine the barriers and facilitators to optimal management of OSA with CPAP among African Americans and to understand the role bed partners may play. METHODS We conducted semi-structured in-depth interviews via video conferencing with African American patients of an urban safety-net health care system with OSA prescribed CPAP and their bed partners. Recruitment continued until theoretical saturation was achieved. Verbatim transcripts were analyzed using the principles of thematic analysis. RESULTS 15 patients (12 women) diagnosed with OSA and prescribed CPAP a mean 2.6 years prior along with 15 bed partners (3 women) were individually interviewed. Four themes emerged regarding impediments to CPAP use: 1) inadequate education and support, 2) CPAP maintenance and hygiene, 3) inconvenient design of CPAP interfaces, and 4) impediment to intimacy. Four themes emerged as facilitators to CPAP use: 1) provider and technical support, 2) properly fitted CPAP masks, 3) active support from partner and family, and 4) experiencing positive results from CPAP. CONCLUSIONS African American patients with OSA and their bed partners identified several unique barriers and facilitators to CPAP use. Active involvement by bed partners was considered by both patients and partners as helpful in improving CPAP adherence. Interventions to improve OSA outcomes in this population should focus on patients and their bed partners.
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Affiliation(s)
- Kristen A. Berg
- Center for Health Care Research and Policy, The MetroHealth Campus of Case Western Reserve University, Cleveland, Ohio
- Population Health Research Institute, The MetroHealth Campus of Case Western Reserve University, Cleveland, Ohio
| | - Marquisha Marbury
- Population Health Research Institute, The MetroHealth Campus of Case Western Reserve University, Cleveland, Ohio
- Center for Reducing Health Disparities, The MetroHealth Campus of Case Western Reserve University, Cleveland, Ohio
| | - Morgan A. Whaley
- Population Health Research Institute, The MetroHealth Campus of Case Western Reserve University, Cleveland, Ohio
- Center for Reducing Health Disparities, The MetroHealth Campus of Case Western Reserve University, Cleveland, Ohio
| | - Adam T. Perzynski
- Center for Health Care Research and Policy, The MetroHealth Campus of Case Western Reserve University, Cleveland, Ohio
- Population Health Research Institute, The MetroHealth Campus of Case Western Reserve University, Cleveland, Ohio
| | - Sanjay R. Patel
- Center for Sleep and Cardiovascular Outcomes Research, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - J. Daryl Thornton
- Population Health Research Institute, The MetroHealth Campus of Case Western Reserve University, Cleveland, Ohio
- Center for Reducing Health Disparities, The MetroHealth Campus of Case Western Reserve University, Cleveland, Ohio
- Division of Pulmonary, Critical Care, and Sleep Medicine, The MetroHealth Campus of Case Western Reserve University, Cleveland, Ohio
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