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Vrooman OPJ, van Kerrebroeck PEV, van Balken MR, van Koeveringe GA, Rahnama'i MS. Nocturia and obstructive sleep apnoea. Nat Rev Urol 2024:10.1038/s41585-024-00887-7. [PMID: 38783115 DOI: 10.1038/s41585-024-00887-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2024] [Indexed: 05/25/2024]
Abstract
Nocturia, the need to urinate at night, is a common symptom in patients with obstructive sleep apnoea (OSA). Continuous positive airway pressure treatment can reduce nocturia in some patients, but the underlying mechanisms are complex and not fully understood. OSA affects the autonomic nervous system, oxidative stress and endothelial damage. Furthermore, the commonly held theory attributing polyuria to a false signal of cardiac overload and response natriuresis has limitations. A comprehensive approach to the management of nocturia in OSA, considering factors such as comorbidities, medication use, alcohol consumption and lifestyle, is needed. Effective management of nocturia in OSA requires a multidisciplinary approach, and urologists should be aware of the potential effect of OSA on physiology and refer patients for further testing at a sleep centre. In addition to continuous positive airway pressure, other interventions such as oral appliances and surgical obstruction treatment could be beneficial for some patients. Overall, understanding the complex interplay between OSA and nocturia is crucial for optimizing patient outcomes.
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Affiliation(s)
- Olaf P J Vrooman
- Department of Urology, Hospital Rijnstate Arnhem, Arnhem, Netherlands.
| | | | | | | | - Mohammad S Rahnama'i
- Department of Urology Nij Smellinghe Hospital, Drachten, Netherlands
- Society of Urological research and education (SURE), Maastricht, Netherlands
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2
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Flack JM, Buhnerkempe MG, Moore KT. Resistant Hypertension: Disease Burden and Emerging Treatment Options. Curr Hypertens Rep 2024; 26:183-199. [PMID: 38363454 DOI: 10.1007/s11906-023-01282-0] [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] [Accepted: 10/27/2023] [Indexed: 02/17/2024]
Abstract
PURPOSE OF REVIEW To define resistant hypertension (RHT), review its pathophysiology and disease burden, identify barriers to effective hypertension management, and to highlight emerging treatment options. RECENT FINDINGS RHT is defined as uncontrolled blood pressure (BP) ≥ 130/80 mm Hg despite concurrent prescription of ≥ 3 or ≥ 4 antihypertensive drugs in different classes or controlled BP despite prescription of ≥ to 4 drugs, at maximally tolerated doses, including a diuretic. BP is regulated by a complex interplay between the renin-angiotensin-aldosterone system, the sympathetic nervous system, the endothelin system, natriuretic peptides, the arterial vasculature, and the immune system; disruption of any of these can increase BP. RHT is disproportionately manifest in African Americans, older patients, and those with diabetes and/or chronic kidney disease (CKD). Amongst drug-treated hypertensives, only one-quarter have been treated intensively enough (prescribed > 2 drugs) to be considered for this diagnosis. New treatment strategies aimed at novel therapeutic targets include inhibition of sodium-glucose cotransporter 2, aminopeptidase A, aldosterone synthesis, phosphodiesterase 5, xanthine oxidase, and dopamine beta-hydroxylase, as well as soluble guanylate cyclase stimulation, nonsteroidal mineralocorticoid receptor antagonism, and dual endothelin receptor antagonism. The burden of RHT remains high. Better use of currently approved therapies and integrating emerging therapies are welcome additions to the therapeutic armamentarium for addressing needs in high-risk aTRH patients.
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Affiliation(s)
- John M Flack
- Department of Medicine, Division of General Internal Medicine, Hypertension Section, Southern Illinois University, Southern Illinois University School of Medicine, 801 North Rutledge Street, Carbondale, IL, 62702, USA.
| | - Michael G Buhnerkempe
- Department of Medicine and the Center for Clinical Research, Southern Illinois University, Carbondale, IL, USA
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3
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Tao M, Dong X, Tu J, Fang Q, Shao C. Symptom and comorbidity burden in hypertensive patients with obstructive sleep apnea. Front Endocrinol (Lausanne) 2024; 15:1361466. [PMID: 38501097 PMCID: PMC10944929 DOI: 10.3389/fendo.2024.1361466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 02/19/2024] [Indexed: 03/20/2024] Open
Abstract
Background Obstructive sleep apnea (OSA) is an important but frequently overlooked risk factor for hypertension (HTN). The prevalence of hypertension is high in patients with OSA, but the differences in clinical symptoms and comorbidities between patients with OSA with hypertension and those with normal blood pressure have not been fully defined. Methods This study retrospectively analyzed OSA patients diagnosed for the first time in Lihuili Hospital Affiliated to Ningbo University from 2016 to 2020. Patients were divided into an OSA group with hypertension and an OSA group without hypertension. The sociodemographic information, clinical symptoms, comorbidities, and polysomnography results of the two groups were compared. The independent risk factors associated with hypertension in patients with OSA were explored. Results A total of 1108 patients with OSA initially diagnosed were included in the study, including 387 with hypertension and 721 without. Compared with OSA patients without hypertension, OSA patients with hypertension were older; had a higher body mass index (BMI) and Epworth sleepiness score (ESS); a higher incidence of nocturia; and a higher proportion of diabetes mellitus, coronary heart disease, and cerebrovascular disease. Multivariate analysis showed age (odds ratio [OR]:1.06, 95% confidence interval [CI]:1.04-1.08), BMI (OR:1.17, 95% CI:1.11-1.23), ESS score (OR:0.97, 95%CI: 0.94-1.00) and nocturia symptoms (OR:1.64, 95% CI:1.19-2.27) was independently associated with hypertension in OSA patients, and comorbid diabetes (OR: 3.86, 95% CI: 2.31-6.45), coronary heart disease (OR: 1.90, 95% CI:1.15-3.16), and ischemic stroke (OR: 3.69,95% CI:1.31-10.40) was independently associated with hypertension in OSA patients. Conclusion Compared to OSA patients with normal blood pressure, OSA patients with hypertension had more significant daytime sleepiness, more frequent nocturnal urination, and a higher risk of diabetes, coronary heart disease, and cerebrovascular disease.
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Affiliation(s)
- MengShi Tao
- Department of Respiratory and Critical Care Medicine, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, China
- Health Science Center, Ningbo University, Ningbo, China
| | - Xiaoqi Dong
- Department of Respiratory and Critical Care Medicine, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, China
| | - Jinjing Tu
- Department of Respiratory and Critical Care Medicine, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, China
| | - Qing Fang
- Department of Respiratory and Critical Care Medicine, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, China
| | - Chuan Shao
- Department of Respiratory and Critical Care Medicine, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, China
- Health Science Center, Ningbo University, Ningbo, China
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Pépin JL, Tamisier R, Benjafield AV, Rinder P, Lavergne F, Josseran A, Sinel-Boucher P, Cistulli PA, Malhotra A, Hornus P, Bailly S. CPAP resumption after a first termination and impact on all-cause mortality in France. Eur Respir J 2024; 63:2301171. [PMID: 38135441 PMCID: PMC10831141 DOI: 10.1183/13993003.01171-2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 11/26/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Continuation of continuous positive airway pressure (CPAP) therapy after initial prescription has been shown to reduce all-cause mortality versus therapy termination. However, there is a lack of data on the rates and impact of resuming CPAP in patients with obstructive sleep apnoea (OSA). This analysis determined the prevalence of CPAP resumption in the year after termination, characterised determinants of CPAP resumption, and examined the impact of CPAP resumption on all-cause mortality. METHODS French national health insurance reimbursement system data for adults aged ≥18 years were used. CPAP prescription was identified by specific treatment codes. Patients who resumed CPAP after first therapy termination and continued to use CPAP for 1 year were matched with those who resumed CPAP then terminated therapy for a second time. RESULTS Out of 103 091 individuals with a first CPAP termination, 26% resumed CPAP over the next 12 months, and 65% of these were still using CPAP 1 year later. Significant predictors of CPAP continuation after resumption included male sex, hypertension and CPAP prescription by a pulmonologist. In the matched population, the risk of all-cause death was 38% lower in individuals who continued using CPAP after therapy resumption versus those who had a second therapy discontinuation (hazard ratio 0.62, 95% CI 0.48-0.79; p=0.0001). CONCLUSION These data suggest that individuals with OSA who fail initial therapy with CPAP should be offered a second trial with the device to ensure that effective therapy is not withheld from those who might benefit.
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Affiliation(s)
- Jean-Louis Pépin
- University Grenoble Alpes, Inserm, CHU Grenoble Alpes, HP2, Grenoble, France
| | - Renaud Tamisier
- University Grenoble Alpes, Inserm, CHU Grenoble Alpes, HP2, Grenoble, France
| | | | | | | | | | | | - Peter A Cistulli
- Charles Perkins Centre, Faculty of Medicine and Health, University Sydney, Sydney, Australia
- Department of Respiratory Medicine, Royal North Shore Hospital, Sydney, Australia
| | - Atul Malhotra
- University of California San Diego, San Diego, CA, USA
| | | | - Sébastien Bailly
- University Grenoble Alpes, Inserm, CHU Grenoble Alpes, HP2, Grenoble, France
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Roberts R, Huckstepp RT. Innate Sleep Apnea in Spontaneously Hypertensive Rats Is Associated With Microvascular Rarefaction and Neuronal Loss in the preBötzinger Complex. Stroke 2023; 54:3141-3152. [PMID: 38011231 PMCID: PMC10769171 DOI: 10.1161/strokeaha.123.044732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 10/13/2023] [Accepted: 10/18/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Sleep apnea (SA) is a major threat to physical health and carries a significant economic burden. These impacts are worsened by its interaction with, and induction of, its comorbidities. SA holds a bidirectional relationship with hypertension, which drives atherosclerosis/arteriolosclerosis, ultimately culminating in vascular dementia. METHODS To enable a better understanding of these sequelae of events, we investigated innate SA and its effects on cognition in adult-aged spontaneously hypertensive rats, which have a range of cardiovascular disorders: plethysmography and electroencephalographic/electromyographic recordings were used to assess sleep-wake state, breathing parameters, and sleep-disordered breathing; immunocytochemistry was used to assess vascular and neural health; the forced alteration Y maze and Barnes maze were used to assess short- and long-term memories, respectively; and an anesthetized preparation was used to assess baroreflex sensitivity. RESULTS Spontaneously hypertensive rats displayed a higher degree of sleep-disordered breathing, which emanates from poor vascular health leading to a loss of preBötzinger Complex neurons. These rats also display small vessel white matter disease, a form of vascular dementia, which may be exacerbated by the SA-induced neuroinflammation in the hippocampus to worsen the related deficits in both long- and short-term memories. CONCLUSIONS Therefore, we postulate that hypertension induces SA through vascular damage in the respiratory column, culminating in neuronal loss in the inspiratory oscillator. This induction of SA, which, in turn, will independently exacerbate hypertension and neural inflammation, increases the rate of vascular dementia.
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Affiliation(s)
- Reno Roberts
- School of Life Sciences, University of Warwick, Coventry, United Kingdom
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Yeung CHC, Bauer C, Xiao Q. Associations between actigraphy-derived rest-activity rhythm characteristics and hypertension in United States adults. J Sleep Res 2023; 32:e13854. [PMID: 36807441 DOI: 10.1111/jsr.13854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/13/2023] [Accepted: 01/30/2023] [Indexed: 02/23/2023]
Abstract
People with disrupted circadian rhythms, such as shift workers, have shown a higher risk of hypertension. However, it is unclear whether more subtle differences in diurnal rest-activity rhythms in the population are associated with hypertension. Clarifying the association between the rest-activity rhythm, a modifiable behavioural factor, and hypertension could provide insight into preventing hypertension and possibly cardiovascular diseases. In this study, we investigated the association between rest-activity rhythm characteristics and hypertension in a large representative sample of United States adults. Cross-sectional data were obtained from the National Health and Nutrition Examination Survey 2011-2014 (N = 6726; mean [range] age 49 [20-79] years; 52% women). Five rest-activity rhythm parameters (i.e., pseudo F statistic, amplitude, mesor, amplitude:mesor ratio, and acrophase) were derived from 24-h actigraphy data using the extended cosine model. We performed multiple logistic regression to assess the associations between the rest-activity rhythm parameters and hypertension. Subgroup analysis stratified by age, gender, race/ethnicity, body mass index and diabetes status was also conducted. A weakened overall rest-activity rhythm, characterised by a lower F statistic, was associated with higher odds of hypertension (odds ratio quintile 1 versus quintile 5 [OR Q1vs.Q5 ] 1.61, 95% confidence interval [CI] 1.26-2.05; p trend < 0.001). Similar results were found for lower amplitude (OR Q1vs.Q5 1.51, 95% CI 1.13-2.03; p trend = 0.01) and amplitude:mesor ratio (OR Q1vs.Q5 1.34, 95% CI 1.01-1.78; p trend = 0.03). The results were robust to the adjustment of confounders, individual behaviours including physical activity levels and sleep duration and appeared consistent across subgroups. Possible interaction between the rest-activity rhythm and body mass index was found. Our results support an association between weakened rest-activity rhythms and higher odds of hypertension.
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Affiliation(s)
- Chris Ho Ching Yeung
- Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA
| | - Cici Bauer
- Department of Biostatistics and Data Science, University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA
| | - Qian Xiao
- Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA
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Haldar P, Prasad K, Kant S, Dwivedi SN, Vibha D, Pandit AK, Srivastava AK, Kumar A, Ikram MA, Henning T. Metabolic risk factors and psychosocial problems independently explain poor sleep quality and obstructive sleep apnea symptoms among adults in urban India. Sleep Breath 2023; 27:1541-1555. [PMID: 36280653 DOI: 10.1007/s11325-022-02725-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/27/2022] [Accepted: 10/03/2022] [Indexed: 06/16/2023]
Abstract
STUDY OBJECTIVES To determine if metabolic risk factors are associated with poor sleep quality and obstructive sleep apnea-like symptoms (OSA symptoms) independent of psychosocial problems and demographic and lifestyle factors in older Indian adults. METHODOLOGY We analyzed baseline data from adults (≥ 50 years) from a population-based cohort, the LoCARPoN study, in India. Variables were grouped as (a) demographic and lifestyle factors such as smoking, alcohol use, and physical activity; (b) psychosocial problems including symptoms of depression, anxiety, and perceived stress; and (c) metabolic risk factors including glycated hemoglobin, high-density lipoprotein, low-density lipoprotein, total cholesterol, body mass index, and hypertension. Variables were examined as predictors of poor sleep quality and OSA symptoms. Groups of variables were added stepwise to a logistic regression. Variance explained by nested models was quantified using McFadden's pseudo R2, and change was formally tested with the log-likelihood ratio test. RESULTS Among 7505 adults, the prevalence of poor sleep quality was 16.9% (95% CI: 16.0, 17.7), and OSA symptoms were present in 7.0% (95% CI: 6.4, 7.6). Psychosocial problems had a strong independent association with both poor sleep quality (pseudo R2 increased from 0.10 to 0.15, p < 0.001) and more OSA symptoms (pseudo R2 increased from 0.08 to 0.10, p < 0.001). Metabolic risk factors had a modest independent association with sleep quality (pseudo R2 increased from 0.14 to 0.15, p < 0.01), but a strong association with OSA symptoms (pseudo R2 increased from 0.08 to 0.10, p < 0.001). CONCLUSION Psychosocial and metabolic risk factors were independently associated with sleep quality and OSA symptoms. This fact implied that OSA symptoms may affect both mental health and physical health. Our findings have public health implications because the number and proportion of the elderly in India is increasing, while the prevalence of metabolic risk factors and psychosocial problems is high already. These facts have the potential to exacerbate not only the burden of sleep disorders and OSA symptoms but also associated cardiovascular and neurologic sequelae, further stretching the Indian health-care system.
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Affiliation(s)
- Partha Haldar
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Kameshwar Prasad
- Rajendra Institute of Medical Sciences, Ranchi, 834009, Jharkhand, India.
| | - Shashi Kant
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sada Nand Dwivedi
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Deepti Vibha
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Awadh Kishor Pandit
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Amit Kumar
- Rajendra Institute of Medical Sciences, Ranchi, 834009, Jharkhand, India
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Tiemeier Henning
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Zhou G, Zhou W, Zhang Y, Zeng Z, Zhao W. Automatic monitoring of obstructive sleep apnea based on multi-modal signals by phone and smartwatch. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-4. [PMID: 38083356 DOI: 10.1109/embc40787.2023.10340237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Obstructive Sleep Apnea (OSA) is the most common sleep-related breathing disorder, with an overall population prevalence ranging from 9% to 38%, and it is associated with many cardiovascular diseases. The diagnosis of OSA requires polysomnography (PSG) testing, which is unsuitable for large-scale preliminary screening due to its high cost and discomfort to wear. Therefore, a simple and inexpensive screening method would be of great value. This study presents a novel at-home OSA screening method using a smartwatch and a smartphone to obtain several physiological signals, snoring segments, and questionnaire information during a whole night's sleep. The proposed method can distinguish four OSA risk levels based on machine learning (ML) classifications; the system was validated by conducting an in-hospital study on 350 subjects with sleep disorders. The estimated OSA risk levels are in good agreement with the OSA severity diagnosed by PSG (correlation with apnea-hypopnea index (AHI) = 0.92), and an encouraging classification performance is achieved (accuracy = 88.1%, 84.5%, 85.1%, sensitivity = 89.1%, 84.2%, 85.6% for mild, moderate and severe OSA). These findings reveal that wearable devices have the potential for large-scale OSA screening.
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Modi NS, Bajoria PS, Dave PA, Rohit RK, Tibrewal C, Patel P, Gandhi SK, Gutlapalli SD, Diaz K, Nfonoyim J. Effectiveness of Continuous Positive Airway Pressure in Treating Hypertension in Obstructive Sleep Apnea: A Traditional Review. Cureus 2023; 15:e42111. [PMID: 37602019 PMCID: PMC10436127 DOI: 10.7759/cureus.42111] [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: 06/18/2023] [Accepted: 07/19/2023] [Indexed: 08/22/2023] Open
Abstract
Almost one billion individuals worldwide suffer from obstructive sleep apnea (OSA). The most widely used treatment for OSA has been continuous positive airway pressure (CPAP), but its effect on blood pressure (BP) has been challenged. Our review aims to evaluate the effects of treating OSA with CPAP on BP and BP-related morbidities in adult hypertensive patients. Medical subject headings (MeSH) terminology was used to search the PubMed Central, MEDLINE, and PubMed databases for articles on the use of CPAP in OSA patients with hypertension. We selected various forms of academic writing, encompassing complete texts that were published in the English language. The study included a total of 21 papers. OSA is a serious health concern associated with a higher risk of cardiovascular disease, kidney disease, pulmonary hypertension, and aortic stiffness, which is brought on by the periodic hypoxia caused by nocturnal respiratory episodes. For individuals with moderate-to-severe OSA, CPAP therapy has been shown to have a considerable long-term benefit with a median drop of 11 mm Hg, and high adherence results in a decrease in diastolic BP. CPAP therapy directly lowers BP in OSA patients with a body mass index (BMI) of more than 30 kg/m2 and has also demonstrated improvement in early signs of atherosclerosis with lower nocturnal systolic BP levels. OSA patients with resistant hypertension also experienced lower BP after using CPAP for a year. Therefore, our findings suggest that obesity, hypersomnolence, high nocturnal BP, prolonged CPAP usage, and resistant hypertension may all have a major impact on the BP response to CPAP therapy in individuals with severe OSA.
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Affiliation(s)
| | - Parth S Bajoria
- Department of Internal Medicine, GMERS (Gujarat Medical Education and Research Society) Medical College Gandhinagar, Gandhinagar, IND
| | | | - Ralph Kingsford Rohit
- Department of Internal Medicine, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Charu Tibrewal
- Department of Internal Medicine, Civil Hospital Ahmedabad, Ahmedabad, IND
| | - Priyansh Patel
- Department of Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Department of Internal Medicine, Medical College Baroda, Vadodara, IND
| | - Siddharth Kamal Gandhi
- Department of Internal Medicine, Shri M.P. Shah Government Medical College, Jamnagar, IND
| | - Sai Dheeraj Gutlapalli
- Department of Internal Medicine, Richmond University Medical Center, New York City, USA
- Department of Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Keith Diaz
- Department of Pulmonary and Critical Care Medicine, Richmond University Medical Center, New York City, USA
| | - Jay Nfonoyim
- Department of Pulmonary and Critical Care Medicine, Richmond University Medical Center, New York City, USA
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Rinkevičius M, Charlton PH, Bailón R, Marozas V. Influence of Photoplethysmogram Signal Quality on Pulse Arrival Time during Polysomnography. SENSORS (BASEL, SWITZERLAND) 2023; 23:2220. [PMID: 36850820 PMCID: PMC9967654 DOI: 10.3390/s23042220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/05/2023] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
Intervals of low-quality photoplethysmogram (PPG) signals might lead to significant inaccuracies in estimation of pulse arrival time (PAT) during polysomnography (PSG) studies. While PSG is considered to be a "gold standard" test for diagnosing obstructive sleep apnea (OSA), it also enables tracking apnea-related nocturnal blood pressure fluctuations correlated with PAT. Since the electrocardiogram (ECG) is recorded synchronously with the PPG during PSG, it makes sense to use the ECG signal for PPG signal-quality assessment. (1) Objective: to develop a PPG signal-quality assessment algorithm for robust PAT estimation, and investigate the influence of signal quality on PAT during various sleep stages and events such as OSA. (2) Approach: the proposed algorithm uses R and T waves from the ECG to determine approximate locations of PPG pulse onsets. The MESA database of 2055 PSG recordings was used for this study. (3) Results: the proportions of high-quality PPG were significantly lower in apnea-related oxygen desaturation (matched-pairs rc = 0.88 and rc = 0.97, compared to OSA and hypopnea, respectively, when p < 0.001) and arousal (rc = 0.93 and rc = 0.98, when p < 0.001) than in apnea events. The significantly large effect size of interquartile ranges of PAT distributions was between low- and high-quality PPG (p < 0.001, rc = 0.98), and regular and irregular pulse waves (p < 0.001, rc = 0.74), whereas a lower quality of the PPG signal was found to be associated with a higher interquartile range of PAT across all subjects. Suggested PPG signal quality-based PAT evaluation reduced deviations (e.g., rc = 0.97, rc = 0.97, rc = 0.99 in hypopnea, oxygen desaturation, and arousal stages, respectively, when p < 0.001) and allowed obtaining statistically larger differences between different sleep stages and events. (4) Significance: the implemented algorithm has the potential to increase the robustness of PAT estimation in PSG studies related to nocturnal blood pressure monitoring.
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Affiliation(s)
- Mantas Rinkevičius
- Biomedical Engineering Institute, Kaunas University of Technology, K. Baršausko Str. 59, LT-51423 Kaunas, Lithuania
| | - Peter H. Charlton
- Department of Public Health and Primary Care, University of Cambridge, Cambridge CB2 1TN, UK
- Research Centre for Biomedical Engineering, University of London, London WC1E 7HU, UK
| | - Raquel Bailón
- Biomedical Signal Interpretation and Computational Simulation (BSICoS) Group, Aragon Institute of Engineering Research (I3A), IIS Aragon, University of Zaragoza, 50009 Zaragoza, Spain
- Biomedical Research Networking Center (CIBER), 50018 Zaragoza, Spain
| | - Vaidotas Marozas
- Biomedical Engineering Institute, Kaunas University of Technology, K. Baršausko Str. 59, LT-51423 Kaunas, Lithuania
- Faculty of Electrical and Electronics Engineering, Kaunas University of Technology, Studentų Str. 50, LT-51368 Kaunas, Lithuania
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Brown RB. Hypertension, Anxiety and Obstructive Sleep Apnea in Cardiovascular Disease and COVID-19: Mediation by Dietary Salt. Diseases 2022; 10:diseases10040089. [PMID: 36278588 PMCID: PMC9590013 DOI: 10.3390/diseases10040089] [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: 09/05/2022] [Revised: 10/07/2022] [Accepted: 10/14/2022] [Indexed: 12/02/2022] Open
Abstract
This perspective paper used a grounded theory method to synthesize evidence proposing that sodium toxicity from excessive dietary salt intake is a potential common pathophysiological mechanism that mediates the association of hypertension, obstructive sleep apnea, and anxiety with cardiovascular disease and COVID-19. Increased anxiety in these conditions may be linked to a high-salt diet through stimulation of the sympathetic nervous system, which increases blood pressure while releasing catecholamines, causing a "fight or flight" response. A rostral shift of fluid overload from the lower to the upper body occurs in obstructive sleep apnea associated with COVID-19 and cardiovascular disease, and may be related to sodium and fluid retention triggered by hypertonic dehydration. Chronic activation of the renin-angiotensin-aldosterone system responds to salt-induced dehydration by increasing reabsorption of sodium and fluid, potentially exacerbating fluid overload. Anxiety may also be related to angiotensin II that stimulates the sympathetic nervous system to release catecholamines. More research is needed to investigate these proposed interrelated mechanisms mediated by dietary salt. Furthermore, dietary interventions should use a whole-food plant-based diet that eliminates foods processed with salt to test the effect of very low sodium intake levels on hypertension, anxiety, and obstructive sleep apnea in cardiovascular disease and COVID-19.
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Affiliation(s)
- Ronald B Brown
- School of Public Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada
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12
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Moula AI, Parrini I, Tetta C, Lucà F, Parise G, Rao CM, Mauro E, Parise O, Matteucci F, Gulizia MM, La Meir M, Gelsomino S. Obstructive Sleep Apnea and Atrial Fibrillation. J Clin Med 2022; 11:jcm11051242. [PMID: 35268335 PMCID: PMC8911205 DOI: 10.3390/jcm11051242] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/18/2022] [Accepted: 02/21/2022] [Indexed: 12/14/2022] Open
Abstract
Atrial fibrillation (AF) is the most common arrhythmia, increasing with age and comorbidities. Obstructive sleep apnea (OSA) is a chronic sleep disorder more common in older men. It has been shown that OSA is linked to AF. Nonetheless, the prevalence of OSA in patients with AF remains unknown because OSA is significantly underdiagnosed. This review, including 54,271 patients, carried out a meta-analysis to investigate the association between OSA and AF. We also performed a meta-regression to explore cofactors influencing this correlation. A strong link was found between these two disorders. The incidence of AF is 88% higher in patients with OSA. Age and hypertension independently strengthened this association, indicating that OSA treatment could help reduce AF recurrence. Further research is needed to confirm these findings. Atrial Fibrillation (AF) is the most common arrhythmia, increasing with age and comorbidities. Obstructive sleep apnea (OSA) is a regulatory respiratory disorder of partial or complete collapse of the upper airways during sleep leading to recurrent pauses in breathing. OSA is more common in older men. Evidence exists that OSA is linked to AF. Nonetheless, the prevalence of OSA in patients with AF remains unknown because OSA is underdiagnosed. In order to investigate the incidence of AF in OSA patients, we carried out a meta-analysis including 20 scientific studies with a total of 54,271 subjects. AF was present in 4801 patients of whom 2203 (45.9%) had OSA and 2598 (54.1%) did not. Of a total of 21,074 patients with OSA, 2203 (10.5%) had AF and 18,871 (89.5%) did not. The incidence of AF was 88% higher in patients with OSA. We performed a meta-regression to explore interacting factors potentially influencing the occurrence of AF in OSA. Older age and hypertension independently strengthened this association. The clinical significance of our results is that patients with OSA should be referred early to the cardiologist. Further research is needed for the definition of the mechanisms of association between AF and OSA.
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Affiliation(s)
- Amalia Ioanna Moula
- Cardiothoracic Department, Maastricht University Hospital, 6229 HX Maastricht, The Netherlands; (A.I.M.); (C.T.); (G.P.); (E.M.); (O.P.); (F.M.); (M.L.M.)
| | - Iris Parrini
- Cardiology Department, Mauriziano Umberto I Hospital, 10128 Torino, Italy; (I.P.); (C.M.R.)
| | - Cecilia Tetta
- Cardiothoracic Department, Maastricht University Hospital, 6229 HX Maastricht, The Netherlands; (A.I.M.); (C.T.); (G.P.); (E.M.); (O.P.); (F.M.); (M.L.M.)
| | - Fabiana Lucà
- Cardiology Department, Big Metropolitan Hospital, 89129 Reggio Calabria, Italy;
| | - Gianmarco Parise
- Cardiothoracic Department, Maastricht University Hospital, 6229 HX Maastricht, The Netherlands; (A.I.M.); (C.T.); (G.P.); (E.M.); (O.P.); (F.M.); (M.L.M.)
| | | | - Emanuela Mauro
- Cardiothoracic Department, Maastricht University Hospital, 6229 HX Maastricht, The Netherlands; (A.I.M.); (C.T.); (G.P.); (E.M.); (O.P.); (F.M.); (M.L.M.)
| | - Orlando Parise
- Cardiothoracic Department, Maastricht University Hospital, 6229 HX Maastricht, The Netherlands; (A.I.M.); (C.T.); (G.P.); (E.M.); (O.P.); (F.M.); (M.L.M.)
| | - Francesco Matteucci
- Cardiothoracic Department, Maastricht University Hospital, 6229 HX Maastricht, The Netherlands; (A.I.M.); (C.T.); (G.P.); (E.M.); (O.P.); (F.M.); (M.L.M.)
| | - Michele Massimo Gulizia
- Cardiology Department, Garibaldi Nesima Hospital, 95122 Catania, Italy;
- Heart Care Foundation, 50121 Firenze, Italy
| | - Mark La Meir
- Cardiothoracic Department, Maastricht University Hospital, 6229 HX Maastricht, The Netherlands; (A.I.M.); (C.T.); (G.P.); (E.M.); (O.P.); (F.M.); (M.L.M.)
- Cardiothoracic Department, Brussels University Hospital, 1099 Jette, Belgium
| | - Sandro Gelsomino
- Cardiothoracic Department, Maastricht University Hospital, 6229 HX Maastricht, The Netherlands; (A.I.M.); (C.T.); (G.P.); (E.M.); (O.P.); (F.M.); (M.L.M.)
- Cardiothoracic Department, Brussels University Hospital, 1099 Jette, Belgium
- Correspondence:
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Thomas S, Patel S, Gummalla P, Tablizo MA, Kier C. You Cannot Hit Snooze on OSA: Sequelae of Pediatric Obstructive Sleep Apnea. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9020261. [PMID: 35204981 PMCID: PMC8870274 DOI: 10.3390/children9020261] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 01/25/2022] [Accepted: 02/06/2022] [Indexed: 12/25/2022]
Abstract
Pediatric obstructive sleep apnea (OSA) has been shown to not only affect the quality of sleep, but also overall health in general. Untreated or inadequately treated OSA can lead to long-term sequelae involving cardiovascular, endothelial, metabolic, endocrine, neurocognitive, and psychological consequences. The physiological effects of pediatric OSA eventually become pathological. As the complex effects of pediatric OSA are discovered, they must be identified early so that healthcare providers can be better equipped to treat and even prevent them. Ultimately, adequate management of OSA improves overall quality of life.
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Affiliation(s)
- Selena Thomas
- Department of Pediatrics, Stony Brook University Medical Center, Stony Brook, NY 11794, USA;
| | - Shefali Patel
- Department of Pediatrics, Valley Children’s Hospital, Madera, CA 93636, USA; (S.P.); (M.A.T.)
| | - Prabhavathi Gummalla
- Department of Pediatric Sleep Medicine, Valley Hospital, Ridgewood, NJ 07450, USA;
| | - Mary Anne Tablizo
- Department of Pediatrics, Valley Children’s Hospital, Madera, CA 93636, USA; (S.P.); (M.A.T.)
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA 94304, USA
| | - Catherine Kier
- Department of Pediatrics, Stony Brook University Medical Center, Stony Brook, NY 11794, USA;
- Correspondence:
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Xie T, Guo D, Luo J, Guo Z, Zhang S, Wang A, Wang X, Wang X, Cao W, Su L, Guo J, Huang R, Xiao Y. The Relationship Between HIF1α and Clock Gene Expression in Patients with Obstructive Sleep Apnea. Nat Sci Sleep 2022; 14:381-392. [PMID: 35299629 PMCID: PMC8922359 DOI: 10.2147/nss.s348580] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 02/27/2022] [Indexed: 12/13/2022] Open
Abstract
PURPOSE In this study, we aimed to investigate the precise relationship between hypoxia-inducible factor 1α (HIF1α), circadian clock genes, and OSA. METHODS We recruited 21 patients with OSA and 22 age-matched controls who underwent polysomnography and had their peripheral blood collected on the evening before and the morning after sleep. OSA was defined as an apnea hypopnea index (AHI) ≥15 events/h. Patients in which T90 > 0 were defined as having nocturnal hypoxemia (NH) and were referred to as the NH group. The mRNA levels of HIF1α, HIF1β and several clock genes (Timeless, Clock, Bmal1, Per1, Per2, Per3, Cry1, Cry2, Ck1δ, Rorα, NR1D1, and NPAS2) were determined by RT-qPCR. The percentage difference in gene expression levels when compared between the morning and evening was then determined as referred to as morning-evening variation (MEV). RESULTS The MEV for HIF1α mRNA expression in OSA patients increased significantly by 23% (P = 0.008) when compared to patients without OSA. The gene expression levels of Timeless (P = 0.038) and Cry2 (P = 0.012) decreased with AHI. The MEV of Bmal1, Rorα, and HIF1α mRNA levels were upregulated by 16% (P = 0.006), 14% (P = 0.027), and 25% (P = 0.005), respectively, in participants with NH when compared to those without NH. Furthermore, the MEV for HIF1α mRNA levels was positively correlated with the MEV of Bmal1, Cry1, and CK1δ mRNA levels (R = 0.638, P < 0.001; R = 0.327, P = 0.002; R = 0.332, P = 0.001, respectively) and negatively correlated with LSpO2 (R = -0.464, P =0.009) and Mean SpO2 (R = -0.500, P = 0.003). CONCLUSION Our data suggest that patients with OSA or NH tend to develop circadian rhythm disorders that may be induced by the hypoxia-mediated augmentation of HIF1α gene expression in OSA.
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Affiliation(s)
- Ting Xie
- Department of Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Dan Guo
- Department of Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Jinmei Luo
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Zijian Guo
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Sumei Zhang
- Department of Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Anqi Wang
- Department of Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Xiaoxi Wang
- Department of Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Xiaona Wang
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Wenhao Cao
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Linfan Su
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Junwei Guo
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Rong Huang
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Yi Xiao
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
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Al-Qattan H, Al-Omairah H, Al-Hashash K, Al-Mutairi F, Al-Mutairat M, Al-Ajmi M, Mohammad A, Alterki A, Ziyab AH. Prevalence, Risk Factors, and Comorbidities of Obstructive Sleep Apnea Risk Among a Working Population in Kuwait: A Cross-Sectional Study. Front Neurol 2021; 12:620799. [PMID: 33889122 PMCID: PMC8056027 DOI: 10.3389/fneur.2021.620799] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 03/10/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Obstructive sleep apnea (OSA) affects a considerable proportion of adults globally and is associated with elevated morbidity and mortality. Given the lack of epidemiologic data on the burden of OSA in Kuwait, this study sought to estimate its prevalence, associated risk factors, and comorbid conditions among a working population in Kuwait. Methods: This was a cross-sectional study of a sample of working adults (n = 651) from public institutions in Kuwait. High/low risk for OSA was ascertained according to the Berlin Questionnaire criteria. Participants self-reported their coexisting health conditions. Associations were assessed using Poisson regression with robust variance estimation; adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) were estimated. Results: Overall, 20.0% (130/651) of participants were classified as being at high risk for OSA, with more male than female subjects being at high risk (24.0% [56/233] vs. 17.7% [74/418], P = 0.053), though this difference did not gain statistical significance. Moreover, a high risk for OSA was more common among older and obese subjects. Factors associated with increased prevalence of a high risk for OSA included current smoking status (aPR = 1.58, 95% CI: 1.02-2.06), longer hours spent watching television (1.76, 1.10-2.81), and lower self-perceived physical health (2.11, 1.15-3.87). However, decreasing trends in the prevalence of high risk for OSA were observed with frequent engagement in vigorous physical activity and longer nightly sleep duration. Compared to those at a low risk for OSA, the subjects at high risk for OSA were more likely to have insomnia disorder (2.83, 1.81-4.41), diabetes (1.94, 1.15-3.27), hypertension (3.00, 1.75-5.16), and depression (4.47, 1.80-11.08). Conclusion: This study estimated that 1/5 of working adults in Kuwait were at high risk for OSA, and the prevalence varied according to personal characteristics and lifestyle factors. Also, a high risk for OSA classification was associated with multiple comorbid health conditions.
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Affiliation(s)
- Husain Al-Qattan
- Department of Nuclear Medicine, Adan Hospital, Ministry of Health, Kuwait City, Kuwait
| | - Hamad Al-Omairah
- Department of Ophthalmology, Al-Bahar Eye Center, Ministry of Health, Kuwait City, Kuwait
| | - Khaled Al-Hashash
- Department of Obstructive and Gynecology, Maternity Hospital, Ministry of Health, Kuwait City, Kuwait
| | - Fahad Al-Mutairi
- Department of Internal Medicine, Farwaniya Hospital, Ministry of Health, Kuwait City, Kuwait
| | | | - Mohammad Al-Ajmi
- Al-Shuhada Health Center, Ministry of Health, Kuwait City, Kuwait
| | - Anwar Mohammad
- Department of Biochemistry and Molecular Biology, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Abdulmohsen Alterki
- Department of Otolaryngology, Head, and Neck Surgery, Zain and Al-Sabah Hospitals, Ministry of Health, Kuwait City, Kuwait
- Medical Division, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Ali H. Ziyab
- Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
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