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Kuang B, Lobbezoo F, Li D, Hilgevoord AAJ, de Vries N, Aarab G. The effect of sleep position on sleep bruxism in adults with obstructive sleep apnea. J Oral Rehabil 2024; 51:1207-1212. [PMID: 38572841 DOI: 10.1111/joor.13696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 03/25/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Most of the respiratory events in adults with obstructive sleep apnea (OSA) occurs in supine position. It has been reported that the contraction of masseter muscles is dependent on the occurrence of arousals rather than on the occurrence of respiratory events. OBJECTIVES This study had two aims: (1) to compare the rhythmic masticatory muscle activity (RMMA) index in supine position (RMMA_sup) and in non-supine positions (RMMA_nsup) in adults with OSA; and (2) to determine the associations between RMMA index in both supine position and non-supine positions on the one hand, and several demographic and polysomnographic variables on the other hand. METHODS One hundred OSA participants (36 females and 64 males; mean age = 50.3 years (SD = 10.5)) were selected randomly from among patients with a full-night polysomnographic recording. RMMA_sup index and RMMA_nsup index were compared using Mann-Whitney U-test. Multivariate linear regression analyses were used to predict RMMA index both in supine and non-supine positions based on several demographic and polysomnographic variables. RESULTS In patients with OSA, the RMMA_sup index was significantly higher than the RMMA_nsup index (p < .001). RMMA_sup index was significantly associated with the arousal index (p = .002) and arousal index in supine position (p < .001). RMMA_nsup index was only significantly associated with the arousal index in non-supine positions (p = .004). CONCLUSION Within the limitations of this study, RMMAs occur more frequently in supine position than in non-supine positions in patients with OSA. In both sleep positions, RMMAs are associated with arousals.
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Affiliation(s)
- Boyuan Kuang
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Department of Clinical Neurophysiology, OLVG, Amsterdam, the Netherlands
- Taikang Bybo Dental, Beijing, China
| | - Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Deshui Li
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Department of Clinical Neurophysiology, OLVG, Amsterdam, the Netherlands
- Department of Orthodontics, School and Hospital of Stomatology, Shandong University, Jinan, China
| | | | - Nico de Vries
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Department of Otorhinolaryngology, OLVG, Amsterdam, the Netherlands
- Faculty of Medicine and Health Sciences, Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital (UZA), Edegem, Belgium
| | - Ghizlane Aarab
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Lechat B, Scott H, Manners J, Adams R, Proctor S, Mukherjee S, Catcheside P, Eckert DJ, Vakulin A, Reynolds AC. Multi-night measurement for diagnosis and simplified monitoring of obstructive sleep apnoea. Sleep Med Rev 2023; 72:101843. [PMID: 37683555 DOI: 10.1016/j.smrv.2023.101843] [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: 04/30/2023] [Revised: 07/13/2023] [Accepted: 08/21/2023] [Indexed: 09/10/2023]
Abstract
Substantial night-to-night variability in obstructive sleep apnoea (OSA) severity has raised misdiagnosis and misdirected treatment concerns with the current prevailing single-night diagnostic approach. In-home, multi-night sleep monitoring technology may provide a feasible complimentary diagnostic pathway to improve both the speed and accuracy of OSA diagnosis and monitor treatment efficacy. This review describes the latest evidence on night-to-night variability in OSA severity, and its impact on OSA diagnostic misclassification. Emerging evidence for the potential impact of night-to-night variability in OSA severity to influence important health risk outcomes associated with OSA is considered. This review also characterises emerging diagnostic applications of wearable and non-wearable technologies that may provide an alternative, or complimentary, approach to traditional OSA diagnostic pathways. The required evidence to translate these devices into clinical care is also discussed. Appropriately sized randomised controlled trials are needed to determine the most appropriate and effective technologies for OSA diagnosis, as well as the optimal number of nights needed for accurate diagnosis and management. Potential risks versus benefits, patient perspectives, and cost-effectiveness of these novel approaches should be carefully considered in future trials.
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Affiliation(s)
- Bastien Lechat
- Flinders Health and Medical Research Institute/Adelaide Institute for Sleep Health, Flinders University, Australia.
| | - Hannah Scott
- Flinders Health and Medical Research Institute/Adelaide Institute for Sleep Health, Flinders University, Australia
| | - Jack Manners
- Flinders Health and Medical Research Institute/Adelaide Institute for Sleep Health, Flinders University, Australia
| | - Robert Adams
- Flinders Health and Medical Research Institute/Adelaide Institute for Sleep Health, Flinders University, Australia
| | - Simon Proctor
- Flinders Health and Medical Research Institute/Adelaide Institute for Sleep Health, Flinders University, Australia
| | - Sutapa Mukherjee
- Flinders Health and Medical Research Institute/Adelaide Institute for Sleep Health, Flinders University, Australia
| | - Peter Catcheside
- Flinders Health and Medical Research Institute/Adelaide Institute for Sleep Health, Flinders University, Australia
| | - Danny J Eckert
- Flinders Health and Medical Research Institute/Adelaide Institute for Sleep Health, Flinders University, Australia
| | - Andrew Vakulin
- Flinders Health and Medical Research Institute/Adelaide Institute for Sleep Health, Flinders University, Australia
| | - Amy C Reynolds
- Flinders Health and Medical Research Institute/Adelaide Institute for Sleep Health, Flinders University, Australia
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3
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Fu W, Li L, Zhang S, Liu S, Liu W. Effects of CPAP and Mandibular Advancement Devices on depressive symptoms in patients with obstructive sleep apnea: a meta-analysis of randomized controlled trials. Sleep Breath 2023; 27:2123-2137. [PMID: 37119355 DOI: 10.1007/s11325-023-02829-w] [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: 02/09/2023] [Revised: 03/25/2023] [Accepted: 04/07/2023] [Indexed: 05/01/2023]
Abstract
PURPOSE Studies show that patients with obstructive sleep apnea (OSA) are more likely than the general population to have psychological disorders such as depression. However, it is less clear how OSA treatment affects this association. This meta-analysis aimed to assess whether or not continuous positive airway pressure (CPAP) and mandibular advancement devices (MADs) reduce depression symptoms in patients with OSA. METHODS We searched Pubmed, Embase, Web of Science, and Cochrane Library from creating the databases until November 2022. Our analysis included RCTs that examined CPAP and MAD treatment effectiveness for depression in patients with OSA. RESULTS We identified 17 CPAP studies comprising 1,931 patients for inclusion in the meta-analysis. The results of the meta-analysis using a fixed effects model found that CPAP improved depressed mood in patients with OSA relative to controls (SMD = 0.27;95% CI:0.18,0.36), with small heterogeneity among trials (I2 = 8.1% < 50%, P = 0.359). We performed subgroup analyses on three factors: the length of trial follow-up, patient adherence data, and depression assessment scales. The meta-analysis also identified six MAD studies involving 315 patients. According to this analysis, there was no heterogeneity between studies (I2 = 0%, P = 0.748). MADs did not significantly improve depression symptoms compared to controls, indicating a combined effect of SMD = 0.07 (95% CI: - 0.15,0.29), P > 0.05. CONCLUSION The present findings confirm that CPAP may improve depressive symptoms in patients with OSA. However, the review results suggest that MADs have no significant effect on depressive symptoms in patients with OSA, a finding that is different from the results of previous meta-analyses.
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Affiliation(s)
- Wenli Fu
- The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, China
| | - Leping Li
- The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, China
| | - Sha Zhang
- The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, China
| | - Shengfei Liu
- The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, China
| | - Weiying Liu
- Department of Respiratory and Critical Care Medicine, The First Hospital of Lanzhou University, Lanzhou, 730000, China.
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4
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Colvin L, Collop N, Lorenz R, Morgenthaler T, Weaver TE. Examining the feasibility of adult quality-of-life measurement for obstructive sleep apnea in clinical settings: what is the path forward for sleep centers? J Clin Sleep Med 2023; 19:1145-1155. [PMID: 36692175 PMCID: PMC10235705 DOI: 10.5664/jcsm.10438] [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: 08/15/2022] [Revised: 11/22/2022] [Accepted: 11/30/2022] [Indexed: 01/25/2023]
Abstract
Quality of life (QoL) is one of the outcomes that can be measured as a component of the required standards for sleep facility accreditation by the American Academy of Sleep Medicine. Utilization of a psychometrically robust QoL instrument is recommended; however, clinicians face a challenge balancing psychometric properties with questionnaire completion and scoring characteristics. This article provides an overview of common QoL instruments as a reference for clinicians when selecting a QoL tool for use in the clinical setting for adult patients with obstructive sleep apnea. CITATION Colvin L, Collop N, Lorenz R, Morgenthaler T, Weaver TE. Examining the feasibility of adult quality-of-life measurement for obstructive sleep apnea in clinical settings: what is the path forward for sleep centers? J Clin Sleep Med. 2023;19(6):1145-1155.
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Affiliation(s)
| | - Nancy Collop
- Emory Sleep Center, Emory University, Atlanta, Georgia
| | - Rebecca Lorenz
- University at Buffalo School of Nursing, Buffalo, New York
| | | | - Terri E. Weaver
- University of Illinois Chicago College of Nursing, Chicago, Illinois
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
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5
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Lechat B, Loffler KA, Reynolds AC, Naik G, Vakulin A, Jennings G, Escourrou P, McEvoy RD, Adams RJ, Catcheside PG, Eckert DJ. High night-to-night variability in sleep apnea severity is associated with uncontrolled hypertension. NPJ Digit Med 2023; 6:57. [PMID: 36991115 DOI: 10.1038/s41746-023-00801-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 03/10/2023] [Indexed: 03/31/2023] Open
Abstract
Obstructive sleep apnea (OSA) severity can vary markedly from night-to-night. However, the impact of night-to-night variability in OSA severity on key cardiovascular outcomes such as hypertension is unknown. Thus, the primary aim of this study is to determine the effects of night-to-night variability in OSA severity on hypertension likelihood. This study uses in-home monitoring of 15,526 adults with ~180 nights per participant with an under-mattress sleep sensor device, plus ~30 repeat blood pressure measures. OSA severity is defined from the mean estimated apnea-hypopnoea index (AHI) over the ~6-month recording period for each participant. Night-to-night variability in severity is determined from the standard deviation of the estimated AHI across recording nights. Uncontrolled hypertension is defined as mean systolic blood pressure ≥140 mmHg and/or mean diastolic blood pressure ≥90 mmHg. Regression analyses are performed adjusted for age, sex, and body mass index. A total of 12,287 participants (12% female) are included in the analyses. Participants in the highest night-to-night variability quartile within each OSA severity category, have a 50-70% increase in uncontrolled hypertension likelihood versus the lowest variability quartile, independent of OSA severity. This study demonstrates that high night-to-night variability in OSA severity is a predictor of uncontrolled hypertension, independent of OSA severity. These findings have important implications for the identification of which OSA patients are most at risk of cardiovascular harm.
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Affiliation(s)
- Bastien Lechat
- Adelaide Institute for Sleep Health and FHMRI Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia.
| | - Kelly A Loffler
- Adelaide Institute for Sleep Health and FHMRI Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Amy C Reynolds
- Adelaide Institute for Sleep Health and FHMRI Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Ganesh Naik
- Adelaide Institute for Sleep Health and FHMRI Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Andrew Vakulin
- Adelaide Institute for Sleep Health and FHMRI Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Garry Jennings
- Baker Heart and Diabetes Research Institute, Melbourne, Australia
| | | | - R Doug McEvoy
- Adelaide Institute for Sleep Health and FHMRI Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Robert J Adams
- Adelaide Institute for Sleep Health and FHMRI Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Peter G Catcheside
- Adelaide Institute for Sleep Health and FHMRI Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Danny J Eckert
- Adelaide Institute for Sleep Health and FHMRI Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia
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6
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Tan ML, Ho JPT, Tuk JG, de Lange J, Lindeboom JA. Impact of maxillomandibular advancement on oral health related quality of life in patients with obstructive sleep apnea: A longitudinal study of the oral health impact profile (OHIP-14). ADVANCES IN ORAL AND MAXILLOFACIAL SURGERY 2023. [DOI: 10.1016/j.adoms.2023.100398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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Fietze I, Laharnar N, Bargiotas P, Basoglu OK, Dogas Z, Drummond M, Fanfulla F, Gislason T, Gouveris H, Grote L, Hein H, Jennum P, Joppa P, van Kralingen K, Kvamme JA, Lombardi C, Ludka O, Mallin W, Marrone O, McNicholas WT, Mihaicuta S, Montserrat J, Pillar G, Pataka A, Randerath W, Riha RL, Roisman G, Saaresranta T, Schiza SE, Sliwinski P, Svaza J, Steiropoulos P, Tamisier R, Testelmans D, Trakada G, Verbraecken J, Zablockis R, Penzel T. Management of obstructive sleep apnea in Europe - A 10-year follow-up. Sleep Med 2022; 97:64-72. [PMID: 35724441 DOI: 10.1016/j.sleep.2022.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 06/02/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE In 2010, a questionnaire-based study on obstructive sleep apnea (OSA) management in Europe identified differences regarding reimbursement, sleep specialist qualification, and titration procedures. Now, 10 years later, a follow-up study was conducted as part of the ESADA (European Sleep Apnea Database) network to explore the development of OSA management over time. METHODS The 2010 questionnaire including questions on sleep diagnostic, reimbursement, treatment, and certification was updated with questions on telemedicine and distributed to European Sleep Centers to reflect European OSA management practice. RESULTS 26 countries (36 sleep centers) participated, representing 20 ESADA and 6 non-ESADA countries. All 21 countries from the 2010 survey participated. In 2010, OSA diagnostic procedures were performed mainly by specialized physicians (86%), whereas now mainly by certified sleep specialists and specialized physicians (69%). Treatment and titration procedures are currently quite homogenous, with a strong trend towards more Autotitrating Positive Airway Pressure treatment (in hospital 73%, at home 62%). From 2010 to 2020, home sleep apnea testing use increased (76%-89%) and polysomnography as sole diagnostic procedure decreased (24%-12%). Availability of a sleep specialist qualification increased (52%-65%) as well as the number of certified polysomnography scorers (certified physicians: 36%-79%; certified technicians: 20%-62%). Telemedicine, not surveyed in 2010, is now in 2020 used in diagnostics (8%), treatment (50%), and follow-up (73%). CONCLUSION In the past decade, formal qualification of sleep center personnel increased, OSA diagnostic and treatment procedures shifted towards a more automatic approach, and telemedicine became more prominent.
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Affiliation(s)
- Ingo Fietze
- Interdisciplinary Center of Sleep Medicine, Charité - Universitätsmedizin Berlin, Germany; Department of Medicine, The Fourth People' Hospital of Guangyuan City, China; 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
| | - Naima Laharnar
- Interdisciplinary Center of Sleep Medicine, Charité - Universitätsmedizin Berlin, Germany.
| | - Panagiotis Bargiotas
- Sleep and Motion Laboratory, Medical School, University of Cyprus, Nicosia, Cyprus
| | - Ozen K Basoglu
- Department of Chest Diseases, Ege University, Faculty of Medicine, Izmir, Turkey
| | - Zoran Dogas
- Sleep Medicine Center, Department of Neuroscience, University of Split, School of Medicine, Split, Croatia
| | - Marta Drummond
- Sleep and Non-Invasive Ventilation Unit, Hospital São João, Medicine Faculty of Porto University, Porto, Portugal
| | - Francesco Fanfulla
- Respiratory Function and Sleep Unit, Clinical Scientific Institutes Maugeri IRCCS, Pavia, Italy
| | - Thorarinn Gislason
- Medical Faculity, University of Iceland, Reykjavik, Iceland; Landspitali University Hospital, Reykjavik, Iceland
| | - Haralampos Gouveris
- Sleep Medicine Center & Department of Otolaryngology, University Medical Center, Mainz, Germany
| | - Ludger Grote
- Centre for Sleep and Wake Disorders, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Holger Hein
- Sleep Disorders Center, Reinbek/Geesthacht, Germany
| | - Poul Jennum
- Dansk Center for Sovnmedicin, Klinisk neurofysiologisk afdeling, Rigshospitalet, Glostrup, Denmark
| | - Pavol Joppa
- Department of Respiratory Medicine and Tuberculosis, Faculty of Medicine, P.J.Safarik University and L. Pasteur University Hospital, Kosice, Slovakia
| | | | | | - Carolina Lombardi
- Sleep Disorders Center, Dept. Medicine and Surgery, University of Milano-Bicocca & Instituto Auxologico Italiano, IRCCS, Dept. of Cardiology, S. Luca Hospital, Milan, Italy
| | - Ondrej Ludka
- Dep. of Internal Medicine, Geriatrics and Practical Medicine, University Hospital Brno and Faculty Medicine, Masaryk University, Brno, Czech Republic
| | - Wolfgang Mallin
- LKH Graz II, Standort Enzenbach, Gratwein - Strassengel, Austria
| | - Oreste Marrone
- CNR Institute for Research and Biomedical Innovation, Palermo, Italy
| | - Walter T McNicholas
- Department of Respiratory and Sleep Medicine, St. Vincent's Hospital Group, University College Dublin, Dublin, Ireland
| | - Stefan Mihaicuta
- Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | | | - Giora Pillar
- Sleep Clinic, Carmel Hospital, Technion Faculty of Medicine, Haifa, Israel
| | - Athanasia Pataka
- Respiratory Failure Unit, Aristotle University of Thessaloniki, G. Papanikolaou Hospital, Thessalonika, Greece
| | - Winfried Randerath
- Institute of Pneumology at the University of Cologne, Bethanien Hospital, Solingen, Germany
| | - Renata L Riha
- Department of Sleep Medicine, Royal Infirmary Edinburgh, Little France, UK
| | - Gabriel Roisman
- Sleep Disorders Center, Antoine-Beclere Hospital, Clamart, France
| | - Tarja Saaresranta
- Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital and Department of Pulmonary Diseases and Clinical Allegology, University of Turku, Turku, Finland
| | - Sophia E Schiza
- Sleep Disorders Unit, Department of Respiratory Medicine, Medical School, University of Crete, Crete, Greece
| | - Pawel Sliwinski
- 2nd Department of Respiratory Medicine, Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | - Juris Svaza
- Department of Anaesthesiology and Sleep Laboratory, Riga Stradins University, Riga, Latvia
| | - Paschalis Steiropoulos
- Sleep Unit, Department of Pneumonology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Renauld Tamisier
- Grenoble Alpes University, Inserm, CHU Grenoble Alpes, Grenoble, France
| | - Dries Testelmans
- Sleep Disorders Centre, University Hospital Gasthuisberg, Leuven, Belgium
| | - Georgia Trakada
- Department of Clinical Therapeutics, Division of Pulmonnary Medicine, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Johan Verbraecken
- Multidisciplinary Sleep Disorders Centre, University Hospital Antwerp and University of Antwerp, Edegem, Belgium
| | - Rolandas Zablockis
- Center of Pulmonology and Allergology, Clinic of Chest Diseases, Immunology and Allergology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Thomas Penzel
- Interdisciplinary Center of Sleep Medicine, Charité - Universitätsmedizin Berlin, Germany; Saratov State University, Saratov, Russia
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Chen TY, Kuo TBJ, Chung CH, Tzeng NS, Lai HC, Chien WC, Yang CCH. Age and sex differences on the association between anxiety disorders and obstructive sleep apnea: A nationwide case-control study in Taiwan. Psychiatry Clin Neurosci 2022; 76:251-259. [PMID: 35297559 DOI: 10.1111/pcn.13352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 01/24/2022] [Accepted: 03/06/2022] [Indexed: 11/30/2022]
Abstract
AIM The aim of this study was to examine the association between anxiety disorders and obstructive sleep apnea (OSA). METHODS This is a population-based, retrospective case-control study using Taiwan's nationwide database. We included patients with OSA aged ≥12 years, diagnosed according to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes: 327 and 780. Each enrolled patient with OSA needed to undergo a polysomnography examination within 1 year pre- or post-OSA occurrence. Patients with OSA and controls were selected in a 1:4 ratio. Patients with anxiety disorders (ICD-9-CM code 300) were diagnosed by board-certified psychiatrists and required to visit the outpatient clinic at least three times per year. Multivariate logistic regression and interaction analyses were used to evaluate the objective association. RESULTS This study enrolled 7987 and 31 948 participants with and without OSA, respectively. A significant difference in anxiety exposure was observed only pre-OSA diagnosis but not post-OSA diagnosis. Compared with patients without anxiety disorders: (i) those with anxiety disorders had an adjusted odds ratio (aOR) of ≈1.864 in OSA comorbidity (aOR = 1.864; 95% confidence interval [CI] = 1.337-2.405); and (ii) subgroup analysis showed a significant interaction that anxiety patients of male sex, aged 18 to 44 years, aged 45 to 64 years, and hypertension had a higher aOR in OSA comorbidity (aOR = 2.104 [95% CI = 1.436-2.589], aOR = 1.942 [95% CI = 1.390-2.503], aOR = 2.179 [95% CI = 1.564-2.811], and aOR = 2.092 [95% CI = 1.497-2.706], respectively). CONCLUSION The study revealed a higher ratio of previous anxiety exposure in patients with OSA. Compared with those without anxiety, anxiety patients of male sex, aged 18 to 64 years, and with hypertension had a higher risk of OSA comorbidity.
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Affiliation(s)
- Tien-Yu Chen
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan.,Sleep Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Terry B J Kuo
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Sleep Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Clinical Research Center, Taoyuan Psychiatric Center, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,School of Public Health, National Defense Medical Center, Taipei, Taiwan.,Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan
| | - Nian-Sheng Tzeng
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan.,Student Counseling Center, National Defense Medical Center, Taipei, Taiwan
| | - Hsiao-Ching Lai
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,School of Public Health, National Defense Medical Center, Taipei, Taiwan.,Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Cheryl C H Yang
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Sleep Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
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9
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Ward SA, Storey E, Gasevic D, Naughton MT, Hamilton GS, Trevaks RE, Wolfe R, O'Donoghue FJ, Stocks N, Abhayaratna WP, Fitzgerald S, Orchard SG, Ryan J, McNeil JJ, Reid CM, Woods RL. Sleep-disordered breathing was associated with lower health-related quality of life and cognitive function in a cross-sectional study of older adults. Respirology 2022; 27:767-775. [PMID: 35580042 PMCID: PMC9540665 DOI: 10.1111/resp.14279] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 04/14/2022] [Indexed: 12/14/2022]
Abstract
Background and objective The clinical significance of sleep‐disordered breathing (SDB) in older age is uncertain. This study determined the prevalence and associations of SDB with mood, daytime sleepiness, quality of life (QOL) and cognition in a relatively healthy older Australian cohort. Methods A cross‐sectional analysis was conducted from the Study of Neurocognitive Outcomes, Radiological and retinal Effects of Aspirin in Sleep Apnoea. Participants completed an unattended limited channel sleep study to measure the oxygen desaturation index (ODI) to define mild (ODI 5–15) and moderate/severe (ODI ≥ 15) SDB, the Centre for Epidemiological Studies Scale, the Epworth Sleepiness Scale, the 12‐item Short‐Form for QOL and neuropsychological tests. Results Of the 1399 participants (mean age 74.0 years), 36% (273 of 753) of men and 25% (164 of 646) of women had moderate/severe SDB. SDB was associated with lower physical health‐related QOL (mild SDB: beta coefficient [β] −2.5, 95% CI −3.6 to −1.3, p < 0.001; moderate/severe SDB: β −1.8, 95% CI −3.0 to −0.6, p = 0.005) and with lower global composite cognition (mild SDB: β −0.1, 95% CI −0.2 to 0.0, p = 0.022; moderate/severe SDB: β −0.1, 95% CI −0.2 to 0.0, p = 0.032) compared to no SDB. SDB was not associated with daytime sleepiness nor depression. Conclusion SDB was associated with lower physical health‐related quality of life and cognitive function. Given the high prevalence of SDB in older age, assessing QOL and cognition may better delineate subgroups requiring further management, and provide useful treatment target measures for this age group. The clinical implications for sleep‐disordered breathing (SDB) in older age remain uncertain. This study of healthy community‐dwelling older Australians reports significant associations between SDB and a lower physical health‐related quality of life, in contrast to other studies of SDB in older age, and between SDB and lower cognitive function. See relatededitorial
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Affiliation(s)
- Stephanie A Ward
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria.,Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Kensington, New South Wales.,Department of Geriatric Medicine, Prince of Wales Hospital, Randwick, New South Wales
| | - Elsdon Storey
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria
| | - Danijela Gasevic
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria.,Centre for Global Health Research, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Matthew T Naughton
- Department of Respiratory Medicine, Alfred Hospital, Melbourne, Victoria, Australia.,The Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Garun S Hamilton
- Department of Lung, Sleep, Allergy and Immunology, Monash Health, Clayton, Victoria, Australia.,School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Ruth E Trevaks
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria
| | - Rory Wolfe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria
| | - Fergal J O'Donoghue
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia.,Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Nigel Stocks
- Discipline of General Practice, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Walter P Abhayaratna
- College of Health and Medicine, Australian National University, Acton, Australian Capital Territory, Australia.,Academic Unit of Internal Medicine, Canberra Hospital, Garran, Australian Capital Territory, Australia
| | - Sharyn Fitzgerald
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria
| | - Suzanne G Orchard
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria
| | - John J McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria
| | - Christopher M Reid
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria.,Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Robyn L Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria
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10
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Krishnan S, Chai-Coetzer CL, Grivell N, Lovato N, Mukherjee S, Vakulin A, Adams RJ, Appleton SL. Comorbidities and quality of life in Australian men and women with diagnosed and undiagnosed high risk obstructive sleep apnea. J Clin Sleep Med 2022; 18:1757-1767. [PMID: 35332868 DOI: 10.5664/jcsm.9972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES In a population-based survey, we determined sex-differences in health profiles and quality of life between individuals who have a confirmed diagnosis of obstructive sleep apnea (OSA) and those who are at high risk of OSA yet remain undiagnosed. METHODS An online survey of Australian adults ≥18 years (n= 3818) identified participants with self-reported diagnosed OSA (n=460) or high risk, undiagnosed OSA (OSA50 score ≥5, n=1015). Ever-diagnosed comorbidities, sociodemographic and quality of life (EQ-5D-5L, Functional Outcomes of Sleep Questionnaire-10) were assessed. RESULTS Females were more frequently represented in the high OSA risk group compared to diagnosed OSA (55.5%, n=563 cf 43%, n=198) p<0.001. In sex-specific logistic regression analyses, diagnosed OSA was associated with increased likelihoods of ≥1 cardiovascular condition (odds ratio:3.0, 95% CI:2.0-4.5), hypertension (1.9, 1.3-2.8), gout (1.8, 1.1-2.9) and COPD (3.8, 2.1-6.9) in males. In females an association with asthma (2.0, 1.3-3.0) was seen. Diabetes, arthritis, mental health conditions (ever-diagnosed) and all EQ-5D-5L dimensions were associated with an OSA diagnosis regardless of sex with the exception of EQ-5D-5L anxiety/depression which was only associated with an OSA diagnosis in females. A diagnosis of OSA was associated with sleepiness related impairment (lowest quartile of FOSQ-10) in males (1.6, 1.01-2.5) and females (2.2, 1.4-3.6). CONCLUSIONS Sex-specific health conditions may drive diagnosis of OSA however a clinical suspicion of OSA needs to be increased in men and women. The impaired quality of life and persistent sleepiness in participants with diagnosed OSA observed at a population level requires greater clinical attention.
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Affiliation(s)
- Sowmya Krishnan
- Respiratory and Sleep Services, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Ching Li Chai-Coetzer
- Respiratory and Sleep Services, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia.,Flinders Health and Medical Research Institute-Sleep Health (Adelaide Institute for Sleep Health), College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Nicole Grivell
- Flinders Health and Medical Research Institute-Sleep Health (Adelaide Institute for Sleep Health), College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Nicole Lovato
- Flinders Health and Medical Research Institute-Sleep Health (Adelaide Institute for Sleep Health), College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Sutapa Mukherjee
- Respiratory and Sleep Services, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia.,Flinders Health and Medical Research Institute-Sleep Health (Adelaide Institute for Sleep Health), College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Andrew Vakulin
- Flinders Health and Medical Research Institute-Sleep Health (Adelaide Institute for Sleep Health), College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Robert J Adams
- Respiratory and Sleep Services, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia.,Flinders Health and Medical Research Institute-Sleep Health (Adelaide Institute for Sleep Health), College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Sarah L Appleton
- Flinders Health and Medical Research Institute-Sleep Health (Adelaide Institute for Sleep Health), College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
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11
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Pattullo GG. Clinical implications of opioid-induced ventilatory impairment. Anaesth Intensive Care 2022; 50:52-67. [PMID: 35189729 DOI: 10.1177/0310057x211070292] [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: 11/15/2022]
Abstract
Opioid-induced ventilatory impairment is the primary mechanism of harm from opioid use. Opioids suppress the activity of the central respiratory centres and are sedating, leading to impairment of alveolar ventilation.Respiratory physiological changes induced with acute opioid use include depression of the hypercapnic ventilatory response and hypoxic ventilatory response. In chronic opioid use a compensatory increase in hypoxic ventilatory response maintains ventilation and contributes to the onset of sleep-disordered breathing patterns of central sleep apnoea and ataxic breathing. Supplemental oxygen use in those at risk of opioid-induced ventilatory impairment requires careful consideration by the clinician to prevent failure to detect hypoventilation, if oximetry is being relied on, and the overriding of hypoxic ventilatory drive. Obstructive sleep apnoea and opioid-induced ventilatory impairment are frequently associated, with this interrelationship being complex and often unpredictable. Monitoring the patient for opioid-induced ventilatory impairment poses challenges in the areas of reliability, avoidance of alarm fatigue, cost, and personnel demands. Many situations remain in which patients cannot be provided effective analgesia without opioids, and for these the clinician requires a comprehensive knowledge of opioid-induced ventilatory impairment.
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Affiliation(s)
- Gavin G Pattullo
- Department of Anaesthesia and Pain Management, Royal North Shore Hospital, St Leonards, Australia
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12
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Chen TY, Kung YY, Lai HC, Lee LA, Jen IA, Chang HA, Liu CY, Kuo TBJ, Yang CCH. Prevalence and effects of sleep-disordered breathing on middle-aged patients with sedative-free generalized anxiety disorder: A prospective case-control study. Front Psychiatry 2022; 13:1067437. [PMID: 36699476 PMCID: PMC9869375 DOI: 10.3389/fpsyt.2022.1067437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 11/17/2022] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE Generalized anxiety disorder (GAD) and sleep-disordered breathing (SDB) share similar symptoms, such as poor sleep quality, irritability, and poor concentration during daily activities. This study aims to investigate the proportion of undiagnosed SDB and its impacts on anxiety severity and autonomic function in newly diagnosed, sedative-free GAD patients. METHODS This prospective case-control study included newly diagnosed GAD patients and control participants with matched age, sex, and body mass index (BMI) in Taiwan. All participants completed questionnaires for sleep and mood symptoms and a resting 5-min heart rate variability (HRV) examination during enrollment. The participants also used a home sleep apnea test to detect SDB. An oxygen desaturation index (ODI) ≥ 5 was considered indicative of SDB. RESULTS In total, 56 controls and 47 newly diagnosed GAD participants (mean age 55.31 ± 12.36 years, mean BMI 23.41 ± 3.42 kg/m2) were included. There was no significant difference in the proportion of undiagnosed SDB in the control and sedative-free GAD groups (46.43 vs. 51.06%). Sedative-free GAD patients with SDB scored significantly higher on Beck Anxiety Inventory (23.83 ± 11.54) than those without SDB (16.52 ± 10.61) (p < 0.001). Both control and sedative-free GAD groups with SDB had worse global autonomic function than the control group without SDB, as evidenced by the HRV results (p < 0.05 for all). CONCLUSION Average age 55 years and mean BMI 23 kg/m2 patients with GAD and matched controls had an undiagnosed SDB prevalence of approximately 50%. SDB correlated with worsening anxiety severity and reduced cardiac autonomic function. Moreover, age and BMI were considered major risk factors for predicting undiagnosed SDB.
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Affiliation(s)
- Tien-Yu Chen
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan.,Sleep Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yen-Ying Kung
- School of Medicine, Institute of Traditional Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Center for Traditional Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hsiao-Ching Lai
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Li-Ang Lee
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Otorhinolaryngology, Head and Neck Surgery, Sleep Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - I-An Jen
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan.,Department of Public Health, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hsin-An Chang
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Chia-Yu Liu
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Terry B J Kuo
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Sleep Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Tsoutun Psychiatric Center, Ministry of Health and Welfare, Nantou, Taiwan.,Clinical Research Center, Taoyuan Psychiatric Center, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Cheryl C H Yang
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Sleep Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
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13
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Lechat B, Naik G, Reynolds A, Aishah A, Scott H, Loffler KA, Vakulin A, Escourrou P, McEvoy RD, Adams RJ, Catcheside PG, Eckert DJ. Multi-night Prevalence, Variability, and Diagnostic Misclassification of Obstructive Sleep Apnea. Am J Respir Crit Care Med 2021; 205:563-569. [PMID: 34904935 PMCID: PMC8906484 DOI: 10.1164/rccm.202107-1761oc] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Rationale Recent studies suggest that obstructive sleep apnea (OSA) severity can vary markedly from night to night which may have important implications for diagnosis and management. Objectives This study aimed to assess OSA prevalence from multi-night in-home recordings and the impact of night-to-night variability in OSA severity on diagnostic classification in a large, global, non-randomly selected community sample from a consumer database of people that purchased a novel, validated, under-mattress sleep analyzer. Methods 67,278 individuals aged between 18 and 90 years underwent in-home nightly monitoring over an average of ~170 nights per participant between July 2020 to March 2021. OSA was defined as a nightly mean apnea-hypopnea index (AHI) >15 events/h. Outcomes were multi-night global prevalence and likelihood of OSA misclassification from a single night AHI value. Measurements and Main Results Over 11.6 million nights of data were collected and analyzed. OSA global prevalence was 22.6% (95% CI: 20.9-24.3%). The likelihood of misdiagnosis in people with OSA based on a single night ranged between ~20% and 50%. Misdiagnosis error rates decreased with increased monitoring nights (e.g. 1-night F1-score=0.77 vs. 0.94 for 14-nights); and remained stable after 14-nights of monitoring. Conclusions Multi-night in-home monitoring using novel non-invasive under mattress sensor technology indicates a global prevalence of moderate to severe OSA of ~20%, and that ~20% of people diagnosed with a single night study may be misclassified. These findings highlight the need to consider night-to-night variation on OSA diagnosis and management. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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Affiliation(s)
- Bastien Lechat
- Flinders University, 1065, Adelaide Institute for Sleep Health and FHMRI Sleep Health, College of Medicine and Public Health, Adelaide, South Australia, Australia;
| | - Ganesh Naik
- Flinders University, 1065, Adelaide Institute for Sleep Health and FHMRI Sleep Health, College of Medicine and Public Health, Adelaide, South Australia, Australia
| | - Amy Reynolds
- Flinders University, 1065, Adelaide Institute for Sleep Health and FHMRI Sleep Health, College of Medicine and Public Health, Adelaide, South Australia, Australia
| | - Atqiya Aishah
- Flinders University, 1065, Adelaide Institute for Sleep Health and FHMRI Sleep Health, College of Medicine and Public Health, Adelaide, South Australia, Australia.,University of New South Wales, 7800, School of Medical Science, Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia
| | - Hannah Scott
- Flinders University, 1065, Adelaide Institute for Sleep Health and FHMRI Sleep Health, College of Medicine and Public Health, Adelaide, South Australia, Australia
| | - Kelly A Loffler
- Flinders University, 1065, Adelaide Institute for Sleep Health and FHMRI Sleep Health, College of Medicine and Public Health, Adelaide, South Australia, Australia
| | - Andrew Vakulin
- Flinders University, 1065, Adelaide Institute for Sleep Health and FHMRI Sleep Health, College of Medicine and Public Health, Adelaide, South Australia, Australia
| | | | - R Doug McEvoy
- Flinders University, 1065, Adelaide Institute for Sleep Health and FHMRI Sleep Health, College of Medicine and Public Health, Adelaide, South Australia, Australia
| | - Robert J Adams
- Flinders University, 1065, Adelaide Institute for Sleep Health and FHMRI Sleep Health, College of Medicine and Public Health, Adelaide, South Australia, Australia
| | - Peter G Catcheside
- Flinders University, 1065, Adelaide Institute for Sleep Health and FHMRI Sleep Health, College of Medicine and Public Health, Adelaide, South Australia, Australia
| | - Danny J Eckert
- Flinders University, 1065, Adelaide Institute for Sleep Health and FHMRI Sleep Health, College of Medicine and Public Health, Adelaide, South Australia, Australia
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14
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Narang I, Carberry JC, Butler JE, Gandevia SC, Chiang AKI, Eckert DJ. Physiological Responses and Perceived Comfort to High Flow Nasal Cannula Therapy in Awake Adults: Effects of Flow Magnitude and Temperature. J Appl Physiol (1985) 2021; 131:1772-1782. [PMID: 34709070 DOI: 10.1152/japplphysiol.00085.2021] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Clinical use of heated, high flow nasal cannula (HFNC) for non-invasive respiratory support is increasing and may have a therapeutic role in stabilizing the upper airway in obstructive sleep apnea (OSA). However, physiological mechanisms by which HFNC therapy may improve upper-airway function and effects of different temperature modes are unclear. Accordingly, this study aimed to determine effects of incremental flows and temperature modes (heated and non-heated) of HFNC on upper airway muscle activity (genioglossus), pharyngeal airway pressure, breathing parameters and perceived comfort. Six participants (2 females, aged 35±14 years) were studied during wakefulness in supine position and received HFNC at variable flows (0-60 L/min) during heated (37ºC) and non-heated (21ºC) modes. Breathing parameters via calibrated Respitrace inductance bands (chest and abdomen), upper-airway pressures via airway transducers, and genioglossus muscle activity via intra-muscular bipolar fine wire electrodes were measured. Comfort levels during HFNC were quantified using a visual analogue scale. Increasing HFNC flows did not increase genioglossus muscle activation despite increased negative epiglottic pressure swings (p=0.009). HFNC provided ~7cmH2O positive airway pressure at 60 L/min in non-heated and heated modes. In addition, increasing the magnitude of HFNC flow reduced breathing frequency (p=0.045), increased expiratory time (p=0.040), increased peak inspiratory flow (p=0.002), and increased discomfort (p=0.004). Greater discomfort occurred at higher flows in non-heated versus heated mode (p=0.034). These findings provide novel insight into key physiological changes that occur with HFNC for respiratory support and indicate the primary mechanism for improved upper-airway stability is positive airway pressure, not increased pharyngeal muscle activity.
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Affiliation(s)
- Indra Narang
- Translational Medicine, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada.,Neuroscience Research Australia (NeuRA), Randwick, Sydney, NSW, Australia
| | - Jayne C Carberry
- Neuroscience Research Australia (NeuRA), Randwick, Sydney, NSW, Australia.,School Of Medicine, University College Dublin, Dublin, Ireland
| | - Jane E Butler
- Neuroscience Research Australia (NeuRA), Randwick, Sydney, NSW, Australia.,School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Simon C Gandevia
- Neuroscience Research Australia (NeuRA), Randwick, Sydney, NSW, Australia.,School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Alan K I Chiang
- Neuroscience Research Australia (NeuRA), Randwick, Sydney, NSW, Australia
| | - Danny J Eckert
- Neuroscience Research Australia (NeuRA), Randwick, Sydney, NSW, Australia.,Flinders Health and Medical Research Institute Sleep Health/Adelaide Institute for Sleep Health, Flinders University, Bedford Park, SA, Australia.,School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
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15
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Osorio RS, Martínez-García MÁ, Rapoport DM. Sleep apnoea in the elderly: a great challenge for the future. Eur Respir J 2021; 59:13993003.01649-2021. [PMID: 34561285 DOI: 10.1183/13993003.01649-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/25/2021] [Indexed: 11/05/2022]
Abstract
Due in part to overall improvements in health, the population of elderly individuals is increasing rapidly. Similarly, obstructive sleep apnoea (OSA) is both gaining increased recognition and also increasing due to the worldwide obesity epidemic. The overlap of OSA and aging is large, but there is strong plausibility for causation in both directions: OSA is associated with pathological processes that may accelerate aging and aging related processes; aging may cause physical and neurological changes that predispose to obstructive (and central) apnoea. In addition, the common symptoms (e.g. excessive daytime somnolence, defects in memory and cognition), possible physiological consequences of OSA (e.g. accelerated cardiovascular and cerebrovascular atherosclerosis), and changes in metabolic and inflammatory markers overlap with the symptoms and associated conditions seen in aging. There is also the possibility of synergy in the effects of these symptoms and conditions on quality of life, as well as a need to separate treatable consequences of OSA from age-related complaints. Taken together, the above make it essential to review the interaction of OSA and aging, both proven and suspected. The present review examines some aspects of what is known and points to the need for further investigation of the relationships, given the large number of potentially affected subjects.
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Affiliation(s)
- Ricardo S Osorio
- Department of Psychiatry, New York University (NYU) Grossman School of Medicine, New York, New York, USA.,Clinical Research Division, Nathan Kline Institute (NKI), Orangeburg, New York, USA
| | - Miguel Ángel Martínez-García
- Respirology Department, University and Politechnic la Fe Hospital, Valencia, Valencian Community, Spain .,CIBERES de Enfermedades Respiratorias, Madrid, Spain
| | - David M Rapoport
- Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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16
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Suurna MV, Jacobowitz O, Chang J, Koutsourelakis I, Smith D, Alkan U, D'Agostino M, Boon M, Heiser C, Hoff P, Huntley C, Kent D, Kominsky A, Lewis R, Maurer JT, Ravesloot M, Soose R, Steffen A, Weaver E, Williams AM, Woodson T, Yaremchuk K, Ishman SL. Improving outcomes of hypoglossal nerve stimulation therapy: current practice, future directions and research gaps. Proceedings of the 2019 International Sleep Surgery Society Research Forum. J Clin Sleep Med 2021; 17:2477-2487. [PMID: 34279214 DOI: 10.5664/jcsm.9542] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Hypoglossal nerve stimulation (HGNS) has evolved as a novel and effective therapy for patients with moderate-to-severe obstructive sleep apnea (OSA). Despite positive published outcomes of HGNS, there exist uncertainties regarding proper patient selection, surgical technique, and the reporting of outcomes and individual factors that impact therapy effectiveness. According to current guidelines, this therapy is indicated for select patients, and recommendations are based on the Stimulation Therapy for Apnea Reduction (STAR) trial. Ongoing research and physician experiences continuously improve methods to optimize the therapy. An understanding of the way in which airway anatomy, OSA phenotypes, individual health status, psychological conditions and comorbid sleep disorders influence the effectiveness of HGNS is essential to improve outcomes and expand therapy indications. This manuscript presents discussions on current evidence, future directions, and research gaps for HGNS therapy from the 10th International Surgical Sleep Society expert research panel.
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Affiliation(s)
- Maria V Suurna
- Division of Sleep Surgery, Department of Otolaryngology - Head and Neck Surgery, Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY
| | | | - Jolie Chang
- Division of Sleep Surgery, Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, CA
| | | | - David Smith
- Divisions of Pediatric Otolaryngology, Pulmonary Medicine, and the Sleep Center; Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Otolaryngology - Head and Neck Surgery of University of Cincinnati College of Medicine, Cincinnati, OH
| | - Uri Alkan
- Department of Otorhinolaryngology, Head and Neck Surgery, Rabin Medical Center, Beilinson Hospital, Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mark D'Agostino
- Southern New England Ear, Nose, Throat and Facial Plastic Surgery Group and Middlesex Hospital, Middletown, CT
| | - Maurits Boon
- Otolaryngology - Head and Neck Surgery, Thomas Jefferson University Hospital
| | - Clemens Heiser
- Department of Otorhinolaryngology, Head and Neck Surgery, Technische Universität München, Munich, Germany
| | - Paul Hoff
- Department of Otolaryngology, University of Michigan, Ann Arbor, MI
| | - Colin Huntley
- Otolaryngology - Head and Neck Surgery, Thomas Jefferson University Hospital
| | - David Kent
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN
| | - Alan Kominsky
- Head and Neck Institute, Cleveland Clinic, Cleveland, OH
| | - Richard Lewis
- Perth Head & Neck Surgery, Hollywood Medical Centre, Nedlands, Australia
| | - Joachim T Maurer
- Division of Sleep Medicine, Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | | | - Ryan Soose
- Division of Sleep Surgery, Department of Otolaryngology, Pittsburgh School of Medicine, UPMC Mercy, University of Pittsburgh, Pittsburgh, PA
| | - Armin Steffen
- Department of otorhinolaryngology, University of Lübeck, Lübeck, Germany
| | - Edward Weaver
- Department of Otolaryngology-Head and Neck Surgery, University of Washington; Surgery Service, Seattle Veterans Affairs Medical Center; Harborview Medical Center, Seattle, WA
| | - Amy M Williams
- Department of Otolaryngology - Head & Neck Surgery of Henry Ford Health System, Detroit, MI
| | - Tucker Woodson
- Division of Sleep Medicine and Sleep Surgery, Department of Otolaryngology and Human Communication of Medical College of Wisconsin, Milwaukee, WI
| | - Kathleen Yaremchuk
- Department of Otolaryngology - Head & Neck Surgery of Henry Ford Health System, Detroit, MI
| | - Stacey L Ishman
- Divisions of Pediatric Otolaryngology, Pulmonary Medicine, and the Sleep Center; Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Otolaryngology - Head and Neck Surgery of University of Cincinnati College of Medicine, Cincinnati, OH
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17
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Boof ML, Dingemanse J, Lederer K, Fietze I, Ufer M. Effect of the new dual orexin receptor antagonist daridorexant on nighttime respiratory function and sleep in patients with mild and moderate obstructive sleep apnea. Sleep 2021; 44:6030922. [PMID: 33305817 DOI: 10.1093/sleep/zsaa275] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 10/30/2020] [Indexed: 11/14/2022] Open
Abstract
In this randomized, double-blind, placebo-controlled, two-period crossover study, the effect of the dual orexin receptor antagonist daridorexant was evaluated on nighttime respiratory function and sleep in 28 patients with mild and moderate obstructive sleep apnea (OSA). In each period, 50 mg daridorexant or placebo was administered every evening for 5 days. The primary endpoint was apnea/hypopnea index (AHI) during total sleep time (TST) after the last dosing. Other endpoints included peripheral oxygen saturation (SpO2), sleep duration, latency to persistent sleep (LPS), wake after sleep onset (WASO), and sleep efficiency index (SEI). Pharmacokinetics, safety, and tolerability were also assessed. The mean treatment difference for AHI during TST (i.e. daridorexant - placebo) after the last dosing was 0.74 events/hour (90% confidence interval [CI]: -1.43, 2.92). The corresponding treatment difference for SpO2 during TST was 0.16% [90% CI: -0.21, 0.53]. Overall, there was no clinically relevant effect of daridorexant on AHI or SpO2-related data after single and repeated dosing irrespective of sleep phase (i.e. rapid eye movement [REM] vs non-REM). Moreover, after single and repeated dosing, daridorexant prolonged TST by 39.6 minutes (90% CI: 16.9, 62.3) and 38.8 minutes (19.7, 57.9), respectively, compared with placebo and favorably modulated other sleep-related endpoints (i.e. increased SEI, decreased WASO, and shortened LPS). It attained expected plasma concentrations and was well tolerated in patients with mild and moderate OSA. These results indicate that single and repeated doses of 50 mg daridorexant do not impair nighttime respiratory function and improve sleep in patients with mild and moderate OSA. Clinical Trial Registration: ClinicalTrials.gov NCT03765294. A study to investigate the effects of ACT-541468 on nighttime respiratory function in patients with mild to moderate obstructive sleep apnea. https://clinicaltrials.gov/ct2/show/ NCT03765294.
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Affiliation(s)
- Marie-Laure Boof
- Department of Clinical Pharmacology, Idorsia Pharmaceuticals Ltd, Allschwil, Switzerland
| | - Jasper Dingemanse
- Department of Clinical Pharmacology, Idorsia Pharmaceuticals Ltd, Allschwil, Switzerland
| | | | - Ingo Fietze
- Advanced Sleep Research GmbH, Berlin, Germany
| | - Mike Ufer
- Department of Clinical Pharmacology, Idorsia Pharmaceuticals Ltd, Allschwil, Switzerland
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18
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Pauletto P, Réus JC, Bolan M, Massignan C, Flores-Mir C, Maia I, Gozal D, Hallal ALC, Porporatti AL, Canto GDL. Association between obstructive sleep apnea and health-related quality of life in untreated adults: a systematic review. Sleep Breath 2021; 25:1773-1789. [PMID: 33709191 DOI: 10.1007/s11325-021-02323-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 02/07/2021] [Accepted: 02/12/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE The objective of this systematic review was to answer the question: "Is there association between obstructive sleep apnea (OSA) and health-related quality of life (HRQoL) in untreated adults?" METHODS We included observational studies that evaluated the health-related quality of life of patients with OSA vs control groups, through generic and disease-specific questionnaires. The searches were conducted in six databases: Embase, Lilacs, PsycINFO, PubMed, Scopus, and Web of Science. Additional search in the grey literature and hand search were performed, and also experts were consulted. Risk of bias was performed by using Joanna Briggs Institute Critical Appraisal Checklist for cross-sectional, cohort, and case-control studies. We analyzed the data using a narrative synthesis. The Grading of Recommendations Assessment, Development, and Evaluation evidence profile was used to verify the overall certainty of the assessed evidence. RESULTS Nineteen studies were included for qualitative analysis. Generic questionnaires showed worse HRQoL in the OSA group compared to the control group in at least one domain of the HRQoL questionnaires. The affected domains that showed statistical and clinically relevant differences were physical functioning, physical role, pain, general health, vitality, emotional role, and mental health. The certainty of evidence assessment was very low. CONCLUSION The available literature suggests that OSA in untreated adults is associated with worse HRQoL. However, this association seems to disappear when we consider only studies adjusted for related covariates. REGISTRATION CRD42018114746.
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Affiliation(s)
- Patrícia Pauletto
- Department of Dentistry, Brazilian Centre for Evidence-Based Research, Health Sciences Center, Federal University of Santa Catarina, Campus Universitário Caixa Postal 476 - Trindade, Florianópolis, Santa Catarina, 88040-900, Brazil.
| | - Jéssica Conti Réus
- Department of Dentistry, Brazilian Centre for Evidence-Based Research, Health Sciences Center, Federal University of Santa Catarina, Campus Universitário Caixa Postal 476 - Trindade, Florianópolis, Santa Catarina, 88040-900, Brazil
| | - Michele Bolan
- Department of Dentistry, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Carla Massignan
- Department of Dentistry, Brazilian Centre for Evidence-Based Research, Health Sciences Center, Federal University of Santa Catarina, Campus Universitário Caixa Postal 476 - Trindade, Florianópolis, Santa Catarina, 88040-900, Brazil.,Department of Dentistry, Federal University of Brasília, Brasilia, Distrito Federal, Brazil
| | | | - Israel Maia
- Baía Sul Research Institute, Florianópolis, Santa Catarina, Brazil
| | - David Gozal
- Department of Child Health, University of Missouri School of Medicine, Columbia, MO, 65201, USA
| | - Ana Luiza Curi Hallal
- Department of Dentistry, Brazilian Centre for Evidence-Based Research, Health Sciences Center, Federal University of Santa Catarina, Campus Universitário Caixa Postal 476 - Trindade, Florianópolis, Santa Catarina, 88040-900, Brazil
| | - André Luís Porporatti
- Department of Dentistry, Brazilian Centre for Evidence-Based Research, Health Sciences Center, Federal University of Santa Catarina, Campus Universitário Caixa Postal 476 - Trindade, Florianópolis, Santa Catarina, 88040-900, Brazil
| | - Graziela De Luca Canto
- Department of Dentistry, Brazilian Centre for Evidence-Based Research, Health Sciences Center, Federal University of Santa Catarina, Campus Universitário Caixa Postal 476 - Trindade, Florianópolis, Santa Catarina, 88040-900, Brazil
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19
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Hwang M, Zhang K, Nagappa M, Saripella A, Englesakis M, Chung F. Validation of the STOP-Bang questionnaire as a screening tool for obstructive sleep apnoea in patients with cardiovascular risk factors: a systematic review and meta-analysis. BMJ Open Respir Res 2021; 8:8/1/e000848. [PMID: 33664122 PMCID: PMC7934717 DOI: 10.1136/bmjresp-2020-000848] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/22/2021] [Accepted: 01/26/2021] [Indexed: 12/20/2022] Open
Abstract
Introduction Obstructive sleep apnoea (OSA) is highly prevalent in patients with cardiovascular risk factors and is associated with increased morbidity and mortality. This review presents the predictive parameters of the STOP-Bang questionnaire as a screening tool for OSA in this population. Methods A search of databases was performed. The inclusion criteria were: (1) use of the STOP-Bang questionnaire to screen for OSA in adults (>18 years) with cardiovascular risk factors; (2) polysomnography or home sleep apnoea testing performed as a reference standard; (3) OSA defined by either Apnoea–Hypopnoea Index (AHI) or Respiratory Disturbance Index; and (4) data on predictive parameters of the STOP-Bang questionnaire. A random-effects model was used to obtain pooled predictive parameters of the STOP-Bang questionnaire. Results The literature search resulted in 3888 articles, of which 9 papers met the inclusion criteria, involving 1894 patients. The average age of the included patients was 58±13 years with body mass index (BMI) of 30±6 kg/m2, and 64% were male. The STOP-Bang questionnaire has a sensitivity of 89.1%, 90.7% and 93.9% to screen for all (AHI ≥5), moderate-to-severe (AHI ≥15) and severe (AHI≥30) OSA, respectively. The specificity was 32.3%, 22.5% and 18.3% and the area under the curve (AUC) was 0.86, 0.65 and 0.52 for all, moderate-to-severe and severe OSA, respectively. Conclusion The STOP-Bang questionnaire is an effective tool to screen for OSA (AHI≥5) with AUC of 0.86 in patients with cardiovascular risk factors.
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Affiliation(s)
- Mark Hwang
- Faculty of Medicine, Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Kevin Zhang
- Faculty of Medicine, Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mahesh Nagappa
- Department of Anaesthesia & Perioperative Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Aparna Saripella
- Department of Anaesthesia and Pain Medicine, University Health Network, Toronto, Ontario, Canada
| | - Marina Englesakis
- Library and Information Services, University Health Network, Toronto, Ontario, Canada
| | - Frances Chung
- Department of Anaesthesia and Pain Medicine, Toronto Western Hospital, Toronto, Ontario, Canada
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20
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McKeown P, O’Connor-Reina C, Plaza G. Breathing Re-Education and Phenotypes of Sleep Apnea: A Review. J Clin Med 2021; 10:jcm10030471. [PMID: 33530621 PMCID: PMC7865730 DOI: 10.3390/jcm10030471] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 01/18/2021] [Accepted: 01/20/2021] [Indexed: 12/13/2022] Open
Abstract
Four phenotypes of obstructive sleep apnea hypopnea syndrome (OSAHS) have been identified. Only one of these is anatomical. As such, anatomically based treatments for OSAHS may not fully resolve the condition. Equally, compliance and uptake of gold-standard treatments is inadequate. This has led to interest in novel therapies that provide the basis for personalized treatment protocols. This review examines each of the four phenotypes of OSAHS and explores how these could be targeted using breathing re-education from three dimensions of functional breathing: biochemical, biomechanical and resonant frequency. Breathing re-education and myofunctional therapy may be helpful for patients across all four phenotypes of OSAHS. More research is urgently needed to investigate the therapeutic benefits of restoring nasal breathing and functional breathing patterns across all three dimensions in order to provide a treatment approach that is tailored to the individual patient.
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Affiliation(s)
- Patrick McKeown
- Buteyko Clinic International, Loughwell, Moycullen, Co., H91 H4C1 Galway, Ireland;
| | - Carlos O’Connor-Reina
- Otorhinolaryngology Department, Hospital Quironsalud Marbella, 29603 Marbella, Spain;
- Otorhinolaryngology Department, Hospital Quironsalud Campo de Gibraltar, 11379 Palmones, Spain
| | - Guillermo Plaza
- Otorhinolaryngology Department, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, 28042 Madrid, Spain
- Otorhinolaryngology Department, Hospital Sanitas la Zarzuela, 28023 Madrid, Spain
- Correspondence:
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21
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Hoon E, González-Chica DA, Vakulin A, McEvoy D, Zwar N, Grunstein R, Chai-Coetzer C, Lack L, Adams R, Hay P, Touyz S, Stocks N. Population-based analysis of sociodemographic predictors, health-related quality of life and health service use associated with obstructive sleep apnoea and insomnia in Australia. Aust J Prim Health 2021; 27:304-311. [PMID: 33653510 DOI: 10.1071/py20216] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 12/28/2020] [Indexed: 11/23/2022]
Abstract
Although there is growing recognition of the effects of living with sleep disorders and the important role of primary care in their identification and management, studies indicate that the detection of sleep apnoea (OSA) and insomnia may still be low. This large representative community-based study (n=2977 adults) used logistic regression models to examine predictors of self-reported OSA and current insomnia and linear regression models to examine the association of these sleep conditions with both mental and physical components of health-related quality of life (HRQoL) and health service use. Overall, 5.6% (95% confidence interval (CI) 4.6-6.7) and 6.8% (95% CI 5.7-7.9) of subjects self-reported OSA (using a single-item question) and current insomnia (using two single-item questions) respectively. Many sociodemographic and lifestyle predictors for OSA and insomnia acted in different directions or showed different magnitudes of association. Both disorders had a similar adverse relationship with physical HRQoL, whereas mental HRQoL was more impaired among those with insomnia. Frequent consultations with a doctor were associated with a lower physical HRQoL across these sleep conditions; however, lower mental HRQoL among those frequently visiting a doctor was observed only among individuals with insomnia. The adverse relationship between sleep disorders and physical and mental HRQoL was substantial and should not be underestimated.
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Affiliation(s)
- E Hoon
- Discipline of General Practice, Adelaide Medical School, The University of Adelaide, Helen Mayo North Building, Frome Road, Adelaide, SA 5000, Australia; and Corresponding author.
| | - D A González-Chica
- Discipline of General Practice, Adelaide Medical School, The University of Adelaide, Helen Mayo North Building, Frome Road, Adelaide, SA 5000, Australia
| | - A Vakulin
- Adelaide Institute for Sleep Health: A Flinders Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Mark Oliphant Building, 5 Laffer Drive, Bedford Park, SA 5049, Australia; and Sleep and Chronobiology Research Group, Woolcock Institute of Medical Research, The University of Sydney, 431 Glebe Point Road, Glebe, NSW 2037, Australia
| | - D McEvoy
- Adelaide Institute for Sleep Health: A Flinders Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Mark Oliphant Building, 5 Laffer Drive, Bedford Park, SA 5049, Australia
| | - N Zwar
- Faculty of Health Sciences and Medicine, Bond University, 14 University Drive, Robina, Qld 4226, Australia
| | - R Grunstein
- Sleep and Chronobiology Research Group, Woolcock Institute of Medical Research, The University of Sydney, 431 Glebe Point Road, Glebe, NSW 2037, Australia; and Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital 50 Missenden Road, Camperdown, NSW 2050, Australia
| | - C Chai-Coetzer
- Adelaide Institute for Sleep Health: A Flinders Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Mark Oliphant Building, 5 Laffer Drive, Bedford Park, SA 5049, Australia; and Respiratory and Sleep Service, Southern Adelaide Local Health Network, Flinders Medical Centre, Bedford Park, SA 5049, Australia
| | - L Lack
- Adelaide Institute for Sleep Health: A Flinders Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Mark Oliphant Building, 5 Laffer Drive, Bedford Park, SA 5049, Australia
| | - R Adams
- Adelaide Institute for Sleep Health: A Flinders Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Mark Oliphant Building, 5 Laffer Drive, Bedford Park, SA 5049, Australia; and Respiratory and Sleep Service, Southern Adelaide Local Health Network, Flinders Medical Centre, Bedford Park, SA 5049, Australia
| | - P Hay
- Translational Health Research Institute, School of Medicine, University of Western Sydney, Building 3, David Pilgrim Avenue, Campbelltown, NSW 2560, Australia
| | - S Touyz
- School of Psychology, University of Sydney, Brennan MacCallum Building, A18 Manning Road, Camperdown, NSW 2050, Australia
| | - N Stocks
- Discipline of General Practice, Adelaide Medical School, The University of Adelaide, Helen Mayo North Building, Frome Road, Adelaide, SA 5000, Australia
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22
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Waldman LT, Parthasarathy S, Villa KF, Bron M, Bujanover S, Brod M. Understanding the burden of illness of excessive daytime sleepiness associated with obstructive sleep apnea: a qualitative study. Health Qual Life Outcomes 2020; 18:128. [PMID: 32381095 PMCID: PMC7206792 DOI: 10.1186/s12955-020-01382-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 04/28/2020] [Indexed: 12/03/2022] Open
Abstract
Background Obstructive sleep apnea (OSA) is associated with excessive daytime sleepiness (EDS), which may go undiagnosed and can significantly impair a patient’s health-related quality of life (HRQOL). This qualitative research examined timing and reasons patients sought medical care for their EDS and OSA symptoms, and the impact of EDS on HRQOL. Methods Focus groups were conducted in 3 US cities with 42 participants currently experiencing EDS with OSA. Transcripts were coded and analyzed using an adapted grounded theory approach common to qualitative research. Results Over three-fifths of study participants (n = 26, 62%) were currently using a positive airway pressure (PAP) or dental device; one-third (n = 14, 33%) had previously used a positive airway pressure (PAP) or dental device, and the remainder had either used another treatment (n = 1, 2%) or were treatment naïve (n = 1, 2%). Twenty-two participants (52%) reported experiencing OSA symptoms for ≥1 year, with an average duration of 11.4 (median 8.0, range 1–37) years before seeking medical attention. Several (n = 7, 32%) considered their symptoms to be “normal,” rather than signaling a serious medical condition. Thirty participants (71%) discussed their reasons for ultimately seeking medical attention, which included: input from spouse/partner, another family member, or friend (n = 20, 67%); their own concern about particular symptoms (n = 7, 23%); and/or falling asleep while driving (n = 5, 17%). For all 42 participants, HRQOL domains impacted by EDS included: physical health and functioning (n = 40, 95%); work productivity (n = 38, 90%); daily life functioning (n = 39, 93%); cognition (n = 38, 90%); social life/relationships (n = 37, 88%); and emotions (n = 30, 71%). Conclusions Findings suggest that patients may be unaware that their symptoms could indicate OSA requiring evaluation and treatment. Even following diagnosis, EDS associated with OSA can continue to substantially affect HRQOL and daily functioning. Further research is needed to address diagnostic delays and unmet treatment needs for patients with EDS associated with OSA.
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Affiliation(s)
| | - Sairam Parthasarathy
- University of Arizona Health Sciences Center for Sleep and Circadian Sciences and Division of Pulmonary, Allergy, Critical Care & Sleep Medicine, University of Arizona, Tucson, AZ, USA
| | | | | | | | - Meryl Brod
- The Brod Group, 219 Julia Ave, Mill Valley, CA, 94941, USA
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23
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Manlises CO, Chen J, Huang C. Dynamic tongue area measurements in ultrasound images for adults with obstructive sleep apnea. J Sleep Res 2020; 29:e13032. [DOI: 10.1111/jsr.13032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 02/09/2020] [Accepted: 02/25/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Cyrel Ontimare Manlises
- Department of Biomedical Engineering National Cheng Kung University Tainan Taiwan
- School of Electrical, Electronics, and Computer Engineering Mapúa University Manila Philippines
| | - Jeng‐Wen Chen
- Department of Otolaryngology–Head and Neck Surgery Cardinal Tien Hospital New Taipei City Taiwan
- School of Medicine Fu Jen Catholic University New Taipei City Taiwan
- Department of Otolaryngology–Head and Neck Surgery National Taiwan University Hospital Taipei Taiwan
- Department of Nursing Cardinal Tien Junior College of Healthcare and Management New Taipei City Taiwan
| | - Chih‐Chung Huang
- Department of Biomedical Engineering National Cheng Kung University Tainan Taiwan
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24
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Saconi B, Yang H, Watach AJ, Sawyer AM. Coping Processes, Self-Efficacy, and CPAP Use in Adults With Obstructive Sleep Apnea. Behav Sleep Med 2020; 18:68-80. [PMID: 30477340 PMCID: PMC6535371 DOI: 10.1080/15402002.2018.1545651] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Coping strategies are predictive of 1 week CPAP use. Coping strategies may predict longer-term CPAP use among adults with obstructive sleep apnea (OSA). Objectives: To investigate the influence of two coping styles (active and passive) and individual coping processes on CPAP use at 1 week and 1 month; and explore the association between self-efficacy and coping on CPAP use. Participants: CPAP-naïve adults (52.3% male, 90.9% White) newly diagnosed with OSA (AHI ≥ 5 events/hr) from two U.S. clinical sleep centers (n = 66). Methods: A post-hoc analysis from a prospective, longitudinal study that examined influential factors on CPAP use among CPAP-naïve patients with newly diagnosed OSA. The Ways of Coping Questionnaire and the Self-Efficacy Measure for Sleep Apnea were completed immediately after CPAP titration polysomnography. Objective 1 week and 1 month CPAP use (mean hr/night) were the primary outcomes. Descriptive analyses and stepwise multiple linear regression analyses modeling for CPAP use (mean hr/night). Results: Active coping was significantly associated with greater CPAP use (mean hr/night) at 1 week, but not at 1 month (p = 0.0397; p = 0.0556, respectively). Higher Planful Problem Solving was significantly associated with greater average CPAP use at 1 week and 1 month (p = 0.0117, p = 0.0378, respectively). Self-efficacy was significantly associated with greater average CPAP use at 1 week (p = 0.0056) and 1 month (p = 0.0056). Conclusions: Self-efficacy and Planful Problem Solving coping are promising behavioral intervention targets to promote CPAP use in newly diagnosed OSA.
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Affiliation(s)
- Bruno Saconi
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Hyunju Yang
- College of Nursing, Chonnam National University, Gwangju, South Korea
| | - Alexa J Watach
- Department of Medicine, Center for Sleep & Circadian Neurobiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Amy M Sawyer
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Evidence Based Practice & Nursing Science, Philadelphia, Pennsylvania,Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
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25
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Phenotypic approach to pharmacotherapy in the management of obstructive sleep apnoea. Curr Opin Pulm Med 2019; 25:594-601. [DOI: 10.1097/mcp.0000000000000628] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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26
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McEvoy RD. Importance of lifestyle change for patients with sleep apnoea. Respirology 2019; 24:710-711. [PMID: 31228299 DOI: 10.1111/resp.13627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 06/04/2019] [Indexed: 12/01/2022]
Affiliation(s)
- R Doug McEvoy
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.,Respiratory and Sleep Service, Southern Adelaide Local Health Network, Flinders Medical Centre, Adelaide, SA, Australia
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27
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Senaratna CV, Walters EH, Hamilton G, Lowe AJ, Lodge C, Burgess J, Erbas B, Giles GG, Thomas P, Abramson MJ, Thompson B, Perret JL, Dharmage SC. Nocturnal symptoms perceived as asthma are associated with obstructive sleep apnoea risk, but not bronchial hyper-reactivity. Respirology 2019; 24:1176-1182. [PMID: 31066970 DOI: 10.1111/resp.13576] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 04/09/2019] [Accepted: 04/15/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND OBJECTIVE Obstructive sleep apnoea (OSA) and asthma are associated, and nocturnal breathing difficulty that is usually identified as asthma-like symptoms can be present in both conditions. We investigated how nocturnal asthma-like symptoms (NAS) and bronchial hyper-reactivity (BHR) contribute to the association between OSA risk and current asthma, which is currently unknown but a clinically important question. METHODS We used data from 794 middle-aged participants in a population-based cohort who provided information on OSA risk (defined by a STOP-Bang questionnaire score of at least 3), current asthma and NAS, and underwent methacholine bronchial challenge testing. Using regression models, we examined the association between OSA risk and current asthma-NAS subgroups and investigated any effect modification by BHR. RESULTS The participants were aged 50 years (49.8% male). OSA risk was associated with NAS with or without current asthma (odds ratio (OR): 2.6; 95% CI = 1.3-5.0; OR: 4.2; 95% CI = 1.1-16.1, respectively), but not with current asthma in the absence of NAS. BHR was associated with current asthma with or without NAS (OR: 2.9; 95% CI = 1.4-5.9; OR: 3.4; 95% CI = 2.0-7.0, respectively) but not with NAS in the absence of current asthma. The associations between OSA risk and current asthma were neither modified nor mediated by BHR. CONCLUSION Our findings suggest that some of the nocturnal symptoms perceived as asthma may be OSA symptoms. Patients with nocturnal asthma symptoms should be considered for possible OSA.
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Affiliation(s)
- Chamara V Senaratna
- Allergy and Lung Health, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.,Department of Community Medicine, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | | | - Garun Hamilton
- School of Clinical Sciences, Monash University, Melbourne, VIC, Australia.,Department of Lung and Sleep, Monash Health, Melbourne, VIC, Australia
| | - Adrian J Lowe
- Allergy and Lung Health, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Caroline Lodge
- Allergy and Lung Health, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - John Burgess
- Allergy and Lung Health, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Bircan Erbas
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Graham G Giles
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, VIC, Australia.,Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Paul Thomas
- School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Michael J Abramson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Bruce Thompson
- Department of Medicine, Monash University, Melbourne, VIC, Australia
| | - Jennifer L Perret
- Allergy and Lung Health, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Shyamali C Dharmage
- Allergy and Lung Health, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
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28
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Farré N, Lorenzi-Filho G. Obstructive sleep apnoea and exercise functional capacity: time to move? Eur Respir J 2018; 51:51/6/1801031. [PMID: 29954926 DOI: 10.1183/13993003.01031-2018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 06/08/2018] [Indexed: 11/05/2022]
Affiliation(s)
- Núria Farré
- Heart Failure Programme, Dept of Cardiology, Hospital del Mar, Heart Diseases Biomedical Research Group, Hospital del Mar Medical Research Institute (IMIM), Dept of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Geraldo Lorenzi-Filho
- Sleep Laboratory, Pulmonary Division, Instituto do Coração, Departamento de Medicina, Universidade de São Paulo, São Paulo, Brazil
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29
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Celle S, Boutet C, Annweiler C, Barthélémy JC, Roche F. Sleep apnoea in the asymptomatic elderly: a real issue for the brain? Eur Respir J 2018; 51:13993003.02450-2017. [PMID: 29903827 DOI: 10.1183/13993003.02450-2017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 04/20/2018] [Indexed: 01/06/2023]
Abstract
The link between sleep apnoea and brain structure is unclear; although dysfunction of the hippocampus, middle temporal gyrus and brainstem/cerebellum have been observed previously. However, this link has been little explored in elderly subjects. The aim of this study was to explore the link between sleep apnoea and the brain in an elderly population.226 asymptomatic elderly subjects (age mean±sd 75.3±0.9 years, range 72.3-77.8 years) from the PROOF (Evaluation of Ageing, Autonomic Nervous System Activity and Cardiovascular Events) cohort study were explored using linear voxel-based or cortical thickness with apnoea/hypopnoea index (AHI; mean±sd 15.9±11.5 events·h-1, range 6-63.6 events·h-1) as a covariate of main interest. The brain volumes of 20 control subjects, 18 apnoeic (AHI >29 events·h-1) treated patients and 20 apnoeic untreated patients from this population were compared using voxel-based morphometry, cortical thickness or surface-based analyses.AHI was not associated with any change in local brain volume, cortical thickness or cortex surface. Control subjects, apnoeic treated and untreated patients were not different in terms of local brain volume, cortical thickness or surface.In a specific population of asymptomatic elderly healthy subjects, sleep apnoea does not seem to be associated with a change in local brain volume or in cortical thickness.
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Affiliation(s)
- Sébastien Celle
- Centre Hospitalier Universitaire de Saint-Etienne, Physiologie clinique et de l'exercice, Saint-Étienne, France.,Université de Lyon, EA 4607 SNA EPIS, Faculté de Médecine J. Lisfranc, Université Jean Monnet, Saint-Étienne, France
| | - Claire Boutet
- Inserm U1059 SAINBIOSE, Université de Lyon, Faculté de Médecine J. Lisfranc, Université Jean Monnet, Saint-Étienne, France.,Service de Radiologie Centrale, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne, France
| | - Cédric Annweiler
- Dept of Neurosciences and Ageing, Division of Geriatric Medicine, Angers University Hospital, Angers University, Angers, France.,Memory Clinic, Research Centre on Autonomy and Longevity, University of Angers, UPRES EA 4638, UNAM, Angers, France
| | - Jean-Claude Barthélémy
- Centre Hospitalier Universitaire de Saint-Etienne, Physiologie clinique et de l'exercice, Saint-Étienne, France.,Université de Lyon, EA 4607 SNA EPIS, Faculté de Médecine J. Lisfranc, Université Jean Monnet, Saint-Étienne, France
| | - Frédéric Roche
- Centre Hospitalier Universitaire de Saint-Etienne, Physiologie clinique et de l'exercice, Saint-Étienne, France.,Université de Lyon, EA 4607 SNA EPIS, Faculté de Médecine J. Lisfranc, Université Jean Monnet, Saint-Étienne, France
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30
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Abstract
Older adults undergo gradual changes in their sleep patterns. It is important to differentiate normal age-related sleep changes from sleep disorders. Because sleep disorders can impact an older adult's day-to-day life and contribute to various comorbidities, these patients should be carefully screened by using a detailed medical history, combined with a detailed sleep history. There is a high prevalence of undiagnosed and untreated sleep apnea in the elderly. Early identification and appropriate management of this disorder may not only provide improvement in quality of life but also decrease disease-associated morbidity and mortality.
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Affiliation(s)
- Jiahui Lin
- Department of Otolaryngology-Head and Neck Surgery, New York-Presbyterian Hospital, Columbia and Weill Cornell, 180 Fort Washington Avenue, New York, NY 10032, USA
| | - Maria Suurna
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, 1305 York Avenue, New York, NY 10021, USA.
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31
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Phenotypic approaches to obstructive sleep apnoea – New pathways for targeted therapy. Sleep Med Rev 2018; 37:45-59. [DOI: 10.1016/j.smrv.2016.12.003] [Citation(s) in RCA: 225] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 11/30/2016] [Accepted: 12/08/2016] [Indexed: 02/01/2023]
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32
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Abstract
The prevalence of obstructive sleep apnea (OSA) continues to rise. So too do the health, safety, and economic consequences. On an individual level, the causes and consequences of OSA can vary substantially between patients. In recent years, four key contributors to OSA pathogenesis or "phenotypes" have been characterized. These include a narrow, crowded, or collapsible upper airway "anatomical compromise" and "non-anatomical" contributors such as ineffective pharyngeal dilator muscle function during sleep, a low threshold for arousal to airway narrowing during sleep, and unstable control of breathing (high loop gain). Each of these phenotypes is a target for therapy. This review summarizes the latest knowledge on the different contributors to OSA with a focus on measurement techniques including emerging clinical tools designed to facilitate translation of new cause-driven targeted approaches to treat OSA. The potential for some of the specific pathophysiological causes of OSA to drive some of the key symptoms and consequences of OSA is also highlighted.
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Affiliation(s)
- Amal M Osman
- Neuroscience Research Australia (NeuRA).,School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Sophie G Carter
- Neuroscience Research Australia (NeuRA).,School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Jayne C Carberry
- Neuroscience Research Australia (NeuRA).,School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Danny J Eckert
- Neuroscience Research Australia (NeuRA).,School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
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33
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Abstract
RATIONALE Owing to resource limitations, the testing of patients for obstructive sleep apnea (OSA) is often delayed. There is a need to accurately triage and expedite testing in those with a high pretest probability of OSA. Acoustic pharyngometry is a simple, noninvasive technique used to assess the upper airway cross-sectional area (UA-XSA), which is known to be reduced in those with OSA. OBJECTIVES To determine the discriminative ability and predictive value of UA-XSA measurements by acoustic pharyngometry for OSA. METHODS We conducted a cross-sectional study with a clinical cohort of consecutive adults with suspected OSA who had undergone both polysomnography and acoustic pharyngometry. OSA was defined as an apnea-hypopnea index greater than or equal to 5. Multivariable logistic regression analyses and receiver operating characteristic curves were used. MEASUREMENTS AND MAIN RESULTS The cohort included 576 subjects, 87% of whom had OSA and 64% of whom were men. The subjects' median body mass index (BMI) was 30.3 kg/m2, and their median age was 57 years. The median UA-XSA at FRC when sitting was significantly smaller in those with OSA compared with those without OSA (3.3 cm2 [interquartile range, 2.7-3.8] vs. 3.7 cm2 [interquartile range, of 2.9-4.2]). When the analysis was controlled for age, sex, BMI, and comorbidities, the odds of OSA increased for every 1-cm2 decrease in the mean UA-XSA FRC when sitting (odds ratio, 1.62; 95% confidence interval, 1.23-2.13). The mean UA-XSA provided fair discrimination for OSA (area under the curve, 0.60). A cutoff value of 3.75 cm2, the point with the best sum of sensitivity and specificity, had sensitivity of 73% and specificity of 46%. The magnitude of the incremental discriminative value of UA-XSA over clinical variables (age, sex, BMI, and comorbidities) was small and nonsignificant (P = 0.5). CONCLUSIONS The mean UA-XSA at FRC when sitting or supine provided no further significant advantage over clinical variables for the discernment of OSA.
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34
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Zarhin D, Oksenberg A. Ambivalent Adherence and Nonadherence to Continuous Positive Airway Pressure Devices: A Qualitative Study. J Clin Sleep Med 2017; 13:1375-1384. [PMID: 28942763 PMCID: PMC5695983 DOI: 10.5664/jcsm.6828] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 07/06/2017] [Accepted: 07/13/2017] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Continuous positive airway pressure (CPAP) therapy is considered the front-line treatment for moderate-severe obstructive sleep apnea (OSA). However, nonuse rates are very high, such that adherence to CPAP has become a major concern. Although the literature on CPAP use is vast, further research is required to understand patients' experiences of CPAP use and nonuse. This is the goal of this study. METHODS This study draws on in-depth interviews with 61 Jewish-Israeli patients with OSA who received a recommendation to use a CPAP device. The sample includes both patients who started using CPAP devices as well as patients who rejected this course of treatment. It follows principles of constructivist-grounded theory in both sampling and analysis. RESULTS The study shows that regardless of patients' status of adherence, their attitudes toward CPAP devices are characterized by ambivalence. Users of CPAP expressed ambivalent adherence, pondering whether they should stop using the device; and patients who rejected the CPAP expressed ambivalent nonadherence, wondering whether they should give the CPAP another chance. This study identifies the experiences involved in using, as well as not using, CPAP devices that produce patients' ambivalence. CONCLUSIONS Both adherence and nonadherence to CPAP are dynamic processes that are characterized by patients' ambivalence and contingent upon diverse factors. These findings have practical implications as they suggest that all patients, regardless of their initial adherence status, would benefit from a close follow-up.
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Affiliation(s)
- Dana Zarhin
- Department of Sociology, University of Haifa, Haifa, Israel
| | - Arie Oksenberg
- Sleep Disorders Unit, Loewenstein Hospital, Raanana, Israel
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35
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Abma IL, Rovers M, IJff M, Hol B, Westert GP, van der Wees PJ. The development of a patient-reported outcome measure for patients with obstructive sleep apnea: the Patient-Reported Apnea Questionnaire (PRAQ). J Patient Rep Outcomes 2017; 1:14. [PMID: 29757310 PMCID: PMC5934917 DOI: 10.1186/s41687-017-0021-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 09/26/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is a chronic condition that can have a wide range of consequences for a patient's health-related quality of life. Monitoring aspects of quality of life in clinical practice has the potential to improve the patient-centeredness of care for patients with OSA. The aim of this article is to describe the development of the Patient-Reported Apnea Questionnaire (PRAQ), a patient-reported outcome measure (PROM) that is designed for use in clinical practice on an individual patient level, as well as subsequent outcome measurement on an aggregate level. METHODS We used the items of available PROMs for OSA to create a new PROM with focus on its applicability in clinical practice. We used a tailored development process to come to a selection of domains and items. Patients and healthcare professionals were intensively involved in the development of the PRAQ via membership of the development team, online surveys and focus groups, as well as two rounds of cognitive validation. RESULTS This first version of the PRAQ consists of 43 items and 10 preliminary domains, and covers the aspects of quality of life that healthcare professionals and patients wish to discuss in clinical practice. Patients indicate that PRAQ is comprehensive and that its length is acceptable. Comprehensive patient involvement has ensured good content validity for the PRAQ. CONCLUSIONS This article shows how a PROM can be developed with a specific focus on its applicability in clinical practice.
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Affiliation(s)
- Inger L. Abma
- Radboud University Medical Center, Radboud Institute of Health Sciences, IQ healthcare, PO box 9101, huispost 114, 6500 HB Nijmegen, The Netherlands
| | - Maroeska Rovers
- Radboud University Medical Center, Radboud Institute of Health Sciences, Departments for Health Evidence and Operating Rooms, Nijmegen, The Netherlands
| | | | - Bernard Hol
- Albert Schweitzer Ziekenhuis, Dordrecht, The Netherlands
| | - Gert P. Westert
- Radboud University Medical Center, Radboud Institute of Health Sciences, IQ healthcare, PO box 9101, huispost 114, 6500 HB Nijmegen, The Netherlands
| | - Philip J. van der Wees
- Radboud University Medical Center, Radboud Institute of Health Sciences, IQ healthcare, PO box 9101, huispost 114, 6500 HB Nijmegen, The Netherlands
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36
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Senaratna CV, Perret JL, Lodge CJ, Lowe AJ, Campbell BE, Matheson MC, Hamilton GS, Dharmage SC. Prevalence of obstructive sleep apnea in the general population: A systematic review. Sleep Med Rev 2017; 34:70-81. [PMID: 27568340 DOI: 10.1016/j.smrv.2016.07.002] [Citation(s) in RCA: 1204] [Impact Index Per Article: 172.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 06/09/2016] [Accepted: 07/10/2016] [Indexed: 01/15/2023]
Affiliation(s)
- Chamara V Senaratna
- School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Department of Community Medicine, University of Sri Jayewardenepura, Nugegoda, Sri Lanka.
| | - Jennifer L Perret
- School of Population and Global Health, The University of Melbourne, Melbourne, Australia; The Institute for Breathing & Sleep, Heidelberg, Melbourne, Australia.
| | - Caroline J Lodge
- School of Population and Global Health, The University of Melbourne, Melbourne, Australia.
| | - Adrian J Lowe
- School of Population and Global Health, The University of Melbourne, Melbourne, Australia.
| | - Brittany E Campbell
- School of Population and Global Health, The University of Melbourne, Melbourne, Australia.
| | - Melanie C Matheson
- School of Population and Global Health, The University of Melbourne, Melbourne, Australia.
| | - Garun S Hamilton
- Department of Lung and Sleep Medicine, Monash Health, Clayton, Australia; School of Clinical Sciences, Monash University, Clayton, Australia.
| | - Shyamali C Dharmage
- School of Population and Global Health, The University of Melbourne, Melbourne, Australia.
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37
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Nutrient patterns and chronic inflammation in a cohort of community dwelling middle-aged men. Clin Nutr 2017; 36:1040-1047. [DOI: 10.1016/j.clnu.2016.06.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Revised: 06/14/2016] [Accepted: 06/27/2016] [Indexed: 11/23/2022]
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38
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Validity of the Berlin questionnaire in detecting obstructive sleep apnea: A systematic review and meta-analysis. Sleep Med Rev 2017; 36:116-124. [PMID: 28599983 DOI: 10.1016/j.smrv.2017.04.001] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 03/31/2017] [Accepted: 04/04/2017] [Indexed: 01/06/2023]
Abstract
We aimed to systematically review the Berlin questionnaire as a screening tool for obstructive sleep apnea. We systematically searched PubMed, Embase, and Scopus databases, reviewed articles reporting the Berlin questionnaire's diagnostic utility as measured against type-1 polysomnography, and performed meta-analyses where possible. Thirty five eligible articles showed that the Berlin questionnaire's diagnostic utility varied by study population, definition of hypopnea used, and apnea-hypopnea index threshold used. It had good sensitivity and specificity for detecting clinically relevant obstructive sleep apnea as well as any obstructive sleep apnea in the sleep clinic population. Despite limited evidence, it showed modest to high sensitivity for detecting clinically relevant obstructive sleep apnea or any obstructive sleep apnea in other clinical and general population subgroups. Its specificity was relatively low. Possible reasons for variability in reported diagnostic utility of the Berlin questionnaire are multifaceted. We conclude that the Berlin questionnaire is useful as a clinical screening test and epidemiological tool in the sleep clinic population. Despite limited evidence, it likely has potential clinical and research utility in other populations. Adopting more consistent methodological definitions and focussing more on the general population and specific clinical populations to determine its usefulness as a clinical or epidemiological screening tool are recommended.
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39
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Banghoej AM, Nerild HH, Kristensen PL, Pedersen-Bjergaard U, Fleischer J, Jensen AEK, Laub M, Thorsteinsson B, Tarnow L. Obstructive sleep apnoea is frequent in patients with type 1 diabetes. J Diabetes Complications 2017; 31:156-161. [PMID: 28029582 DOI: 10.1016/j.jdiacomp.2016.10.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 10/10/2016] [Accepted: 10/12/2016] [Indexed: 01/03/2023]
Abstract
AIM Obstructive Sleep Apnoea (OSA) is frequent in patients with type 2 diabetes. The aim of this study is to evaluate prevalence of OSA in patients with type 1 diabetes. METHODS In a cross-sectional design, all patients with type 1 diabetes attending the outpatient clinic were offered screening for OSA for one night with the ApneaLink+ home-monitoring device. OSA was classified by the Apnoea-Hypopnea index (AHI; apnoeas/hypopneas per hour sleep). Symptoms of OSA were scored using the Epworth Sleepiness Score. Presence of autonomic neuropathy was evaluated by the Vagus® device. RESULTS A total of 200 of 518 eligible patients with type 1 diabetes (39%) participated (68% men; age 52±15years (mean±SD), diabetes duration 24±14years and BMI 25.3±3.3kg/m2). OSA was diagnosed in 92 patients (46% (95% CI: 40-53)). Five patients had known OSA, and OSA was newly diagnosed in 87 patients, predominantly mild OSA (60 patients (69%)). OSA was present in 32% of the patients with normal BMI, in 60% of overweight patients, and in 61% of obese patients. Patients with type 1 diabetes and OSA were largely asymptomatic and did not report more sleepiness than patients without OSA. At multivariate analysis, age, BMI and presence of nephropathy were positively associated with risk of OSA. CONCLUSIONS The prevalence of asymptomatic OSA is high in a cohort of patients with type 1 diabetes. Older age, overweight, and presence of nephropathy are associated with OSA.
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Affiliation(s)
- Anne Margareta Banghoej
- Nordsjællands University Hospital, Department of Cardiology, Nephrology and Endocrinology, Hillerød.
| | - Henriette Holst Nerild
- Nordsjællands University Hospital, Department of Cardiology, Nephrology and Endocrinology, Hillerød
| | - Peter Lommer Kristensen
- Nordsjællands University Hospital, Department of Cardiology, Nephrology and Endocrinology, Hillerød
| | - Ulrik Pedersen-Bjergaard
- Nordsjællands University Hospital, Department of Cardiology, Nephrology and Endocrinology, Hillerød; Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | | | | | | | - Birger Thorsteinsson
- Nordsjællands University Hospital, Department of Cardiology, Nephrology and Endocrinology, Hillerød; Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Lise Tarnow
- Nordsjællands University Hospital, Department of Cardiology, Nephrology and Endocrinology, Hillerød; Aarhus University Hospital, Medical Research Laboratory, Aarhus
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40
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Batool-Anwar S, Goodwin JL, Kushida CA, Walsh JA, Simon RD, Nichols DA, Quan SF. Impact of continuous positive airway pressure (CPAP) on quality of life in patients with obstructive sleep apnea (OSA). J Sleep Res 2016; 25:731-738. [PMID: 27242272 PMCID: PMC5436801 DOI: 10.1111/jsr.12430] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 04/16/2016] [Indexed: 12/01/2022]
Abstract
Obstructive sleep apnea is a chronic illness with increasing prevalence. In addition to associated cardiovascular comorbidities, obstructive sleep apnea syndrome has been linked to poor quality of life, occupational accidents, and motor vehicle crashes secondary to excessive daytime sleepiness. Although continuous positive airway pressure is the gold standard for sleep apnea treatment, its effects on quality of life are not well defined. In the current study we investigated the effects of treatment on quality of life using the data from the Apnea Positive Pressure Long-term Efficacy Study (APPLES), a randomized controlled trial of continuous positive airway pressure (CPAP) versus sham CPAP. The Calgary Sleep Apnea Quality of Life Index (SAQLI) was used to assess quality of life. Overall we found no significant improvement in quality of life among sleep apnea patients after CPAP treatment. However, after stratifying by OSA severity, it was found that long-term improvement in quality of life might occur with the use of CPAP in people with severe and possibly moderate sleep apnea, and no demonstrable improvement in quality of life was noted among participants with mild obstructive sleep apnea.
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Affiliation(s)
- Salma Batool-Anwar
- Division of Sleep and Circadian Disorders Medicine, Brigham and Women’s Hospital and Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - James L. Goodwin
- Arizona Respiratory Center, University of Arizona College of Medicine, Tucson, AZ
| | | | | | | | | | - Stuart F. Quan
- Division of Sleep and Circadian Disorders Medicine, Brigham and Women’s Hospital and Division of Sleep Medicine, Harvard Medical School, Boston, MA
- Arizona Respiratory Center, University of Arizona College of Medicine, Tucson, AZ
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41
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Zarhin D. Delaying and seeking care for obstructive sleep apnea: The role of gender, family, and morality. Health (London) 2016; 22:36-53. [PMID: 27895102 DOI: 10.1177/1363459316677625] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Social scientists have proposed various theories as to when, why, and how people come to seek medical care for multiple conditions. Yet, there is still little empirical research to illustrate the pathways into and out of care, especially for chronic illness. This article contributes to this body of work by exploring individuals' reasons for delaying and seeking care for obstructive sleep apnea, which despite being the most diagnosed sleep disorder, has been largely neglected by social scientists. Drawing upon in-depth interviews with 65 Jewish-Israeli obstructive sleep apnea patients, this study shows how intersections of gender, family, and morality shape and are shaped by care-seeking behavior. The analysis reveals that married men claim they do not do health, thereby reaffirming their masculinity, but they maintain moral status because their wives do much of their illness work for them. Unmarried men, however, claim to be more vigilant in their pursuit of health and present it as one of their responsibilities. Women acknowledge they have the double burden of protecting their own health as well as that of their loved ones, and often feel that they are incapable of meeting these social expectations. However, men and women are able to maintain moral status by explaining their neglect of health as resulting from their attempts to care for significant others. Finally, married women differ from men and unmarried women in their motivations for seeking care. In keeping with their gender roles, married women emphasize disturbance to others whereas men stress disturbance to self.
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Affiliation(s)
- Dana Zarhin
- Tel Aviv University, Israel; Brandeis University, USA
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42
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Nocturia, Other Lower Urinary Tract Symptoms and Sleep Dysfunction in a Community-Dwelling Cohort of Men. Urology 2016; 97:219-226. [DOI: 10.1016/j.urology.2016.06.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 06/01/2016] [Accepted: 06/14/2016] [Indexed: 11/20/2022]
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43
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Senaratna CV, English DR, Currier D, Perret JL, Lowe A, Lodge C, Russell M, Sahabandu S, Matheson MC, Hamilton GS, Dharmage SC. Sleep apnoea in Australian men: disease burden, co-morbidities, and correlates from the Australian longitudinal study on male health. BMC Public Health 2016; 16:1029. [PMID: 28185594 PMCID: PMC5103243 DOI: 10.1186/s12889-016-3703-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background Obstructive sleep apnoea is a common disorder with under-rated clinical impact, which is increasingly being recognised as having a major bearing on global disease burden. Men are especially vulnerable and become a priority group for preventative interventions. However, there is limited information on prevalence of the condition in Australia, its co-morbidities, and potential risk factors. Methods We used data from 13,423 adult men included in the baseline wave of Ten to Men, an Australian national study of the health of males, assembled using stratified cluster sampling with oversampling from rural and regional areas. Those aged 18–55 years self-completed a paper-based questionnaire that included a question regarding health professional-diagnosed sleep apnoea, physical and mental health status, and health-related behaviours. Sampling weights were used to account for the sampling design when reporting the prevalence estimates. Odds ratios were used to describe the association between health professional-diagnosed sleep apnoea and potential correlates while adjusting for age, country of birth, and body-mass index (BMI). Results Prevalence of self-reported health professional-diagnosed sleep apnoea increased from 2.2 % in age 18–25 years to 7.8 % in the age 45–55 years. Compared with those without sleep apnoea, those with sleep apnoea had significantly poorer physical, mental, and self-rated health as well as lower subjective wellbeing and poorer concentration/remembering (p < 0.001 for all). Sleep apnoea was significantly associated with older age (p < 0.001), unemployment (p < 0.001), asthma (p = 0.011), chronic obstructive pulmonary disease/chronic bronchitis (p = 0.002), diabetes (p < 0.001), hypercholesterolemia (p < 0.001), hypertension (p < 0.001), heart attack (p < 0.001), heart failure (p < 0.001), angina (p < 0.001), depression (p < 0.001), post-traumatic stress disorder (p < 0.001), other anxiety disorders (p < 0.001), schizophrenia (p = 0.002), overweight/obesity (p < 0.001), insufficient physical activity (p = 0.006), smoking (p = 0.005), and high alcohol consumption (p < 0.001). Conclusion Health professional-diagnosed sleep apnoea is relatively common, particularly in older males. Associations between sleep apnoea and cardiovascular, metabolic, respiratory, and psychiatric disorders have important clinical and public health implications. As men are especially vulnerable to sleep apnoea as well as some of its chronic co-morbidities, they are potentially a priority group for health interventions. Modifiable lifestyle related factors such as smoking, alcohol consumption, level of physical activity and BMI are possible key foci for interventions.
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Affiliation(s)
- Chamara Visanka Senaratna
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, 3010, Australia.,Department of Community Medicine, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Dallas R English
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, 3010, Australia
| | - Dianne Currier
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, 3010, Australia
| | - Jennifer L Perret
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, 3010, Australia.,Institute for Breathing & Sleep, Heidelberg, 3084, Australia
| | - Adrian Lowe
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, 3010, Australia
| | - Caroline Lodge
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, 3010, Australia
| | - Melissa Russell
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, 3010, Australia
| | - Sashane Sahabandu
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, 3010, Australia
| | - Melanie C Matheson
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, 3010, Australia
| | - Garun S Hamilton
- Department of Lung and Sleep Medicine, Monash Health, Clayton, 3168, Australia.,School of Clinical Sciences, Monash University, Clayton, 3168, Australia
| | - Shyamali C Dharmage
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, 3010, Australia.
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Silva GE, Goodwin JL, Vana KD, Quan SF. Obstructive Sleep Apnea and Quality of Life: Comparison of the SAQLI, FOSQ, and SF-36 Questionnaires. SOUTHWEST JOURNAL OF PULMONARY AND CRITICAL CARE 2016; 13:137-149. [PMID: 27738560 DOI: 10.13175/swjpcc082-16] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The impact of sleep on quality of life (QoL) has been well documented; however, there is a great need for reliable QoL measures for persons with obstructive sleep apnea (OSA). We compared the QoL scores between the 36-Item Short Form of the Medical Outcomes Survey (SF-36), Calgary Sleep Apnea Quality of Life Index (SAQLI), and Functional Outcomes Sleep Questionnaire (FOSQ) in persons with OSA. METHODS A total of 884 participants from the Sleep Heart Health Study second examination, who completed the SF-36, FOSQ, and SAQLI, and in-home polysomnograms, were included. The apnea hypopnea index (AHI) at 4% desaturation was categorized as no OSA (<5 /hour), mild to moderate OSA (5-30 /hour) and severe OSA (>30 /hour). QoL scores for each questionnaire were determined and compared by OSA severity category and by gender. RESULTS Participants were 47.6% male, 49.2% (n=435) had no OSA, 43.2% (n=382) had mild to moderate OSA, and 7.6% (n=67) had severe OSA. Participants with severe OSA were significantly older (mean age = 63.7 years, p <.0001), had higher BMI (mean = 34.3 kg/m2, p <.0001) and had lower SF-36 Physical Component scores (PCS) (45.1) than participants with no OSA (48.5) or those with mild to moderate OSA (46.5, p= .006). When analyzed according to gender, no significant differences were found in males for QoL by OSA severity categories. However, females with severe OSA had significantly lower mean scores for the SAQLI (5.4, p= .006), FOSQ (10.9, p= .02), and SF-36 PCS (37.7, p<.0001) compared to females with no OSA (6.0, 11.5, 44.6) and those with mild to moderate OSA (5.9, 11.4, 48, respectively). Females with severe OSA also had significantly higher mean BMI (41.8 kg/m2,) than females with no OSA (26.5 kg/m2) or females with mild to moderate OSA (30.6 kg/m2, p<.0001). The SF-36 PCS and Mental Component Scores (MCS) were correlated with the FOSQ and SAQLI (r=.37 PCS vs FOSQ; r=.31 MCS vs FOSQ; r=.42 PCS vs SAQLI; r=.52 MCS vs SAQLI; and r=.66 FOSQ vs SAQLI, p<.001 for all correlations). Linear regression analyses, adjusting for potential confounders, indicated that the impact of OSA severity on QoL is largely explained by the presence of daytime sleepiness. CONCLUSION The impact of OSA on QoL differs between genders with a larger effect on females and is largely explained by the presence of daytime sleepiness. Correlations among QoL instruments are not high and various instruments may assess different aspects of QoL.
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Affiliation(s)
| | - James L Goodwin
- Arizona Respiratory Center, University of Arizona, Tucson, AZ
| | - Kimberly D Vana
- College of Nursing & Health Innovation, Arizona State University, Phoenix, AZ
| | - Stuart F Quan
- Arizona Respiratory Center, University of Arizona, Tucson, AZ; College of Medicine, University of Arizona, Tucson, AZ; Division of Sleep Medicine, Harvard Medical School, Boston, MA; Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA
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45
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Adams RJ, Appleton SL, Vakulin A, Lang C, Martin SA, Taylor AW, McEvoy RD, Antic NA, Catcheside PG, Wittert GA. Association of daytime sleepiness with obstructive sleep apnoea and comorbidities varies by sleepiness definition in a population cohort of men. Respirology 2016; 21:1314-21. [DOI: 10.1111/resp.12829] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Revised: 03/29/2016] [Accepted: 04/13/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Robert J. Adams
- The Health Observatory, Discipline of Medicine; University of Adelaide; Woodville South Australia Australia
| | - Sarah L. Appleton
- The Health Observatory, Discipline of Medicine; University of Adelaide; Woodville South Australia Australia
- Freemasons Centre for Men's Health, Discipline of Medicine; University of Adelaide; Adelaide South Australia Australia
| | - Andrew Vakulin
- Adelaide Institute for Sleep Health, a Flinders Centre of Research Excellence, School of Medicine, Faculty of Medicine, Nursing and Health Sciences; Flinders University; Bedford Park South Australia Australia
- NHMRC Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, Central Clinical School; University of Sydney; Sydney New South Wales Australia
| | - Carol Lang
- The Health Observatory, Discipline of Medicine; University of Adelaide; Woodville South Australia Australia
| | - Sean A. Martin
- Freemasons Centre for Men's Health, Discipline of Medicine; University of Adelaide; Adelaide South Australia Australia
| | - Anne W. Taylor
- Population Research & Outcomes Studies, Discipline of Medicine; University of Adelaide; Adelaide South Australia Australia
| | - R. Doug McEvoy
- Adelaide Institute for Sleep Health, a Flinders Centre of Research Excellence, School of Medicine, Faculty of Medicine, Nursing and Health Sciences; Flinders University; Bedford Park South Australia Australia
- Department of Medicine; Flinders University; Bedford Park, Adelaide South Australia Australia
| | - Nick A. Antic
- Adelaide Institute for Sleep Health, a Flinders Centre of Research Excellence, School of Medicine, Faculty of Medicine, Nursing and Health Sciences; Flinders University; Bedford Park South Australia Australia
- Department of Medicine; Flinders University; Bedford Park, Adelaide South Australia Australia
| | - Peter G. Catcheside
- Adelaide Institute for Sleep Health, a Flinders Centre of Research Excellence, School of Medicine, Faculty of Medicine, Nursing and Health Sciences; Flinders University; Bedford Park South Australia Australia
- Department of Medicine; Flinders University; Bedford Park, Adelaide South Australia Australia
| | - Gary A. Wittert
- The Health Observatory, Discipline of Medicine; University of Adelaide; Woodville South Australia Australia
- Freemasons Centre for Men's Health, Discipline of Medicine; University of Adelaide; Adelaide South Australia Australia
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Appleton SL, Vakulin A, Wittert GA, Martin SA, Grant JF, Taylor AW, McEvoy RD, Antic NA, Catcheside PG, Adams RJ. The association of obstructive sleep apnea (OSA) and nocturnal hypoxemia with the development of abnormal HbA1c in a population cohort of men without diabetes. Diabetes Res Clin Pract 2016; 114:151-9. [PMID: 26810273 DOI: 10.1016/j.diabres.2015.12.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 12/29/2015] [Indexed: 11/23/2022]
Abstract
AIM To examine the relationship between indices of undiagnosed OSA and the development of abnormal glycaemic control in community-dwelling men free of diabetes. METHODS The Men, Androgens, Inflammation, Lifestyle, Environment, and Stress (MAILES) Study is a population-based cohort study in Adelaide, South Australia. Clinic visits at baseline (2002-06) and follow-up (2007-10) identified abnormal glycaemic metabolism [HbA1c 6.0 to <6.5% (42 to <48mmol/mol)] in men without diabetes. At follow-up (2010-11), n=837 underwent assessment of OSA by full in-home unattended polysomnography (Embletta X100). RESULTS Development of abnormal glycaemic metabolism over 4-6 years (n=103 "incident" cases, 17.0%) showed adjusted associations [odds ratio (95% CI)] with the 1st [1.7 (0.8-3.8)], 2nd [2.4 (1.1-4.9)], and 3rd [2.3 (1.1-4.8)] quartiles of mean oxygen saturation (SaO2) compared to the highest quartile. Prevalent abnormal glycaemic metabolism (n=140, 20.8%) was independently associated with the third and fourth quartiles of percentage of sleep time with oxygen saturation <90% and lowest quartile of mean SaO2. Linear regression analysis showed a significant reduction in HbA1c [unstandardized B, 95% CI: -0.02 (-0.04, -0.002), p=0.034] per percentage point increase in mean SaO2. OSA as measured by the apnea-hypopnea index showed no adjusted relationship with abnormal glycaemic metabolism. CONCLUSIONS Development of abnormal glycaemic metabolism was associated with nocturnal hypoxemia. Improved management of OSA and glycaemic control may occur if patients presenting with one abnormality are assessed for the other.
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Affiliation(s)
- Sarah L Appleton
- The Health Observatory, Discipline of Medicine, University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville, South Australia, Australia; Freemason's Centre for Men's Health, Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia.
| | - Andrew Vakulin
- Adelaide Institute of Sleep Health, Repatriation General Hospital, Daw Park, South Australia, Australia; NHMRC Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, Central Clinical School, University of Sydney, New South Wales, Australia
| | - Gary A Wittert
- The Health Observatory, Discipline of Medicine, University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville, South Australia, Australia; Freemason's Centre for Men's Health, Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Sean A Martin
- Freemason's Centre for Men's Health, Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Janet F Grant
- Population Research & Outcomes Studies, Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Anne W Taylor
- Population Research & Outcomes Studies, Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - R Douglas McEvoy
- Adelaide Institute of Sleep Health, Repatriation General Hospital, Daw Park, South Australia, Australia; Department of Medicine, Flinders University, Bedford Park, Adelaide, South Australia, Australia
| | - Nick A Antic
- Adelaide Institute of Sleep Health, Repatriation General Hospital, Daw Park, South Australia, Australia; Department of Medicine, Flinders University, Bedford Park, Adelaide, South Australia, Australia
| | - Peter G Catcheside
- Adelaide Institute of Sleep Health, Repatriation General Hospital, Daw Park, South Australia, Australia; Department of Medicine, Flinders University, Bedford Park, Adelaide, South Australia, Australia
| | - Robert J Adams
- The Health Observatory, Discipline of Medicine, University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville, South Australia, Australia
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Quality of Life Assessment After Maxillomandibular Advancement Surgery for Obstructive Sleep Apnea. J Oral Maxillofac Surg 2016; 74:1228-37. [PMID: 26917205 DOI: 10.1016/j.joms.2016.01.043] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 01/13/2016] [Accepted: 01/22/2016] [Indexed: 11/21/2022]
Abstract
PURPOSE Although maxillomandibular advancement (MMA) surgery is highly efficacious for the management of obstructive sleep apnea (OSA), little information exists regarding the subjective effect of this treatment modality. The present study was undertaken to investigate the effect of MMA on patient-perceived quality of life (QOL) in OSA. PATIENTS AND METHODS A retrospective cohort study of patients treated with MMA for OSA from May 2010 to April 2015 was performed. The primary outcome measure was a change in the QOL detected using the Ottawa Sleep Apnea Questionnaire (OSA-Q), which assesses the MMA-related changes in QOL with a 5-point Likert scale. The secondary outcome measure was a change in the apnea hypopnea index (AHI). RESULTS Twenty-two patients participated in the present study. The mean maxillary and mandibular advancement were 8.36 and 11.08 mm, respectively. The AHI decreased from 42.4 to 6.9 events per hour postoperatively (P < .001). The QOL improved significantly after MMA (OSA-Q score 3.98 ± 0.35; P < 001). The sleep quality (4.35 ± 0.63), daytime function (4.13 ± 0.46), physical health (4.19 ± 0.45), mental and emotional health (4.02 ± 0.55), and sexual health (3.78 ± 0.62) categories all improved postoperatively (P < .001). The MMA-related side effects did not adversely affect the QOL. CONCLUSIONS MMA for OSA significantly improves patient's subjective overall QOL, with few MMA-related side effects.
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Sleep Disorders, Obesity, Hypertension, and Cardiovascular Risk. Int J Hypertens 2015; 2015:197534. [PMID: 26557386 PMCID: PMC4628664 DOI: 10.1155/2015/197534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 06/15/2015] [Indexed: 11/17/2022] Open
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A Tahrani A. Obstructive Sleep Apnoea and Vascular Disease in Patients with Type 2 Diabetes. EUROPEAN ENDOCRINOLOGY 2015; 11:81-89. [PMID: 29632575 PMCID: PMC5819072 DOI: 10.17925/ee.2015.11.02.81] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 07/10/2015] [Indexed: 12/21/2022]
Abstract
Obstructive sleep apnoea (OSA) is common and is associated with many vascular risk factors, such as hypertension, insulin resistance, albuminuria, dyslipidaemia, increased inflammation and endothelial dysfunction. Epidemiological studies have shown that OSA is associated with increased cardiovascular disease (CVD) and that continuous positive airway pressure (CPAP) might reduce CVD events in patients with OSA. In addition, OSA has also been shown to be associated with albuminuria, chronic kidney disease, a wide range of ocular diseases and peripheral neuropathy. Considering that CVD and microvascular complications are major contributors to the morbidity, mortality and the economic burden of diabetes and that OSA is common in patients with type 2 diabetes (T2D), it is important to understand the role of OSA in the development and/or progression of vascular disease in patients with T2D and to explore the impact of CPAP on diabetes-related vascular outcomes. The purpose of this article is to review the evidence for the relationship and impact of OSA on vascular disease and vascular risk factors particularly in patients with T2D.
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Affiliation(s)
- Abd A Tahrani
- Centre of Endocrinology, Diabetes and Metabolism, University of Birmingham; Birmingham, UK; Department of Diabetes and Endocrinology, Birmingham Heartlands Hospital, Birmingham, UK
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