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Ghorvei M, Karhu T, Hietakoste S, Ferreira‐Santos D, Hrubos‐Strøm H, Islind AS, Biedebach L, Nikkonen S, Leppänen T, Rusanen M. A comparative analysis of unsupervised machine-learning methods in PSG-related phenotyping. J Sleep Res 2025; 34:e14349. [PMID: 39448265 PMCID: PMC12069737 DOI: 10.1111/jsr.14349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Revised: 08/20/2024] [Accepted: 09/03/2024] [Indexed: 10/26/2024]
Abstract
Obstructive sleep apnea is a heterogeneous sleep disorder with varying phenotypes. Several studies have already performed cluster analyses to discover various obstructive sleep apnea phenotypic clusters. However, the selection of the clustering method might affect the outputs. Consequently, it is unclear whether similar obstructive sleep apnea clusters can be reproduced using different clustering methods. In this study, we applied four well-known clustering methods: Agglomerative Hierarchical Clustering; K-means; Fuzzy C-means; and Gaussian Mixture Model to a population of 865 suspected obstructive sleep apnea patients. By creating five clusters with each method, we examined the effect of clustering methods on forming obstructive sleep apnea clusters and the differences in their physiological characteristics. We utilized a visualization technique to indicate the cluster formations, Cohen's kappa statistics to find the similarity and agreement between clustering methods, and performance evaluation to compare the clustering performance. As a result, two out of five clusters were distinctly different with all four methods, while three other clusters exhibited overlapping features across all methods. In terms of agreement, Fuzzy C-means and K-means had the strongest (κ = 0.87), and Agglomerative hierarchical clustering and Gaussian Mixture Model had the weakest agreement (κ = 0.51) between each other. The K-means showed the best clustering performance, followed by the Fuzzy C-means in most evaluation criteria. Moreover, Fuzzy C-means showed the greatest potential in handling overlapping clusters compared with other methods. In conclusion, we revealed a direct impact of clustering method selection on the formation and physiological characteristics of obstructive sleep apnea clusters. In addition, we highlighted the capability of soft clustering methods, particularly Fuzzy C-means, in the application of obstructive sleep apnea phenotyping.
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Grants
- Respiratory Foundation of Kuopio Region
- 5041828 The State Research Funding for university-level health research, Kuopio University Hospital, Wellbeing Service County of North Savo
- 5041790 The State Research Funding for university-level health research, Kuopio University Hospital, Wellbeing Service County of North Savo
- 5041794 The State Research Funding for university-level health research, Kuopio University Hospital, Wellbeing Service County of North Savo
- 5041798 The State Research Funding for university-level health research, Kuopio University Hospital, Wellbeing Service County of North Savo
- 5041809 The State Research Funding for university-level health research, Kuopio University Hospital, Wellbeing Service County of North Savo
- 5041797 The State Research Funding for university-level health research, Kuopio University Hospital, Wellbeing Service County of North Savo
- Tampere Tuberculosis Foundation
- 965417 European Union's Horizon 2020 Research and Innovation Programme
- Orion Research Foundation
- Research Foundation of the pulmonary diseases
- ANR-15-IDEX-02: ANR-19-P3IA-0003 French National Research Agency, MIAI@Grenoble Alpes
- Tampere Tuberculosis Foundation
- Orion Research Foundation
- Research Foundation of the pulmonary diseases
- French National Research Agency, MIAI@Grenoble Alpes
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Affiliation(s)
- Mohammadreza Ghorvei
- Department of Technical PhysicsUniversity of Eastern FinlandKuopioFinland
- Diagnostic Imaging CenterKuopio University HospitalKuopioFinland
| | - Tuomas Karhu
- Department of Technical PhysicsUniversity of Eastern FinlandKuopioFinland
- Diagnostic Imaging CenterKuopio University HospitalKuopioFinland
| | - Salla Hietakoste
- Department of Technical PhysicsUniversity of Eastern FinlandKuopioFinland
- Diagnostic Imaging CenterKuopio University HospitalKuopioFinland
| | - Daniela Ferreira‐Santos
- Department of Technical PhysicsUniversity of Eastern FinlandKuopioFinland
- INESC TEC ‐ Institute for Systems and Computer EngineeringTechnology and SciencePortoPortugal
| | - Harald Hrubos‐Strøm
- Department of ear‐nose and throatAkershus University HospitalLørenskogNorway
- Campus Akershus University HospitalInstitute of Clinical Medicine, University of OsloOsloNorway
| | | | - Luka Biedebach
- Department of Computer ScienceReykjavik UniversityReykjavikIceland
| | - Sami Nikkonen
- Department of Technical PhysicsUniversity of Eastern FinlandKuopioFinland
- Diagnostic Imaging CenterKuopio University HospitalKuopioFinland
| | - Timo Leppänen
- Department of Technical PhysicsUniversity of Eastern FinlandKuopioFinland
- Diagnostic Imaging CenterKuopio University HospitalKuopioFinland
- School of Electrical Engineering and Computer ScienceThe University of QueenslandBrisbaneQueenslandAustralia
| | - Matias Rusanen
- Department of Technical PhysicsUniversity of Eastern FinlandKuopioFinland
- Diagnostic Imaging CenterKuopio University HospitalKuopioFinland
- HP2 LaboratoryINSERM U1300, Grenoble Alpes University, Grenoble Alpes University HospitalGrenobleFrance
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Dong Z, Zeng Y, Chen J, Wu L, Hong H. Upper airway and hyoid bone-related morphological parameters associated with the apnea-hypopnea index and lowest nocturnal oxygen saturation: a cephalometric analysis. BMC Oral Health 2025; 25:583. [PMID: 40247217 PMCID: PMC12007296 DOI: 10.1186/s12903-025-05969-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2024] [Accepted: 04/07/2025] [Indexed: 04/19/2025] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is a common disorder characterized by repetitive complete or partial closure of the upper airway during sleep, resulting in sleep fragmentation and oxygen desaturation. Cephalogram is recognized as an effective diagnostic tool for predicting OSA risk in clinical practice. This study aims to assess and analyze the morphological characteristics of the upper airway and hyoid bone position associated with OSA using data from polysomnography studies and two-dimensional cephalometric analysis. METHODS The study included lateral cephalograms and polysomnography reports from the records of 105 adult (64 males & 41 females) patients who underwent comprehensive clinical examination. The severity of OSA was evaluated based on the apnea-hypopnea index (AHI) and lowest nocturnal oxygen saturation (LSaO2). The participants were divided into male and female groups to investigate the correlation between cephalometric parameters and OSA severity. Thirteen cephalometric parameters, including eleven linear measurements and two angular measurements, were analyzed. The significance level was set at P-value < 0.05. RESULTS The male group exhibited significantly higher severity of OSA compared to the female group, as indicated by higher AHI and lower LSaO2. There was an inverse association between AHI values with width of upper airway as well as distance between hyoid bone position relative to mandibular plane in both male and female groups. Additionally, only the male group showed a correlation between hyoid bone position relative to gonion/third-fourth vertebrae positions with AHI values. 4 out of 7 parameters associated with AHI in male group remained correlated with LSaO2, while in females only the distance between hyoid bone and line formed by ptergoid and pterygomaxillary fissure point showed correlation with LSaO2. CONCLUSION Correlation analysis revealed that a narrower upper airway was positively associated with increased AHI, while an inferiorly positioned hyoid bone in relation to mandible was negatively correlated with LSaO2. Our findings highlight the importance of several cephalometric parameters in predicting OSA severity based on AHI and LSaO2 levels; moreover, certain parameters exhibited significant gender-specific associations.
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Affiliation(s)
- Zhili Dong
- Hospital of Stomatology, Guangdong Provincial Clinical Research Center of Oral Diseases, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yue Zeng
- Department of Stomatology, The People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi Academy of Medical Sciences, Nanning, Guangxi, China
| | - Jieyi Chen
- Hospital of Stomatology, Guangdong Provincial Clinical Research Center of Oral Diseases, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Liping Wu
- Hospital of Stomatology, Guangdong Provincial Clinical Research Center of Oral Diseases, Sun Yat-sen University, Guangzhou, Guangdong, China.
| | - Hong Hong
- Hospital of Stomatology, Guangdong Provincial Clinical Research Center of Oral Diseases, Sun Yat-sen University, Guangzhou, Guangdong, China.
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Hietakoste S, Karhu T, Lombardi C, Armañac-Julián P, Bailón R, Duce B, Sillanmäki S, Töyräs J, Leppänen T, Myllymaa S, Kainulainen S. Nocturnal short-term heart rate variability reflects impaired daytime vigilance better than overnight heart rate variability in suspected obstructive sleep apnea patients. Sleep 2025; 48:zsae282. [PMID: 39670869 PMCID: PMC11985393 DOI: 10.1093/sleep/zsae282] [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: 05/16/2024] [Revised: 10/24/2024] [Indexed: 12/14/2024] Open
Abstract
In obstructive sleep apnea (OSA), heart rate variability (HRV) decreases and performance in psychomotor vigilance task (PVT) worsens with more severe hypoxic load. Nevertheless, the association between HRV and PVT performance is poorly understood. Thus, we hypothesize that nocturnal short-term HRV is better related to daytime psychomotor vigilance compared with overnight HRV. To investigate this hypothesis, we retrospectively analyzed the electrocardiograms from polysomnographies of 546 consecutive patients with suspected OSA. We determined overnight HRV and short-term HRV in nonoverlapping 5-min segments and performed stepwise linear regression analyses to associate HRV with the median reaction time (RT) in the PVT. The short-term decrease in the median interval between two successive normal R peaks (NN interval), root mean square of successive NNs, and normalized high-frequency band power were all significant (p < 0.001) indicators of longer median RTs. However, the overnight HRV parameters did not indicate worsening median RT. Instead, increased hypoxic load and N3 duration were associated with longer median RT in men but not in women. The association of HRV and cardiorespiratory coupling with PVT performance was generally weak. Nocturnal short-term HRV evaluation reflected a state of vigilance better than the average overnight HRV. Thus, the overnight HRV analysis might not be optimal for patients with OSA. Utilizing the HRV analysis in a time-series manner and combined with the hypoxic load and sleep stages could bring new aspects to the health assessment of patients with OSA.
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Affiliation(s)
- Salla Hietakoste
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Tuomas Karhu
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Carolina Lombardi
- Department of Cardiology, Neural and Metabolic Sciences, Sleep Disorders Center, San Luca Hospital, IRCCS Istituto Auxologico Italiano, Milan, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Pablo Armañac-Julián
- Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Instituto de Salud Carlos III, Madrid, Spain
- Biomedical Signal Interpretation and Computational Simulation (BSICoS) Group, Aragón Institute of Engineering Research (I3A), University of Zaragoza, Zaragoza, Spain
| | - Raquel Bailón
- Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Instituto de Salud Carlos III, Madrid, Spain
- Biomedical Signal Interpretation and Computational Simulation (BSICoS) Group, Aragón Institute of Engineering Research (I3A), University of Zaragoza, Zaragoza, Spain
| | - Brett Duce
- Department of Respiratory and Sleep Medicine, Sleep Disorders Centre, Princess Alexandra Hospital, Brisbane, Australia
- Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Saara Sillanmäki
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Juha Töyräs
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- Science Service Center, Kuopio University Hospital, Kuopio, Finland
- School of Electrical Engineering and Computer Science, University of Queensland, Brisbane, Australia
| | - Timo Leppänen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
- School of Electrical Engineering and Computer Science, University of Queensland, Brisbane, Australia
| | - Sami Myllymaa
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Samu Kainulainen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
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Ahonen H, Berggren K, Kvarnvik C, Sunnergren O, Lindmark U, Broström A, Stensson M. Prevalence of Dental Caries in Persons With or Without Long-Term Experience of Positive Airway Pressure-Treated Obstructive Sleep Apnoea. Int J Dent Hyg 2025. [PMID: 39901640 DOI: 10.1111/idh.12905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 12/18/2024] [Accepted: 01/27/2025] [Indexed: 02/05/2025]
Abstract
Oral dryness is common in persons with untreated obstructive sleep apnoea (OSA) as well as in those using positive airway pressure (PAP). OSA with or without PAP treatment could therefore be a risk factor of dental caries. OBJECTIVES To describe and compare the prevalence of dental caries among persons with or without PAP-treated OSA. METHODS Cross-sectional data derived from a clinical examination of 121 adults without OSA, and with or without long-time experience of PAP treated OSA (> 10 years) were used. The participants responded to a questionnaire and were clinically and radiographically examined. Decayed, missing, and filled teeth, decayed surfaces, gingivitis and presence of dental plaque were registered. Descriptive analyses were performed to describe dental caries prevalence among groups. To compare groups, one-way ANOVA and Kruskal-Wallis tests was conducted. RESULTS Participants (52% females, mean age 69.5 ± 5.8 years) were categorised into groups based on OSA status; non-OSA (n = 49), non-PAP-treated OSA (n = 38), and PAP-treated OSA (n = 34). Dental caries prevalence showed no statistically significant differences among groups, except for occlusal caries, where the PAP-treated OSA group had a higher mean compared to the non-OSA group (p = 0.033). Most participants did not report xerostomia, but the highest prevalence was found in the non-PAP-treated OSA group (31.6%). CONCLUSIONS The prevalence of dental caries was slightly higher in persons with PAP treated OSA compared to non-PAP-treated OSA and persons without OSA, but the results were not statistically significant.
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Affiliation(s)
- H Ahonen
- Centre for Oral Health, School of Health and Welfare, Jönköping University, Jönköping, Sweden
- Department of Odontology and Oral Health, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - K Berggren
- Centre for Oral Health, School of Health and Welfare, Jönköping University, Jönköping, Sweden
- Department of Odontology and Oral Health, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - C Kvarnvik
- Centre for Oral Health, School of Health and Welfare, Jönköping University, Jönköping, Sweden
- Department of Periodontology, Institute for Postgraduate Education, Region Jönköping County Council, Jönköping, Sweden
| | - O Sunnergren
- Centre for Oral Health, School of Health and Welfare, Jönköping University, Jönköping, Sweden
- Department of Odontology and Oral Health, School of Health and Welfare, Jönköping University, Jönköping, Sweden
- Department of Otorhinolaryngology, Region Jönköping County Council, Jönköping, Sweden
| | - U Lindmark
- Department of Health Sciences, Karlstad University, Karlstad, Sweden
| | - A Broström
- Department of Clinical Neurophysiology, University Hospital Linköping, Linköping, Sweden
- Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - M Stensson
- Centre for Oral Health, School of Health and Welfare, Jönköping University, Jönköping, Sweden
- Department of Odontology and Oral Health, School of Health and Welfare, Jönköping University, Jönköping, Sweden
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Mazzotti DR, Magalang UJ, Keenan BT, Mindel J, Younes M, Penzel T, Pack AI, de Chazal P. OSA symptom subtypes and hypoxic burden independently predict distinct cardiovascular outcomes. ERJ Open Res 2025; 11:00511-2024. [PMID: 40008168 PMCID: PMC11849095 DOI: 10.1183/23120541.00511-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Accepted: 08/31/2024] [Indexed: 02/27/2025] Open
Abstract
Study objectives Studies on obstructive sleep apnoea (OSA) have identified clinically relevant symptom-based subtypes and novel OSA-specific nocturnal hypoxic measures. Both traits are individually associated with cardiovascular outcomes, but evidence about their independent or shared effects is unknown. This study investigated the simultaneous contributions of OSA symptom subtypes and hypoxic burden (HB) on incident cardiovascular outcomes. Methods Sleep Heart Health Study participants with high-quality oxygen saturation, apnoea-hypopnea index (AHI) and symptom data were included. Participants with OSA (AHI ≥5 events·h-1) were grouped into symptom subtypes. HB was calculated from respiratory event-related hypoxia. Cox proportional hazards models assessed whether symptom subtypes and/or HB were independently associated with cardiovascular mortality and major adverse cardiovascular events (MACE). Results 4396 participants free of cardiovascular disease were analysed, with median follow-up >11 years. Higher HB was associated with worse cardiovascular mortality (HR (95% CI): 1.63 (1.13-2.35); p=0.009) independently of symptom subtypes. Compared to those without OSA, the excessively sleepy OSA subtype had higher risk of incident MACE (1.62 (1.23-2.15); p<0.001), independently of HB. Among participants with moderate-severe OSA (AHI ≥15 events·h-1), excessively sleepy participants had higher risk of cardiovascular end-points compared to other subtypes, but HB was not associated with cardiovascular mortality or MACE risk. Conclusion OSA symptom subtypes and HB are independently associated with MACE and cardiovascular mortality, respectively. Thus, both are important for understanding OSA-related cardiovascular risk. Future studies using clinical samples including OSA therapy information that incorporate symptom subtypes and novel biomarkers, such as HB, could improve predictive models for cardiovascular disease risk.
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Affiliation(s)
- Diego R. Mazzotti
- Division of Medical Informatics, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
- Division of Pulmonary Critical Care and Sleep Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Ulysses J. Magalang
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center
| | - Brendan T. Keenan
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Jesse Mindel
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center
| | - Magdy Younes
- Sleep Disorders Centre, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Thomas Penzel
- Interdisciplinary Sleep Medicine Center, Charite Universitatsmedizin, Berlin, Germany
| | - Allan I. Pack
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Philip de Chazal
- Charles Perkins Centre and School of Biomedical Engineering, University of Sydney, Sydney, NSW, Australia
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Selimoğlu Şen H, Çetin Yilmaz S, Tekin V, Kaya S, Kılıç T, Işık Ş. Apnea-hypopnea duration may be a better choice rather than apnea-hypopnea index for forecasting complications in OSAS. Cranio 2024:1-9. [PMID: 39710953 DOI: 10.1080/08869634.2024.2441529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2024]
Abstract
OBJECTIVE Mean apnea-hypopnea duration (AHD) is the mean duration of apnea-hypopneas experienced during sleep and was found as an indicator of blood oxygenation. The aim of this study was to compare and define the differences in clinical, demographic and polysomnographic characteristics of obstructive sleep apnea (OSA) patients in long and short AHD groups and investigate the relationship between apnea-hypopnea index (AHI), oxygen desaturation index (ODI), and sleepiness. METHODS The cross-sectional analysis included 511 OSA patients who were >18 years and followed up between June 2019 and December 2019 in the Sleep Center of university hospital. The consecutive polysomnography reports and patient data were recorded retrospectively. RESULTS Polysomnographic evaluation of different AHD groups showed obvious differences. Although there were no statistically significant differences in the overall AHI values. The Epworth measurements, ODI, time that saturation is below 90%, and N1 and N2 sleep were higher in the long AHD group. On the contrary, sleep efficiency, total sleep time, N3 and REM sleep, average oxygen saturation (AOS), and lowest oxygen saturation (LOS) were lower in the long AHD group. CONCLUSIONS The findings of this study showed that the AHD is a useful indicator of blood oxygenation and, therefore, tissue oxygenation, independent of the AHI. OSA patients with longer AHD have more vascular complications such as diabetes and hypertension. We suggest that the severity of OSA should be monitored with AHD for preventing potential complications of OSA.
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Affiliation(s)
| | | | - Veysi Tekin
- Pulmonology Department, Dicle University Medical Faculty, Diyarbakir, Turkey
| | - Süheyla Kaya
- Pulmonology Department, Diyarbakır Selahattin Eyyubi State Hospital, Diyarbakır, Turkey
| | - Tarık Kılıç
- Pulmonology Department, Muş State Hospital, Muş, Turkey
| | - Şehmus Işık
- Pulmonology Department, Dicle University Medical Faculty, Diyarbakir, Turkey
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Fridgeirsdottir KY, Ólafsdóttir KA, Islind AS, Leppänen T, Arnardottir ES, Saavedra JM. The role of physical activity on obstructive sleep apnea severity and hypoxic load, and the mismatch between subjective and objective physical activity assessments. J Sleep Res 2024; 33:e14195. [PMID: 38480993 PMCID: PMC11597024 DOI: 10.1111/jsr.14195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 03/01/2024] [Accepted: 03/04/2024] [Indexed: 11/28/2024]
Abstract
Obesity is the primary risk factor for the development of obstructive sleep apnea, and physical inactivity plays an important role. However, most studies have either only evaluated physical activity subjectively or objectively in obstructive sleep apnea. The objectives of this study were: (i) to assess the relationship between obstructive sleep apnea severity (both apnea-hypopnea index and desaturation parameters) and both objectively and subjectively measured physical activity after adjustment for anthropometry and body composition parameters; and (ii) to assess the relationship between objective and subjective physical activity parameters and whether obstructive sleep apnea severity has a modulatory effect on this relationship. Fifty-four subjects (age 47.7 ± 15.0 years, 46% males) were categorized into groups according to obstructive sleep apnea severity: no obstructive sleep apnea; mild obstructive sleep apnea; and moderate-to-severe obstructive sleep apnea. All subjects were evaluated with subjective and objective physical activity, anthropometric and body composition measurements, and 3-night self-applied polysomnography. A one-way ANOVA was used to evaluate the differences between the three obstructive sleep apnea severity groups and multiple linear regression to predict obstructive sleep apnea severity. Differences in subjectively reported sitting time (p ≤ 0.004) were found between participants with moderate-to-severe obstructive sleep apnea, and those with either mild or no obstructive sleep apnea (p = 0.004). Age, body mass index and neck circumference explained 63.3% of the variance in the apnea-hypopnea index, and age, body mass index and visceral adiposity explained 67.8% of the variance in desaturation parameters. The results showed that the person's physical activity does not affect obstructive sleep apnea severity. A weak correlation was found between objective and subjective physical activity measures, which could be relevant for healthcare staff encouraging patients with obstructive sleep apnea to increase their physical activity.
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Affiliation(s)
- Katrin Y. Fridgeirsdottir
- Physical Activity, Physical Education, Sport and Health (PAPESH) Research Centre, Sports Science Department, School of Social SciencesReykjavik UniversityReykjavikIceland
- Reykjavik University Sleep Institute (RUSI)ReykjavikIceland
| | - Kristín A. Ólafsdóttir
- Reykjavik University Sleep Institute (RUSI)ReykjavikIceland
- Department of Engineering, School of TechnologyReykjavik UniversityReykjavikIceland
| | - Anna Sigridur Islind
- Reykjavik University Sleep Institute (RUSI)ReykjavikIceland
- Department of Computer Science, School of TechnologyReykjavik UniversityReykjavíkIceland
| | - Timo Leppänen
- Department of Technical PhysicsUniversity of Eastern FinlandKuopioFinland
- Diagnostic Imaging CenterKuopio University HospitalKuopioFinland
- School of Electrical Engineering and Computer ScienceThe University of QueenslandBrisbaneAustralia
| | - Erna S. Arnardottir
- Reykjavik University Sleep Institute (RUSI)ReykjavikIceland
- Department of Engineering, School of TechnologyReykjavik UniversityReykjavikIceland
- Department of Computer Science, School of TechnologyReykjavik UniversityReykjavíkIceland
| | - Jose M. Saavedra
- Physical Activity, Physical Education, Sport and Health (PAPESH) Research Centre, Sports Science Department, School of Social SciencesReykjavik UniversityReykjavikIceland
- Reykjavik University Sleep Institute (RUSI)ReykjavikIceland
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8
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Azzopardi M, Parsons R, Cadby G, King S, McArdle N, Singh B, Hillman DR. Identifying Risk of Postoperative Cardiorespiratory Complications in OSA. Chest 2024; 166:1197-1208. [PMID: 39134145 DOI: 10.1016/j.chest.2024.04.045] [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: 09/26/2023] [Revised: 03/15/2024] [Accepted: 04/09/2024] [Indexed: 09/29/2024] Open
Abstract
BACKGROUND Patients with OSA are at increased risk of postoperative cardiorespiratory complications and death. Attempts to stratify this risk have been inadequate, and predictors from large, well-characterized cohort studies are needed. RESEARCH QUESTION What is the relationship between OSA severity, defined by various polysomnography-derived metrics, and risk of postoperative cardiorespiratory complications or death, and which metrics best identify such risk? STUDY DESIGN AND METHODS In this cohort study, 6,770 consecutive patients who underwent diagnostic polysomnography for possible OSA and a procedure involving general anesthesia within a period of 2 years before and at least 5 years after polysomnography. Participants were identified by linking polysomnography and health databases. Relationships between OSA severity measures and the composite primary outcome of cardiorespiratory complications or death within 30 days of hospital discharge were investigated using univariable and multivariable analyses. RESULTS The primary outcome was observed in 5.3% (n = 361) of the cohort. Although univariable analysis showed strong dose-response relationships between this outcome and multiple OSA severity measures, multivariable analysis showed its independent predictors were: age older than 65 years (OR, 2.67 [95% CI, 2.03-3.52]; P < .0001), age 55.1 to 65 years (OR, 1.47 [95% CI, 1.09-1.98]; P = .0111), time between polysomnography and procedure of ≥ 5 years (OR, 1.32 [95% CI, 1.02-1.70]; P = .0331), BMI of ≥ 35 kg/m2 (OR, 1.43 [95% CI, 1.13-1.82]; P = .0032), presence of known cardiorespiratory risk factor (OR, 1.63 [95% CI, 1.29-2.06]; P < .0001), > 4.7% of sleep time at an oxygen saturation measured by pulse oximetry of < 90% (T90; OR, 1.91 [95% CI, 1.51-2.42]; P < .0001), and cardiothoracic procedures (OR, 7.95 [95% CI, 5.71-11.08]; P < .0001). For noncardiothoracic procedures, age, BMI, presence of known cardiorespiratory risk factor, and percentage of sleep time at an oxygen saturation of < 90% remained the significant predictors, and a risk score based on their ORs was predictive of outcome (area under receiver operating characteristic curve, 0.7 [95% CI, 0.64-0.75]). INTERPRETATION These findings provide a basis for better identifying high-risk patients with OSA and determining appropriate postoperative care.
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Affiliation(s)
- Maree Azzopardi
- Department of Pulmonary Physiology & Sleep Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia; West Australian Sleep Disorders Research Institute, Queen Elizabeth II Medical Centre, Perth, WA, Australia
| | - Richard Parsons
- School of Medicine, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Gemma Cadby
- School of Population and Global Health, University of Western Australia, Perth, WA, Australia
| | - Stuart King
- Department of Pulmonary Physiology & Sleep Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Nigel McArdle
- Department of Pulmonary Physiology & Sleep Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia; West Australian Sleep Disorders Research Institute, Queen Elizabeth II Medical Centre, Perth, WA, Australia
| | - Bhajan Singh
- Department of Pulmonary Physiology & Sleep Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia; West Australian Sleep Disorders Research Institute, Queen Elizabeth II Medical Centre, Perth, WA, Australia; School of Human Sciences, University of Western Australia, Perth, WA, Australia
| | - David R Hillman
- Department of Pulmonary Physiology & Sleep Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia; West Australian Sleep Disorders Research Institute, Queen Elizabeth II Medical Centre, Perth, WA, Australia; School of Human Sciences, University of Western Australia, Perth, WA, Australia.
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Azarbarzin A, Labarca G, Kwon Y, Wellman A. Physiologic Consequences of Upper Airway Obstruction in Sleep Apnea. Chest 2024; 166:1209-1217. [PMID: 38885898 PMCID: PMC11562659 DOI: 10.1016/j.chest.2024.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 05/22/2024] [Accepted: 05/27/2024] [Indexed: 06/20/2024] Open
Abstract
OSA is diagnosed and managed by a metric called the apnea-hypopnea index (AHI). The AHI quantifies the number of respiratory events (apnea or hypopnea), disregarding important information on the characteristics and physiologic consequences of respiratory events, including degrees of ventilatory deficit and associated hypoxemia, cardiac autonomic response, and cortical activity. The oversimplification of the disorder by the AHI is considered one of the reasons for divergent findings on the associations of OSA and cardiovascular disease (CVD) in observational and randomized controlled trial studies. Prospective observational cohort studies have demonstrated strong associations of OSA with several cardiovascular diseases, and randomized controlled trials of CPAP intervention have not been able to detect a benefit of CPAP to reduce the risk of CVD. Over the last several years, novel methodologies have been proposed to better quantify the magnitude of OSA-related breathing disturbance and its physiologic consequences. As a result, stronger associations with cardiovascular and neurocognitive outcomes have been observed. In this review, we focus on the methods that capture polysomnographic heterogeneity of OSA.
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Affiliation(s)
- Ali Azarbarzin
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
| | - Gonzalo Labarca
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Respiratory Diseases, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Younghoon Kwon
- Department of Medicine, University of Washington, Seattle, WA
| | - Andrew Wellman
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
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10
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Chen X, Leppänen T, Kainulainen S, Howarth TP, Oksenberg A, Töyräs J, Terrill PI, Korkalainen H. Sleep stage continuity is associated with objective daytime sleepiness in patients with suspected obstructive sleep apnea. J Clin Sleep Med 2024; 20:1595-1606. [PMID: 38722264 PMCID: PMC11446124 DOI: 10.5664/jcsm.11198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 04/30/2024] [Accepted: 04/30/2024] [Indexed: 10/03/2024]
Abstract
STUDY OBJECTIVES Excessive daytime sleepiness (EDS) in patients with obstructive sleep apnea is poorly explained by standard clinical sleep architecture metrics. We hypothesized that reduced sleep stage continuity mediates this connection independently from standard sleep architecture metrics. METHODS A total of 1,907 patients with suspected obstructive sleep apnea with daytime sleepiness complaints underwent in-lab diagnostic polysomnography and next-day Multiple Sleep Latency Test. Sleep architecture was evaluated with novel sleep-stage continuity quantifications (mean sleep stage duration and probability of remaining in each sleep stage), and conventional metrics (total non-rapid eye movement stages 1, 2, 3 (N1, N2, N3) and rapid eye movement times; and sleep onset latency). Multivariate analyses were utilized to identify variables associated with moderate EDS (5 ≤ mean daytime sleep latency ≤ 10 minutes) and severe EDS (mean daytime sleep latency < 5 minutes). RESULTS Compared to those without EDS, participants with severe EDS had lower N3 sleep continuity (mean N3 period duration 10.4 vs 13.7 minutes, P < .05), less N3 time (53.8 vs 76.5 minutes, P < .05), greater total sleep time (374.0 vs 352.5 minutes, P < .05), and greater N2 time (227.5 vs 186.8 minutes, P < .05). After adjusting for standard sleep architecture metrics using multivariate logistic regression, decreased mean wake and N3 period duration, and the decreased probability of remaining in N2 and N3 sleep remained significantly associated with severe EDS, while the decreased probability of remaining in wake and N2 sleep were associated with moderate EDS. CONCLUSIONS Patients with obstructive sleep apnea and EDS experience lower sleep continuity, noticeable especially during N3 sleep and wake. Sleep-stage continuity quantifications assist in characterizing the sleep architecture and are associated with objective daytime sleepiness highlighting the need for more detailed evaluations of sleep quality. CITATION Chen X, Leppänen T, Kainulainen S, et al. Sleep stage continuity is associated with objective daytime sleepiness in patients with suspected obstructive sleep apnea. J Clin Sleep Med. 2024;20(10):1595-1606.
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Affiliation(s)
- Xin Chen
- School of Electrical Engineering and Computer Science, The University of Queensland, Brisbane, Queensland, Australia
| | - Timo Leppänen
- School of Electrical Engineering and Computer Science, The University of Queensland, Brisbane, Queensland, Australia
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Centre, Kuopio University Hospital, Kuopio, Finland
| | - Samu Kainulainen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Centre, Kuopio University Hospital, Kuopio, Finland
| | - Timothy P. Howarth
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- Darwin Respiratory and Sleep Health, Darwin Private Hospital, Darwin, Northern Territory, Australia
| | - Arie Oksenberg
- Sleep Disorders Unit, Loewenstein Hospital – Rehabilitation Centre, Raanana, Israel
| | - Juha Töyräs
- School of Electrical Engineering and Computer Science, The University of Queensland, Brisbane, Queensland, Australia
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- Science Service Centre, Kuopio University Hospital, Kuopio, Finland
| | - Philip I. Terrill
- School of Electrical Engineering and Computer Science, The University of Queensland, Brisbane, Queensland, Australia
| | - Henri Korkalainen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Centre, Kuopio University Hospital, Kuopio, Finland
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11
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Ioachimescu OC. Obstructive sleep apnoea, oxygen desaturation and hypoxic burden: pebble, rock or boulder? Respirology 2024; 29:761-764. [PMID: 39041296 DOI: 10.1111/resp.14801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Accepted: 07/10/2024] [Indexed: 07/24/2024]
Abstract
See related article
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Affiliation(s)
- Octavian C Ioachimescu
- Clinical and Translational Science Institute of Southeast Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Clement J. Zablocki Veteran Affairs Medical Center, Milwaukee, Wisconsin, USA
- Emory University, Atlanta, Georgia, USA
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12
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Hui X, Cao W, Xu Z, Guo J, Luo J, Xiao Y. Hypoxic indices for obstructive sleep apnoea severity and cardiovascular disease risk prediction: A comparison and application in a community population. Respirology 2024; 29:825-834. [PMID: 38773880 PMCID: PMC11329350 DOI: 10.1111/resp.14754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 05/09/2024] [Indexed: 05/24/2024]
Abstract
BACKGROUND AND OBJECTIVE The apnoea-hypopnoea index (AHI) and oxygen desaturation index (ODI) encounter challenges in capturing the intricate relationship between obstructive sleep apnoea (OSA) and cardiovascular disease (CVD) risks. Although novel hypoxic indices have been proposed to tackle these limitations, there remains a gap in comprehensive validation and comparisons across a unified dataset. METHODS Samples were derived from the Sleep Heart Health Study (SHHS), involving 4485 participants aged over 40 years after data quality screening. The study compared several key indices, including AHI, ODI, the reconstructed hypoxic burden (rHB), the percentage of sleep time with the duration of respiratory events causing desaturation (pRED_3p) and the sleep breathing impairment index (SBII), in relation to CVD mortality and morbidity risks. Adjusted Cox proportional models were employed to calculate hazard ratios (HRs) for each index, and comparisons were performed. RESULTS SBII and pRED_3p exhibited significant correlations with both CVD mortality and morbidity, with SBII showing the highest adjusted HR (95% confidence interval) for mortality (2.04 [1.25, 3.34]) and pRED_3p for morbidity (1.43 [1.09-1.88]). In contrast, rHB was only significant in predicting CVD mortality (1.63 [1.05-2.53]), while AHI and ODI did not show significant correlations with CVD outcomes. The adjusted models based on SBII and pRED_3p exhibited optimal performance in the CVD mortality and morbidity datasets, respectively. CONCLUSION This study identified the optimal indices for OSA-related CVD risks prediction, SBII for mortality and pRED_3p for morbidity. The open-source online platform provides the computation of the indices.
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Affiliation(s)
- Xinjie Hui
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Wenhao Cao
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Zeyu Xu
- State Key Laboratory of Information Photonics and Optical Communications, Beijing University of Posts and Telecommunications, Beijing 100876, China
| | - Junwei Guo
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Jinmei Luo
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Yi Xiao
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
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Pahari P, Korkalainen H, Arnardóttir ES, Islind AS, August E, Oksenberg A, Töyräs J, Leppänen T, Nikkonen S. Prolonged lung-to-finger circulation time indicates an increased risk of intermittent hypoxaemia in sleep apnoea patients. ERJ Open Res 2024; 10:01051-2023. [PMID: 39040584 PMCID: PMC11261378 DOI: 10.1183/23120541.01051-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 03/06/2024] [Indexed: 07/24/2024] Open
Abstract
Introduction Intermittent hypoxaemia is closely associated with cardiovascular dysfunction and may be a more accurate indicator of obstructive sleep apnoea (OSA) severity than conventional metrics. Another key factor is the lung-to-finger circulation time (LFCt), defined as the duration from the cessation of a respiratory event to the lowest point of oxygen desaturation. LFCt serves as a surrogate marker for circulatory delay and is linked with cardiovascular function. Yet, the specific associations between respiratory and hypoxaemia characteristics and LFCt in patients with OSA remain unclear. This study aims to investigate these associations, ultimately contributing to a more nuanced understanding of OSA severity. Methods The study comprised 878 in-lab polysomnographies of patients with suspected OSA. The conventional OSA metrics were computed along with nine hypoxaemia metrics and then divided into quartiles (Q1-Q4) based on respiratory event duration. In addition, these were further divided into subquartiles based on LFCt. The empirical cumulative distribution functions (CDFs) and linear regression models were used to investigate the association between desaturation metrics and LFCt. Results The results showed that prolonged LFCt was associated with increased hypoxic severity. Based on CDFs, the hypoxic severity significantly increased with longer LFCt despite the duration of respiratory events. Furthermore, fall duration was elevated in patients with longer LFCt (Q1- desaturation fall duration (FallDur): 14.6 s; Q4-FallDur: 29.8 s; p<0.0001). The regression models also showed significant association between hypoxic severity and LFCt (Q1-desaturation fall slope (FallSlope): β=-3.224; Q4-FallSlope: β=-6.178; p<0.0001). Discussion Considering LFCt along with desaturation metrics might be useful in estimating the association between the severity of OSA, physiological consequences of respiratory events and cardiac health.
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Affiliation(s)
- Purbanka Pahari
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Henri Korkalainen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Erna Sif Arnardóttir
- Reykjavik University Sleep Institute, School of Technology, Reykjavik University, Reykjavik, Iceland
- Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland
| | - Anna Sigridur Islind
- Reykjavik University Sleep Institute, School of Technology, Reykjavik University, Reykjavik, Iceland
| | - Elias August
- Reykjavik University Sleep Institute, School of Technology, Reykjavik University, Reykjavik, Iceland
| | - Arie Oksenberg
- Sleep Disorders Unit, Loewenstein Hospital Rehabilitation Center, Raanana, Israel
| | - Juha Töyräs
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- School of Electrical Engineering and Computer Science, The University of Queensland, Brisbane, Australia
- Science Service Center, Kuopio University Hospital, Kuopio, Finland
| | - Timo Leppänen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
- School of Electrical Engineering and Computer Science, The University of Queensland, Brisbane, Australia
| | - Sami Nikkonen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
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Staykov E, Mann DL, Duce B, Kainulainen S, Leppänen T, Töyräs J, Azarbarzin A, Georgeson T, Sands SA, Terrill PI. Increased Flow Limitation During Sleep Is Associated With Increased Psychomotor Vigilance Task Lapses in Individuals With Suspected OSA. Chest 2024; 165:990-1003. [PMID: 38048938 DOI: 10.1016/j.chest.2023.11.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 09/03/2023] [Accepted: 11/16/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Impaired daytime vigilance is an important consequence of OSA, but several studies have reported no association between objective measurements of vigilance and the apnea-hypopnea index (AHI). Notably, the AHI does not quantify the degree of flow limitation, that is, the extent to which ventilation fails to meet intended ventilation (ventilatory drive). RESEARCH QUESTION Is flow limitation during sleep associated with daytime vigilance in OSA? STUDY DESIGN AND METHODS Nine hundred ninety-eight participants with suspected OSA completed a 10-min psychomotor vigilance task (PVT) before same-night in-laboratory polysomnography. Flow limitation frequency (percent of flow-limited breaths) during sleep was quantified using airflow shapes (eg, fluttering and scooping) from nasal pressure airflow. Multivariable regression assessed the association between flow limitation frequency and the number of lapses (response times > 500 ms, primary outcome), adjusting for age, sex, BMI, total sleep time, depression, and smoking status. RESULTS Increased flow limitation frequency was associated with decreased vigilance: a 1-SD (35.3%) increase was associated with 2.1 additional PVT lapses (95% CI, 0.7-3.7; P = .003). This magnitude was similar to that for age, where a 1-SD increase (13.5 years) was associated with 1.9 additional lapses. Results were similar after adjusting for AHI, hypoxemia severity, and arousal severity. The AHI was not associated with PVT lapses (P = .20). In secondary exploratory analysis, flow limitation frequency was associated with mean response speed (P = .012), median response time (P = .029), fastest 10% response time (P = .041), slowest 10% response time (P = .018), and slowest 10% response speed (P = .005). INTERPRETATION Increased flow limitation during sleep was associated with decreased daytime vigilance in individuals with suspected OSA, independent of the AHI. Flow limitation may complement standard clinical metrics in identifying individuals whose vigilance impairment most likely is explained by OSA.
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Affiliation(s)
- Eric Staykov
- School of Electrical Engineering and Computer Science, The University of Queensland, Brisbane, QLD, Australia.
| | - Dwayne L Mann
- School of Electrical Engineering and Computer Science, The University of Queensland, Brisbane, QLD, Australia; Institute for Social Science Research, The University of Queensland, Brisbane, QLD, Australia
| | - Brett Duce
- Department of Respiratory & Sleep Medicine, Princess Alexandra Hospital, Brisbane, QLD, Australia; Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Samu Kainulainen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland; Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Timo Leppänen
- School of Electrical Engineering and Computer Science, The University of Queensland, Brisbane, QLD, Australia; Department of Technical Physics, University of Eastern Finland, Kuopio, Finland; Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Juha Töyräs
- School of Electrical Engineering and Computer Science, The University of Queensland, Brisbane, QLD, Australia; Department of Technical Physics, University of Eastern Finland, Kuopio, Finland; Science Service Center, Kuopio University Hospital, Kuopio, Finland
| | - Ali Azarbarzin
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, MA
| | - Thomas Georgeson
- School of Electrical Engineering and Computer Science, The University of Queensland, Brisbane, QLD, Australia; Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Scott A Sands
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, MA
| | - Philip I Terrill
- School of Electrical Engineering and Computer Science, The University of Queensland, Brisbane, QLD, Australia
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Pahari P, Korkalainen H, Karhu T, Arnardottir ES, Töyräs J, Leppänen T, Nikkonen S. Reaction time in psychomotor vigilance task is related to hypoxic load in males with sleep apnea. J Sleep Res 2024; 33:e13988. [PMID: 37448111 DOI: 10.1111/jsr.13988] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 06/06/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023]
Abstract
Oxygen saturation (SpO2 )-based parameters are more strongly linked to impaired daytime vigilance than the conventional diagnostic metrics in patients with obstructive sleep apnea (OSA). However, whether the association between SpO2 -based parameters and impaired daytime vigilance is modulated by sex, remains unknown. Hence, we investigated the interplay between sex and detailed SpO2 -based metrics and their association with impaired vigilance in patients with OSA. The study population consisted of 855 (473 males, 382 females) patients with suspected OSA who underwent overnight polysomnography and psychomotor vigilance task (PVT). The population was grouped by sex and divided into quartiles (Q1-Q4) based on median reaction times (RTs) in the PVT. In addition to conventional diagnostic metrics, desaturation severity (DesSev), fall severity (FallSev), and recovery severity (RecovSev) were compared between the sexes and between the best (Q1) and worst (Q4) performing quartiles by using cumulative distribution functions (CDFs). Additionally, sex-specific covariate-adjusted linear regression models were used to investigate the connection between the parameters and RTs. The CDFs showed significantly higher hypoxic load in Q4 in males compared to females. In addition, the DesSev (β = 8.05, p < 0.01), FallSev (β = 6.48, p = 0.02), RecovSev (β = 9.13, p < 0.01), and Oxygen Desaturation Index (β = 12.29, p < 0.01) were associated with increased RTs only in males. Conversely, the Arousal Index (β = 10.75-11.04, p < 0.01) was associated with impaired vigilance in females. The severity of intermittent hypoxaemia was strongly associated with longer RTs in males whereas the Arousal Index had the strongest association in females. Thus, the impact of hypoxic load on impaired vigilance seems to be stronger in males than females.
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Affiliation(s)
- Purbanka Pahari
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Henri Korkalainen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Tuomas Karhu
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Erna Sif Arnardottir
- Reykjavik University Sleep Institute, School of Technology, Reykjavik University, Reykjavik, Iceland
- Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland
| | - Juha Töyräs
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- School of Electrical Engineering and Computer Science, The University of Queensland, Brisbane, Queensland, Australia
- Science Service Center, Kuopio University Hospital, Kuopio, Finland
| | - Timo Leppänen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
- School of Electrical Engineering and Computer Science, The University of Queensland, Brisbane, Queensland, Australia
| | - Sami Nikkonen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
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Zhang B, Lu S, Guo H, Xu J, Xiao Z, Tang J. Relationship between ODI and sleep structure of obstructive sleep apnea and cardiac remodeling. Sleep Breath 2024; 28:173-181. [PMID: 37453997 DOI: 10.1007/s11325-023-02872-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 04/27/2023] [Accepted: 06/12/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE The purpose of the study was to evaluate the quantitative relationship between Oxygen Desaturation Index (ODI) and sleep structure of obstructive sleep apnea (OSA) and cardiac remodeling. METHODS In this study, patients were enrolled from January 2015 to October 2022, and were divided into 3 groups according to AHI: patients with AHI < 15, patients with 15 ≤ AHI < 30, and 260 patients with AHI ≥ 30. Stratified linear regression was used to analyze independent risk factors for cardiac remodeling in OSA. RESULTS A total of 479 patients were enrolled. We found that compared with AHI < 15 group (n = 120), the group with AHI > 30 (n = 260) had increased left atrial anteroposterior diameter, left ventricular end-diastolic internal diameter, left ventricular posterior wall thickness, right ventricular anteroposterior diameter, and interventricular septal thickness (P < 0.05). The group with 15 ≤ AHI ≤ 30 (n = 99) had increased left atrial anteroposterior diameter (P < 0.05). Multivariate linear regression revealed that N2 sleep was an independent risk factor for left ventricular posterior wall thickness, with positive correlation (p < 0.05). N3 sleep was an independent risk factor for transverse right atrial diameter and right ventricular anteroposterior diameter, with negative correlation (P < 0.05). ODI was an independent risk factor for interventricular septal thickness, with positive correlation (P < 0.05). The arousal index was an independent risk factor for increased left atrial anteroposterior diameter, with positive correlation (P < 0.05). CONCLUSIONS Increased ODI is an independent risk factor for interventricular septal thickness, while decreased slow wave sleep is an independent risk factor for right heart remodeling in OSA.
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Affiliation(s)
- Baokun Zhang
- Department of Neurology, Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, NO. 16766 Jingshi Road, Jinan, Shandong, 250012, People's Republic of China
| | - Shanshan Lu
- Department of Neurology, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Neuroimmunology, Jinan, People's Republic of China
| | - Huiying Guo
- Department of Neurology, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Neuroimmunology, Jinan, People's Republic of China
| | - Juanjuan Xu
- Department of Neurology, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Neuroimmunology, Jinan, People's Republic of China
| | - Zhang Xiao
- Department of Neurology, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Neuroimmunology, Jinan, People's Republic of China
| | - Jiyou Tang
- Department of Neurology, Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, NO. 16766 Jingshi Road, Jinan, Shandong, 250012, People's Republic of China.
- Department of Neurology, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Neuroimmunology, Jinan, People's Republic of China.
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Hietakoste S, Armanac-Julian P, Karhu T, Bailon R, Sillanmaki S, Toyras J, Leppanen T, Myllymaa S, Kainulainen S. Acute Cardiorespiratory Coupling Impairment in Worsening Sleep Apnea-Related Intermittent Hypoxemia. IEEE Trans Biomed Eng 2024; 71:326-333. [PMID: 37523277 DOI: 10.1109/tbme.2023.3300079] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
OBJECTIVE Hypoxic load is one of the main characteristics of obstructive sleep apnea (OSA) contributing to sympathetic overdrive and weakened cardiorespiratory coupling (CRC). Whether this association changes with increasing hypoxic load has remained obscure. Therefore, we aimed to study our hypothesis that increasing hypoxic load acutely decreases the CRC. METHODS We retrospectively analyzed the electrocardiography and nasal pressure signals in 5-min segment pairs (n = 36 926) recorded during clinical polysomnographies of 603 patients with suspected OSA. The segment pairs were pooled into five groups based on the hypoxic load severity described with the the total integrated area under the blood oxygen saturation curve during desaturations. In these severity groups, we determined the frequency-domain heart rate variability (HRV) parameters, the HRV and respiratory high-frequency (HF, 0.15-0.4 Hz) peaks, and the difference between those peaks. We also computed the spectral HF coherence between HRV and respiration in the HF band. RESULTS The ratio of low-frequency (LF, 0.04-0.15 Hz) to HF power increased from 1.047 to 1.805 (p < 0.001); the difference between the HRV and respiratory HF peaks increased from 0.001 Hz to 0.039 Hz (p < 0.001); and the spectral coherence between HRV and respiration in the HF band decreased from 0.813 to 0.689 (p < 0.001) as the hypoxic load increased. CONCLUSION AND SIGNIFICANCE The vagal modulation decreases and CRC weakens significantly with increasing hypoxic load. Thus, the hypoxic load could be utilized more thoroughly in contemporary OSA diagnostics to better assess the severity of OSA-related cardiac stress.
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Schwerthöffer D, Haselwarter T, Grimmer T. Obstructive Sleep Apnea Among Patients with Mild Cognitive Impairment. J Alzheimers Dis 2024; 100:809-823. [PMID: 38968050 DOI: 10.3233/jad-240251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2024]
Abstract
Background Obstructive sleep apnea (OSA) is associated with cognitive disorders, but little is known about prevalence of co-occurring OSA and mild cognitive impairment (MCI) as well as about co-occurring OSA and Alzheimer's disease (AD). Pathophysiological models integrating OSA, cognitive deficits and neurodegeneration remain speculative. Findings in this area could contribute to the knowledge about pathophysiological processes in cognitive disorders and neurodegenerative processes, be helpful for the diagnosis of cognitive disorders and provide approaches for the treatment of cognitive disorders. Objective Examining the prevalence of OSA and patterns of cognitive deficits as well as AD biomarker profiles associated with OSA in a cohort of 104 MCI patients. Methods Assessments used include: respiratory polygraphy, The Consortium to Establish a Registry for Alzheimer's Disease Neuropsychological Battery (CERAD NB), Tau, phosphoTau181, amyloid-β-1-42/1-40, 18F-fluorodeoxyglucose positron emission tomography (F18-FDG-PET). Results Prevalence of OSA of any severity: 58,7% (Apnea Hypopnea Index (AHI)≥5/h), OSA in a moderate-to-severe extent (AHI≥15/h): 25%. Only 13.1% of MCI patients with OSA reported daytime sleepiness. MCI-OSA patients showed no specific neuropsychological pattern. Presence of OSA was not associated with specific AD biomarker profiles in the whole study group besides a positive association between AD positivity in an AD biomarker sub cohort. Conclusions OSA is highly prevalent in patients with MCI. It might often remain undiagnosed as only a small number of MCI-OSA patients report daytime sleepiness. OSA could contribute to MCI symptoms and even to AD pathology. Further research is needed to validate these findings and to investigate possible pathophysiological relationships between OSA and MCI as well as between OSA and AD.
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Affiliation(s)
- Dirk Schwerthöffer
- Department of Psychiatry and Psychotherapy, School of Medicine and Health, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
- Klinik für Suchtmedizin und Psychotherapie, kbo Isar-Amper-Klinikum Region München, Haar bei München, Germany
| | - Tim Haselwarter
- Department of Psychiatry and Psychotherapy, School of Medicine and Health, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Timo Grimmer
- Department of Psychiatry and Psychotherapy, School of Medicine and Health, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
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Esmaeili N, Labarca G, Hu WH, Vena D, Messineo L, Gell L, Hajipour M, Taranto-Montemurro L, Sands SA, Redline S, Wellman A, Sehhati M, Azarbarzin A. Hypoxic Burden Based on Automatically Identified Desaturations Is Associated with Adverse Health Outcomes. Ann Am Thorac Soc 2023; 20:1633-1641. [PMID: 37531573 PMCID: PMC10632930 DOI: 10.1513/annalsats.202303-248oc] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 08/02/2023] [Indexed: 08/04/2023] Open
Abstract
Rationale: Recent studies have shown that sleep apnea-specific intermittent hypoxemia quantified by the hypoxic burden (HB) predicted cardiovascular disease (CVD)-related mortality in community-based and clinical cohorts. Calculation of HB is based on manual scoring of hypopneas and apneas, which is time-consuming and prone to interscorer variability. Objective: To validate a novel method to quantify the HB that is based on automatically scored desaturations. Methods: The sample included 5,655 middle-aged or older adults from the Sleep Heart Health Study (52.8% women; age, 63.2 ± 11.3 yr). The original HB method was based on a subject-specific search window obtained from an ensemble average of oxygen saturation signals (as measured by pulse oximetry) and synchronized with respect to the termination of scored respiratory events. In this study, however, the search window was obtained from ensemble average of oxygen saturation signals that synchronized with respect to the minimum of all automatically identified desaturations (⩾2% and other thresholds, including 3% and 4%, in sensitivity analyses). The time interval between the two maxima around the minimum saturation was defined as the search window. The oximetry-derived HB (HBOxi) was defined as the total area under all desaturation curves (restricted by the search window) divided by the total sleep time. Logistic and Cox regression models assessed the adjusted odds ratio (aOR)/hazard ratio of excessive daytime sleepiness (EDS), hypertension (HTN), and CVD mortality per 1-standard deviation increase in HBOxi after adjusting for several covariates and confounders. Results: The Spearman's rank correlation between HB (median [interquartile range], 34.4 [18.4-59.8] % min/h) and HBOxi (median [interquartile range], 34.5 [21.6-53.8] % min/h) was 0.81 (P < 0.001). Similar to HB, HBOxi was significantly associated with EDS (aOR [95% confidence interval (CI)], 1.17 [1.09-1.26] per standard deviation), HTN (aOR [95% CI], 1.13 [1.05-1.21]), and CVD mortality (adjusted hazard ratio [95% CI], 1.15 [1.01-1.30]) in fully adjusted models. Conclusions: The HBOxi was highly correlated with the HB based on manually scored apneas and hypopneas and was associated with EDS, HTN, and CVD mortality with similar effect sizes as previously reported. This method could be incorporated into wearable technology that accurately records oxygen saturation signals.
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Affiliation(s)
- Neda Esmaeili
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Bioelectric and Biomedical Engineering, School of Advanced Technologies in Medicine, Isfahan University of Medical Sciences, Isfahan, Iran; and
| | - Gonzalo Labarca
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Wen-Hsin Hu
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Daniel Vena
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ludovico Messineo
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Laura Gell
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mohammadreza Hajipour
- Department of Experimental Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Luigi Taranto-Montemurro
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Scott A. Sands
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Andrew Wellman
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mohammadreza Sehhati
- Department of Bioelectric and Biomedical Engineering, School of Advanced Technologies in Medicine, Isfahan University of Medical Sciences, Isfahan, Iran; and
| | - Ali Azarbarzin
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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20
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He S, Cistulli PA, de Chazal P. A Review of Novel Oximetry Parameters for the Prediction of Cardiovascular Disease in Obstructive Sleep Apnoea. Diagnostics (Basel) 2023; 13:3323. [PMID: 37958218 PMCID: PMC10649141 DOI: 10.3390/diagnostics13213323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/18/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023] Open
Abstract
Obstructive sleep apnoea (OSA) is a sleep disorder with repetitive collapse of the upper airway during sleep, which leads to intermittent hypoxic events overnight, adverse neurocognitive, metabolic complications, and ultimately an increased risk of cardiovascular disease (CVD). The standard diagnostic parameter for OSA, apnoea-hypopnoea index (AHI), is inadequate to predict CVD morbidity and mortality, because it focuses only on the frequency of apnoea and hypopnoea events, and fails to reveal other physiological information for the prediction of CVD events. Novel parameters have been introduced to compensate for the deficiencies of AHI. However, the calculation methods and criteria for these parameters are unclear, hindering their use in cross-study analysis and studies. This review aims to discuss novel parameters for predicting CVD events from oximetry signals and to summarise the corresponding computational methods.
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Affiliation(s)
- Siying He
- Charles Perkins Centre, Faculty of Engineering, Sydney University, Camperdown, NSW 2050, Australia;
| | - Peter A. Cistulli
- Charles Perkins Centre, Faculty of Medicine and Health, Sydney University, Camperdown, NSW 2050, Australia;
- Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, St Leonards, NSW 2065, Australia
| | - Philip de Chazal
- Charles Perkins Centre, Faculty of Engineering, Sydney University, Camperdown, NSW 2050, Australia;
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21
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Labarca G, Vena D, Hu WH, Esmaeili N, Gell L, Yang HC, Wang TY, Messineo L, Taranto-Montemurro L, Sofer T, Barr RG, Stone KL, White DP, Wellman A, Sands S, Redline S, Azarbarzin A. Sleep Apnea Physiological Burdens and Cardiovascular Morbidity and Mortality. Am J Respir Crit Care Med 2023; 208:802-813. [PMID: 37418748 PMCID: PMC10563185 DOI: 10.1164/rccm.202209-1808oc] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 07/07/2023] [Indexed: 07/09/2023] Open
Abstract
Rationale: Obstructive sleep apnea is characterized by frequent reductions in ventilation, leading to oxygen desaturations and/or arousals. Objectives: In this study, association of hypoxic burden with incident cardiovascular disease (CVD) was examined and compared with that of "ventilatory burden" and "arousal burden." Finally, we assessed the extent to which the ventilatory burden, visceral obesity, and lung function explain variations in hypoxic burden. Methods: Hypoxic, ventilatory, and arousal burdens were measured from baseline polysomnograms in the Multi-Ethnic Study of Atherosclerosis (MESA) and the Osteoporotic Fractures in Men (MrOS) studies. Ventilatory burden was defined as event-specific area under ventilation signal (mean normalized, area under the mean), and arousal burden was defined as the normalized cumulative duration of all arousals. The adjusted hazard ratios for incident CVD and mortality were calculated. Exploratory analyses quantified contributions to hypoxic burden of ventilatory burden, baseline oxygen saturation as measured by pulse oximetry, visceral obesity, and spirometry parameters. Measurements and Main Results: Hypoxic and ventilatory burdens were significantly associated with incident CVD (adjusted hazard ratio [95% confidence interval] per 1 SD increase in hypoxic burden: MESA, 1.45 [1.14, 1.84]; MrOS, 1.13 [1.02, 1.26]; ventilatory burden: MESA, 1.38 [1.11, 1.72]; MrOS, 1.12 [1.01, 1.25]), whereas arousal burden was not. Similar associations with mortality were also observed. Finally, 78% of variation in hypoxic burden was explained by ventilatory burden, whereas other factors explained only <2% of variation. Conclusions: Hypoxic and ventilatory burden predicted CVD morbidity and mortality in two population-based studies. Hypoxic burden is minimally affected by measures of adiposity and captures the risk attributable to ventilatory burden of obstructive sleep apnea rather than a tendency to desaturate.
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Affiliation(s)
- Gonzalo Labarca
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Daniel Vena
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Wen-Hsin Hu
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Neda Esmaeili
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Laura Gell
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Hyung Chae Yang
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, South Korea
| | - Tsai-Yu Wang
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ludovico Messineo
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Luigi Taranto-Montemurro
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Tamar Sofer
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Robert G. Barr
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York; and
| | - Katie L. Stone
- Research Institute, California Pacific Medical Center, San Francisco, California
| | - David P. White
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Andrew Wellman
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Scott Sands
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ali Azarbarzin
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
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22
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La Fisca L, Jennebauffe C, Bruyneel M, Ris L, Lefebvre L, Siebert X, Gosselin B. Enhancing OSA Assessment with Explainable AI . ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-6. [PMID: 38083271 DOI: 10.1109/embc40787.2023.10341035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Explainable Artificial Intelligence (xAI) is a rapidly growing field that focuses on making deep learning models interpretable and understandable to human decision-makers. In this study, we introduce xAAEnet, a novel xAI model applied to the assessment of Obstructive Sleep Apnea (OSA) severity. OSA is a prevalent sleep disorder that can lead to numerous medical conditions and is currently assessed using the Apnea-Hypopnea Index (AHI). However, AHI has been criticized for its inability to accurately estimate the effect of OSAs on related medical conditions. To address this issue, we propose a human-centric xAI approach that emphasizes similarity between apneic events as a whole and reduces subjectivity in diagnosis by examining how the model makes its decisions. Our model was trained and tested on a dataset of 60 patients' Polysomnographic (PSG) recordings. Our results demonstrate that the proposed model, xAAEnet, outperforms models with traditional architectures such as convolutional regressor, autoencoder (AE), and variational autoencoder (VAE). This study highlights the potential of xAI in providing an objective OSA severity scoring method.Clinical relevance- This study provides an objective OSA severity scoring technique which could improve the management of apneic patients in clinical practice.
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23
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Varis M, Karhu T, Leppänen T, Nikkonen S. Utilizing Envelope Analysis of a Nasal Pressure Signal for Sleep Apnea Severity Estimation. Diagnostics (Basel) 2023; 13:diagnostics13101776. [PMID: 37238259 DOI: 10.3390/diagnostics13101776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/12/2023] [Accepted: 05/13/2023] [Indexed: 05/28/2023] Open
Abstract
Obstructive sleep apnea (OSA) severity assessment is based on manually scored respiratory events and their arbitrary definitions. Thus, we present an alternative method to objectively evaluate OSA severity independently of the manual scorings and scoring rules. A retrospective envelope analysis was conducted on 847 suspected OSA patients. Four parameters were calculated from the difference between the nasal pressure signal's upper and lower envelopes: average (AV), median (MD), standard deviation (SD), and coefficient of variation (CoV). We computed the parameters from the entirety of the recorded signals to perform binary classifications of patients using three different apnea-hypopnea index (AHI) thresholds (5-15-30). Additionally, the calculations were undertaken in 30-second epochs to estimate the ability of the parameters to detect manually scored respiratory events. Classification performances were assessed with areas under the curves (AUCs). As a result, the SD (AUCs ≥ 0.86) and CoV (AUCs ≥ 0.82) were the best classifiers for all AHI thresholds. Furthermore, non-OSA and severe OSA patients were separated well with SD (AUC = 0.97) and CoV (AUC = 0.95). Respiratory events within the epochs were identified moderately with MD (AUC = 0.76) and CoV (AUC = 0.82). In conclusion, envelope analysis is a promising alternative method by which to assess OSA severity without relying on manual scoring or the scoring rules of respiratory events.
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Affiliation(s)
- Mikke Varis
- Department of Technical Physics, University of Eastern Finland, Canthia, P.O. Box 1627, FI-70211 Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, FI-70210 Kuopio, Finland
| | - Tuomas Karhu
- Department of Technical Physics, University of Eastern Finland, Canthia, P.O. Box 1627, FI-70211 Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, FI-70210 Kuopio, Finland
| | - Timo Leppänen
- Department of Technical Physics, University of Eastern Finland, Canthia, P.O. Box 1627, FI-70211 Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, FI-70210 Kuopio, Finland
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Sami Nikkonen
- Department of Technical Physics, University of Eastern Finland, Canthia, P.O. Box 1627, FI-70211 Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, FI-70210 Kuopio, Finland
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24
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Outcome of nasal measurements in patients with OSA - Mounting evidence of a nasal endotype. Sleep Med 2023; 103:131-137. [PMID: 36791622 DOI: 10.1016/j.sleep.2023.01.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/26/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND Increased nasal resistance as measured by 4-phase rhinomanometry is associated with a paucity of apneas relative to hypopneas in obstructive sleep apnea (OSA) patients. The ratio of hypopneas to apneas for a given apnea hypopnea index (AHI) may influence treatment choice. This study aimed to investigate if OSA patients with an elevated hypopnea apnea ratio are associated with differences in acoustic rhinometry measurements. METHODS One hundred and thirty-nine (n = 139) OSA patients (AHI >5) were enrolled in this prospective case-control study (all male). OSA Diagnosis was established through a type three sleep study. Both acoustic rhinometry and 4-phase rhinomanometry were performed on all patients at baseline and after decongestion. Possible associations between apnea-hypopnea index, oxygen desaturation index, nadir oxygen saturation, apnea index, hypopnea index, hypopnea to apnea ratio and body mass index and were analysed using multiple logistic and linear regression models. RESULTS The acoustic rhinometry measurements minimal cross-sectional area, total volume and minimal cross-sectional areas are significantly smaller in patients with increased nasal resistance as measured by 4-phase rhinomanometry (P < 0.01). No consistent statistically significant associations were found between the acoustic rhinometry variables, and the respiratory variables analysed in the sleep studies. OSA patients with an elevated hypopnea apnea ratio are more than 4 times more likely to present with increased nasal resistance measured by 4-phase rhinomanometry (OR = 4.4, 95% CI [1.5-13.2], P < 0.01). CONCLUSIONS Acoustic rhinometry is significantly associated with 4-phase rhinomanometry. However, acoustic rhinometry measurements are not associated with the respiratory indices routinely measured in OSA in a clinical setting. 4-phase rhinomanometry is a more suitable method for detecting clinically relevant nasal obstruction in obstructive sleep apnea patients.
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25
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Verbraecken J. Respiratory event duration in obstructive sleep apnea: don't forget the chemical drive ! Sleep Med Rev 2023; 68:101765. [PMID: 36924700 DOI: 10.1016/j.smrv.2023.101765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 02/14/2023] [Indexed: 03/16/2023]
Affiliation(s)
- Johan Verbraecken
- Department of Pulmonary Medicine and Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital and University of Antwerp, Drie Eikenstraat 655, 2650, Edegem, Antwerp, Belgium.
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26
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Müller MB, Stihl C, Schmid A, Hirschberger S, Mitsigiorgi R, Holzer M, Patscheider M, Weiss BG, Reichel C, Hübner M, Uhl B. A novel OSA-related model of intermittent hypoxia in endothelial cells under flow reveals pronounced inflammatory pathway activation. Front Physiol 2023; 14:1108966. [PMID: 37123277 PMCID: PMC10133699 DOI: 10.3389/fphys.2023.1108966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 03/31/2023] [Indexed: 05/02/2023] Open
Abstract
Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder characterized by recurrent episodes of upper airway obstruction and subsequent hypoxia. In patients with OSA, severity and number of these hypoxic events positively correlate with the extent of associated cardiovascular pathology. The molecular mechanisms underlying intermittent hypoxia (IH)-driven cardiovascular disease in OSA, however, remain poorly understood-partly due to the lack of adequate experimental models. Here, we present a novel experimental approach that utilizes primary human endothelial cells cultivated under shear stress. Oxygen partial pressure dynamics were adopted in our in vitro model according to the desaturation-reoxygenation patterns identified in polysomnographic data of severe OSA patients (n = 10, with 892 severe desaturations, SpO2<80%). Using western blot analysis, we detected a robust activation of the two major inflammatory pathways ERK and NF-κB in endothelial cells, whereas no HIF1α and HIF2α protein stabilization was observed. In line with these findings, mRNA and protein expression of the pro-inflammatory adhesion and signaling molecule ICAM-1 and the chemokine CCL2 were significantly increased. Hence, we established a novel in vitro model for deciphering OSA-elicited effects on the vascular endothelium. First data obtained in this model point to the endothelial activation of pro-inflammatory rather than hypoxia-associated pathways in OSA. Future studies in this model might contribute to the development of targeted strategies against OSA-induced, secondary cardiovascular disease.
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Affiliation(s)
- Martin B. Müller
- Department of Anaesthesiology and Intensive Care Medicine, Research Unit Molecular Medicine, LMU University Hospital, Ludwig-Maximilians-University München (LMU), Munich, Germany
- Walter Brendel Center of Experimental Medicine (WBex), Ludwig-Maximilians-University München (LMU), Munich, Germany
- *Correspondence: Martin B. Müller,
| | - Clemens Stihl
- Department of Otorhinolaryngology, LMU University Hospital, Ludwig-Maximilians-University München (LMU), Munich, Germany
| | - Annika Schmid
- Walter Brendel Center of Experimental Medicine (WBex), Ludwig-Maximilians-University München (LMU), Munich, Germany
| | - Simon Hirschberger
- Department of Anaesthesiology and Intensive Care Medicine, Research Unit Molecular Medicine, LMU University Hospital, Ludwig-Maximilians-University München (LMU), Munich, Germany
- Walter Brendel Center of Experimental Medicine (WBex), Ludwig-Maximilians-University München (LMU), Munich, Germany
| | - Rea Mitsigiorgi
- Walter Brendel Center of Experimental Medicine (WBex), Ludwig-Maximilians-University München (LMU), Munich, Germany
- Department of Otorhinolaryngology, LMU University Hospital, Ludwig-Maximilians-University München (LMU), Munich, Germany
| | - Martin Holzer
- Department of Otorhinolaryngology, LMU University Hospital, Ludwig-Maximilians-University München (LMU), Munich, Germany
| | - Martin Patscheider
- Department of Otorhinolaryngology, LMU University Hospital, Ludwig-Maximilians-University München (LMU), Munich, Germany
| | - Bernhard G. Weiss
- Department of Otorhinolaryngology, LMU University Hospital, Ludwig-Maximilians-University München (LMU), Munich, Germany
| | - Christoph Reichel
- Walter Brendel Center of Experimental Medicine (WBex), Ludwig-Maximilians-University München (LMU), Munich, Germany
- Department of Otorhinolaryngology, LMU University Hospital, Ludwig-Maximilians-University München (LMU), Munich, Germany
| | - Max Hübner
- Department of Anaesthesiology and Intensive Care Medicine, Research Unit Molecular Medicine, LMU University Hospital, Ludwig-Maximilians-University München (LMU), Munich, Germany
- Walter Brendel Center of Experimental Medicine (WBex), Ludwig-Maximilians-University München (LMU), Munich, Germany
| | - Bernd Uhl
- Walter Brendel Center of Experimental Medicine (WBex), Ludwig-Maximilians-University München (LMU), Munich, Germany
- Department of Otorhinolaryngology, LMU University Hospital, Ludwig-Maximilians-University München (LMU), Munich, Germany
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27
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Martinez-Garcia MA, Sánchez-de-la-Torre M, White DP, Azarbarzin A. Hypoxic Burden in Obstructive Sleep Apnea: Present and Future. Arch Bronconeumol 2023; 59:36-43. [PMID: 36115739 DOI: 10.1016/j.arbres.2022.08.005] [Citation(s) in RCA: 54] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 08/12/2022] [Indexed: 12/27/2022]
Abstract
Conventional measures of obstructive sleep apnea (OSA) severity, such as the apnea-hypopnea index (AHI) and oxygen desaturation index (ODI) are commonly used to quantify OSA severity and guide therapeutical decision-making processes. However, it is widely recognized that both AHI and ODI have important limitations and novel physiologically-informed metrics are needed to better capture the severity of OSA and characterize its physiological consequences, particularly the severity of recurrent nocturnal hypoxemia, ensuing the respiratory events. According to recent studies, the sleep apnea-specific "hypoxic burden (HB)", defined as the sum of individual areas under the oxygen desaturation curve, has shown some promise in identifying high risk individuals with OSA. In addition to the frequency of respiratory events, HB capture the depth and duration of OSA-related hypoxemia that may prove to be important disease characterizing features, not captured by the conventional "frequency-based" metrics, such as AHI and ODI. In this "perspective" paper the methods to quantify the HB, its characteristics, associations with health outcomes, and its limitations will be discussed.
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Affiliation(s)
- Miguel A Martinez-Garcia
- Respiratory Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.
| | - Manuel Sánchez-de-la-Torre
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain; Precision Medicine in Chronic Diseases, Hospital Universitari Arnau de Vilanova-Santa Maria, IRB Lleida, Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
| | - David P White
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Ali Azarbarzin
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
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Pahari P, Korkalainen H, Karhu T, Rissanen M, Arnardottir ES, Hrubos‐Strøm H, Duce B, Töyräs J, Leppänen T, Nikkonen S. Obstructive sleep apnea‐related intermittent hypoxaemia is associated with impaired vigilance. J Sleep Res 2022; 32:e13803. [PMID: 36482788 DOI: 10.1111/jsr.13803] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/10/2022] [Accepted: 11/25/2022] [Indexed: 12/13/2022]
Abstract
Obstructive sleep apnea (OSA)-related intermittent hypoxaemia is a potential risk factor for different OSA comorbidities, for example cardiovascular disease. However, conflicting results are found as to whether intermittent hypoxaemia is associated with impaired vigilance. Therefore, we aimed to investigate how desaturation characteristics differ between the non-impaired vigilance and impaired vigilance patient groups formed based on psychomotor vigilance task (PVT) performance and compared with traditional OSA severity parameters. The study population comprised 863 patients with suspected OSA who underwent a PVT test before polysomnography. The conventional OSA parameters, for example, the apnea-hypopnea index, oxygen desaturation index, and arousal index were computed. Furthermore, the median desaturation area, fall area, recovery area, and desaturation depth were computed with the pre-event baseline reference and with reference to the 100% oxygen saturation level. Patients were grouped into best- and worst-performing quartiles based on the number of lapses in PVT (Q1: PVT lapses <5 and Q4: PVT lapses >36). The association between parameters and impaired vigilance was evaluated by cumulative distribution functions (CDFs) and binomial logistic regression. Based on the CDFs, patients in Q4 had larger desaturation areas, recovery areas, and deeper desaturations when these were referenced to 100% saturation compared with Q1. The odds ratio (OR) of the median desaturation area (OR = 1.56), recovery area (OR = 1.71), and depth (OR = 1.65) were significantly elevated in Q4 in regression models. However, conventional OSA parameters were not significantly associated with impaired vigilance (ORs: 0.79-1.09). Considering desaturation parameters with a 100% SpO2 reference in the diagnosis of OSA could provide additional information on the severity of OSA and related daytime vigilance impairment.
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Affiliation(s)
- Purbanka Pahari
- Department of Applied Physics University of Eastern Finland Kuopio Finland
- Diagnostic Imaging Centre Kuopio University Hospital Kuopio Finland
| | - Henri Korkalainen
- Department of Applied Physics University of Eastern Finland Kuopio Finland
- Diagnostic Imaging Centre Kuopio University Hospital Kuopio Finland
| | - Tuomas Karhu
- Department of Applied Physics University of Eastern Finland Kuopio Finland
- Diagnostic Imaging Centre Kuopio University Hospital Kuopio Finland
| | - Marika Rissanen
- Department of Applied Physics University of Eastern Finland Kuopio Finland
- Diagnostic Imaging Centre Kuopio University Hospital Kuopio Finland
| | - Erna Sif Arnardottir
- Reykjavik University Sleep Institute, School of Technology Reykjavik University Reykjavik Iceland
- Landspitali The National University Hospital of Iceland Reykjavik Iceland
| | - Harald Hrubos‐Strøm
- Department of Ear, Nose and Throat Surgery Akershus University Hospital Lørenskog Norway
- Department of Behavioural Medicine, Faculty of Medicine, Institute of Basic Medical Sciences University of Oslo Oslo Norway
| | - Brett Duce
- Department of Respiratory & Sleep Medicine, Sleep Disorders Centre Princess Alexandra Hospital Brisbane Queensland Australia
- Institute for Health and Biomedical Innovation Queensland University of Technology Brisbane Queensland Australia
| | - Juha Töyräs
- Department of Applied Physics University of Eastern Finland Kuopio Finland
- School of Information Technology and Electrical Engineering The University of Queensland Brisbane Queensland Australia
- Science Service Centre Kuopio University Hospital Kuopio Finland
| | - Timo Leppänen
- Department of Applied Physics University of Eastern Finland Kuopio Finland
- Diagnostic Imaging Centre Kuopio University Hospital Kuopio Finland
- School of Information Technology and Electrical Engineering The University of Queensland Brisbane Queensland Australia
| | - Sami Nikkonen
- Department of Applied Physics University of Eastern Finland Kuopio Finland
- Diagnostic Imaging Centre Kuopio University Hospital Kuopio Finland
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Sundbom F, Janson C, Ljunggren M, Lindberg E. Asthma and asthma-related comorbidity: effects on nocturnal oxygen saturation. J Clin Sleep Med 2022; 18:2635-2641. [PMID: 35924855 PMCID: PMC9622994 DOI: 10.5664/jcsm.10178] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/27/2022] [Accepted: 06/29/2022] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Nocturnal symptoms are very common in asthma, which is associated with worse sleep quality. The nocturnal oxygen saturation may be decreased in asthma; however, whether this association is dependent on nocturnal asthma symptoms, lung function, coexisting obstructive sleep apnea (OSA), or other asthma-related comorbidities is unknown. The objective of this study was to examine the effects of asthma, OSA, lung function, airway symptoms, and asthma-related comorbidities on the nocturnal oxygen saturation in a cross-sectional community-based population study. METHODS In total, 395 women and 392 men underwent overnight polysomnography, performed spirometry, and completed questionnaires on airway symptoms and asthma-related comorbidities. RESULTS Participants with asthma (n = 88) had a lower nocturnal oxygen saturation than those without asthma (93.8% vs 94.3%, P = .01) also after adjusting for comorbidity, age, body mass index, and smoking status (coefficient -0.38; CI -0.67, -0.10; P < .01). The nocturnal oxygen saturation was lower among participants with wheezing, nocturnal chest tightness, fixed airflow limitation, gastroesophageal reflux, obesity, and OSA than in those without these conditions. The associations between lower oxygen saturation and wheezing, forced expiratory volume in 1 second, gastroesophageal reflux, and apnea-hypopnea index were significant also after adjusting for age, sex, body mass index, and smoking status. Participants with both wheezing and OSA had a significantly lower nocturnal oxygen saturation (92.5 ± 0.5%) than participants with wheezing only (94.3 ± 0.3%) and OSA only (93.6 ± 0.2% %) (P < .01). CONCLUSIONS Participants with asthma displayed a lower mean oxygen saturation during sleep, which could not be explained only by coexisting OSA or obesity. Also, asthma symptoms and lung function were associated with lower nocturnal oxygen saturation. The lower oxygen saturation seen in asthma is hence multifactorial in origin and is a result of the combination of symptoms, lung function, and comorbidity. CITATION Sundbom F, Janson C, Ljunggren M, Lindberg E. Asthma and asthma-related comorbidity: effects on nocturnal oxygen saturation. J Clin Sleep Med. 2022;18(11):2635-2641.
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Affiliation(s)
- Fredrik Sundbom
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Christer Janson
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Mirjam Ljunggren
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Eva Lindberg
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
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30
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Oksenberg A, Leppänen T. Duration of respiratory events in obstructive sleep apnea: In search of paradoxical results. Sleep Med Rev 2022; 68:101728. [PMID: 36521320 DOI: 10.1016/j.smrv.2022.101728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 11/15/2022] [Accepted: 11/23/2022] [Indexed: 12/02/2022]
Abstract
Research related to the duration of respiratory events in obstructive sleep apnea (OSA) has been scarce, perhaps due to the dominant role played by the apnea-hypopnea index (AHI) in the diagnosis and severity estimation of OSA. Lately, however, researchers and clinicians have started to acknowledge the importance of this overlooked parameter. Intuitively, 40-s-long apneas have more harmful physiological and health consequences than 10-s-long apneas. But is this the case? Here, we review the research-based evidence showing physiological, hemodynamic, clinical, sleep quality, and health consequences of long vs. short respiratory events. Most of the reviewed studies support the idea that longer respiratory events have more severe physiological and clinical consequences than shorter events, most probably due to the higher hypoxic burden associated with longer respiratory events. However, a few but highly qualified studies provide clear evidence that short respiratory events have also a deleterious effect on sleep and the physiological and clinical aspects of OSA. The somewhat paradoxical findings that short respiratory events are also associated with a high risk of all-cause mortality is a serious concern. From these results, it is therefore evident that the duration of respiratory events should be quantified when diagnosing and assessing the severity of OSA.
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31
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Hypoxic Burden in Obstructive Sleep Apnea: Present and Future. Arch Bronconeumol 2022:S0300-2896(22)00524-5. [PMID: 36127216 DOI: 10.1016/j.arbres.2022.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/11/2022] [Accepted: 08/12/2022] [Indexed: 11/24/2022]
Abstract
Conventional measures of obstructive sleep apnea (OSA) severity, such as the apnea-hypopnea index (AHI) and oxygen desaturation index (ODI) are commonly used to quantify OSA severity and guide therapeutical decision-making processes. However, it is widely recognized that both AHI and ODI have important limitations and novel physiologically informed metrics are needed to better capture the severity of OSA and characterize its physiological consequences, particularly the severity of recurrent nocturnal hypoxemia, ensuing the respiratory events. According to recent studies, the sleep apnea-specific "Hypoxic Burden (HB)", defined as the sum of individual areas under the oxygen desaturation curve, has shown some promise in identifying high risk individuals with OSA. In addition to the frequency of respiratory events, HB capture the depth and duration of OSA-related hypoxemia that may prove to be important disease characterizing features, not captured by the conventional "frequency-based" metrics, such as AHI and ODI. In this "Perspective" paper the methods to quantify the HB, its characteristics, associations with health outcomes, and its limitations will be discussed.
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32
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Blekic N, Bold I, Mettay T, Bruyneel M. Impact of Desaturation Patterns versus Apnea-Hypopnea Index in the Development of Cardiovascular Comorbidities in Obstructive Sleep Apnea Patients. Nat Sci Sleep 2022; 14:1457-1468. [PMID: 36045914 PMCID: PMC9423119 DOI: 10.2147/nss.s374572] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 08/15/2022] [Indexed: 11/23/2022] Open
Abstract
Various phenotypes of obstructive sleep apnea (OSA) have been recently described and are poorly assessed by the commonly used polysomnographic indices, such as the apnea-hypopnea index and oxygen desaturation index. Nocturnal hypoxemia is the hallmark of OSA and new quantitative markers, as hypoxic burden or desaturation severity, have been shown to be associated with cardiovascular (CV) mortality. The purpose of this overview is to review the endophenotypical and clinical characteristics of OSA, the current metrics, and to analyze different measurements of hypoxemia in OSA to predict the cardiovascular impact (eg hypoxic burden). Potential interest of multidimensional models to classify OSA, such as BAVENO classification, is also discussed, with the goal of focusing on specific endophenotypes that are likely to develop CV comorbidities, in order to guide clinicians to more aggressive management of OSA in these individuals.
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Affiliation(s)
- Nathan Blekic
- Department of Pulmonary Medicine, Saint-Pierre University Hospital, Brussels, Belgium and Université Libre de Bruxelles, Brussels, Belgium
| | - Ionela Bold
- Department of Pulmonary Medicine, Saint-Pierre University Hospital, Brussels, Belgium and Université Libre de Bruxelles, Brussels, Belgium
| | - Thomas Mettay
- Department of Pulmonary Medicine, Brugmann University Hospital, Brussels, Belgium and Université Libre de Bruxelles, Brussels, Belgium
| | - Marie Bruyneel
- Department of Pulmonary Medicine, Saint-Pierre University Hospital, Brussels, Belgium and Université Libre de Bruxelles, Brussels, Belgium
- Department of Pulmonary Medicine, Brugmann University Hospital, Brussels, Belgium and Université Libre de Bruxelles, Brussels, Belgium
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33
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Sutherland K, Sadr N, Bin YS, Cook K, Dissanayake HU, Cistulli PA, de Chazal P. Comparative associations of oximetry patterns in Obstructive Sleep Apnea with incident cardiovascular disease. Sleep 2022; 45:6650848. [PMID: 35896039 PMCID: PMC9742894 DOI: 10.1093/sleep/zsac179] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 06/27/2022] [Indexed: 12/15/2022] Open
Abstract
STUDY OBJECTIVES Intermittent hypoxia is a key mechanism linking Obstructive Sleep Apnea (OSA) to cardiovascular disease (CVD). Oximetry analysis could enhance understanding of which OSA phenotypes are associated with CVD risk. The aim of this study was to compare associations of different oximetry patterns with incident CVD in men and women with OSA. METHODS Sleep Heart Health Study data were used for analysis. n = 2878 Participants (51.8% female; mean age 63.5 ± 10.5 years) with OSA (Apnea Hypopnea Index [AHI] ≥ 5 events/h) and no pre-existing CVD at baseline or within the first 2 years of follow-up were included. Four oximetry analysis approaches were applied: desaturation characteristics, time series analysis, power spectral density, and non-linear analysis. Thirty-one resulting oximetry patterns were compared to incident CVD using proportional hazards regression models adjusted for age, race, smoking, BMI, and sex. RESULTS There were no associations between OSA oximetry patterns and incident CVD in the total sample or in men. In women, there were some associations between incident CVD and time series analysis (e.g. SpO2 distribution standard deviation, HR 0.81, 95% CI 0.68-0.96, p = 0.014) and power spectral density oximetry patterns (e.g. Full frequency band mean HR 0.75; 95% CI 0.59-0.95; p = 0.015). CONCLUSIONS Comprehensive comparison of baseline oximetry patterns in OSA found none were related to development of CVD. There were no standout individual oximetry patterns that appear to be candidates for CVD risk phenotyping in OSA, but some showed marginal relationships with CVD risk in women. Further work is required to understand whether OSA phenotypes can be used to predict susceptibility to cardiovascular disease.
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Affiliation(s)
- Kate Sutherland
- Sleep Research Group, Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia,Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Nadi Sadr
- Sleep Research Group, Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia,Department of Biomedical Informatics, Emory University, Atlanta, Georgia, USA
| | - Yu Sun Bin
- Sleep Research Group, Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia,Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Kristina Cook
- Sleep Research Group, Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia,Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Hasthi U Dissanayake
- Sleep Research Group, Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia,Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Peter A Cistulli
- Sleep Research Group, Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia,Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia,Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Philip de Chazal
- Corresponding author. Philip de Chazal, Sleep Research Group, Level 3, D17 Charles Perkins Centre, University of Sydney Camperdown, New South Wales 2006, Australia.
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34
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S ME, K B, H D, Ludwig K, N K, T H, H G, M M. A Novel Quantitative Arousal-Associated EEG-Metric to Predict Severity of Respiratory Distress in Obstructive Sleep Apnea Patients. Front Physiol 2022; 13:885270. [PMID: 35812317 PMCID: PMC9257225 DOI: 10.3389/fphys.2022.885270] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 05/31/2022] [Indexed: 11/25/2022] Open
Abstract
Respiratory arousals (RA) on polysomnography (PSG) are an important predictor of obstructive sleep apnea (OSA) disease severity. Additionally, recent reports suggest that more global indices of desaturation such as the hypoxic burden, namely the area under the curve (AUC) of the oxygen saturation (SaO2) PSG trace may better depict the desaturation burden in OSA. Here we investigated possible associations between a new metric, namely the AUC of the respiratory arousal electroencephalographic (EEG) recording, and already established parameters as the apnea/hypopnea index (AHI), arousal index and hypoxic burden in patients with OSA. In this data-driven study, polysomnographic data from 102 patients with OSAS were assessed (32 female; 70 male; mean value of age: 52 years; mean value of Body-Mass-Index-BMI: 31 kg/m2). The marked arousals from the pooled EEG signal (C3 and C4) were smoothed and the AUC was estimated. We used a support vector regressor (SVR) analysis to predict AHI, arousal index and hypoxic burden as captured by the PSG. The SVR with the arousal-AUC metric could quite reliably predict the AHI with a high correlation coefficient (0,58 in the training set, 0,65 in the testing set and 0,64 overall), as well as the hypoxic burden (0,62 in the training set, 0,58 in the testing set and 0,59 overall) and the arousal index (0,58 in the training set, 0,67 in the testing set and 0,66 overall). This novel arousal-AUC metric may predict AHI, hypoxic burden and arousal index with a quite high correlation coefficient and therefore could be used as an additional quantitative surrogate marker in the description of obstructive sleep apnea disease severity.
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Affiliation(s)
- Malatantis-Ewert S
- Department of Otorhinolaryngology, Sleep Medicine Center, Medical Center of the University of Mainz, Mainz, Germany
- Movement Disorders and Neurostimulation, Department of Neurology, Biomedical Statistics and Multimodal Signal Processing Unit, Medical Center of the University of Mainz, Mainz, Germany
| | - Bahr K
- Department of Otorhinolaryngology, Sleep Medicine Center, Medical Center of the University of Mainz, Mainz, Germany
| | - Ding H
- Movement Disorders and Neurostimulation, Department of Neurology, Biomedical Statistics and Multimodal Signal Processing Unit, Medical Center of the University of Mainz, Mainz, Germany
| | - Katharina Ludwig
- Department of Otorhinolaryngology, Sleep Medicine Center, Medical Center of the University of Mainz, Mainz, Germany
| | - Koirala N
- Haskins Laboratories, Yale University, New Haven, CT, United States
| | - Huppertz T
- Department of Otorhinolaryngology, Sleep Medicine Center, Medical Center of the University of Mainz, Mainz, Germany
| | - Gouveris H
- Department of Otorhinolaryngology, Sleep Medicine Center, Medical Center of the University of Mainz, Mainz, Germany
| | - Muthuraman M
- Movement Disorders and Neurostimulation, Department of Neurology, Biomedical Statistics and Multimodal Signal Processing Unit, Medical Center of the University of Mainz, Mainz, Germany
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35
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Borsky M, Serwatko M, Arnardottir ES, Mallett J. Towards Sleep Study Automation: Detection Evaluation of Respiratory-Related Events. IEEE J Biomed Health Inform 2022; 26:3418-3426. [PMID: 35294367 DOI: 10.1109/jbhi.2022.3159727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The diagnosis of sleep disordered breathing depends on the detection of several respiratory-related events: apneas, hypopneas, snores, or respiratory event-related arousals from sleep studies. While a number of automatic detection methods have been proposed, reproducibility of these methods has been an issue, in part due to the absence of a generally accepted protocol for evaluating their results. With sleep measurements this is usually treated as a classification problem and the accompanying issue of localization is not treated as similarly critical. To address these problems we present a detection evaluation protocol that is able to qualitatively assess the match between two annotations of respiratory-related events. This protocol relies on measuring the relative temporal overlap between two annotations in order to find an alignment that maximizes their F1-score at the sequence level. This protocol can be used in applications which require a precise estimate of the number of events, total event duration, and a joint estimate of event number and duration. We assess its application using a data set that contains over 10,000 manually annotated snore events from 9 subjects, and show that when using the American Academy of Sleep Medicine Manual standard, two sleep technologists can achieve an F1-score of 0.88 when identifying the presence of snore events. In addition, we drafted rules for marking snore boundaries and showed that one sleep technologist can achieve F1-score of 0.94 at the same tasks. Finally, we compared our protocol against the protocol that is used to evaluate sleep spindle detection and highlighted the differences.
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36
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Sigurdardottir FD, Øverby CT, Nikkonen S, Karhu T, Dammen T, Nordhus IH, Thorshov T, Einvik G, Kainulainen S, Leppänen T, Arnardottir ES, Töyräs J, Omland T, Hrubos-Strøm H. Novel oxygen desaturation parameters are associated with cardiac troponin I: Data from the Akershus Sleep Apnea Project. J Sleep Res 2022; 31:e13581. [PMID: 35289009 DOI: 10.1111/jsr.13581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 02/15/2022] [Accepted: 02/21/2022] [Indexed: 12/27/2022]
Abstract
Novel diagnostic markers for obstructive sleep apnea beyond the apnea-hypopnea index (AHI) have been introduced. There are no studies on their association with markers of subclinical myocardial injury. We assessed the association between novel desaturation parameters and elevated cardiac troponin I and T. Participants with polysomnography (498) from the Akershus Sleep Apnea study were divided into normal and elevated biomarker groups based on sex-specific concentration thresholds (cardiac troponin I: ≥4 ng/L for women, ≥6 ng/L for men; and cardiac troponin T: ≥7 ng/L for women, ≥8 ng/L for men). Severity of obstructive sleep apnea was evaluated with the AHI, oxygen desaturation index, total sleep time with oxygen saturation below 90% (T90), lowest oxygen saturation (Min SpO2 %), and novel oxygen desaturation parameters: desaturation duration and desaturation severity. How the AHI and novel desaturation parameters predicted elevated cardiac troponin I and cardiac troponin T levels was assessed by the area under the curve (AUC). Based on multivariable-adjusted linear regression, the AHI (β = 0.004, p = 0.012), desaturation duration (β = 0.007, p = 0.004), and desaturation severity (β = 0.147, p = 0.002) were associated with cardiac troponin I levels but not cardiac troponin T. T90 was associated with cardiac troponin I (β = 0.006, p = 0.009) and cardiac troponin T (β = 0.005, p = 0.007). The AUC for the AHI 0.592 (standard error 0.043) was not significantly different from the AUC of T90 (SD 0.640, p = 0.08), desaturation duration 0.609 (SD 0.044, p = 0.42) or desaturation severity 0.616 (SD 0.043, p = 0.26) in predicting myocardial injury as assessed by cardiac troponin I. Oxygen desaturation parameters and the AHI were associated with cardiac troponin I levels but not cardiac troponin T levels. Novel oxygen desaturation parameters did not improve the prediction of subclinical myocardial injury compared to the AHI.
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Affiliation(s)
- Fjola D Sigurdardottir
- Department of Cardiology, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Caroline Tonje Øverby
- Department of Ear, Nose and Throat Surgery, Akershus University Hospital, Lørenskog, Norway.,Department of Behavioural Medicine, Faculty of Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Sami Nikkonen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.,Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Tuomas Karhu
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.,Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Toril Dammen
- Department of Behavioural Medicine, Faculty of Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Inger Hilde Nordhus
- Department of Behavioural Medicine, Faculty of Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.,Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Thea Thorshov
- Department of Ear, Nose and Throat Surgery, Akershus University Hospital, Lørenskog, Norway.,Department of Behavioural Medicine, Faculty of Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Gunnar Einvik
- Department of Cardiology, Akershus University Hospital, Lørenskog, Norway
| | - Samu Kainulainen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.,Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Timo Leppänen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.,Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland.,School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Queensland, Australia
| | - Erna Sif Arnardottir
- School of Technology, Reykjavik University Sleep Institute, Reykjavik University, Reykjavik, Iceland.,Landspitali University Hospital, Reykjavik, Iceland
| | - Juha Töyräs
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.,School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Queensland, Australia.,Service Center, Kuopio University Hospital, Kuopio, Finland
| | - Torbjørn Omland
- Department of Cardiology, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Harald Hrubos-Strøm
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Ear, Nose and Throat Surgery, Akershus University Hospital, Lørenskog, Norway
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Smoking Obstructive Sleep Apnea: Arguments for a Distinctive Phenotype and a Personalized Intervention. J Pers Med 2022; 12:jpm12020293. [PMID: 35207781 PMCID: PMC8875333 DOI: 10.3390/jpm12020293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/31/2022] [Accepted: 02/11/2022] [Indexed: 02/01/2023] Open
Abstract
Background: This is the first study that aims to define smoking, with obstructive sleep apnea (OSA), as a phenotype (SOSA). Moreover, we wanted to demonstrate the deleterious effects of the continuation of smoking on OSA. Methods: The cross-sectional study highlighted four dimensions of SOSA: the demographic and anthropometric features, the symptoms, the comorbidities, and the sleep study parameters. This study compared these characteristics between current smokers (CS), those who have never smoked (NS), and ex-smokers (ES) with OSA. Results: More men (83.95% in CS, versus 66.67% in NS) and an earlier onset of OSA (average age = 50.05 in CS, versus 52.26 in NS, p = 0.04) were recorded among CS. The distinguishing symptom of CS was daytime sleepiness, with an Epworth score that was significantly higher than in NS. Chronic obstructive pulmonary disease (COPD) was significantly more prevalent in CS (38.27%) than in NS (1.51%) (p < 0.001). The severity of OSA, consisting of a higher apnea-hypopnea index, a higher oxygen desaturation index, and a longer time spent below 90% oxygen saturation during sleep was significantly influenced by smoking. Conclusions: The SOSA phenotype includes younger male patients with a higher waist circumference, suggesting central obesity. They have a higher prevalence of COPD and a greater severity of OSA, in correlation with the number of pack-years of smoking.
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38
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Negative impact of the hypopnea index or duration increase after a non-frame work surgery in patients with very severe obstructive sleep apnea. Sci Rep 2022; 12:2251. [PMID: 35145170 PMCID: PMC8831531 DOI: 10.1038/s41598-022-06293-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 01/25/2022] [Indexed: 11/26/2022] Open
Abstract
A non-framework surgery could change the postoperative components of breathing disturbances and increase the frequency or duration of hypopnea in patients with very severe obstructive sleep apnea (OSA). Either an increase of hypopnea index, which increases apnea–hypopnea index (AHI), or an increase of its duration raises the concern of worsening the oxygen desaturation and so morbidity and mortality associated with OSA. It is unclear how the oxygen saturation would change in those having increased frequency or duration of hypopneas after the surgery. Here in 17 patients with AHI ≥ 60 events/h, having increased frequency or duration of hypopneas after the non-framework surgery, the results show that the surgery improved oxygen saturation by reducing obstructive-apnea index (36.1 events/h) and duration (8.6 s/event), despite it increased hypopnea index (16.8 events/h) and duration (9.8 s/event). The surgery improved the average of the mean oxyhemoglobin saturation of pulse oximetry (SpO2) by 2.8% (toward a ceiling mean of 94.3%), mean minimal SpO2 by 7.5%, and mean desaturation by 5%. The results suggest sufficient apnea reduction and shift from apnea to hypopnea may mask the negative impact of the increase of hypopnea index or duration and improve postoperative mean SpO2, minimal SpO2, and mean desaturation.
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Chen YL, Chen YC, Wang HT, Chang YT, Fang YN, Hsueh S, Liu WH, Lin PT, Hsu PY, Su MC, Huang KT, Lin MC. The Impact of Intermittent Hypoxemia on Left Atrial Remodeling in Patients with Obstructive Sleep Apnea Syndrome. Life (Basel) 2022; 12:life12020148. [PMID: 35207436 PMCID: PMC8874769 DOI: 10.3390/life12020148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/13/2022] [Accepted: 01/19/2022] [Indexed: 01/01/2023] Open
Abstract
Obstructive sleep apnea syndrome (OSAS) is a significant risk factor for left atrial (LA) remodeling. Intermittent hypoxemia occurs during the sleep cycle in patients with OSAS and plays a crucial role in cardiovascular pathologies such as stroke, arrhythmia, and coronary artery disease. However, there is very little information about the role of intermittent hypoxemia in LA remodeling in patients with OSAS. In total, 154 patients with sleep-related breathing disorders (SRBD) were prospectively recruited for this study. All enrolled SRBD patients underwent polysomnography and echocardiography. Significant OSAS was defined as an oxygen desaturation index (ODI) of ≥10 per hour. Intermittent hypoxia/reoxygenation (IHR) stimulation was used to test the effect of hypoxia on the viability, reactive oxygen species, apoptosis, and inflammation-associated cytokine expression in the HL-1 cell line. To investigate the effect of patients’ exosomes on HIF-1 and inflammation-associated cytokine expression, as well as the relationship between ODI and their expression, exosomes were purified from the plasma of 95 patients with SRBD and incubated in HL-1 cells. The LA size was larger in patients with significant OSAS than in those without. There was a significant association between ODI, lowest SpO2, mean SpO2, and LA size (all p < 0.05) but not between the apnea–hypopnea index and LA size. IHR condition caused increased LDH activity, reactive oxygen species (ROS) levels, and apoptosis in HL-1 cells and decreased cellular viability (all p < 0.05). The expression of HIF-1α, TNF-α, IL-6, and TGF-β increased in the IHR condition compared with the control (all p < 0.05). The expression of HIF-1α, IL-1β, and IL-6 increased in the HL-1 cells incubated with exosomes from those patients with significant OSAS than those without (all p < 0.05). There was a significantly positive correlation between ODI and the expression of HIF-1α, TNF-α, IL-1β, IL-6, and TGF-β; a significantly negative correlation between mean SpO2 and IL-6 and TGF-β; and a significantly negative correlation between the lowest SpO2 and HIF-1α (all p < 0.05). In conclusion, intermittent hypoxemia was strongly associated with LA remodeling, which might be through increased ROS levels, LDH activity, apoptosis, and the expression of HIF-1α and inflammation-associated cytokines.
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Affiliation(s)
- Yung-Lung Chen
- Department of Internal Medicine, Division of Cardiology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan; (Y.-L.C.); (Y.-N.F.); (S.H.); (W.-H.L.); (P.-T.L.)
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (Y.-C.C.); (H.-T.W.); (Y.-T.C.)
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Yung-Che Chen
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (Y.-C.C.); (H.-T.W.); (Y.-T.C.)
- Department of Internal Medicine, Division of Pulmonary & Critical Care Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan; (P.-Y.H.); (M.-C.S.); (K.-T.H.)
| | - Hui-Ting Wang
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (Y.-C.C.); (H.-T.W.); (Y.-T.C.)
- Emergency Department, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
| | - Ya-Ting Chang
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (Y.-C.C.); (H.-T.W.); (Y.-T.C.)
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
| | - Yen-Nan Fang
- Department of Internal Medicine, Division of Cardiology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan; (Y.-L.C.); (Y.-N.F.); (S.H.); (W.-H.L.); (P.-T.L.)
| | - Shukai Hsueh
- Department of Internal Medicine, Division of Cardiology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan; (Y.-L.C.); (Y.-N.F.); (S.H.); (W.-H.L.); (P.-T.L.)
| | - Wen-Hao Liu
- Department of Internal Medicine, Division of Cardiology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan; (Y.-L.C.); (Y.-N.F.); (S.H.); (W.-H.L.); (P.-T.L.)
| | - Pei-Ting Lin
- Department of Internal Medicine, Division of Cardiology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan; (Y.-L.C.); (Y.-N.F.); (S.H.); (W.-H.L.); (P.-T.L.)
| | - Po-Yuan Hsu
- Department of Internal Medicine, Division of Pulmonary & Critical Care Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan; (P.-Y.H.); (M.-C.S.); (K.-T.H.)
| | - Mao-Chang Su
- Department of Internal Medicine, Division of Pulmonary & Critical Care Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan; (P.-Y.H.); (M.-C.S.); (K.-T.H.)
| | - Kuo-Tung Huang
- Department of Internal Medicine, Division of Pulmonary & Critical Care Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan; (P.-Y.H.); (M.-C.S.); (K.-T.H.)
| | - Meng-Chih Lin
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (Y.-C.C.); (H.-T.W.); (Y.-T.C.)
- Department of Internal Medicine, Division of Pulmonary & Critical Care Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan; (P.-Y.H.); (M.-C.S.); (K.-T.H.)
- Correspondence: ; Tel.: +886-7-731-7123 (ext. 8300)
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Álvarez D, Gutiérrez-Tobal GC, Vaquerizo-Villar F, Moreno F, Del Campo F, Hornero R. Oximetry Indices in the Management of Sleep Apnea: From Overnight Minimum Saturation to the Novel Hypoxemia Measures. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1384:219-239. [PMID: 36217087 DOI: 10.1007/978-3-031-06413-5_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Obstructive sleep apnea (OSA) is a multidimensional disease often underdiagnosed due to the complexity and unavailability of its standard diagnostic method: the polysomnography. Among the alternative abbreviated tests searching for a compromise between simplicity and accurateness, oximetry is probably the most popular. The blood oxygen saturation (SpO2) signal is characterized by a near-constant profile in healthy subjects breathing normally, while marked drops (desaturations) are linked to respiratory events. Parameterization of the desaturations has led to a great number of indices of severity assessment commonly used to assist in OSA diagnosis. In this chapter, the main methodologies used to characterize the overnight oximetry profile are reviewed, from visual inspection and simple statistics to complex measures involving signal processing and pattern recognition techniques. We focus on the individual performance of each approach, but also on the complementarity among the great amount of indices existing in the state of the art, looking for the most relevant oximetric feature subset. Finally, a quick overview of SpO2-based deep learning applications for OSA management is carried out, where the raw oximetry signal is analyzed without previous parameterization. Our research allows us to conclude that all the methodologies (conventional, time, frequency, nonlinear, and hypoxemia-based) demonstrate high ability to provide relevant oximetric indices, but only a reduced set provide non-redundant complementary information leading to a significant performance increase. Finally, although oximetry is a robust tool, greater standardization and prospective validation of the measures derived from complex signal processing techniques are still needed to homogenize interpretation and increase generalizability.
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Affiliation(s)
- Daniel Álvarez
- Biomedical Engineering Group (GIB), University of Valladolid, Valladolid, Spain.
- Pneumology Department, Río Hortega University Hospital, Valladolid, Spain.
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina, Instituto de Salud Carlos III, Valladolid, Spain.
| | - Gonzalo C Gutiérrez-Tobal
- Biomedical Engineering Group (GIB), University of Valladolid, Valladolid, Spain
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina, Instituto de Salud Carlos III, Valladolid, Spain
| | - Fernando Vaquerizo-Villar
- Biomedical Engineering Group (GIB), University of Valladolid, Valladolid, Spain
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina, Instituto de Salud Carlos III, Valladolid, Spain
| | - Fernando Moreno
- Pneumology Department, Río Hortega University Hospital, Valladolid, Spain
| | - Félix Del Campo
- Biomedical Engineering Group (GIB), University of Valladolid, Valladolid, Spain
- Pneumology Department, Río Hortega University Hospital, Valladolid, Spain
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina, Instituto de Salud Carlos III, Valladolid, Spain
| | - Roberto Hornero
- Biomedical Engineering Group (GIB), University of Valladolid, Valladolid, Spain
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina, Instituto de Salud Carlos III, Valladolid, Spain
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Liu R, Li C, Xu H, Wu K, Li X, Liu Y, Yuan J, Meng L, Zou J, Huang W, Yi H, Sheng B, Guan J, Yin S. Fusion of Whole Night Features and Desaturation Segments Combined with Feature Extraction for Event-Level Screening of Sleep-Disordered Breathing. Nat Sci Sleep 2022; 14:927-940. [PMID: 35607445 PMCID: PMC9123935 DOI: 10.2147/nss.s355369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 05/03/2022] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Misdiagnosis and missed diagnosis of sleep-disordered breathing (SDB) is common because polysomnography (PSG) is time-consuming, expensive, and uncomfortable. The use of recording methods based on the oxygen saturation (SpO2) signals detected by wearable devices is impractical and inaccurate for extracting signal features and detecting apnoeic events. We propose a method to automatically detect the apnoea-based SpO2 signal segments and compute the apnoea-hypopnea index (AHI) for SDB screening and grading. PATIENTS AND METHODS First, apnoea-related desaturation segments in raw SpO2 signals were detected; global features were extracted from whole night signals. Then, the SpO2 signal segments and global features were fed into a bi-directional long short-term memory convolutional neural network model to identify apnoea-related and non-apnoea-related events. The apnoea-related segments were used to assess the AHI. RESULTS The model was trained on 500 individuals and tested on 8131 individuals from two public hospitals and one private centre. In the testing data, the classification accuracy for apnoea-related segments was 84.3%. Individuals with SDB (AHI 15) were identified with a mean accuracy of 88.95%. CONCLUSION Using automatic SDB detection based on SpO2 signals can accurately screen for SDB.
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Affiliation(s)
- Ruhan Liu
- Department of Otolaryngology Head and Neck Surgery and Shanghai Key Laboratory of Sleep Disordered Breathing & Otolaryngological Institute of Shanghai Jiao Tong University, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China.,Department of Computer Science and Engineering, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Chenyang Li
- Department of Otolaryngology Head and Neck Surgery and Shanghai Key Laboratory of Sleep Disordered Breathing & Otolaryngological Institute of Shanghai Jiao Tong University, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Huajun Xu
- Department of Otolaryngology Head and Neck Surgery and Shanghai Key Laboratory of Sleep Disordered Breathing & Otolaryngological Institute of Shanghai Jiao Tong University, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Kejia Wu
- Department of Otolaryngology Head and Neck Surgery and Shanghai Key Laboratory of Sleep Disordered Breathing & Otolaryngological Institute of Shanghai Jiao Tong University, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Xinyi Li
- Department of Otolaryngology Head and Neck Surgery and Shanghai Key Laboratory of Sleep Disordered Breathing & Otolaryngological Institute of Shanghai Jiao Tong University, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Yupu Liu
- Department of Otolaryngology Head and Neck Surgery and Shanghai Key Laboratory of Sleep Disordered Breathing & Otolaryngological Institute of Shanghai Jiao Tong University, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Jie Yuan
- Department of Otolaryngology Head and Neck Surgery and Shanghai Key Laboratory of Sleep Disordered Breathing & Otolaryngological Institute of Shanghai Jiao Tong University, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Lili Meng
- Department of Otolaryngology Head and Neck Surgery and Shanghai Key Laboratory of Sleep Disordered Breathing & Otolaryngological Institute of Shanghai Jiao Tong University, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Jianyin Zou
- Department of Otolaryngology Head and Neck Surgery and Shanghai Key Laboratory of Sleep Disordered Breathing & Otolaryngological Institute of Shanghai Jiao Tong University, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Weijun Huang
- Department of Otolaryngology Head and Neck Surgery and Shanghai Key Laboratory of Sleep Disordered Breathing & Otolaryngological Institute of Shanghai Jiao Tong University, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Hongliang Yi
- Department of Otolaryngology Head and Neck Surgery and Shanghai Key Laboratory of Sleep Disordered Breathing & Otolaryngological Institute of Shanghai Jiao Tong University, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Bin Sheng
- Department of Computer Science and Engineering, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Jian Guan
- Department of Otolaryngology Head and Neck Surgery and Shanghai Key Laboratory of Sleep Disordered Breathing & Otolaryngological Institute of Shanghai Jiao Tong University, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Shankai Yin
- Department of Otolaryngology Head and Neck Surgery and Shanghai Key Laboratory of Sleep Disordered Breathing & Otolaryngological Institute of Shanghai Jiao Tong University, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
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Wang L, Wei DH, Zhang J, Cao J. Time Under 90% Oxygen Saturation and Systemic Hypertension in Patients with Obstructive Sleep Apnea Syndrome. Nat Sci Sleep 2022; 14:2123-2132. [PMID: 36474481 PMCID: PMC9719713 DOI: 10.2147/nss.s388238] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/19/2022] [Indexed: 12/03/2022] Open
Abstract
PURPOSE The diagnosis and severity of obstructive sleep apnea (OSA) are commonly based on the apnea hypopnea index (AHI). However, patients with similar severity AHIs may show widely varying comorbidities and risks for cardiovascular disease, which may be associated with different severities of nocturnal hypoxia. The percentage of cumulative time with oxygen saturation below 90% in total sleep time (T90) is receiving increasing attention in OSA research because it describes the duration and degree of hypoxia during the whole sleep. This study aimed to explore the distribution of T90 in OSA patients with similar severity and to evaluate the relationship between T90 and hypertension. PATIENTS AND METHODS A total of 775 patients with OSA were enrolled in this study, all participants were divided into groups according to the T90 value: light hypoxia (T90≤5%), mild hypoxia (T90 accounted for 5-10%), moderate hypoxia (T90 accounted for 10-25%), and severe hypoxia (T90>25%). Multivariate logistic regression analysis was performed to assess the association between T90 and hypertension. RESULTS Of the patients with mild OSA, 94.33% had light hypoxia, and 88.64% of moderate OSA patients had light hypoxia. The proportions of light, mild, moderate, and severe hypoxia among patients with severe OSA were 28.60%, 17.69%, 21.40%, and 32.31%, respectively. After adjustment for potential confounders, the risk of hypertension in patients with severe OSA increased according to the severity categories of T90. The odds ratio for T90 accounting for 10-25% relative to T90≤5% was 2.544 (95%confidence interval, 1.254-5.164; P=0.010) and as high as 2.692 (95%confidence interval, 1.403-5.166; P=0.003) in patients with T90>25%. CONCLUSION OSA patients with similar degree of AHI may have different T90 values, especially in severe OSA. A higher T90 was independently associated with the risk of hypertension after adjustment for traditional risk factors in patients with severe OSA. Our findings highlight the potential role for T90 in predicting hypertension in patients severe OSA.
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Affiliation(s)
- Le Wang
- Department of Respiratory and Critical Care, Tianjin Medical University General Hospital, Tianjin, People's Republic of China
| | - Dong-Hui Wei
- Department of Respiratory and Critical Care, Tianjin Medical University General Hospital, Tianjin, People's Republic of China
| | - Jing Zhang
- Department of Respiratory and Critical Care, Tianjin Medical University General Hospital, Tianjin, People's Republic of China
| | - Jie Cao
- Department of Respiratory and Critical Care, Tianjin Medical University General Hospital, Tianjin, People's Republic of China
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Berggren K, Broström A, Firestone A, Wright B, Josefsson E, Lindmark U. Oral health problems linked to obstructive sleep apnea are not always recognized within dental care-As described by dental professionals. Clin Exp Dent Res 2021; 8:84-95. [PMID: 34791818 PMCID: PMC8874038 DOI: 10.1002/cre2.517] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 10/18/2021] [Accepted: 10/27/2021] [Indexed: 11/27/2022] Open
Abstract
Objectives Obstructive sleep apnea (OSA) has an impact on an individual's quality of life and general health, and can also affect their oral health. The patient's experiences, together with intraoral signs and symptoms could indicate the presence of OSA. Knowledge that the patient has, or is at high risk for having OSA can help the dental healthcare provider maintain the oral health and general health for these patients. The purpose was to explore dentists and dental hygienists' experiences when encountering adult patients with potential, untreated and treated OSA. Methods A qualitative inductive approach was used. Experienced dentists and dental hygienists working within Swedish Public Dental Service were strategically selected. Semi‐structured face‐to‐face interviews were performed followed by qualitative content analysis. Results Interviews from 13 participants, seven dental hygienist and six dentists, led to three areas describing varied experience: Importance of the patient encounter and identifying intraoral signs both of which describe experiences related to the importance of the initial unstructured conversation and focused clinical assessments, and strategies for nurturing care which point to interest about care, treatment, and collaborations with medical health care providers. Conclusions Dental professionals are not able to consistently recognize patients who have, or are at high risk for OSA. During the patient encounter, is it important to determine if a patient is at risk for, or has oral signs of OSA.
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Affiliation(s)
- Kristina Berggren
- Center of Oral Health, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Anders Broström
- Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden.,Department of Clinical Neurophysiology, Linköping University Hospital, Linköping, Sweden
| | - Allen Firestone
- Division of Orthodontics, Ohio State University, Columbus, Ohio, USA
| | - Bridget Wright
- Division of Dental Hygiene, Ohio State University, Columbus, Ohio, USA
| | - Eva Josefsson
- Odontologiska Institutionen, Department of Orthodontics, Jönköping, Sweden
| | - Ulrika Lindmark
- Center of Oral Health, School of Health and Welfare, Jönköping University, Jönköping, Sweden.,Division of Dental Hygiene, Ohio State University, Columbus, Ohio, USA.,Department of Health Sciences, Karlstad University, Karlstad, Sweden
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Karhu T, Myllymaa S, Nikkonen S, Mazzotti DR, Töyräs J, Leppänen T. Longer and Deeper Desaturations Are Associated With the Worsening of Mild Sleep Apnea: The Sleep Heart Health Study. Front Neurosci 2021; 15:657126. [PMID: 33994931 PMCID: PMC8113677 DOI: 10.3389/fnins.2021.657126] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 03/17/2021] [Indexed: 11/13/2022] Open
Abstract
Study Objectives Obesity, older age, and male sex are recognized risk factors for sleep apnea. However, it is unclear whether the severity of hypoxic burden, an essential feature of sleep apnea, is associated with the risk of sleep apnea worsening. Thus, we investigated our hypothesis that the worsening of sleep apnea is expedited in individuals with more severe desaturations. Methods The blood oxygen saturation (SpO2) signals of 805 Sleep Heart Health Study participants with mild sleep apnea [5 ≤ oxygen desaturation index (ODI) < 15] were analyzed at baseline and after a mean follow-up time of 5.2 years. Linear regression analysis, adjusted for relevant covariates, was utilized to study the association between baseline SpO2-derived parameters and change in sleep apnea severity, determined by a change in ODI. SpO2-derived parameters, consisting of ODI, desaturation severity (DesSev), desaturation duration (DesDur), average desaturation area (avg. DesArea), and average desaturation duration (avg. DesDur), were standardized to enable comparisons between the parameters. Results In the group consisting of both men and women, avg. DesDur (β = 1.594, p = 0.001), avg. DesArea (β = 1.316, p = 0.004), DesDur (β = 0.998, p = 0.028), and DesSev (β = 0.928, p = 0.040) were significantly associated with sleep apnea worsening, whereas ODI was not (β = -0.029, p = 0.950). In sex-stratified analysis, avg. DesDur (β = 1.987, p = 0.003), avg. DesArea (β = 1.502, p = 0.024), and DesDur (β = 1.374, p = 0.033) were significantly associated with sleep apnea worsening in men. Conclusion Longer and deeper desaturations are more likely to expose a patient to the worsening of sleep apnea. This information could be useful in the planning of follow-up monitoring or lifestyle counseling in the early stage of the disease.
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Affiliation(s)
- Tuomas Karhu
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.,Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Sami Myllymaa
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.,Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Sami Nikkonen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.,Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Diego R Mazzotti
- Division of Medical Informatics, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Juha Töyräs
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.,Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland.,School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, OLD, Australia
| | - Timo Leppänen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.,Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
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A novel parameter is better than the AHI to assess nocturnal hypoxaemia and excessive daytime sleepiness in obstructive sleep apnoea. Sci Rep 2021; 11:4702. [PMID: 33633338 PMCID: PMC7907378 DOI: 10.1038/s41598-021-84239-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 02/12/2021] [Indexed: 01/15/2023] Open
Abstract
To evaluate whether the percentage of total sleep time spent with apnoea and hypopnoea duration time (AHT%) is better than the apnoea-hypopnoea index (AHI) for the assessment of nocturnal hypoxaemia and excessive daytime sleepiness (EDS) in patients with obstructive sleep apnoea (OSA). Patients with suspected OSA were enrolled. Polysomnography, Epworth Sleepiness Scale, self-administered surveys and anthropometric measures were performed. The efficiency of AHT% and the AHI was evaluated for nocturnal hypoxaemia and EDS. A total of 160 eligible participants were analysed. The median AHT% in normal, mild, moderate and severe OSA patients was significantly different in the four-group patients with OSA. Spearman rank correlations analysis found that the associations were stronger between AHT% with percentage of total sleep time and O2 saturation of < 90% and minimum nocturnal oxygen saturation than these parameters with the AHI. AHT% had a greater area under the curve than the AHI for predicting EDS in patients with OSA. AHT% was significantly higher in the EDS group. We present a novel parameter, AHT%, to evaluate nocturnal hypoxaemia and EDS in OSA patients. AHT% partially compensates for the shortcomings of the AHI. AHT% is better than the AHI for assessing nocturnal hypoxaemia and EDS. AHT% reflects different clinical characteristics associated with OSA from a new perspective.
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Ma EY, Kim JW, Lee Y, Cho SW, Kim H, Kim JK. Combined unsupervised-supervised machine learning for phenotyping complex diseases with its application to obstructive sleep apnea. Sci Rep 2021; 11:4457. [PMID: 33627761 PMCID: PMC7904925 DOI: 10.1038/s41598-021-84003-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 02/10/2021] [Indexed: 12/24/2022] Open
Abstract
Unsupervised clustering models have been widely used for multimetric phenotyping of complex and heterogeneous diseases such as diabetes and obstructive sleep apnea (OSA) to more precisely characterize the disease beyond simplistic conventional diagnosis standards. However, the number of clusters and key phenotypic features have been subjectively selected, reducing the reliability of the phenotyping results. Here, to minimize such subjective decisions for highly confident phenotyping, we develop a multimetric phenotyping framework by combining supervised and unsupervised machine learning. This clusters 2277 OSA patients to six phenotypes based on their multidimensional polysomnography (PSG) data. Importantly, these new phenotypes show statistically different comorbidity development for OSA-related cardio-neuro-metabolic diseases, unlike the conventional single-metric apnea-hypopnea index-based phenotypes. Furthermore, the key features of highly comorbid phenotypes were identified through supervised learning rather than subjective choice. These results can also be used to automatically phenotype new patients and predict their comorbidity risks solely based on their PSG data. The phenotyping framework based on the combination of unsupervised and supervised machine learning methods can also be applied to other complex, heterogeneous diseases for phenotyping patients and identifying important features for high-risk phenotypes.
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Affiliation(s)
- Eun-Yeol Ma
- Department of Industrial and Systems Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Jeong-Whun Kim
- Department of Otorhinolaryngology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Youngmin Lee
- Department of Industrial and Systems Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Sung-Woo Cho
- Department of Otorhinolaryngology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Heeyoung Kim
- Department of Industrial and Systems Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea.
| | - Jae Kyoung Kim
- Department of Mathematical Sciences, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea.
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Sasai-Sakuma T, Kayaba M, Inoue Y, Nakayama H. Prevalence, clinical symptoms and polysomnographic findings of REM-related sleep disordered breathing in Japanese population. Sleep Med 2021; 80:52-56. [PMID: 33556778 DOI: 10.1016/j.sleep.2021.01.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/09/2020] [Accepted: 01/04/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Rapid eye movement sleep -predominant sleep-disordered breathing (REM-SDB) is a condition in which sleep apneas or hypopneas predominantly occur during REM sleep. This study aimed to investigate the prevalence, clinical findings including daytime sleepiness or comorbid cardio-metabolic diseases, and detailed polysomnographic features of REM-SDB in Japanese population. METHODS Total of 1458 patients diagnosed as SDB were selected for this study. Prevalence of REM-SDB was estimated in the groups of mild, moderate and severe SDB. Polysomnographic findings, daytime sleepiness self-measured with Epworth Sleepiness Scale (ESS) and history of comorbid cardio-metabolic diseases were obtained and compared between the groups with REM-SDB and non-stage specific SDB. RESULTS Prevalence of REM-SDB according to the criteria #2 was 22.1% in total SDB subjects, 46,1% in mild SDB and 18.9% in moderate SDB. None was found in severe SDB. Patients with REM-SDB showed milder SDB, higher BMI and higher female predominance than those with non-stage specific SDB. They also showed lower arousal index, respiratory arousal index per total AHI, percentage of N1 sleep, total AHI, ODI, and higher sleep efficiency. Meanwhile, maximum event durations of obstructive apnea and hypopnea were significantly longer, and the nadir SpO2 was lower in REM-SDB. The ESS score and percentages of comorbid cardio-metabolic diseases were roughly equivalent between REM-SDB and non-stage specific SDB. CONCLUSION REM-SDB was associated with high obesity, female gender, and mild severity of SDB. They showed daytime sleepiness and comorbid cardio-metabolic diseases quite equally to patients with non-stage specific SDB in spite of their lower AHI and better sleep quality.
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Affiliation(s)
- Taeko Sasai-Sakuma
- Teikyo University, Faculty of Medical Technique, Department of Clinical Laboratory Science, Japan; Tokyo Medical University, Department of Somnology, Japan; Japan Somnology Center, Neuropsychiatric Research Institute, Japan.
| | - Momoko Kayaba
- Tokyo Medical University, Department of Somnology, Japan; Japan Somnology Center, Neuropsychiatric Research Institute, Japan
| | - Yuichi Inoue
- Tokyo Medical University, Department of Somnology, Japan; Japan Somnology Center, Neuropsychiatric Research Institute, Japan
| | - Hideaki Nakayama
- Tokyo Medical University, Department of Somnology, Japan; Japan Somnology Center, Neuropsychiatric Research Institute, Japan
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Digital oximetry biomarkers for assessing respiratory function: standards of measurement, physiological interpretation, and clinical use. NPJ Digit Med 2021; 4:1. [PMID: 33398041 PMCID: PMC7782845 DOI: 10.1038/s41746-020-00373-5] [Citation(s) in RCA: 108] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 11/25/2020] [Indexed: 01/29/2023] Open
Abstract
Pulse oximetry is routinely used to non-invasively monitor oxygen saturation levels. A low oxygen level in the blood means low oxygen in the tissues, which can ultimately lead to organ failure. Yet, contrary to heart rate variability measures, a field which has seen the development of stable standards and advanced toolboxes and software, no such standards and open tools exist for continuous oxygen saturation time series variability analysis. The primary objective of this research was to identify, implement and validate key digital oximetry biomarkers (OBMs) for the purpose of creating a standard and associated reference toolbox for continuous oximetry time series analysis. We review the sleep medicine literature to identify clinically relevant OBMs. We implement these biomarkers and demonstrate their clinical value within the context of obstructive sleep apnea (OSA) diagnosis on a total of n = 3806 individual polysomnography recordings totaling 26,686 h of continuous data. A total of 44 digital oximetry biomarkers were implemented. Reference ranges for each biomarker are provided for individuals with mild, moderate, and severe OSA and for non-OSA recordings. Linear regression analysis between biomarkers and the apnea hypopnea index (AHI) showed a high correlation, which reached [Formula: see text]. The resulting python OBM toolbox, denoted "pobm", was contributed to the open software PhysioZoo ( physiozoo.org ). Studying the variability of the continuous oxygen saturation time series using pbom may provide information on the underlying physiological control systems and enhance our understanding of the manifestations and etiology of diseases, with emphasis on respiratory diseases.
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Veugen CCAFM, Teunissen EM, den Otter LAS, Kos MP, Stokroos RJ, Copper MP. Prediction of obstructive sleep apnea: comparative performance of three screening instruments on the apnea-hypopnea index and the oxygen desaturation index. Sleep Breath 2020; 25:1267-1275. [PMID: 33098537 PMCID: PMC8376723 DOI: 10.1007/s11325-020-02219-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 10/03/2020] [Accepted: 10/08/2020] [Indexed: 02/06/2023]
Abstract
Purpose To evaluate the performance of the NoSAS (neck, obesity, snoring, age, sex) score, the STOP-Bang (snoring, tiredness, observed apneas, blood pressure, body mass index, age, neck circumference, gender) questionnaire, and the Epworth sleepiness score (ESS) as a screening tool for obstructive sleep apnea (OSA) severity based on the apnea-hypopnea index (AHI) and the oxygen desaturation index (ODI). Methods Data from 235 patients who were monitored by ambulant polysomnography (PSG) were retrospectively analyzed. OSA severity was classified based on the AHI; similar classification categories were made based on the ODI. Discrimination was assessed by the area under the curve (AUC), while predictive parameters were calculated by four-grid contingency tables. Results The NoSAS score and the STOP-Bang questionnaire were both equally adequate screening tools for the AHI and the ODI with AUC ranging from 0.695 to 0.767 and 0.684 to 0.767, respectively. Both questionnaires perform better when used as a continuous variable. The ESS did not show adequate discrimination for screening for OSA (AUC ranging from 0.450 to 0.525). Male gender, age, and BMI proved to be the strongest individual predictors in this cohort. Conclusion This is the first study to evaluate the predictive performance of three different screening instruments with respect to both the AHI and the ODI. This is important, due to increasing evidence that the ODI may have a higher reproducibility in the clinical setting. The NoSAS score and the STOP-Bang questionnaire proved to be equally adequate to predict OSA severity based on both the AHI and the ODI. Electronic supplementary material The online version of this article (10.1007/s11325-020-02219-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Christianne C A F M Veugen
- Department of Otorhinolaryngology Head and Neck surgery, Sint Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands.
- Department of Otorhinolaryngology Head and Neck surgery, Universitair Medisch Centrum Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - Emma M Teunissen
- Department of Otorhinolaryngology Head and Neck surgery, Radboud Universitair Medisch Centrum, Geert Groteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Leontine A S den Otter
- Faculty of Medicine, Universitair Medisch Centrum Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Martijn P Kos
- Ruysdael Sleepclinic, Ruysdaelstraat 49 A1-D, 1071 XA, Amsterdam, The Netherlands
| | - Robert J Stokroos
- Department of Otorhinolaryngology Head and Neck surgery, Universitair Medisch Centrum Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Marcel P Copper
- Department of Otorhinolaryngology Head and Neck surgery, Sint Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands
- Ruysdael Sleepclinic, Ruysdaelstraat 49 A1-D, 1071 XA, Amsterdam, The Netherlands
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Kainulainen S, Töyräs J, Oksenberg A, Korkalainen H, Sefa S, Kulkas A, Leppänen T. Severity of Desaturations Reflects OSA-Related Daytime Sleepiness Better Than AHI. J Clin Sleep Med 2020; 15:1135-1142. [PMID: 31482835 DOI: 10.5664/jcsm.7806] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The aim was to investigate how the severity of apneas, hypopneas, and related desaturations is associated with obstructive sleep apnea (OSA)-related daytime sleepiness. METHODS Multiple Sleep Latency Tests and polysomnographic recordings of 362 patients with OSA were retrospectively analyzed and novel diagnostic parameters (eg, obstruction severity and desaturation severity), incorporating severity of apneas, hypopneas, and desaturations, were computed. Conventional statistical analysis and multivariate analyses were utilized to investigate connection of apnea-hypopnea index (AHI), oxygen desaturation index (ODI), conventional hypoxemia parameters, and novel diagnostic parameters with mean daytime sleep latency (MSL). RESULTS In the whole population, 10% increase in values of desaturation severity (risk ratio = 2.01, P < .001), obstruction severity (risk ratio = 2.18, P < .001) and time below 90% saturation (t90%) (risk ratio = 2.05, P < .001) induced significantly higher risk of having mean daytime sleep latency ≤ 5 minutes compared to 10% increase in AHI (risk ratio = 1.63, P < .05). In severe OSA, desaturation severity had significantly (P < .02) stronger negative correlation (ρ = -.489, P < .001) with mean daytime sleep latency compared to AHI (ρ = -.402, P < 0.001) and ODI (ρ = -.393, P < .001). Based on general regression model, desaturation severity and male sex were the most significant factors predicting daytime sleep latency. CONCLUSIONS Severity of sleep-related breathing cessations and desaturations is a stronger contributor to daytime sleepiness than AHI or ODI and therefore should be included in the diagnostics and severity assessment of OSA. CITATION Kainulainen S, Töyräs J, Oksenberg A, Korkalainen H, Sefa S, Kulkas A, Leppänen T. Severity of desaturations reflects OSA-related daytime sleepiness better than AHI. J Clin Sleep Med. 2019;15(8):1135-1142.
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Affiliation(s)
- Samu Kainulainen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland; Department of Clinical Neurophysiology, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland; Department of Clinical Neurophysiology, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Juha Töyräs
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland; Department of Clinical Neurophysiology, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland; School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
| | - Arie Oksenberg
- Sleep Disorders Unit, Loewenstein Hospital - Rehabilitation Center, Raanana, Israel
| | - Henri Korkalainen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland; Department of Clinical Neurophysiology, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Sandra Sefa
- Department of Clinical Neurophysiology, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Antti Kulkas
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland; Department of Clinical Neurophysiology, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Timo Leppänen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland; Department of Clinical Neurophysiology, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
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