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Yalim SD, Bayram N, Ozdemir I, Cingi C, Muluk NB. The differences between the subtypes of obstructive sleep apnea among different provinces in Turkey: a multicenter study. Eur Arch Otorhinolaryngol 2025; 282:2687-2696. [PMID: 39979625 PMCID: PMC12055919 DOI: 10.1007/s00405-025-09271-6] [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: 12/02/2024] [Accepted: 02/03/2025] [Indexed: 02/22/2025]
Abstract
PURPOSE Our aim in this study is to investigate the significance and implications of different clinical subtypes of patients with obstructive sleep apnea syndrome (OSAS) in three different sleep centers from varied provinces. METHODS Between January 2023 and November 2024, 330 patients from three sleep centers (Adana, Gaziantep, and Istanbul) were retrospectively examined for age, gender, body mass index (BMI), polysomnography parameters, sleep stages, arousals, oxygen parameters, heart rates, apnea-hypopnea indexes (AHI) and snoring. RESULTS OSAS patients of Gaziantep were fat and severe OSAS patients who slept lightly but efficiently at lower oxygen levels with longer durations. They fell into Rapid Eye Movement (REM) sleep quickly. The number of hypopneas is high. OSAS patients of Adana sleep deeply, frequently wake after sleep onset, and snore less. The number of obstructive apnea is high. OSAS patients of Istanbul sleep efficiently but snore a lot. REM oxygen saturation, oxygen desaturation index (ODI) levels, and the average heart rate were high in Istanbul. The number of central and mixed apneas is high. CONCLUSIONS Sleep patterns and oxygen measurements varied among clinical subtypes of patients with OSAS, as well as among provinces. Understanding regional or subtype-specific OSAS could alter practice because treatment can be planned according to the severity of OSAS.
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Affiliation(s)
- Sidika Deniz Yalim
- Department of Otorhinolaryngology, University of Health Sciences, Adana City Training and Research Hospital, Adana, Turkey.
| | - Nazan Bayram
- Department of Pulmonary Diseases, Gaziantep University, Gaziantep, Turkey
| | - Imran Ozdemir
- Department of Pulmonary Diseases, Uskudar University, Istanbul, Turkey
| | - Cemal Cingi
- Department of Otorhinolaryngology, Eskisehir University, Eskisehir, Turkey
| | - Nuray Bayar Muluk
- Department of Otorhinolaryngology, Kirikkale University, Kirikkale, Turkey
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Alaqeel AM, Aldammas MA, Alaraik EF, Abanumay FM, Aleissi SA, Nashwan SZ, Olaish AH, Dhafar HO, BaHammam AS. The prevalence and predictors of obstructive sleep apnea in patients undergoing bariatric surgery in Saudi Arabia. Saudi Med J 2025; 46:274-281. [PMID: 40096986 PMCID: PMC11918664 DOI: 10.15537/smj.2025.46.3.20240851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2024] [Accepted: 02/18/2025] [Indexed: 03/19/2025] Open
Abstract
OBJECTIVES To address a gap in the literature on the prevalence and predictors of obstructive sleep apnea (OSA) among patients undergoing bariatric surgery in Saudi Arabia, considering the region's unique cultural and dietary practices. METHODS This retrospective study at King Saud University Medical City, Riyadh, analyzed data from morbidly obese patients referred from the bariatric surgery unit to the sleep disorders clinic. Using the Sleep Disorders Center database (September 2015 to March 2019), it examined demographic and clinical variables, with in-laboratory polysomnography (PSG) employed to diagnose and assess OSA severity. RESULTS The study assessed 265 morbidly obese patients for OSA using PSG before bariatric surgery. Of these, 153 (57.7%) were diagnosed with OSA, with the mean apnea hypopnea index for patients with OSA being 67.8±19.6 events/hr. In terms of predictors, our study identified age, body mass index, neck circumference, male gender, smoking, snoring, ankle swelling, hypertension, and diabetes mellitus as significant factors associated with OSA. Additionally, our study found that waist measurements, hemoglobin level, and hematocrit were significant predictors. CONCLUSION This study underscores the high prevalence of OSA in bariatric surgery patients in Saudi Arabia and delineates several demographic and clinical factors associated with the condition. These findings highlight the importance of screening for OSA in this population to optimize patient outcomes and minimize postoperative complications.
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Affiliation(s)
- Alaa M. Alaqeel
- From the Department of Home Health Care (Alaqeel), King Fahad Medical City, Second Health Cluster, from the Department of Family and Community Medicine (Alaraik); from the Department of Medicine (Aldammas, Aleissi, Nashwan, Olaish, Dhafar, BaHammam), The University Sleep Disorders Center, College of Medicine, King Saud University, and from the Department of Critical Care (Abanumay), Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia.
| | - Mohammed A. Aldammas
- From the Department of Home Health Care (Alaqeel), King Fahad Medical City, Second Health Cluster, from the Department of Family and Community Medicine (Alaraik); from the Department of Medicine (Aldammas, Aleissi, Nashwan, Olaish, Dhafar, BaHammam), The University Sleep Disorders Center, College of Medicine, King Saud University, and from the Department of Critical Care (Abanumay), Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia.
| | - Enas F. Alaraik
- From the Department of Home Health Care (Alaqeel), King Fahad Medical City, Second Health Cluster, from the Department of Family and Community Medicine (Alaraik); from the Department of Medicine (Aldammas, Aleissi, Nashwan, Olaish, Dhafar, BaHammam), The University Sleep Disorders Center, College of Medicine, King Saud University, and from the Department of Critical Care (Abanumay), Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia.
| | - Faisal M. Abanumay
- From the Department of Home Health Care (Alaqeel), King Fahad Medical City, Second Health Cluster, from the Department of Family and Community Medicine (Alaraik); from the Department of Medicine (Aldammas, Aleissi, Nashwan, Olaish, Dhafar, BaHammam), The University Sleep Disorders Center, College of Medicine, King Saud University, and from the Department of Critical Care (Abanumay), Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia.
| | - Salih A. Aleissi
- From the Department of Home Health Care (Alaqeel), King Fahad Medical City, Second Health Cluster, from the Department of Family and Community Medicine (Alaraik); from the Department of Medicine (Aldammas, Aleissi, Nashwan, Olaish, Dhafar, BaHammam), The University Sleep Disorders Center, College of Medicine, King Saud University, and from the Department of Critical Care (Abanumay), Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia.
| | - Samar Z. Nashwan
- From the Department of Home Health Care (Alaqeel), King Fahad Medical City, Second Health Cluster, from the Department of Family and Community Medicine (Alaraik); from the Department of Medicine (Aldammas, Aleissi, Nashwan, Olaish, Dhafar, BaHammam), The University Sleep Disorders Center, College of Medicine, King Saud University, and from the Department of Critical Care (Abanumay), Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia.
| | - Awad H. Olaish
- From the Department of Home Health Care (Alaqeel), King Fahad Medical City, Second Health Cluster, from the Department of Family and Community Medicine (Alaraik); from the Department of Medicine (Aldammas, Aleissi, Nashwan, Olaish, Dhafar, BaHammam), The University Sleep Disorders Center, College of Medicine, King Saud University, and from the Department of Critical Care (Abanumay), Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia.
| | - Hamza O. Dhafar
- From the Department of Home Health Care (Alaqeel), King Fahad Medical City, Second Health Cluster, from the Department of Family and Community Medicine (Alaraik); from the Department of Medicine (Aldammas, Aleissi, Nashwan, Olaish, Dhafar, BaHammam), The University Sleep Disorders Center, College of Medicine, King Saud University, and from the Department of Critical Care (Abanumay), Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia.
| | - Ahmed S. BaHammam
- From the Department of Home Health Care (Alaqeel), King Fahad Medical City, Second Health Cluster, from the Department of Family and Community Medicine (Alaraik); from the Department of Medicine (Aldammas, Aleissi, Nashwan, Olaish, Dhafar, BaHammam), The University Sleep Disorders Center, College of Medicine, King Saud University, and from the Department of Critical Care (Abanumay), Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia.
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Goldstein LA, Bernhard PA, Hoffmire CA, Schneiderman A, Maguen S. Prevalence of Obstructive Sleep Apnea Among Veterans and Nonveterans. Am J Health Promot 2025; 39:215-223. [PMID: 39136615 DOI: 10.1177/08901171241273443] [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] [Indexed: 08/23/2024]
Abstract
PURPOSE Understanding disease prevalence can inform treatment and resource needs across populations. This study aimed to identify the prevalence of sleep apnea (OSA) among veterans and nonveterans. DESIGN The national Comparative Health Assessment Interview Study, cross-sectional survey using probability-based sampling frames. SETTING Surveys completed by Internet or phone. SUBJECTS 15,166 veterans (40% response rate) and 4,654 nonveterans (57% response rate). MEASURES Self-report of healthcare provider-based diagnosis of OSA. ANALYSIS Calculation of prevalence of OSA using statistical weighting to allow for direct comparison between veterans and nonveterans. Secondary analyses evaluated OSA by deployment status among veterans and compared average age of OSA diagnosis and differences in OSA prevalence among veterans and nonveterans stratified by gender, marital status, race/ethnicity, and posttraumatic stress disorder diagnosis. RESULTS OSA diagnosis was more than twice as prevalent among veterans (21%, 95% CI 20%-22%) than nonveterans (9%, 95% CI 8%-10%; aOR: 2.56, 95% CI 2.22-2.95, P < .001). Deployment was associated with higher odds of OSA among veterans (aOR: 1.64, 95% CI 1.43-18.7, P < 001.) Veterans were diagnosed with OSA on average 5 years earlier than nonveterans. CONCLUSION Veterans have a high prevalence rate of OSA, highlighting the importance of veterans' access to treatment. OSA is likely underdiagnosed in nonveterans, particularly among racial/ethnic minoritized groups. Future research should investigate disparities in access to diagnostic testing for racial/ethnic minority nonveterans and/or risk factors for OSA among racial/ethnic minority veterans. The increased odds of OSA among those with PTSD highlights in the importance of early referral for OSA testing by providers as well as development of trauma-informed strategies to promote OSA treatment adherence. Limitations include a bias toward underestimation of true disease prevalence due to self-report of diagnosis.
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Affiliation(s)
- Lizabeth A Goldstein
- San Francisco VA Health Care System, San Francisco, CA, USA
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California at San Francisco, San Francisco, CA, USA
| | - Paul A Bernhard
- Epidemiology Program, Health Outcomes of Military Exposures, US Department of Veterans Affairs, Washington, DC, USA
| | - Claire A Hoffmire
- Rocky Mountain Mental Illness Research, Education, and Clinical Center, US Department of Veterans Affairs, Aurora, CO, USA
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO, USA
| | - Aaron Schneiderman
- Epidemiology Program, Health Outcomes of Military Exposures, US Department of Veterans Affairs, Washington, DC, USA
| | - Shira Maguen
- San Francisco VA Health Care System, San Francisco, CA, USA
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California at San Francisco, San Francisco, CA, USA
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Wang VHC, Li Y, Kent DT, Pagán JA, Arabadjian M, Divers J, Zhang D. Racial and ethnic differences in the receipt of continuous positive airway pressure treatment for obstructive sleep apnea. Sleep Med 2024; 124:42-49. [PMID: 39276697 PMCID: PMC11663105 DOI: 10.1016/j.sleep.2024.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 09/09/2024] [Accepted: 09/10/2024] [Indexed: 09/17/2024]
Abstract
OBJECTIVE To examine the pattern of health services access and utilization that may contribute to racial/ethnic disparities in receiving continuous positive airway pressure (CPAP) treatment for obstructive sleep apnea (OSA). METHODS This cross-sectional study used a national sample from the All of Us Research Program, which included over 80 % of participants from underrepresented populations in biomedical research. Study participants included adults aged 18 years and older diagnosed with OSA (N = 8518). Diagnosis of OSA and CPAP treatment were ascertained by diagnostic and procedural codes from the electronic health records. Sociodemographic characteristics and health service utilization factors were identified using self-reported survey data. RESULTS With this national survey, the overall diagnosed prevalence of OSA was 8.8 %, with rates of 8.12 % in non-Hispanic (NH) Black adults, 5.99 % in Hispanic adults, and 10.35 % in NH White adults. When comparing to NH White adults, Hispanic adults were less likely to receive CPAP treatment for OSA after adjusting for socioeconomic and demographic characteristics, access to and utilization of health services, and comorbidities such as obesity and having multiple chronic conditions (OR = 0.73, 95 % CI = 0.59,0.90), p < 0.01. CONCLUSIONS The rates of CPAP treatment among OSA patients are not consistent across racial and ethnic groups. Unequal access to health services based on residence may contribute to these differences. Interventions that target disparities in OSA diagnosis, access to treatment, and barriers in insurance coverage could potentially help reduce racial and ethnic differences in OSA diagnosis and management.
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Affiliation(s)
- Vivian Hsing-Chun Wang
- Center for Population Health and Health Services Research, New York University Grossman Long Island School of Medicine, 101 Mineola Blvd, Mineola, NY, 11501, USA.
| | - Yike Li
- Department of Otolaryngology - Head & Neck Surgery, Vanderbilt University Medical Center, 1215 Medical Center Drive, Medical Center East, Nashville, TN, 37212, USA
| | - David T Kent
- Department of Otolaryngology - Head & Neck Surgery, Vanderbilt University Medical Center, 1215 Medical Center Drive, Medical Center East, Nashville, TN, 37212, USA
| | - José A Pagán
- Department of Public Health Policy and Management, School of Global Public Health, New York University, 708 Broadway, New York, NY, 10012, USA
| | - Milla Arabadjian
- Center for Population Health and Health Services Research, New York University Grossman Long Island School of Medicine, 101 Mineola Blvd, Mineola, NY, 11501, USA
| | - Jasmin Divers
- Center for Population Health and Health Services Research, New York University Grossman Long Island School of Medicine, 101 Mineola Blvd, Mineola, NY, 11501, USA
| | - Donglan Zhang
- Center for Population Health and Health Services Research, New York University Grossman Long Island School of Medicine, 101 Mineola Blvd, Mineola, NY, 11501, USA
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McDowell C, Giudicessi A, Martinez JE, Badillo-Cabrera AL, Félix NAB, Martinez L, Munera D, Vila-Castelar C, Schwab N, Ramirez-Gomez L, Saldana DG, Catalan MG, Amariglio R, Duffy JF, Cronin-Golomb A, Quiroz YT. Sleep Apnea Risk, Subjective Cognitive Decline, and Cognitive Performance: Findings from the Boston Latino Aging Study. Dement Geriatr Cogn Disord 2024:1-7. [PMID: 39586246 PMCID: PMC12103629 DOI: 10.1159/000542691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Accepted: 11/17/2024] [Indexed: 11/27/2024] Open
Abstract
INTRODUCTION Obstructive sleep apnea (OSA) is associated with subjective cognitive decline (SCD) and increased risk of cognitive decline and dementia. These relations are understudied in ethnoracially diverse groups. We examined associations among self-reported OSA risk, SCD, and cognitive performance in community-dwelling older Latinos. High OSA risk was hypothesized to be associated with greater SCD and worse cognitive performance. METHODS 112 participants (40 female) from the Boston Latino Aging Study (BLAST) were included (Mage = 67.0 years [SD = 8.0]; Meducation = 11.0 years [SD = 5.1]). Participants completed the Preclinical Alzheimer's Cognitive Composite-5 (PACC5; z-scores), the Berlin Questionnaire (high vs. low OSA risk), and the Cognitive Function Instrument (SCD). The Mini-Mental State Examination (MMSE) indexed global cognition. Hierarchical regressions assessed associations among OSA risk, SCD, and cognitive performance while controlling for demographics. t tests examined demographic and cognitive differences between those at high/low OSA risk. RESULTS On average, participants had an MMSE score of 25.9 (SD = 3.7, range 11-30; 37 participants with MMSE <26) and mild SCD (CFI; M = 4.2 [3.6]). OSA risk did not predict SCD (β = 0.09, p = 0.33) or PACC5 performance (β = 0.01, p = 0.92). No differences in SCD or PACC5 performance were observed between those at low versus high OSA risk (p's ≥ 0.21). CONCLUSION Preliminary findings suggest that self-reported OSA risk may not signal cognitive decline risk for older Latinos. Questionnaires screening for OSA may need to be used in tandem with other assessments to identify those experiencing early cognitive decline. More work with larger sample sizes is needed; BLAST data collection is ongoing.
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Affiliation(s)
- Celina McDowell
- Department of Psychological and Brain Sciences, Boston University, Boston, MA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women’s Hospital, and Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - Averi Giudicessi
- Department of Psychological and Brain Sciences, Boston University, Boston, MA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Jairo Enrique Martinez
- Department of Psychological and Brain Sciences, Boston University, Boston, MA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Alex L. Badillo-Cabrera
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | - Lusiana Martinez
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Diana Munera
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Clara Vila-Castelar
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Nadine Schwab
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Liliana Ramirez-Gomez
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Daniel Gilberto Saldana
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Marta Gonzalez Catalan
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Rebecca Amariglio
- Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Jeanne F. Duffy
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women’s Hospital, and Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - Alice Cronin-Golomb
- Department of Psychological and Brain Sciences, Boston University, Boston, MA
| | - Yakeel T. Quiroz
- Department of Psychological and Brain Sciences, Boston University, Boston, MA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Cohen O, Kundel V, Barbé F, Peker Y, McEvoy D, Sánchez-de-la-Torre M, Gottlieb DJ, Bradley TD, Suárez-Fariñas M, Zinchuk A, Azarbarzin A, Malhotra A, Schotland H, Gozal D, Jelic S, Ramos AR, Martin JL, Pamidi S, Johnson DA, Mehra R, Somers VK, Hoyos CM, Jackson CL, Alcantara C, Billings ME, Bhatt DL, Patel SR, Redline S, Yaggi HK, Shah NA. The Great Controversy of Obstructive Sleep Apnea Treatment for Cardiovascular Risk Benefit: Advancing the Science Through Expert Consensus. An Official American Thoracic Society Workshop Report. Ann Am Thorac Soc 2024; 22:1-22. [PMID: 39513996 PMCID: PMC11708754 DOI: 10.1513/annalsats.202409-981st] [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: 09/25/2024] [Indexed: 11/16/2024] Open
Abstract
The prevalence of obstructive sleep apnea (OSA) is on the rise, driven by various factors including more sensitive diagnostic criteria, increased awareness, enhanced technology through at-home testing enabling easy and cost-effective diagnosis, and a growing incidence of comorbid conditions such as obesity. Treating symptomatic patients with OSA syndrome to enhance quality of life remains a cornerstone approach. However, there is a lack of consensus regarding treatment to improve cardiovascular disease (CVD) outcomes, particularly in light of overall negative results from several randomized controlled trials (RCT) indicating no benefit of positive airway pressure (PAP) therapy on primary and secondary CVD events. These RCTs were limited by suboptimal PAP adherence, use of composite CVD outcomes, and limited diversity and generalizability to Sleep Clinic patients. As such, this workshop assembled clinical experts, as well as researchers in basic and translational science, epidemiology, clinical trials, and population health to discuss the current state, and future research directions to guide personalized therapeutic strategies and future research directions in OSA. There was overall consensus among workshop participants that OSA represents a heterogeneous disease with variable endotypes and phenotypes, and heterogeneous responses to treatment. Future research should prioritize employing multi-modal therapeutic approaches within innovative and adaptive trial designs, focusing on specific subgroups of OSA patients hypothesized to benefit from a CVD perspective. Future work should also be inclusive of diverse populations and consider the life-course of OSA to better comprehend treatment strategies that can address the disproportionate impact of OSA on racially minoritized groups. Further, a more holistic approach to sleep must be adopted to include broader assessments of symptoms, sleep duration, and comorbid sleep and circadian disorders. Finally, it is imperative to establish a sleep research consortium dedicated to collecting raw data and biospecimens categorized by OSA subtypes. This will facilitate mechanistic determinations, foster collaborative research, and help bolster the pipeline of early-career researchers.
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Affiliation(s)
- Oren Cohen
- Icahn School of Medicine at Mount Sinai, Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, New York, New York, United States
| | - Vaishnavi Kundel
- Icahn School of Medicine at Mount Sinai, Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, New York, New York, United States
| | - Ferran Barbé
- University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Translational Research in Respiratory Medicine, Lleida, Spain
- Carlos III Health Institute, CIBER of Respiratory Diseases (CIBERES), Madrid, Comunidad de Madrid, Spain
| | - Yüksel Peker
- Koc University School of Medicine, Department of Pulmonary Medicine, Istanbul, Turkey
| | - Doug McEvoy
- Flinders University, Adelaide Institute for Sleep Health, Flinders Health and Medical Research Institute, Adelaide, Australia
| | - Manuel Sánchez-de-la-Torre
- Hospital Nacional de Parapléjicos de Toledo, Group of Precision Medicine in Chronic Diseases, Toledo, Castilla-La Mancha, Spain
- CIBERES, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Comunidad de Madrid, Spain
- University of Castilla-La Mancha, Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Physiotherapy and Nursing, Toledo, Spain
| | - Daniel J Gottlieb
- VA Boston Healthcare System, Department of Medicine, Boston, Massachusetts, United States
- Brigham and Women's Hospital, Division of Sleep and Circadian Disorders, Boston, Massachusetts, United States
| | - T Douglas Bradley
- University Health Network Toronto Rehabilitation Institute (KITE), Toronto, Ontario, Canada
- Toronto General Hospital, Department of Medicine, Toronto, Ontario, Canada
| | - Mayte Suárez-Fariñas
- Icahn School of Medicine at Mount Sinai, Center for Biostatistics, Department of Population Health Science and Policy, New York, New York, United States
| | - Andrey Zinchuk
- Yale School of Medicine, Department of Internal Medicine, New Haven, Connecticut, United States
| | - Ali Azarbarzin
- Brigham and Women's Hospital, Division of Sleep and Circadian Disorders, Boston, Massachusetts, United States
- Harvard Medical School, Boston, Massachusetts, United States
| | - Atul Malhotra
- University of California San Diego, Division of Pulmonary, Critical Care, Sleep Medicine, and Physiology, La Jolla, California, United States
| | - Helena Schotland
- Icahn School of Medicine at Mount Sinai, Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, New York, New York, United States
| | - David Gozal
- Marshall University Joan C Edwards School of Medicine, Office of the Dean, Huntington, West Virginia, United States
| | - Sanja Jelic
- Columbia University Medical Center, Division of Pulmonary, Allergy and Critical Care Medicine, New York, New York, United States
| | - Alberto R Ramos
- University of Miami Miller School of Medicine, Sleep Disorders Program, Department of Neurology, Miami, Florida, United States
| | - Jennifer L Martin
- VA Greater Los Angeles Healthcare System, Geriatric Research, Education, and Clinical Center, Los Angeles, California, United States
- University of California Los Angeles, David Geffen School of Medicine, Los Angeles, California, United States
| | - Sushmita Pamidi
- McGill University, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Dayna A Johnson
- Emory University, Department of Epidemiology, Rollins School of Public Health, Atlanta, Georgia, United States
| | - Reena Mehra
- University of Washington, Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Seattle, Washington, United States
| | - Virend K Somers
- Mayo Clinic, Department of Cardiovascular Medicine, Rochester, Minnesota, United States
| | - Camilla M Hoyos
- Macquarie University Faculty of Medicine Health and Human Sciences, Department of Health Science, Sydney, New South Wales, Australia
- Woolcock Institute of Medical Research, Centre for Sleep and Chronobiology, Glebe, New South Wales, Australia
- Macquarie University, NHMRC Centre of Research Excellence to Optimise Sleep in Brain Ageing and Neurodegeneration (CogSleep), Sydney, New South Wales, Australia
| | - Chandra L Jackson
- National Institutes of Health, Earl Stadtman Investigator, Epidemiology Branch, Social and Environmental Determinants of Health Equity, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, United States
| | - Carmela Alcantara
- Columbia University, School of Social Work, New York, New York, United States
| | - Martha E Billings
- University of Washington, Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Seattle, Washington, United States
| | - Deepak L Bhatt
- Icahn School of Medicine at Mount Sinai, Mount Sinai Fuster Heart Hospital, New York, New York, United States
| | - Sanjay R Patel
- University of Pittsburgh, Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Pittsburgh, Pennsylvania, United States
| | - Susan Redline
- Brigham and Women's Hospital, Division of Sleep and Circadian Disorders, Boston, Massachusetts, United States
- Harvard Medical School, Boston, Massachusetts, United States
- Harvard T H Chan School of Public Health, Boston, Massachusetts, United States
| | - Henry K Yaggi
- Yale School of Medicine, Section of Pulmonary, Critical Care and Sleep Medicine, New Haven, Connecticut, United States
- Connecticut Department of Veterans' Affairs, Clinical Epidemiology Research Center, West Haven, Connecticut, United States
| | - Neomi A Shah
- Icahn School of Medicine at Mount Sinai, Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, New York, New York, United States;
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Brock LU, Yeager KA, Miller AH, Pelkmans J, Graetz I, Giordano NA. Psychometric Assessment of Anxiety Measures in a Pilot Study of African American Patients with Obstructive Sleep Apnea. Clin Nurs Res 2024; 33:603-609. [PMID: 39340150 PMCID: PMC11812460 DOI: 10.1177/10547738241282166] [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] [Indexed: 09/30/2024]
Abstract
African American patient populations are disproportionately diagnosed with severe obstructive sleep apnea (OSA) compared to non-Hispanic white adults. Research suggests a link between OSA and anxiety. However, OSA and anxiety symptoms may present differently across minority groups. Research examining the reliability and validity of measures used to assess anxiety symptom severity in African American patient populations living with OSA is needed. This pilot study evaluated the reliability and validity of the Patient Reported Outcomes Measurement Information System (PROMIS) Anxiety short form and the longer State-Trait Anxiety Inventory-State (STAI-S) in a sample of African American adults recently diagnosed with OSA. In this cross-sectional pilot study, 32 African American patients newly diagnosed with OSA were recruited from an academic sleep medicine clinic in the Southeastern United States to complete survey measures. Participants completed the 6-item PROMIS Anxiety short form and 20-item STAI-S. Cronbach's alphas assessed the internal reliability of measures, and concurrent validity between measures was assessed using correlation coefficients (rs). Both PROMIS Anxiety and STAI-S showed excellent internal consistency with Cronbach's α ≥.90. The PROMIS Anxiety T-scores and STAI-S scores were positively moderately correlated with each other (rs = .68; p < .0001), indicating concurrent validity. These results illustrate that both the PROMIS Anxiety and STAI-S scales have strong internal reliability in this sample of African American adults with co-occurring OSA and prediabetes. The brief PROMIS Anxiety short-form measure is validated to the longer STAI measure in this sample. An advantage of the PROMIS Anxiety scale is that it has a lower participant burden when completing questionnaires, contributing to a more refined approach to diagnosis and management when both OSA and anxiety coexist. These findings also underscore the importance of validating psychometric measures in marginalized populations, such as African Americans, who have historically been underrepresented in psychometric research.
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Affiliation(s)
- La-Urshalar Brock
- Emory University, Nell Hodgson Woodruff School of Nursing, Atlanta, GA
| | | | | | - Jordan Pelkmans
- Emory University, Nell Hodgson Woodruff School of Nursing, Atlanta, GA
| | - Ilana Graetz
- Emory University Rollins School of Public Health, Atlanta, GA
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Landeo-Gutierrez J, Ryu J, Tantisira K, Bhattacharjee R. Ethnic/racial and sex disparities in obstructive sleep apnea among adolescents in southern California. J Clin Sleep Med 2024; 20:1637-1645. [PMID: 38913342 PMCID: PMC11446114 DOI: 10.5664/jcsm.11238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 05/24/2024] [Accepted: 05/29/2024] [Indexed: 06/25/2024]
Abstract
STUDY OBJECTIVES Pediatric obstructive sleep apnea (OSA) is common; however, inclusion of adolescents and especially those of ethnic/racial minorities in research is scarce. We hypothesized that ethnic/racial minority adolescents undergoing polysomnography have higher prevalence and more severe OSA compared to those who are non-Hispanic (NH) White. METHODS Retrospective review of 1,745 adolescents undergoing diagnostic polysomnography. Demographic characteristics, age, body mass index percentile, and polysomnography parameters were obtained. Descriptive statistics comparing race/ethnicity were analyzed. Linear regression of log-transformed obstructive apnea-hypopnea index, and logistic regression of moderate-severe OSA (obstructive apnea-hypopnea index ≥ 5 events/h) adjusting for covariates were analyzed. RESULTS A total of 58.2% adolescents were Hispanic, 24.1% NH-White, 4.3% NH-Asian/Pacific Islander, 4.2% NH-Black/African American, and 6.6% NH-other. Compared to the NH-White group, the Hispanic group had higher obstructive apnea-hypopnea index and any level of OSA severity, the Black/African American group had higher any level of OSA, and the NH-Asian group had higher moderate-severe OSA. Multiple linear regression of log-obstructive apnea-hypopnea index identified a positive association with Hispanic ethnicity (β: 0.25, P value < .05). Compared to the NH-White group, the Hispanic and the Asian/Pacific Islander groups were 1.45 (95% confidence interval: 1.10, 1.93) and 1.81 (95% confidence interval: 1.05, 3.10) times more likely to have moderate-severe OSA, respectively, after adjusting for relevant covariates. Stratified analysis by sex identified an association only among males between Hispanic ethnicity (odds ratio: 1.85, 95% confidence interval: 1.27, 2.70) and Asian/Pacific Islander ethnicity (odds ratio: 2.62, 95% confidence interval: 1.35, 5.11) and moderate-severe OSA, compared to the NH-White group. CONCLUSIONS Among adolescents undergoing polysomnography evaluation, we identified OSA racial/ethnic and sex disparities in Hispanic and NH-Asian adolescents. Community level studies with adequate representation of these minority groups are needed to identify factors associated with the reported increased susceptibility. CITATION Landeo-Gutierrez J, Ryu J, Tantisira K, Bhattacharjee R. Ethnic/racial and sex disparities in obstructive sleep apnea among adolescents in southern California. J Clin Sleep Med. 2024;20(10):1637-1645.
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Affiliation(s)
- Jeremy Landeo-Gutierrez
- Division of Respiratory Medicine, Department of Pediatrics, University of California San Diego, Rady Children’s Hospital of San Diego, San Diego, California
| | - Julie Ryu
- Division of Respiratory Medicine, Department of Pediatrics, University of California San Diego, Rady Children’s Hospital of San Diego, San Diego, California
| | - Kelan Tantisira
- Division of Respiratory Medicine, Department of Pediatrics, University of California San Diego, Rady Children’s Hospital of San Diego, San Diego, California
| | - Rakesh Bhattacharjee
- Division of Respiratory Medicine, Department of Pediatrics, University of California San Diego, Rady Children’s Hospital of San Diego, San Diego, California
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Kwon Y, Tzeng WS, Seo J, Logan JG, Tadic M, Lin GM, Martinez-Garcia MA, Pengo M, Liu X, Cho Y, Drager LF, Healy W, Hong GR. Obstructive sleep apnea and hypertension; critical overview. Clin Hypertens 2024; 30:19. [PMID: 39090691 PMCID: PMC11293186 DOI: 10.1186/s40885-024-00276-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 05/22/2024] [Indexed: 08/04/2024] Open
Abstract
Obstructive sleep apnea (OSA) and hypertension are two important modifiable risk factors for cardiovascular disease and mortality. Numerous studies have highlighted the interplay between these two conditions. We provide a critical review of the current literature on the role of the OSA as a risk factor for hypertension and its effect on blood pressure (BP). We discuss several key topics: the effect of OSA on nocturnal BP, BP response to continuous positive airway pressure (CPAP) treatment, CPAP effect on BP in refractory hypertension, the role of OSA in BP variability (BPV), and maladaptive cardiac remodeling mediated by OSA's effect on BP. Finally, we discuss the unique aspects of ethnicity and social determinants of health on OSA with a focus on Asian populations and the disparity in BP control and cardiovascular outcomes.
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Affiliation(s)
- Younghoon Kwon
- Department of Medicine, University of Washington, Seattle, WA, USA.
- Division of Cardiology, University of Washington, Seattle, WA, USA.
| | - William S Tzeng
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Jiwon Seo
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea
| | - Jeongok Gang Logan
- Department of Acute & Specialty Care, University of Virginia School of Nursing, Charlottesville, VA, USA
| | - Marijana Tadic
- Klinik Für Innere Medizin II, Universitätsklinikum Ulm, Ulm, Germany
| | - Gen-Min Lin
- Department of Medicine, Hualien Armed Forces General Hospital, Hualien, Taiwan
- Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | | | - Martino Pengo
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Department of Cardiology, Istituto Auxologico Italiano IRCCS, S.Luca Hospital, Milan, Italy
| | - Xiaoyue Liu
- Johns Hopkins School of Nursing, Johns Hopkins University, Baltimore, MD, USA
| | - Yeilim Cho
- Department of Sleep Medicine, University of Washington, Seattle, WA, USA
- Department of Sleep Medicine, Veteran's Affairs Puget Sound Healthcare System, Seattle, WA, USA
| | - Luciano F Drager
- Hypertension Unit, Heart Institute, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - William Healy
- Division of Pulmonary, Critical Care, Sleep Medicine, Medical College of Georgia, Augusta, GA, USA
| | - Geu-Ru Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea.
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10
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Robbins R, Yuan Y, Johnson DA, Long DL, Molano J, Kleindorfer D, Petrov ME, Howard VJ. Sleep Apnea and Incident Stroke in a National Cohort of Black and White Adults. Neurology 2024; 102:e209171. [PMID: 38447086 PMCID: PMC11383872 DOI: 10.1212/wnl.0000000000209171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 12/11/2023] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Racial/ethnic differences have been documented in the relationship between obstructive sleep apnea (OSA) and stroke incidence, yet racial differences in OSA symptoms or treatment and their relationship with stroke incidence are underexplored and may contribute to stroke disparities. We comprehensively examined OSA symptoms and their relationships to stroke incidence by race/ethnicity. METHODS Data were collected from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study, a population-based cohort of Black and White individuals in the United States. Participants free from a stroke diagnosis at baseline were included. Participants self-reported the following: (1) snoring; (2) daytime sleepiness; (3) provider-diagnosed sleep apnea (PDSA); and (4) treatment for PDSA using positive airway pressure (PAP). OSA risk was categorized as high or low based on the Berlin Sleep Questionnaire. Incident stroke was defined as first occurrence of stroke over an average of 12 (SD 3.9) years of follow-up. We report the relationships between snoring, OSA risk, PDSA, PAP therapy use, and incident stroke by race/ethnicity using Cox proportional hazards models after adjusting for demographic and socioeconomic factors and stroke risk factors. RESULTS Among the 22,192 participants (mean age [SD] 64.2[9.1] years), 38.1% identified as Black. Overall, snoring was not associated with incident stroke (hazard ratio [HR] 0.98, 95% CI 0.85-1.13). However, among White individuals but not Black individuals, high OSA risk and PDSA were associated with incident stroke (HR 1.22, 95% CI 1.01-1.47; HR 1.33, 95% CI 1.04-1.70, respectively). PAP therapy use among those with PDSA (compared with non-PDSA) was associated with incident stroke in White individuals (HR 1.38, 95% CI 1.05-1.80). PAP therapy use among those with PDSA (compared with those with PDSA without PAP therapy use) was associated with reduced risk of incident stroke in Black (HR 0.39, 95% CI 0.17-0.91) but not White (HR 0.63, 95% CI 0.37-1.10) individuals. DISCUSSION White individuals with high OSA risk and those with PDSA with or without PAP therapy use were at increased incident stroke risk, whereas Black individuals reporting PDSA and PAP had reduced incident stroke risk relative to those not using PAP. Future research is needed to understand the mechanisms underlying racial differences in OSA and stroke such as differences in assessment modes and treatment.
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Affiliation(s)
- Rebecca Robbins
- From the Division of Sleep and Circadian Disorders (R.R.), Departments of Medicine and Neurology and Division of Sleep Medicine (R.R.), Harvard Medical School, Boston, MA; Departments of Biostatistics (Y.Y., D.L.L.) and Epidemiology (V.J.H.), School of Public Health, University of Alabama at Birmingham; Department of Epidemiology (D.A.J.), Rollins School of Public Health, Emory University, Atlanta, GA; Department of Neurology and Rehabilitation Medicine (J.M.), University of Cincinnati, OH; Department of Neurology (D.K.), University of Michigan Medical Center, Ann Arbor; and Edson College of Nursing and Health Innovation (M.E.P.), Arizona State University, Phoenix
| | - Ya Yuan
- From the Division of Sleep and Circadian Disorders (R.R.), Departments of Medicine and Neurology and Division of Sleep Medicine (R.R.), Harvard Medical School, Boston, MA; Departments of Biostatistics (Y.Y., D.L.L.) and Epidemiology (V.J.H.), School of Public Health, University of Alabama at Birmingham; Department of Epidemiology (D.A.J.), Rollins School of Public Health, Emory University, Atlanta, GA; Department of Neurology and Rehabilitation Medicine (J.M.), University of Cincinnati, OH; Department of Neurology (D.K.), University of Michigan Medical Center, Ann Arbor; and Edson College of Nursing and Health Innovation (M.E.P.), Arizona State University, Phoenix
| | - Dayna A Johnson
- From the Division of Sleep and Circadian Disorders (R.R.), Departments of Medicine and Neurology and Division of Sleep Medicine (R.R.), Harvard Medical School, Boston, MA; Departments of Biostatistics (Y.Y., D.L.L.) and Epidemiology (V.J.H.), School of Public Health, University of Alabama at Birmingham; Department of Epidemiology (D.A.J.), Rollins School of Public Health, Emory University, Atlanta, GA; Department of Neurology and Rehabilitation Medicine (J.M.), University of Cincinnati, OH; Department of Neurology (D.K.), University of Michigan Medical Center, Ann Arbor; and Edson College of Nursing and Health Innovation (M.E.P.), Arizona State University, Phoenix
| | - D Leann Long
- From the Division of Sleep and Circadian Disorders (R.R.), Departments of Medicine and Neurology and Division of Sleep Medicine (R.R.), Harvard Medical School, Boston, MA; Departments of Biostatistics (Y.Y., D.L.L.) and Epidemiology (V.J.H.), School of Public Health, University of Alabama at Birmingham; Department of Epidemiology (D.A.J.), Rollins School of Public Health, Emory University, Atlanta, GA; Department of Neurology and Rehabilitation Medicine (J.M.), University of Cincinnati, OH; Department of Neurology (D.K.), University of Michigan Medical Center, Ann Arbor; and Edson College of Nursing and Health Innovation (M.E.P.), Arizona State University, Phoenix
| | - Jennifer Molano
- From the Division of Sleep and Circadian Disorders (R.R.), Departments of Medicine and Neurology and Division of Sleep Medicine (R.R.), Harvard Medical School, Boston, MA; Departments of Biostatistics (Y.Y., D.L.L.) and Epidemiology (V.J.H.), School of Public Health, University of Alabama at Birmingham; Department of Epidemiology (D.A.J.), Rollins School of Public Health, Emory University, Atlanta, GA; Department of Neurology and Rehabilitation Medicine (J.M.), University of Cincinnati, OH; Department of Neurology (D.K.), University of Michigan Medical Center, Ann Arbor; and Edson College of Nursing and Health Innovation (M.E.P.), Arizona State University, Phoenix
| | - Dawn Kleindorfer
- From the Division of Sleep and Circadian Disorders (R.R.), Departments of Medicine and Neurology and Division of Sleep Medicine (R.R.), Harvard Medical School, Boston, MA; Departments of Biostatistics (Y.Y., D.L.L.) and Epidemiology (V.J.H.), School of Public Health, University of Alabama at Birmingham; Department of Epidemiology (D.A.J.), Rollins School of Public Health, Emory University, Atlanta, GA; Department of Neurology and Rehabilitation Medicine (J.M.), University of Cincinnati, OH; Department of Neurology (D.K.), University of Michigan Medical Center, Ann Arbor; and Edson College of Nursing and Health Innovation (M.E.P.), Arizona State University, Phoenix
| | - Megan E Petrov
- From the Division of Sleep and Circadian Disorders (R.R.), Departments of Medicine and Neurology and Division of Sleep Medicine (R.R.), Harvard Medical School, Boston, MA; Departments of Biostatistics (Y.Y., D.L.L.) and Epidemiology (V.J.H.), School of Public Health, University of Alabama at Birmingham; Department of Epidemiology (D.A.J.), Rollins School of Public Health, Emory University, Atlanta, GA; Department of Neurology and Rehabilitation Medicine (J.M.), University of Cincinnati, OH; Department of Neurology (D.K.), University of Michigan Medical Center, Ann Arbor; and Edson College of Nursing and Health Innovation (M.E.P.), Arizona State University, Phoenix
| | - Virginia J Howard
- From the Division of Sleep and Circadian Disorders (R.R.), Departments of Medicine and Neurology and Division of Sleep Medicine (R.R.), Harvard Medical School, Boston, MA; Departments of Biostatistics (Y.Y., D.L.L.) and Epidemiology (V.J.H.), School of Public Health, University of Alabama at Birmingham; Department of Epidemiology (D.A.J.), Rollins School of Public Health, Emory University, Atlanta, GA; Department of Neurology and Rehabilitation Medicine (J.M.), University of Cincinnati, OH; Department of Neurology (D.K.), University of Michigan Medical Center, Ann Arbor; and Edson College of Nursing and Health Innovation (M.E.P.), Arizona State University, Phoenix
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11
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Orbell SL, Scott PW, Baniak LM, Chasens ER, Godzik C, Jeon B, Morris JL, Luyster FS. Patient-level factors associated with the self-report of trouble sleeping to healthcare providers in adults at high risk for obstructive sleep apnea. Sleep Health 2023; 9:984-990. [PMID: 37821259 DOI: 10.1016/j.sleh.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 06/15/2023] [Accepted: 08/15/2023] [Indexed: 10/13/2023]
Abstract
INTRODUCTION In adults at risk for obstructive sleep apnea, it is unclear what patient-level factors and symptoms may influence communication with healthcare providers regarding sleep difficulties. This analysis examined associations between sociodemographic characteristics, comorbidities, and obstructive sleep apnea-related symptoms and whether adults at high risk for obstructive sleep apnea reported trouble sleeping to an healthcare provider. METHODS The sample included participants from the 2015-2018 National Health and Nutrition Examination Survey determined by a modified STOP-Bang to be at high risk for obstructive sleep apnea (n = 2009). Participants were asked if they had ever reported trouble sleeping to an healthcare provider. Self-reported comorbidities and obstructive sleep apnea-related symptoms (ie, snoring, snorting, gasping, or breathing cessation during sleep, daytime sleepiness, fatigue, insomnia, and nocturia) were assessed. RESULTS Half of the sample (50.8%) never reported trouble sleeping to an healthcare provider. Factors associated with an increased likelihood of reporting trouble sleeping included female sex, former smoker, and prediabetes or diabetes, obstructive lung disease, daytime sleepiness, insomnia, nocturia, and symptoms of snorting, gasping, and/or breathing cessation during sleep. Factors associated with a decreased likelihood of reporting trouble sleeping included Mexican American background or Asian race and having less than a high school education. CONCLUSION Differences in sex, race, education, comorbidities, and obstructive sleep apnea-related symptoms exist between adults at high risk for obstructive sleep apnea who have and have not reported trouble sleeping to an healthcare provider. It is important for healthcare providers to ask all adults about sleep problems, recognizing that men, minorities, and persons with lower educational attainment may be less likely to report trouble sleeping.
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Affiliation(s)
- Staci L Orbell
- Department of Health and Community Systems, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
| | - Paul W Scott
- Department of Health and Community Systems, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Lynn M Baniak
- Department of Health and Community Systems, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Veteran Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Eileen R Chasens
- Department of Health and Community Systems, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Cassandra Godzik
- Department of Psychiatry, Dartmouth College and Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Bomin Jeon
- College of Nursing, University of Iowa, Iowa City, Iowa, USA
| | - Jonna L Morris
- Department of Health and Community Systems, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Faith S Luyster
- Department of Health and Community Systems, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Veteran Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
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12
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Wallace DA, Gallagher JP, Peterson SR, Ndiaye-Gueye S, Fox K, Redline S, Johnson DA. Is exposure to chemical pollutants associated with sleep outcomes? A systematic review. Sleep Med Rev 2023; 70:101805. [PMID: 37392613 PMCID: PMC10528206 DOI: 10.1016/j.smrv.2023.101805] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 05/25/2023] [Accepted: 06/08/2023] [Indexed: 07/03/2023]
Abstract
Environmental exposures may influence sleep; however, the contributions of environmental chemical pollutants to sleep health have not been systematically investigated. We conducted a systematic review to identify, evaluate, summarize, and synthesize the existing evidence between chemical pollutants (air pollution, exposures related to the Gulf War and other conflicts, endocrine disruptors, metals, pesticides, solvents) and dimensions of sleep health (architecture, duration, quality, timing) and disorders (sleeping pill use, insomnia, sleep-disordered breathing)). Of the 204 included studies, results were mixed; however, the synthesized evidence suggested associations between particulate matter, exposures related to the Gulf War, dioxin and dioxin-like compounds, and pesticide exposure with worse sleep quality; exposures related to the Gulf War, aluminum, and mercury with insomnia and impaired sleep maintenance; and associations between tobacco smoke exposure with insomnia and sleep-disordered breathing, particularly in pediatric populations. Possible mechanisms relate to cholinergic signaling, neurotransmission, and inflammation. Chemical pollutants are likely key determinants of sleep health and disorders. Future studies should aim to evaluate environmental exposures on sleep across the lifespan, with a particular focus on developmental windows and biological mechanisms, as well as in historically marginalized or excluded populations.
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Affiliation(s)
- Danielle A Wallace
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Jayden Pace Gallagher
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Shenita R Peterson
- Woodruff Health Sciences Center Library, Emory University, Atlanta, GA, USA
| | - Seyni Ndiaye-Gueye
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Kathleen Fox
- Woodruff Health Sciences Center Library, Emory University, Atlanta, GA, USA
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Dayna A Johnson
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Johnson DA, Reiss B, Cheng P, Jackson CL. Understanding the role of structural racism in sleep disparities: a call to action and methodological considerations. Sleep 2022; 45:zsac200. [PMID: 35999030 PMCID: PMC9548670 DOI: 10.1093/sleep/zsac200] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Dayna A Johnson
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Benjamin Reiss
- Department of English, College of Arts and Sciences, Emory University, N302 Callaway Memorial Center, Atlanta, GA, USA
| | - Philip Cheng
- Department of Internal Medicine, Thomas Roth Sleep Disorders and Research Center, Henry Ford Health System, Novi, MI, USA
| | - Chandra L Jackson
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC, USA
- Intramural Program, National Institute on Minority Health and Health Disparities, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
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Jean-Louis G, Grandner MA, Seixas AA. Social determinants and health disparities affecting sleep. Lancet Neurol 2022; 21:864-865. [PMID: 36115351 DOI: 10.1016/s1474-4422(22)00347-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 08/22/2022] [Indexed: 10/14/2022]
Affiliation(s)
- Girardin Jean-Louis
- Department of Psychiatry and Behavioral Sciences, University of Miami, Miami, FL 33136, USA; Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL 33136, USA.
| | - Michael A Grandner
- Sleep and Health Research Program, Department of Psychiatry, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Azizi A Seixas
- Department of Psychiatry and Behavioral Sciences, University of Miami, Miami, FL 33136, USA
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