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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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Howarth TP, Hietakoste S, Ebrahimian S, Rissanen M, Kainulainen S, Karhu T. The interaction between comorbidities and sleep stages influences oxygen re-saturation characteristics. J Sleep Res 2025:e14459. [PMID: 39905694 DOI: 10.1111/jsr.14459] [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: 07/16/2024] [Revised: 12/19/2024] [Accepted: 12/23/2024] [Indexed: 02/06/2025]
Abstract
Sleep stages exhibit differing patterns of cardiac, respiratory and nervous system activation. Rapid eye movement (REM) sleep is associated with deeper oxygen desaturation events in obstructive sleep apnea. However, no studies have looked to the effect of sleep staging on re-saturation characteristics. Polysomnographic data from the Sleep Heart Health Study were utilised to derive oxygen saturation parameters from events having both desaturation and re-saturation parts. Sleep stages were described as non-REM (NREM) 1 or 2 (combined), 3 and REM. Sleep stage effects on desaturation and re-saturation characteristics were investigated in a healthy subgroup (n = 759) and participants with hypertension (n = 2534), lung disease (n = 715), heart failure (n = 199) and myocardial infarction (n = 713). A total of 3793 participants (48.3% female) were included for analysis (171,976 saturation events; median 20 per participant). Events during REM had the longest duration, deepest nadirs and greatest area for desaturations and re-saturations. Sleep stage effected re-saturation parameters more than desaturation parameters, with a relative difference from NREM 1/2 to REM in duration of 16.7% and 29.8%, in rate of 0.2% and 4.5% and in area of 36.1% and 48.0% for desaturation and re-saturation, respectively, among healthy participants. Similarly, the effect of comorbidities was greater upon re-saturations than desaturations, as participants with heart failure recorded a relative difference to healthy participants of 10.3% and 24.4% for desaturation and re-saturation duration, respectively, 12.8% and 15.0% for rate and 6.4% and 16.4% for area. Sleep stages and comorbidities have significant effects upon nocturnal oxygen re-saturation parameters. Cardiorespiratory comorbidities elicit greater degradations in oxygen re-saturations than they do desaturations.
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Affiliation(s)
- Timothy P Howarth
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- Darwin Respiratory and Sleep Health, Darwin Private Hospital, Darwin, Australia
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Salla Hietakoste
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Serajeddin Ebrahimian
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Marika Rissanen
- 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
| | - Tuomas Karhu
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
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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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Thorisdottir K, Hrubos-Strøm H, Karhu T, Nikkonen S, Dammen T, Nordhus IH, Leppänen T, Jónsdóttir MK, Arnardottir ES. Verbal memory is linked to average oxygen saturation during sleep, not the apnea-hypopnea index nor novel hypoxic load variables. Sleep Med 2024; 123:29-36. [PMID: 39232262 DOI: 10.1016/j.sleep.2024.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/15/2024] [Accepted: 08/26/2024] [Indexed: 09/06/2024]
Abstract
INTRODUCTION The apnea-hypopnea index (AHI) is the current diagnostic parameter for diagnosing and estimating the severity of obstructive sleep apnea (OSA). It is, however, poorly associated with the main clinical symptom of OSA, excessive daytime sleepiness, and with the often-seen cognitive decline among OSA patients. To better evaluate OSA severity, novel hypoxic load parameters have been introduced that consider the duration and depth of oxygen saturation drops associated with apneas or hypopneas. The aim of this paper was to compare novel hypoxic load parameters and traditional OSA parameters to verbal memory and executive function in OSA patients. METHOD A total of 207 adults completed a one-night polysomnography at sleep laboratory and two neuropsychological assessments, the Rey Auditory Verbal Learning Test and Stroop test. RESULTS Simple linear regression analyses were used to evaluate independent associations between each OSA parameter and cognitive performance. Associations were found between immediate recall and arousal index, hypoxia <90 %, average SpO2 during sleep, and DesSev100+RevSev100. Total recall was associated with all OSA parameters, and no associations were found with the Stroop test. Subsequently, sex, age, and education were included as covariates in multiple linear regression analyses for each OSA parameter and cognitive performance. The main findings of the study were that average SpO2 during sleep was a significant predictor of total recall (p < .007, β = -.188) with the regression model explaining 21.2 % of performance variation. Average SpO2 during sleep was also a significant predictor of immediate recall (p < .022, β = -.171) with the regression model explaining 11.4 % of performance variation. Neither traditional OSA parameters nor novel hypoxic load parameters predicted cognitive performance after adjustment for sex, age, and education. CONCLUSION The findings validate that the AHI is not an effective indicator of cognitive performance in OSA and suggest that average oxygen saturation during sleep may be the strongest PSG predictor of cognitive decline seen in OSA. The results also underline the importance of considering age when choosing neurocognitive tests, the importance of including more than one test for each cognitive domain as most tests are not pure measures of a single cognitive factor, and the importance of including tests that cover all cognitive domains as OSA is likely to have diffuse cognitive effects.
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Affiliation(s)
- K Thorisdottir
- Reykjavik University Sleep Institute, School of Technology, Reykjavik University, Reykjavik, Iceland; Department of Psychology, Reykjavik University, Reykjavik, Iceland
| | - H Hrubos-Strøm
- Akershus University Hospital, Akershus, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - T Karhu
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland; Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - S Nikkonen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland; Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - T Dammen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Research and Innovation, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - I H Nordhus
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - T Leppänen
- Department of Technical 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, Australia
| | - M K Jónsdóttir
- Reykjavik University Sleep Institute, School of Technology, Reykjavik University, Reykjavik, Iceland; Department of Psychology, Reykjavik University, Reykjavik, Iceland; Landspitali - The National University Hospital of Iceland, Iceland
| | - E S Arnardottir
- Reykjavik University Sleep Institute, School of Technology, Reykjavik University, Reykjavik, Iceland; Landspitali - The National University Hospital of Iceland, Iceland
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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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Parekh A. Hypoxic burden - definitions, pathophysiological concepts, methods of evaluation, and clinical relevance. Curr Opin Pulm Med 2024; 30:00063198-990000000-00198. [PMID: 39229876 PMCID: PMC11451971 DOI: 10.1097/mcp.0000000000001122] [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] [Indexed: 09/05/2024]
Abstract
PURPOSE OF REVIEW Obstructive sleep apnea (OSA) is a common chronic condition that affects over a billion people worldwide and is associated with adverse cardio- and cerebrovascular consequences. Currently, the go-to clinical measure that determines the presence and severity of OSA is the apnea-hypopnea index (AHI). The AHI captures the frequency of respiratory events due to changes in ventilation that are associated with either oxygen desaturations or arousal from sleep. The AHI is poorly correlated to adverse outcomes in OSA with poor prognostic ability. To overcome the limitations of AHI and perhaps driven by the ease of acquisition, several studies have suggested characterizing nocturnal hypoxia in OSA, termed as "hypoxic burden". The purpose of this review is to focus on the hypoxic burden in OSA, its various definitions, and its utility in moving OSA diagnosis beyond the AHI. RECENT FINDINGS Several measures and definitions of hypoxic burden have been proposed and studied that show promise in overcoming limitations of AHI and also have a greater prognostic ability than AHI. More recently, area-based measures that attempt to characterize the depth and duration of oxygen desaturations, i.e., nocturnal hypoxia in OSA, have been shown to better relate to incident cardiovascular disease than AHI. In this review, we delve into the evidence for these novel area-based metrics and also delve into the pathophysiological concepts underlying nocturnal hypoxia while cautioning the reader on interpretation of the recent findings relating hypoxic burden to adverse outcomes in OSA. SUMMARY In this review on hypoxic burden, we focus on the need that has driven the sudden influx of studies assessing hypoxic burden for various outcomes of OSA, its underlying pathophysiology, the various definitions, and clinical relevance. We hope that the reader can appreciate the nuances underlying hypoxic burden in OSA and suggest the need for a cohesive framework for moving beyond the AHI with hypoxic burden.
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Affiliation(s)
- Ankit Parekh
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Howarth TP, Sillanmäki S, Karhu T, Rissanen M, Islind AS, Hrubos-Strøm H, de Chazal P, Huovila J, Kainulainen S, Leppänen T. Nocturnal oxygen resaturation parameters are associated with cardiorespiratory comorbidities. Sleep Med 2024; 118:101-112. [PMID: 38657349 DOI: 10.1016/j.sleep.2024.03.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 03/12/2024] [Accepted: 03/30/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND There are strong associations between oxygen desaturations and cardiovascular outcomes. Additionally, oxygen resaturation rates are linked to excessive daytime sleepiness independent of oxygen desaturation severity. No studies have yet looked at the independent effects of comorbidities or medications on resaturation parameters. METHODS The Sleep Heart Health Study data was utilised to derive oxygen saturation parameters from 5804 participants. Participants with a history of comorbidities or medication usage were compared against healthy participants with no comorbidity/medication history. RESULTS 4293 participants (50.4% female, median age 64 years) were included in the analysis. Females recorded significantly faster resaturation rates (mean 0.61%/s) than males (mean 0.57%/s, p < 0.001), regardless of comorbidities. After adjusting for demographics, sleep parameters, and desaturation parameters, resaturation rate was reduced with hypertension (-0.09 (95% CI -0.16, -0.03)), myocardial infarction (-0.13 (95% CI -0.21, -0.04)) and heart failure (-0.19 (95% CI -0.33, -0.05)), or when using anti-hypertensives (-0.10 (95% CI -0.17, -0.03)), mental health medications (-0.18 (95% CI -0.27, -0.08)) or anticoagulants (-0.41 (95% CI -0.56, -0.26)). Desaturation to Resaturation ratio for duration was decreased with mental health (-0.21 (95% CI -0.34, -0.08)) or diabetic medications (-0.24 (95% CI -0.41, -0.07)), and desaturation to resaturation ratio for area decreased with heart failure (-0.25 (95% CI -0.42, -0.08)). CONCLUSIONS Comorbidities and medications significantly affect nocturnal resaturation parameters, independent of desaturation parameters. However, the causal relationship remains unclear. Further research can enhance our knowledge and develop more precise and safer interventions for individuals affected by certain comorbidities.
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Affiliation(s)
- Timothy P Howarth
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland; Darwin Respiratory and Sleep Health, Darwin Private Hospital, Darwin, Australia; College of Health and Human Sciences, Charles Darwin University, Darwin, Australia; Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland.
| | - Saara Sillanmäki
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland; Faculty of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Tuomas Karhu
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland; Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Marika Rissanen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland; Department of Clinical Neurophysiology, Seinäjoki Central Hospital, Seinäjoki, Finland
| | | | - Harald Hrubos-Strøm
- Department of Otorhinolaryngology, Akershus University Hospital, Lørenskog, Norway; Clinic for Surgical Research, Campus Ahus, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Philip de Chazal
- School of Biomedical Engineering, The University of Sydney, Sydney, Australia
| | - Juuso Huovila
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
| | - Samu Kainulainen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland; Diagnostic Imaging 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
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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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Howarth TP, Karhu T, Kainulainen S, Chen X, Mahamid A, Töyräs J, Leppänen T. Oxygen resaturation rate is significantly associated with objectively assessed excessive daytime sleepiness in suspected obstructive sleep apnoea patients. Sleep Med 2023; 107:171-178. [PMID: 37187080 DOI: 10.1016/j.sleep.2023.04.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/22/2023] [Accepted: 04/27/2023] [Indexed: 05/17/2023]
Abstract
INTRODUCTION Commonly utilised metrics such as the apnoea-hypopnoea index show limited correlation to excessive daytime sleepiness (EDS). Oxygen desaturation parameters show better predictive power, however oxygen resaturation parameters have not yet been investigated. Oxygen resaturation may represent increased cardiovascular fitness and thus we hypothesized that a higher resaturation rate would be protective against EDS. METHODS Oxygen saturation parameters were computed via ABOSA software for adult patients referred for polysomnography and multiple sleep latency test in Israel Loewenstein hospital 2001-2011. EDS was defined as a mean sleep latency (MSL) below 8 min. RESULTS 1629 patients (75% male, 53% obese, median age of 54 years) were included for analysis. The average desaturation event nadir was 90.4% and resaturation rate 0.59%/second. Median MSL was 9.6 min, and 606 patients met criteria for EDS. Patients who were younger, female, and with larger desaturations had significantly higher resaturation rates (p < 0.001). In multivariate models, adjusted for age, sex, body mass index, and average desaturation depth, resaturation rate showed a significant negative correlation with MSL (z-score standardised beta, -1 (95%CI -0.49, -1.52)), and significantly increased odds ratio (OR) of EDS (OR, 1.28 (95%CI 1.07, 1.53)). The beta associated with resaturation rate was larger, though non-significantly, than that of desaturation depth (difference 0.36 (95% CI -1.34, 0.62), p = 0.470). CONCLUSION Oxygen resaturation parameters show significant associations with objectively assessed EDS independent of desaturation parameters. Thus, resaturation and desaturation parameters may reflect differing underlying mechanistic pathways and both be considered novel and appropriate markers for assessing sleep-disordered breathing and associated outcomes.
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Affiliation(s)
- Timothy P Howarth
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland; Darwin Respiratory and Sleep Health, Darwin Private Hospital, Darwin, Australia; College of Health and Human Sciences, Charles Darwin University, Darwin, Australia.
| | - Tuomas Karhu
- 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
| | - Xin Chen
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
| | - Alaa Mahamid
- Sleep Disorders Unit, Loewenstein Hospital-Rehabilitation Center, Raanana, Israel
| | - Juha Töyräs
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland; School of Information Technology and Electrical Engineering, 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 Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
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