Menopausal estrogen therapy predicts better nocturnal oxyhemoglobin saturation

Nocturnal oxygen resaturation parameters are associated with cardiorespiratory comorbidities

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.

Higher Hospital Frailty Risk Score Is an Independent Predictor of In-Hospital Mortality in Hospitalized Older Adults with Obstructive Sleep Apnea

Background: Frailty predisposes individuals to stressors, increasing morbidity and mortality risk. Therefore, this study examined the impact of frailty defined by the Hospital Frailty Risk Score (HFRS) and other characteristics in older hospitalized patients with Obstructive Sleep Apnea (OSA). Methods: We conducted a retrospective study using the National Inpatient Sample 2016 in patients ≥65 years old with OSA. Logistic regression was used to evaluate the impact of frailty on inpatient mortality. A Kaplan-Meier curve with a log-rank test was used to estimate survival time between frailty groups. Results: 182,174 discharge records of elderly OSA were included in the study. 54% of the cohort were determined to be a medium/high frailty risk, according to HFRS. In multivariable analysis, frailty was associated with a fourfold (medium frailty, adjusted odd ratio (aOR): 4.12, 95% Confidence Interval (CI): 3.76−4.53, p-value < 0.001) and sixfold (high frailty, OR: 6.38, 95% CI: 5.60−7.27, p-value < 0.001) increased odds of mortality. Hospital survival time was significantly different between the three frailty groups (Log-rank test, p < 0.0001). Comorbidity burden defined by Charlson comorbidity Index (CCI) was associated with increased mortality (p < 0.001). Conclusion: More than half of the whole cohort was determined to be at medium and high frailty risk. Frailty was a significant predictor of in-hospital deaths in hospitalized OSA patients. Frailty assessment may be applicable for risk stratification of older hospitalized OSA patients.

Role of menopause and hormone replacement therapy in sleep-disordered breathing

There are suggestions that the loss of female sex hormones following menopause is critical for the development or progression of sleep-disordered breathing (SDB). We conducted a review of the literature on the role of menopause and hormone replacement therapy (HRT) in SDB risk. There is an increase in SDB during the menopausal transition period, but data on an effect beyond that of increasing age and changes in body habitus are weak or absent. Early community-based, observational studies reported a protective effect by HRT on SDB prevalence, but this could possibly be explained as a healthy user effect. Interventional studies of the effect of HRT on SDB are sparse, with only a few randomized placebo-controlled studies, often performed on small samples of women without clinically significant SDB. HRT regimens have varied and all the studies are fairly old. They do not definitely assure the alleviation of SDB and HRT cannot thus be recommended as treatment for SDB. It is concluded that there is no evidence that female sex hormone changes during menopause per se are able to explain the increase in SDB in midlife women and conclusions on the effect of HRT on SDB cannot be drawn from the current literature.

Sleep disordered breathing: is it different for females?

Obstructive sleep apnoea (OSA) is no longer considered to be a disease of males only. The latest prevalence estimates of moderate-to-severe OSA in women range from 6% to 20% [1, 2], resulting in male/female ratio from 3/1 to 2/1 [1]. These figures may still underestimate the prevalence of sleep disordered breathing (SDB) in women, in whom the upper airway obstruction often manifests as noncountable, nonapnoeic respiratory events (snoring, flow limitation or partial upper airway obstruction) [3–6]. Failure to recognise the distinct clinical presentation and partial obstruction in sleep studies may lead to under-recognition of SDB in females [7, 8]. For instance, prior to diagnosing OSA, women are twice as likely as men to be treated for depression [7].

Predominance of low AHI and partial upper airway obstruction may lead to undertreatment of female SDBhttp://ow.ly/TKN7d

Treatment of Insomnia, Insomnia Symptoms, and Obstructive Sleep Apnea During and After Menopause: Therapeutic Approaches

Understanding sleep complaints among menopausal women is an emerging area of clinical and research interest. Several recent reviews have focused on mechanisms of menopausal insomnia and symptoms. In this review, we present a discussion on the most relevant and recent publications on the treatment of sleep disorders for menopausal women, with a focus on menopause-related insomnia, insomnia symptoms, and obstructive sleep apnea. We discuss both nonpharmacological and pharmacological treatments, including cognitive-behavioral therapy for insomnia (CBT-I), complementary and alternative medicine, hormone replacement therapy, sedative hypnotics, antidepressants, and continuous positive airway pressure. In addition, we briefly discuss methods and considerations of assessment of sleep disorders in menopausal women.

Sleep apnea and the risk of dementia: a population-based 5-year follow-up study in Taiwan

BACKGROUND

Sleep apnea (SA) has been associated with cognitive impairment. However, no data regarding the risk of dementia in patients with SA has been reported in the general population. This retrospective matched-control cohort study was designed to estimate and compare the risk of dementia in SA and non-SA patients among persons aged 40 and above over a 5-year period follow-up.

METHODS

We conducted a nationwide 5-year population-based study using data retrieved from the Longitudinal Health Insurance Database 2005 (LHID2005) in Taiwan. The study cohort comprised 1414 patients with SA aged 40 years who had at least 1 inpatient service claim or 1 ambulatory care claim. The comparison cohort comprised 7070 randomly selected patients who were matched with the study group according to sex, age, and index year. We performed Cox proportional-hazards regressions to compute the 5-year dementia-free survival rates after adjusting for potentially confounding factors.

RESULTS

The SA patients in this study had a 1.70-times greater risk of developing dementia within 5 years of diagnosis compared to non-SA age- and sex-matched patients, after adjusting for other risk factors (95% confidence interval (CI) = 1.26-2.31; P < .01). For the gender-dependent effect, only females with SA were more likely to develop dementia (adjust HR: 2.38, 95% CI =1.51-3.74; P < .001). For the age-dependent effect of different genders, males with SA aged 50-59 years had a 6.08 times greater risk for developing dementia (95% CI = 1.96-18.90), and females with SA aged ≥ 70 years had a 3.20 times greater risk of developing dementia (95% CI =1.71-6.00). For the time-dependent effect, dementia may be most likely to occur in the first 2.5 years of follow-up (adjusted HR:2.04, 95% CI =1.35-3.07).

CONCLUSIONS

SA may be a gender-dependent, age-dependent, and time-dependent risk factor for dementia.

Nocturnal transcutaneous carbon dioxide tension in postmenopausal estrogen users and non-users

Objective

The effect of menopause on breathing is not fully understood. We have previously shown that postmenopausal women have a higher sleep-induced increase in transcutaneously measured carbon dioxide tension (TcCO2) than premenopausal women. Therefore, we hypothesized that estrogen therapy (ET) would normalize this sleep-induced TcCO2 increase.

Methods

Nine postmenopausal ET users and nine non-users went through an overnight polygraphic sleep study including continuous monitoring of TcCO2.

Results

TcCO2 levels were higher during sleep than evening wakefulness (awake median 6.55 kPa versus sleep median 6.90 kPa, P = 0.001). ET users had a greater sleep-induced increase in TcCO2 than non-users when comparing the difference between wakefulness and slow-wave sleep (0.85 kPa versus 0.28 kPa, P = 0.004). Lower sleep efficiency was associated with higher sleep-induced increase in TcCO2.

Conclusions

In contrast to our initial hypothesis, postmenopausal ET users have a higher sleep-induced increase in TcCO2 than women without ET. Thus, TcCO2 may be sensitive in measuring the peripheral estrogen effect. These findings warrant placebo-controlled intervention studies to confirm the effects of ET on TcCO2 measurements.

High serum testosterone levels are associated with excessive erythrocytosis of chronic mountain sickness in men

Chronic mountain sickness (CMS) is characterized by excessive erythrocytosis (EE) secondary to hypoventilation. Erythropoietin (Epo) and testosterone regulate erythrocyte production. Low thyroid hormone levels are also associated to hypoventilation. Hence, these hormones can play a role in etiopathogeny of EE. The purpose of this study was to elucidate the effect of sexual and thyroid hormones and Epo in residents from Lima (150 m) and Cerro de Pasco (4,340 m), Peru, and the response to human chorionic gonadotrophin stimulation (hCG). Three groups, one at low altitude and two at high altitude [1 with hemoglobin values >16-21 g/dl and the second with Hb >or=21 g/dl (EE)], were studied. hCG was administered intramuscularly in a single dose (1,000 IU), and blood samples were obtained at 0, 6, 12, 24, 48, and 72 h after injection. High-altitude natives present similar levels of gonadotropins and thyroid hormones but lower dehydroepiandrosterone sulphate (DHEAS) levels (P < 0.01) and greater Epo (P < 0.01), 17alpha-hydroxyprogesterone (P < 0.01), and testosterone levels (P < 0.01) than those at 150 m. Serum testosterone levels (524.13 +/- 55.91 microg/dl vs. 328.14 +/- 53.23 ng/dl, means +/- SE; P < 0.05) and testosterone/DHEAS ratios are higher (7.98 +/- 1.1 vs. 3.65 +/- 1.1; P < 0.01) and DHEAS levels lower in the EE group (83.85 +/- 14.60 microg/dl vs. 148.95 +/- 19.11 ug/dl; P < 0.05), whereas Epo was not further affected. Testosterone levels were highest and DHEAS levels lowest in the EE group at all times after hCG stimulation. In conclusion, high androgen activity could be involved in the etiopathogeny of CMS. This evidence provides an opportunity to develop new therapeutic strategies.

Sleep and menopause

Understanding sleep complaints of menopausal women is an emerging area of clinical and research interest. In this article, we summarize the most relevant and recent literature to provide an update on sleep in perimenopause and postmenopause. Our discussion includes the causes, clinical diagnosis, and treatment of sleep disorders in perimenopausal and postmenopausal women.

Obstructive sleep apnea in older adults

The "typical" presentation of obstructive sleep apnea (OSA) is chronic loud snoring and excessive daytime sleepiness in middle-aged obese men. OSA can result in increased risk for cardiovascular morbidity and mortality. The diagnostic features of OSA in older adults are similar to those in younger adults; however, the older adult may be less likely to seek medical attention or have the sleep disorder recognized because symptoms of snoring, sleepiness, fatigue, nocturia, unintentional napping, and cognitive dysfunction may be ascribed to the aging process itself or to other disorders. This article reviews the basic terminology and pathophysiology of sleep-disordered breathing, discusses why OSA may be even more prevalent in older adults than in the middle-aged group, and reviews similarities and differences between the two groups in the manifestations, consequences, and treatments of OSA.