Excessive daytime sleepiness with snoring or witnessed apnea is associated with handgrip strength: a population-based study

Lower handgrip strength in short-sleeper individuals with obstructive sleep apnea

BACKGROUND

Obstructive sleep apnea (OSA) is a frequently observed and remarkably incapacitating disorder worldwide. As a multisystem disorder, OSA has been linked to a plethora of clinical parameters though physical parameters like muscle strength have been scantily studied. Hand grip strength (HGS) is a practical marker of physical function that has been associated with mortality and an array of clinical outcomes as well as physiological parameters like sleep duration. A few seminal studies have observed no link between HGS and OSA severity while no studies evaluated the relationship between objectively determined sleep duration and HGS in OSA.

OBJECTIVE

The present study aimed to evaluate the HGS indices among both OSA severity groups and objectively determined sleep duration groups in OSA.

METHODS

111 treatment-naïve mostly middle-aged individuals with OSA (86 males) were recruited in a tertiary sleep center. Three OSA severity groups were determined by the Apnea-Hypopnea Index while three sleep duration groups were objectively determined by Total Sleep Time (TST). Dominant and non-dominant maximum and average HGS were calculated using a digital hand dynamometer.

RESULTS

Short-sleeper individuals with OSA were found to have lower HGS indices than intermediate or sufficient sleepers with OSA while no differences in HGS indices among OSA severity groups were observed. All HGS indices correlated with TST.

CONCLUSIONS

Future insights can be gleaned from the present results regarding the conceivably transdiagnostic relationship between sleep duration and HGS as well as the potential use of HGS as a marker in OSA.

Sleep duration, weekend catch-up sleep, and risk of obstructive sleep apnea in relation to handgrip strength

PURPOSE

This cross-sectional study aimed to evaluate whether weekday sleep duration, weekend catch-up sleep, and risk of obstructive sleep apnea are individually and in combination associated with handgrip strength.

METHODS

Data from the Korea National Health and Nutrition Examination Survey 2019, including weekday sleep duration, weekend catch-up sleep, STOP-BANG scores, relative handgrip strength (handgrip strength divided by body mass index), and confounding factors (sociodemographic factors, health behaviors, and health and nutritional status), were evaluated in 3678 Korean adults aged 40 to 80 years. Adequate (vs. inadequate) sleep parameters were defined as weekday sleep duration (6-7 vs. ≤ 5 or ≥ 8 h), weekend catch-up sleep (presence vs. absence), and risk of obstructive sleep apnea (low vs. high based on STOP-BANG scores). Sex-specific quintiles of relative handgrip strength were categorized as high (highest 5th quintile) or low (lower 1^st to 4^th quintiles). A complex-sample logistic regression analysis was performed.

RESULTS

After adjusting for other sleep parameters and confounding variables, each adequate sleep parameter individually and collectively was associated with high relative handgrip strength (adjusted odds ratios [95% confidence interval], 1.43 [1.09, 1.89] for 6-7 h weekday sleep duration; 1.44 [1.10, 1.90] for low risk of obstructive sleep apnea; 1.72 [1.23, 2.40] for any two parameters; 1.81 [1.18, 2.79] for all parameters). The combination of adequate weekend catch-up sleep and obstructive sleep apnea risk had the highest odds ratio for high relative handgrip strength (2.36 [1.45, 3.83]).

CONCLUSIONS

Adequate weekday sleep duration, weekend catch-up sleep, and low obstructive sleep apnea risk were individually and in combination associated with high handgrip strength.

Associations between nutritional factors and excessive daytime sleepiness in older patients with chronic kidney disease

BACKGROUND

Excessive daytime sleepiness (EDS) is prevalent in not only older adults, but also patients with chronic kidney disease (CKD), and is associated with higher risks of morbidity and mortality.

AIMS

The aim of the present study is to determine associations between EDS and nutritional status and serum nutrient levels in older patients with CKD.

METHODS

This cross-sectional study included 367 patients (aged ≥ 65 years) with CKD (eGFR < 60 ml/min/1.73 m² and/or > 30 mg/day of albuminuria for > 3 months). EDS was recorded using the Epworth Sleepiness Scale (a score of ≥ 11). Malnutrition was diagnosed according to the Mini Nutritional Assessment (MNA) tool (a score of < 17).

RESULTS

The mean age was 81 ± 7 years, and 248 (67%) were female. EDS was seen in 99 (26.9%) patients. Those with EDS had significantly lower MNA scores and more frequent malnutrition than those without EDS (p < 0.05). In multivariable analysis adjusted for age, sex, cerebrovascular disease, dementia, number of drugs, and number of urinations at night, and the Charlson Comorbidity Index the relationship between malnutrition and EDS persisted (OR 2.58, 95% CI 1.38-4.83, p = 0.003). There was no significant difference between the presence of EDS and serum levels or deficiencies of vitamin D, vitamin B₁₂, and folate (p > 0.05).

CONCLUSIONS

EDS is associated with malnutrition in older patients with CKD. Therefore, EDS and nutritional status should be evaluated together in clinical practice. However, future studies are needed to determine the direction of the association between malnutrition and EDS and to evaluate if dietary intervention can improve EDS.

Is sleep time associated with handgrip strength in adolescents from the 1997/1998 São Luís Birth Cohort?

This article aims to analyze the association between sleep time and handgrip strength in adolescents belonging to the 1997/1998 São Luís Birth Cohort. This was a cross-sectional study nested in a birth cohort study. One thousand two hundred sixty-nine individuals (18 and 19 years) wore an Actigraph® GTX3+ accelerometer on their wrist 24 hr/day for 7 consecutive days. Handgrip strength was measured using a digital hand dynamometer. We used directed acyclic graphs (DAG) to identify confounding variables. This sample of adolescents was mostly composed of men, with brown skin color, economic class C, which did not work, did not consume alcohol, did not smoke, and never used drugs. The mean value of handgrip strength was 28.2 (±9.3) kgf, and the mean of sleep time was 6 (±1.0) hours per day. The crude analysis showed an association between sleep time and muscle strength. An increase of one hour of sleep reduced the handgrip strength by 1.95 kgf (95%CI:-2.51;-1.39). However, after adjustment for confounders, the association was not maintained (β:-0.07; 95%CI:-0.48;0.36). Sleep time is not associated with handgrip strength in adolescents in São Luís.

Association of sleep disturbances with sarcopenia and its defining components: the ELSA-Brasil study

Sarcopenia and sleep problems share common physiopathology. We aimed to investigate the association of sleep disturbances with sarcopenia and its defining components in Brazilian middle-aged and older adults. In this cross-sectional analysis of the second wave of the ELSA-Brasil study, we included data from 7948 participants aged 50 years and older. Muscle mass was evaluated by bioelectrical impedance analysis and muscle strength by hand-grip strength. Sarcopenia was defined according to the Foundation for the National Institutes of Health criteria. Sleep duration and insomnia complaint were self-reported. Short sleep duration was considered as ≤6 h/night and long sleep duration as >8 h/night. High risk of obstructive sleep apnea (OSA) was assessed using the STOP-Bang questionnaire. Possible confounders included socio-demographic characteristics, lifestyle, clinical comorbidities, and use of sedatives and hypnotics. The frequencies of sarcopenia, low muscle mass, and low muscle strength were 1.6, 21.1, and 4.1%, respectively. After adjustment for possible confounders, high risk of OSA was associated with low muscle mass (OR=2.17, 95%CI: 1.92-2.45). Among obese participants, high risk of OSA was associated with low muscle strength (OR=1.68, 95%CI: 1.07-2.64). However, neither short nor long sleep duration or frequent insomnia complaint were associated with sarcopenia or its defining components. In conclusion, high risk of OSA was associated with low muscle mass in the whole sample and with low muscle strength among obese participants. Future studies are needed to clarify the temporal relationship between both conditions.

Excessive daytime sleepiness is associated with an increased frequency of falls and sarcopenia

BACKGROUND

This cross-sectional study aimed to examine associations between excessive daytime sleepiness (EDS) with falls and falls related conditions in older adults.

METHODS

To assess EDS, the Epworth Sleepiness Scale was used, with a score of ≥11/24 points indicating EDS. Number of falls and fall history (at least one) in the last year were recorded. Timed Up and Go test (TUG) was used to assess fall risk. Sarcopenia was defined by SARC-F tool. A grip strength score of the dominant hand, measured with a hand-grip dynamometer, less than 16 kg in females and 27 kg in males was accepted as dynapenia. Frailty status was defined by five dimensions including shrinking, exhaustion, low levels of activity, weakness, and slowness with those scoring positive on ≥3 dimensions being categorized as frail. The relationship between EDS with outcomes including fall, number of falls, falls risk, dynapenia, sarcopenia and frailty was investigated.

RESULTS

Of the 575 outpatients (mean age 78.7 ± 7.5 years, female:70.4%), the prevalence of EDS was 19.8%. In the multivariable model adjusted for age, sex, living status, marital status, polypharmacy, osteoarthritis, Parkinson disease, depression and dementia; EDS was significantly associated with the number of falls last year (IRR = 1.94, 95% CI: 1.42-2.65) and sarcopenia (OR = 2.41, 95% CI: 1.41-4.12). EDS was not significantly associated with TUG based fall risk, frailty and dynapenia.

CONCLUSIONS

EDS was observed in approximately one in every five older adults. EDS should be evaluated as part of geriatric assessment. Moreover, older patients with EDS should be further assessed for falls and sarcopenia.

Associations of OSA and Nocturnal Hypoxemia with Strength and Body Composition in Community Dwelling Middle Aged and Older Men

PURPOSE

Reduced hand grip strength (HGS) is associated with poorer health in chronic conditions, yet there has been little research examining the association with hand grip strength and obstructive sleep apnea (OSA). Further, these studies have not examined, nor adjusted, for muscle mass. The aim of this study was to determine associations between OSA indices, HGS, muscle mass, and fat mass.

PARTICIPANTS AND METHODS

A total of 613 participants (age range 41-88, BMI 28.6 ± 4.3) from the population-based Men Androgen Inflammation Lifestyle Environment and Stress Study underwent in-home overnight polysomnography, assessment of dominant and non-dominant HGS, and dual x-ray absorptiometry to determine whole body muscle mass and fat mass. Linear models determined cross-sectional associations of polysomnographic-derived OSA indices with hand grip strength, muscle mass, and fat mass, whilst adjusting for lifestyle information (income, smoking status, diet, self-reported physical activity), blood sample derived testosterone and systemic inflammation (C-reactive protein), cardiometabolic health (cardiovascular disease, hypertension, type 2 diabetes), and depression.

RESULTS

In adjusted models, reduced dominant HGS was associated with lower oxygen nadir (unstandardised β [B] = 0.19, 95% confidence interval [CI] 0.08 to 0.29), greater time spent below 90% oxygen saturation (B = -0.08, 95% CI -0.14 to -0.02), and increased apnea duration (B = -0.3, 95% CI -0.23 to -0.02). By contrast, there were no associations between HGS and both AHI and REM AHI. Fat mass was consistently associated with worsening OSA indices, whereas muscle mass demonstrated no associations with any OSA index.

CONCLUSION

Our findings suggest impairments in HGS may be related to fat infiltration of muscle, hypoxemia-induced reductions in peripheral neural innervation, or even endothelial dysfunction, which is a common outcome of hypoxemia. Longitudinal data are needed to further examine these hypotheses and establish if reduced grip strength in patients with OSA is associated with long-term adverse health outcomes.