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Guo J, Redline S, Stone KL, Xiao Y. Redefining Comorbid Insomnia and Sleep Apnea: The Association of Sleep Breathing Impairment and Insomnia with Incident Diabetes. Ann Am Thorac Soc 2023; 20:1791-1800. [PMID: 37695743 PMCID: PMC10704235 DOI: 10.1513/annalsats.202302-171oc] [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] [Accepted: 09/08/2023] [Indexed: 09/13/2023] Open
Abstract
Rationale: Obstructive sleep apnea (OSA) is a prevalent sleep disorder that is frequently comorbid with insomnia and often accompanied by metabolic diseases such as type 2 diabetes. Although the apnea-hypopnea index (AHI) is currently the diagnostic criterion for gauging the severity of OSA, the AHI has not consistently predicted incident diabetes. Objectives: To test whether a combined insomnia-OSA (COMISA) phenotype based on comorbid insomnia and sleep breathing impairment index (COMISA-SBII) predicts incident diabetes and to compare the association with an AHI definition of COMISA (COMISA-AHI) in the MrOS (Osteoporotic Fractures in Men) study. Methods: The study samples came from participants in the MrOS sleep study without diabetes at their baseline examination. The SBII was derived as the product of the duration of each respiratory event (apnea and hypopnea) and the accompanying desaturation area from baseline unattended polysomnography. A subgroup of individuals classified as having comorbid insomnia (difficulties falling asleep, waking up in the middle of the night and/or early morning awakenings >15 times per month, and daytime impairments) and sleep breathing impairment (greater than 50th percentile of SBII) were identified at baseline. The primary outcome was incident diabetes during the follow-up visits. Cox proportional models were built to assess the adjusted hazard ratios of COMISA-AHI and COMISA-SBII. Prediction model performances of incident diabetes were compared across different models. Results: A total of 2,365 men (mean age, 76 yr) without diabetes at baseline were included. During a median follow-up of 10.0 years, diabetes developed in 181. After adjusting for demographic characteristics, comorbidities, and behavioral risk factors, participants with COMISA-SBII had a higher risk of incident diabetes (hazard ratio, 1.82; 95% confidence interval, 1.15-2.89) than those without sleep disorders (those with an SBII ⩽13.17 and no insomnia). The result remained significant in the risk competing model. Compared with COMISA-AHI, the addition of COMISA-SBII to a crude model with established risk factors significantly improved the predictive value of incident diabetes. Conclusions: COMISA-SBII, but not COMISA-AHI, predicted incident diabetes after accounting for multiple covariates in a cohort of older men. A comorbid insomnia phenotype based on SBII plus insomnia symptoms may be an important clinical subtype.
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Affiliation(s)
- Junwei Guo
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts; and
| | - Katie L. Stone
- Research Institute, California Pacific Medical Center, San Francisco, California
| | - Yi Xiao
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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2
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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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Baldanzi G, Sayols-Baixeras S, Theorell-Haglöw J, Dekkers KF, Hammar U, Nguyen D, Lin YT, Ahmad S, Holm JB, Nielsen HB, Brunkwall L, Benedict C, Cedernaes J, Koskiniemi S, Phillipson M, Lind L, Sundström J, Bergström G, Engström G, Smith JG, Orho-Melander M, Ärnlöv J, Kennedy B, Lindberg E, Fall T. OSA Is Associated With the Human Gut Microbiota Composition and Functional Potential in the Population-Based Swedish CardioPulmonary bioImage Study. Chest 2023; 164:503-516. [PMID: 36925044 PMCID: PMC10410248 DOI: 10.1016/j.chest.2023.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 02/17/2023] [Accepted: 03/05/2023] [Indexed: 03/15/2023] Open
Abstract
BACKGROUND OSA is a common sleep-breathing disorder linked to increased risk of cardiovascular disease. Intermittent upper airway obstruction and hypoxia, hallmarks of OSA, have been shown in animal models to induce substantial changes to the gut microbiota composition, and subsequent transplantation of fecal matter to other animals induced changes in BP and glucose metabolism. RESEARCH QUESTION Does OSA in adults associate with the composition and functional potential of the human gut microbiota? STUDY DESIGN AND METHODS We used respiratory polygraphy data from up to 3,570 individuals 50 to 64 years of age from the population-based Swedish Cardiopulmonary bioimage Study combined with deep shotgun metagenomics of fecal samples to identify cross-sectional associations between three OSA parameters covering apneas and hypopneas, cumulative sleep time in hypoxia, and number of oxygen desaturation events with gut microbiota composition. Data collection about potential confounders was based on questionnaires, onsite anthropometric measurements, plasma metabolomics, and linkage with the Swedish Prescribed Drug Register. RESULTS We found that all three OSA parameters were associated with lower diversity of species in the gut. Furthermore, in multivariable-adjusted analysis, the OSA-related hypoxia parameters were associated with the relative abundance of 128 gut bacterial species, including higher abundance of Blautia obeum and Collinsella aerofaciens. The latter species was also independently associated with increased systolic BP. Furthermore, the cumulative time in hypoxia during sleep was associated with the abundance of genes involved in nine gut microbiota metabolic pathways, including propionate production from lactate. Finally, we observed two heterogeneous sets of plasma metabolites with opposite association with species positively and negatively associated with hypoxia parameters, respectively. INTERPRETATION OSA-related hypoxia, but not the number of apneas/hypopneas, is associated with specific gut microbiota species and functions. Our findings lay the foundation for future research on the gut microbiota-mediated health effects of OSA.
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Affiliation(s)
- Gabriel Baldanzi
- Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Sergi Sayols-Baixeras
- Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden; CIBER Cardiovascular Diseases (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Jenny Theorell-Haglöw
- Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden; Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Koen F Dekkers
- Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Ulf Hammar
- Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Diem Nguyen
- Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Yi-Ting Lin
- Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden; Division of Family Medicine and Primary Care, Department of Neurobiology, Care Science and Society, Karolinska Institute, Huddinge, Sweden; Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Taiwan
| | - Shafqat Ahmad
- Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden; Preventive Medicine Division, Harvard Medical School, Brigham and Women's Hospital, Boston, MA
| | | | | | - Louise Brunkwall
- Department of Clinical Sciences in Malmö, Lund University Diabetes Center, Lund University, Malmö, Sweden
| | - Christian Benedict
- Molecular Neuropharmacology (Sleep Science Lab), Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
| | - Jonathan Cedernaes
- Department of Medical Sciences, Transplantation and Regenerative Medicine, Uppsala University, Uppsala, Sweden; Department of Medical Cell Biology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Sanna Koskiniemi
- Department of Cell and Molecular Biology, Uppsala University, Uppsala, Sweden
| | - Mia Phillipson
- Department of Medical Cell Biology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Lars Lind
- Department of Medical Sciences, Clinical Epidemiology, Uppsala University, Uppsala, Sweden
| | - Johan Sundström
- Department of Medical Sciences, Clinical Epidemiology, Uppsala University, Uppsala, Sweden; The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Göran Bergström
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Clinical Physiology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Gunnar Engström
- Department of Clinical Sciences in Malmö, Lund University Diabetes Center, Lund University, Malmö, Sweden
| | - J Gustav Smith
- The Wallenberg Laboratory/Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University and the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Cardiology, Clinical Sciences, Lund University and Skåne University Hospital, Lund, Sweden; Wallenberg Center for Molecular Medicine and Lund University Diabetes Center, Lund University, Lund, Sweden
| | - Marju Orho-Melander
- Department of Clinical Sciences in Malmö, Lund University Diabetes Center, Lund University, Malmö, Sweden
| | - Johan Ärnlöv
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Science and Society, Karolinska Institute, Huddinge, Sweden; School of Health and Social Studies, Dalarna University, Falun, Sweden
| | - Beatrice Kennedy
- Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Eva Lindberg
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Tove Fall
- Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden.
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De Chazal P, Sutherland K, Cook K, Bin YS, He S, Cistulli PA. A comparison of cardiovascular disease associations of time-domain oximetry parameters in sleep apnoea cases from the Sleep Heart Health Study. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-4. [PMID: 38083161 DOI: 10.1109/embc40787.2023.10340541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Polysomnograms (PSGs) contain a wealth of physiological information that is routinely recorded but not utilised in sleep studies. Intermittent hypoxia arising from obstructive sleep apnoea (OSA) events is an important risk in the later development of cardiovascular disease (CVD). Analysis of oximetry patterns from PSG studies may enable early assessment of CVD risk. The aim of this study was to compare associations of different time-domain oximetry patterns with incident CVD in OSA patients. All participants with OSA and no pre-existing CVD at baseline or within the first two years of follow-up, were selected from the Sleep Heart Health Study data and used for analysis (N=2878). We examined oximetry parameters that are calculated from desaturation events and from time series analysis and compared them to incident CVD outcomes using proportional hazards regression models adjusted for age, race, smoking, BMI, and sex. Our results show that were no associations between OSA oximetry parameters and incident CVD for OSA patients.
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Baumert M, Linz D, Arzt M. Modeling sleep-disordered breathing using overnight polysomnography-opportunities for patient-oriented research and patient care. Sleep 2022; 45:6693847. [PMID: 36070754 PMCID: PMC9742886 DOI: 10.1093/sleep/zsac213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Indexed: 12/15/2022] Open
Affiliation(s)
- Mathias Baumert
- Corresponding author. Mathias Baumert, University of Adelaide, School of Electrical and Electronic Engineering, Adelaide, SA 5005, Australia.
| | - Dominik Linz
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands,Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands,Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Michael Arzt
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
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6
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Sutherland K, Sadr N, Bin YS, Cook K, Dissanayake HU, Cistulli PA, de Chazal P. Comparative associations of oximetry patterns in Obstructive Sleep Apnea with incident cardiovascular disease. Sleep 2022; 45:6650848. [PMID: 35896039 PMCID: PMC9742894 DOI: 10.1093/sleep/zsac179] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 06/27/2022] [Indexed: 12/15/2022] Open
Abstract
STUDY OBJECTIVES Intermittent hypoxia is a key mechanism linking Obstructive Sleep Apnea (OSA) to cardiovascular disease (CVD). Oximetry analysis could enhance understanding of which OSA phenotypes are associated with CVD risk. The aim of this study was to compare associations of different oximetry patterns with incident CVD in men and women with OSA. METHODS Sleep Heart Health Study data were used for analysis. n = 2878 Participants (51.8% female; mean age 63.5 ± 10.5 years) with OSA (Apnea Hypopnea Index [AHI] ≥ 5 events/h) and no pre-existing CVD at baseline or within the first 2 years of follow-up were included. Four oximetry analysis approaches were applied: desaturation characteristics, time series analysis, power spectral density, and non-linear analysis. Thirty-one resulting oximetry patterns were compared to incident CVD using proportional hazards regression models adjusted for age, race, smoking, BMI, and sex. RESULTS There were no associations between OSA oximetry patterns and incident CVD in the total sample or in men. In women, there were some associations between incident CVD and time series analysis (e.g. SpO2 distribution standard deviation, HR 0.81, 95% CI 0.68-0.96, p = 0.014) and power spectral density oximetry patterns (e.g. Full frequency band mean HR 0.75; 95% CI 0.59-0.95; p = 0.015). CONCLUSIONS Comprehensive comparison of baseline oximetry patterns in OSA found none were related to development of CVD. There were no standout individual oximetry patterns that appear to be candidates for CVD risk phenotyping in OSA, but some showed marginal relationships with CVD risk in women. Further work is required to understand whether OSA phenotypes can be used to predict susceptibility to cardiovascular disease.
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Affiliation(s)
- Kate Sutherland
- Sleep Research Group, Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia,Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Nadi Sadr
- Sleep Research Group, Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia,Department of Biomedical Informatics, Emory University, Atlanta, Georgia, USA
| | - Yu Sun Bin
- Sleep Research Group, Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia,Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Kristina Cook
- Sleep Research Group, Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia,Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Hasthi U Dissanayake
- Sleep Research Group, Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia,Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Peter A Cistulli
- Sleep Research Group, Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia,Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia,Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Philip de Chazal
- Corresponding author. Philip de Chazal, Sleep Research Group, Level 3, D17 Charles Perkins Centre, University of Sydney Camperdown, New South Wales 2006, Australia.
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Xia Y, You K, Xiong Y. Relationships Between Cardinal Features of Obstructive Sleep Apnea and Blood Pressure: A Retrospective Study. Front Psychiatry 2022; 13:846275. [PMID: 35463518 PMCID: PMC9027567 DOI: 10.3389/fpsyt.2022.846275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 03/02/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is associated with hypertension; however, the associations between cardinal features of OSA, such as intermittent hypoxia (IH) and sleep fragmentation (SF), and blood pressure remain unclear. We performed this study to address this issue. METHOD We investigated 335 subjects with the polysomnography (PSG) tests. Data, including basic characteristics, PSG parameters, and blood pressure, were collected. We calculated p-values for linear trends of blood pressure across oxygen-desaturation index (ODI)/microarousal index (MAI) quartiles. Logistic regressions were used to determine the risk factors for abnormal blood pressure and to detect the multiplicative interaction between ODI and MAI with blood pressure. RESULTS After adjusting for multiple variables, compared with subjects with lower ODI quartiles, those with higher ODI quartiles had significant higher systolic blood pressure (SBP) and diastolic blood pressure (DBP) (p for trend = 0.010 and 0.018, respectively). And compared with subjects with lower ODI quartiles, those with higher ODI quartiles were also more likely to have abnormal DBP and hypertension after adjusting for multiple variables. Similarly, compared with subjects with lower MAI quartiles, those with higher MAI quartiles had significant higher SBP and DBP, and were more likely to have abnormal DBP and hypertension. No significant multiplicative interactions between ODI and MAI with blood pressure were detected. CONCLUSION Subjects with more severe IH/SF had significant higher blood pressure and were more likely to have abnormal DBP and hypertension than those with less severe IH/SF. No interaction between IH and SF on the relationship with blood pressure was shown.
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Affiliation(s)
- Yunyan Xia
- Department of Otorhinolaryngology-Head and Neck Surgery, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Kai You
- Department of Anesthesiology, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yuanping Xiong
- Department of Otorhinolaryngology-Head and Neck Surgery, First Affiliated Hospital of Nanchang University, Nanchang, China
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Álvarez D, Gutiérrez-Tobal GC, Vaquerizo-Villar F, Moreno F, Del Campo F, Hornero R. Oximetry Indices in the Management of Sleep Apnea: From Overnight Minimum Saturation to the Novel Hypoxemia Measures. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1384:219-239. [PMID: 36217087 DOI: 10.1007/978-3-031-06413-5_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Obstructive sleep apnea (OSA) is a multidimensional disease often underdiagnosed due to the complexity and unavailability of its standard diagnostic method: the polysomnography. Among the alternative abbreviated tests searching for a compromise between simplicity and accurateness, oximetry is probably the most popular. The blood oxygen saturation (SpO2) signal is characterized by a near-constant profile in healthy subjects breathing normally, while marked drops (desaturations) are linked to respiratory events. Parameterization of the desaturations has led to a great number of indices of severity assessment commonly used to assist in OSA diagnosis. In this chapter, the main methodologies used to characterize the overnight oximetry profile are reviewed, from visual inspection and simple statistics to complex measures involving signal processing and pattern recognition techniques. We focus on the individual performance of each approach, but also on the complementarity among the great amount of indices existing in the state of the art, looking for the most relevant oximetric feature subset. Finally, a quick overview of SpO2-based deep learning applications for OSA management is carried out, where the raw oximetry signal is analyzed without previous parameterization. Our research allows us to conclude that all the methodologies (conventional, time, frequency, nonlinear, and hypoxemia-based) demonstrate high ability to provide relevant oximetric indices, but only a reduced set provide non-redundant complementary information leading to a significant performance increase. Finally, although oximetry is a robust tool, greater standardization and prospective validation of the measures derived from complex signal processing techniques are still needed to homogenize interpretation and increase generalizability.
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Affiliation(s)
- Daniel Álvarez
- Biomedical Engineering Group (GIB), University of Valladolid, Valladolid, Spain.
- Pneumology Department, Río Hortega University Hospital, Valladolid, Spain.
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina, Instituto de Salud Carlos III, Valladolid, Spain.
| | - Gonzalo C Gutiérrez-Tobal
- Biomedical Engineering Group (GIB), University of Valladolid, Valladolid, Spain
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina, Instituto de Salud Carlos III, Valladolid, Spain
| | - Fernando Vaquerizo-Villar
- Biomedical Engineering Group (GIB), University of Valladolid, Valladolid, Spain
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina, Instituto de Salud Carlos III, Valladolid, Spain
| | - Fernando Moreno
- Pneumology Department, Río Hortega University Hospital, Valladolid, Spain
| | - Félix Del Campo
- Biomedical Engineering Group (GIB), University of Valladolid, Valladolid, Spain
- Pneumology Department, Río Hortega University Hospital, Valladolid, Spain
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina, Instituto de Salud Carlos III, Valladolid, Spain
| | - Roberto Hornero
- Biomedical Engineering Group (GIB), University of Valladolid, Valladolid, Spain
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina, Instituto de Salud Carlos III, Valladolid, Spain
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Baumert M, Immanuel SA, Stone KL, Litwack Harrison S, Redline S, Mariani S, Sanders P, McEvoy RD, Linz D. Composition of nocturnal hypoxaemic burden and its prognostic value for cardiovascular mortality in older community-dwelling men. Eur Heart J 2021; 41:533-541. [PMID: 30590586 DOI: 10.1093/eurheartj/ehy838] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 08/17/2018] [Accepted: 11/22/2018] [Indexed: 11/13/2022] Open
Abstract
AIMS To investigate the composition of nocturnal hypoxaemic burden and its prognostic value for cardiovascular (CV) mortality in community-dwelling older men. METHODS AND RESULTS We analysed overnight oximetry data from polysomnograms obtained in 2840 men from the Outcomes of Sleep Disorders in Older Men (MrOS Sleep) study (ClinicalTrials.gov Identifier: NCT00070681) to determine the number of acute episodic desaturations per hour (oxygen desaturation index, ODI) and time spent below 90% oxygen saturation (T90) attributed to acute desaturations (T90desaturation) and to non-specific drifts in oxygen saturation (T90non-specific), respectively, and their relationship with CV mortality. After 8.8 ± 2.7 years follow-up, 185 men (6.5%) died from CV disease. T90 [hazard ratio (HR) 1.21, P < 0.001], but not ODI (HR 1.13, P = 0.06), was significantly associated with CV death in univariate analysis. T90 remained significant when adjusting for potential confounders (HR 1.16, P = 0.004). Men with T90 > 12 min were at an elevated risk of CV mortality (HR 1.59; P = 0.006). Approximately 20.7 (5.7-48.5) percent of the variation in T90 could be attributed to non-specific drifts in oxygen saturation. T90desaturation and T90non-specific were individually associated with CV death but combining both variables did not improve the prediction. CONCLUSION In community-dwelling older men, T90 is an independent predictor of CV mortality. T90 is not only a consequence of frank desaturations, but also reflects non-specific drifts in oxygen saturation, both contributing towards the association with CV death. Whether T90 can be used as a risk marker in the clinical setting and whether its reduction may constitute a treatment target warrants further study.
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Affiliation(s)
- Mathias Baumert
- School of Electrical and Electronic Engineering, University of Adelaide, North Terrace, Adelaide, SA 5000, Australia
| | - Sarah A Immanuel
- School of Electrical and Electronic Engineering, University of Adelaide, North Terrace, Adelaide, SA 5000, Australia
| | - Katie L Stone
- California Pacific Medical Center Research Institute, Brannan Street, San Francisco, CA 94107, USA
| | | | - Susan Redline
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Francis Street, Boston, MA 02115, USA.,Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Shattuck Street, Boston, MA 02115, USA
| | - Sara Mariani
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Francis Street, Boston, MA 02115, USA
| | - Prashanthan Sanders
- Center for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000, Australia
| | - R Doug McEvoy
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, and Sleep Health Service, Respiratory and Sleep Services, Southern Adelaide Local Health Network, Laffer Drive, Adelaide, SA 5042, Australia
| | - Dominik Linz
- Center for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000, Australia
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10
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Linz D, Malfertheiner MV, Werner N, Lerzer C, Gfüllner F, Linz B, Zeman F, McEvoy RD, Arzt M, Baumert M. Nocturnal hypoxemic burden during positive airway pressure treatment across different central sleep apnea etiologies. Sleep Med 2021; 79:62-70. [PMID: 33482454 DOI: 10.1016/j.sleep.2021.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 12/18/2020] [Accepted: 01/03/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Nocturnal hypoxemia is associated with increased cardiovascular mortality. Here, we assess whether positive airway pressure by adaptive servo-ventilation (ASV) reduces nocturnal hypoxemic burden in patients with primary central sleep apnea (primary CSA), or heart failure related central sleep apnea (CSA-HF) and treatment emergent central sleep apnea (TECSA). METHODS Overnight oximetry data from 328 consecutive patients who underwent ASV initiation between March 2010 and May 2018 were retrospectively analyzed. Patients were stratified into three groups: primary CSA (n = 14), CSA-HF (n = 31), TECSA (n = 129). Apnea hypopnea index (AHI) and time spent below 90% SpO2 (T90) was measured. Additionally, T90 due to acute episodic desaturations (T90Desaturation) and due to non-specific and non-cyclic drifts of SpO2 (T90Non-specific) were assessed. RESULTS ASV reduced the AHI below 15/h in all groups. ASV treatment significantly shortened T90 in all three etiologies to a similar extent. T90Desaturation, but not T90Non-specific, was reduced by ASV across all three patient groups. AHI was identified as an independent modulator for ΔT90Desaturation upon ASV treatment (B (95% CI: -1.32 (-1.73; -0.91), p < 0.001), but not for ΔT90 or ΔT90Non-specific. Body mass index was one independent predictor of T90. CONCLUSIONS Across different central sleep apnea etiologies, ASV reduced AHI, but nocturnal hypoxemic burden remained high due to a non-specific component of T90 not related to episodic desaturation. Whether adjunct risk factor management such as weight-loss can further reduce T90 warrants further study.
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Affiliation(s)
- Dominik Linz
- Center for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia; Department of Cardiology, Maastricht University Medical Centre, Maastricht, the Netherlands.
| | | | - Nils Werner
- Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | | | | | - Benedikt Linz
- University of Copenhagen, Faculty of Health Science, Department of Biomedical Sciences, Copenhagen, Denmark
| | - Florian Zeman
- Centre for Clinical Studies, University Medical Centre, Regensburg, Germany
| | - R Doug McEvoy
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, and Sleep Health Service, Respiratory and Sleep Services, Southern Adelaide Local Health Network, Adelaide, Australia
| | - Michael Arzt
- Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Mathias Baumert
- University of Adelaide, School of Electrical and Electronic Engineering, Adelaide, Australia
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Linz D, Loffler KA, Sanders P, Catcheside P, Anderson CS, Zheng D, Quan W, Barnes M, Redline S, McEvoy RD, Baumert M. Low Prognostic Value of Novel Nocturnal Metrics in Patients With OSA and High Cardiovascular Event Risk: Post Hoc Analyses of the SAVE Study. Chest 2020; 158:2621-2631. [PMID: 32679239 DOI: 10.1016/j.chest.2020.06.072] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 06/05/2020] [Accepted: 06/10/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Traditional methods for the quantification of OSA severity may not encapsulate potential relationships between hypoxemia in OSA and cardiovascular risk. RESEARCH QUESTION Do novel nocturnal oxygen saturation (Spo2) metrics have prognostic value in patients with OSA and high cardiovascular event risk? STUDY DESIGN AND METHODS We conducted post hoc analyses of the Sleep Apnea Cardiovascular Endpoints (SAVE) trial. In 2687 individuals, Cox proportional hazards models that were stratified for treatment allocation were used to determine the associations between clinical characteristics, pulse oximetry-derived metrics that were designed to quantify sustained and episodic features of hypoxemia, and cardiovascular outcomes. Metrics included oxygen desaturation index, time <90% Spo2, average Spo2 for the entire recording (mean Spo2), average Spo2 during desaturation events (desaturation Spo2), average baseline Spo2 interpolated across episodic desaturation events (baseline Spo2), episodic desaturation event duration and desaturation/resaturation-time ratio, and mean and SD of pulse rate. RESULTS Neither apnea-hypopnea index, oxygen desaturation index, nor any of the novel Spo2 metrics were associated with the primary SAVE composite cardiovascular outcome. Mean and baseline Spo2 were associated with heart failure (hazard ratio [HR], 0.81; 95% CI, 0.69-0.95; P = .009; and HR, 0.78; 95% CI, 0.67-0.90; P = .001, respectively) and myocardial infarction (HR, 0.86; 95% CI, 0.77-0.95; P = .003; and HR, 0.81; 95% CI, 0.73-0.90; P < .001, respectively). Desaturation duration and desaturation/resaturation time ratio, with established risk factors, predicted future heart failure (area under the curve, 0.86; 95% CI, 0.79-0.93). INTERPRETATION Apnea-hypopnea index and oxygen desaturation index were not associated with cardiovascular outcomes. In contrast, the pattern of oxygen desaturation was associated with heart failure and myocardial infarction. However, concomitant risk factors remained the predominant determinants for secondary cardiovascular events and thus deserve the most intensive management.
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Affiliation(s)
- Dominik Linz
- Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia; Department of Cardiology, Maastricht University Medical Centre, Maastricht, Cardiovascular Research Institute Maastricht (CARIM), University Maastricht, Maastricht, The Netherlands; Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - Kelly A Loffler
- Adelaide Institute for Sleep Health (AISH), College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Prashanthan Sanders
- Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Peter Catcheside
- Adelaide Institute for Sleep Health (AISH), College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Craig S Anderson
- George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; Neurology Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Danni Zheng
- George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - WeiWei Quan
- George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; Department of Cardiology, Rui Jin Hospital and Institute of Cardiovascular Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mary Barnes
- Flinders Centre for Epidemiology and Biostatistics, Flinders University, Adelaide, Australia
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - R Doug McEvoy
- Adelaide Institute for Sleep Health (AISH), College of Medicine and Public Health, Flinders University, Adelaide, Australia; Sleep Health Service, Respiratory and Sleep Services, Southern Adelaide Local Health Network, Adelaide, Australia
| | - Mathias Baumert
- School of Electrical and Electronic Engineering, University of Adelaide, Adelaide, Australia
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Cao W, Luo J, Xiao Y. A Review of Current Tools Used for Evaluating the Severity of Obstructive Sleep Apnea. Nat Sci Sleep 2020; 12:1023-1031. [PMID: 33239929 PMCID: PMC7680675 DOI: 10.2147/nss.s275252] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 10/08/2020] [Indexed: 12/21/2022] Open
Abstract
Obstructive sleep apnea (OSA) is a common and heterogeneous disease characterized by episodic collapse within the upper airways, which leads to reduced ventilation and adverse consequences, including hypoxia, hypercapnia, sleep fragmentation, and long-term effects such as cardiovascular comorbidities. The clinical diagnosis of OSA and its severity classification are often determined based on the apnea-hypopnea index (AHI), defining the number of apneic and hypopnea events per hour of sleep. However, the limitations of the AHI to assess disease severity have necessitated the exploration of other metrics for additional information to reflect the complexity of OSA. Novel parameters such as the hypoxic burden have the potential to better capture the main features of OSA by maximizing the information available from the polysomnogram. These emerging measures have described multidimensional qualities of sleep-disordered breathing events and breathing irregularity and will ultimately result in better management of OSA.
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Affiliation(s)
- Wenhao Cao
- Department of Respiratory Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China
| | - Jinmei Luo
- Department of Respiratory Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China
| | - Yi Xiao
- Department of Respiratory Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China
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Ribeiro S, Bonito L, Guimarães MJ, Português J, Rodrigues B, Alves A, Durães C, Ferreira D, Sanfins V, Lourenço A. Importance of cardiac implantable eletronic devices in the diagnosis of Sleep Apnea Syndrome. Rev Port Cardiol 2019; 38:451-455. [PMID: 31320221 DOI: 10.1016/j.repc.2018.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 06/13/2018] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Sleep Apnea Syndrome (SAS) is a prevalent respiratory disease with marked expression in the population with cardiovascular disease. The diagnosis is based on polysomnography. In patients with cardiac implantable electronic devices (CIED), the prevalence of SAS may reach 60%. The objective of this study was to evaluate the value of DEC in the SAS screening. METHODS Prospective study that included patients with CIED with sleep apnea algorithm. The frequency response function was activated and simplified polygraphy was performed. The data of the device were collected on the day of the polygraph. RESULTS The sample included 29 patients, with a mean age of 76.1 years, 71.4% of the male gender. The prevalence of SAS was 77%. For SAS, the agreement between polysomnography and the Pacemaker was Kappa = 0.54 (p = 0.001), 95% CI (0.28, 0.81) (moderate agreement); for moderate to severe SAS, the agreement was Kappa = 0.73 (p <0.001), 95% CI (0.49, 0.976) (substantial agreement). Severe SAS was obtained: sensitivity 60%, specificity 100%, positive predictive value 100%, negative predictive value 60% and diagnostic accuracy 75%; for moderate to severe SAS: sensitivity of 90%, specificity of 83%, positive predictive values of 90% and negative of 87.5%, with a diagnostic accuracy of 87.5%. CONCLUSION SAS is highly prevalent in patients with CIED. The values obtained through these devices have a strong positive correlation with the Apnea-Hypopnea Índex, which makes them a good tool for the screening of severe SAS.
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Affiliation(s)
- Sílvia Ribeiro
- Serviço de Cardiologia, Hospital Nossa Senhora da Oliveira, Guimarães, Portugal.
| | - Laura Bonito
- Serviço de Medicina Interna, Centro Hospitalar Lisboa Central, Hospital de São José, Lisboa, Portugal
| | | | - João Português
- Serviço de Cardiologia, Hospital Nossa Senhora da Oliveira, Guimarães, Portugal
| | | | - Assunção Alves
- Serviço de Cardiologia, Hospital Nossa Senhora da Oliveira, Guimarães, Portugal
| | - Célia Durães
- Serviço de Pneumologia, Hospital Nossa Senhora da Oliveira, Guimarães, Portugal
| | - Daniela Ferreira
- Serviço de Pneumologia, Hospital Nossa Senhora da Oliveira, Guimarães, Portugal
| | - Victor Sanfins
- Serviço de Cardiologia, Hospital Nossa Senhora da Oliveira, Guimarães, Portugal
| | - António Lourenço
- Serviço de Cardiologia, Hospital Nossa Senhora da Oliveira, Guimarães, Portugal
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Ribeiro S, Bonito L, Guimarães MJ, Português J, Rodrigues B, Alves A, Durães C, Ferreira D, Sanfins V, Lourenço A. Importance of cardiac implantable electronic devices in the diagnosis of sleep apnea syndrome. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.repce.2018.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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15
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Linz D, Baumert M, Catcheside P, Floras J, Sanders P, Lévy P, Cowie MR, Doug McEvoy R. Assessment and interpretation of sleep disordered breathing severity in cardiology: Clinical implications and perspectives. Int J Cardiol 2018; 271:281-288. [DOI: 10.1016/j.ijcard.2018.04.076] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 04/14/2018] [Accepted: 04/17/2018] [Indexed: 10/28/2022]
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