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Li A, Jaakkola MK, Saaresranta T, Klén R, Li XG. Analysis of sleep apnea research with a special focus on the use of positron emission tomography as a study tool. Sleep Med Rev 2024; 77:101967. [PMID: 38936220 DOI: 10.1016/j.smrv.2024.101967] [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: 03/01/2024] [Revised: 05/20/2024] [Accepted: 06/02/2024] [Indexed: 06/29/2024]
Abstract
The quality of sleep plays a significant role in determining human well-being, and studying sleep and sleep disorders using various methods can aid in the prevention and treatment of diseases. Positron emission tomography (PET) is a noninvasive and highly sensitive medical imaging technique that has been widely adopted in the clinic. This review article provides data on research activity related to sleep and sleep apnea and discusses the use of PET in investigating sleep apnea and other sleep disorders. We conducted a statistical analysis of the number of original research articles published on sleep and sleep apnea between 1965 and 2021 and found that there has been a dramatic increase in publications since 1990. The distribution of contributing countries and regions has also undergone significant changes. Although there is an extensive body of literature on sleep research (256,399 original research articles during 1965-2021), PET has only been used in 54 of these published studies, indicating a largely untapped area of research. Nonetheless, PET is a useful tool for identifying connections between sleep disorders and pathological changes in various diseases, including neurological, metabolic, and cardiovascular disorders, as well as cancer. To facilitate the broader use of PET in sleep apnea research, further studies are needed in both clinical and preclinical settings.
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Affiliation(s)
- Anting Li
- Turku PET Centre, University of Turku, Turku, Finland; Faculty of Medicine, University of Turku, Turku, Finland
| | - Maria K Jaakkola
- Turku PET Centre, University of Turku, Turku, Finland; Turku PET Centre, Turku University Hospital, Turku, Finland
| | - Tarja Saaresranta
- Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, Turku, Finland; Sleep Research Centre, Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland
| | - Riku Klén
- Turku PET Centre, University of Turku, Turku, Finland; Turku PET Centre, Turku University Hospital, Turku, Finland
| | - Xiang-Guo Li
- Turku PET Centre, University of Turku, Turku, Finland; Turku PET Centre, Turku University Hospital, Turku, Finland; InFLAMES Research Flagship, University of Turku, Turku, Finland; Department of Chemistry, University of Turku, Turku, Finland.
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Bikov A, Mihaicuta S. What has the ESADA Registry Contributed to the Current OSA Knowledge? Arch Bronconeumol 2024; 60:466-467. [PMID: 38902194 DOI: 10.1016/j.arbres.2024.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 06/01/2024] [Indexed: 06/22/2024]
Affiliation(s)
- Andras Bikov
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Faculty of Medical and Human Sciences, Manchester, United Kingdom
| | - Stefan Mihaicuta
- Centre for Research and Innovation in Precision Medicine of Respiratory Diseases, Department of Pulmonology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Timisoara, Romania.
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Bikov A, Bailly S, Testelmans D, Fanfulla F, Pataka A, Bouloukaki I, Hein H, Dogas Z, Basoglu OK, Staats R, Parati G, Lombardi C, Grote L, Mihaicuta S. The relationship between periodic limb movement during sleep and dyslipidaemia in patients with obstructive sleep apnea. J Sleep Res 2024; 33:e14012. [PMID: 37596874 DOI: 10.1111/jsr.14012] [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: 04/09/2023] [Revised: 07/16/2023] [Accepted: 07/18/2023] [Indexed: 08/20/2023]
Abstract
Periodic limb movements during sleep and obstructive sleep apnea are both associated with increased sympathetic tone, and have been proposed as risk factors for heart diseases and, in particular, cardiovascular disease. As sympathetic system activation may lead to dyslipidaemia, periodic limb movements during sleep could be an additional risk factor for cardiovascular disease in patients with obstructive sleep apnea. The aim of the study was to determine whether the presence of periodic limb movements during sleep affects serum lipid levels in obstructive sleep apnea. Total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, non- high-density lipoprotein cholesterol and triglyceride levels were investigated in 4138 patients with obstructive sleep apnea in the European Sleep Apnea Database (ESADA) cohort, divided into those with periodic limb movements during sleep index ≥ 15 per hr (n = 628) and controls (n = 3510). ANCOVA adjusted for age, sex, body mass index, apnea-hypopnea index, alcohol intake, smoking status, diabetes, insomnia and study site was used to assess differences in lipids between periodic limb movements during sleep and controls. Patients with periodic limb movements during sleep (24% female, 54.4 ± 12.1 years, body mass index 31.9 ± 5.8 kg m-2 , apnea-hypopnea index 36.7 ± 25.4 per hr) had higher triglyceride (1.81 ± 1.04 versus 1.69 ± 0.90 mmol L-1 , p = 0.002) and lower high-density lipoprotein cholesterol (1.19 ± 0.34 versus 1.24 ± 0.37 mmol L-1 , p = 0.002) levels, whilst there was no difference in either total cholesterol (4.98 ± 1.10 versus 4.94 ± 1.07 mmol L-1 ), low-density lipoprotein cholesterol (3.04 ± 0.96 versus 2.98 ± 0.98 mmol L-1 ) or non- high-density lipoprotein cholesterol (3.78 ± 1.10 versus 3.70 ± 1.05 mmol L-1 ) concentrations (all p > 0.05). The results remained unchanged after most sensitivity analyses. Patients with obstructive sleep apnea with periodic limb movements during sleep had more prevalent cardiovascular disease (11% versus 6%, p < 0.01). Periodic limb movements during sleep in obstructive sleep apnea is associated with dyslipidaemia independently of important confounders. Our results highlight periodic limb movements during sleep as an additional risk factor for cardiovascular disease in obstructive sleep apnea.
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Affiliation(s)
- Andras Bikov
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Division of Infection, Immunity & Respiratory Medicine, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Sebastien Bailly
- Grenoble Alpes University, Inserm, CHU Grenoble Alpes, Grenoble, France
| | - Dries Testelmans
- Department of Pneumology, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Leuven, Belgium
| | - Francesco Fanfulla
- Sleep Medicine Unit - Istituti Clinici Scientifici Maugeri - Istituto Scientifico di Pavia e Montescano IRCCS, Pavia, Italy
| | - Athanasia Pataka
- Respiratory Failure Unit, School of Medicine, G Papanikolaou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Izolde Bouloukaki
- Sleep Disorders Center, Department of Respiratory Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Holger Hein
- Private practice for Sleep Medicine and Sleep Disorders Center, Reinbek, Germany
| | - Zoran Dogas
- Sleep Medicine Center, Department of Neuroscience, University of Split School of Medicine, Split, Croatia
| | - Ozen K Basoglu
- Department of Respiratory Medicine, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Richard Staats
- Thorax Department, Centro Hospitalar Universitario Lisboa Norte, Lisbon, Portugal
- Instituto de Saúde Ambiental - ISAMB; Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Gianfranco Parati
- Sleep Center-Department of Cardiology, IRCCS, Istituto Auxologico Italiano, San Luca Hospital, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Carolina Lombardi
- Sleep Center-Department of Cardiology, IRCCS, Istituto Auxologico Italiano, San Luca Hospital, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Ludger Grote
- Center for Sleep and Wake Disorders, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Pulmonary Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Stefan Mihaicuta
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, Department of Pulmonology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Timisoara, Romania
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Hoff E, Strassberger C, Zou D, Grote L, Stenlöf K, Hedner J. Modification of Endotypic Traits in OSA by the Carbonic Anhydrase Inhibitor Sulthiame. Chest 2024; 165:704-715. [PMID: 37776971 DOI: 10.1016/j.chest.2023.09.022] [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: 04/14/2023] [Revised: 08/29/2023] [Accepted: 09/14/2023] [Indexed: 10/02/2023] Open
Abstract
BACKGROUND The carbonic anhydrase inhibitor sulthiame reduces OSA severity, increases overnight oxygenation, and improves sleep quality. Insights into how sulthiame modulates OSA pathophysiologic features (endotypic traits) adds to our understanding of the breathing disorder itself, as well as the effects of carbonic anhydrases in respiratory regulation. RESEARCH QUESTION How does sulthiame treatment modify endotypic traits in OSA? STUDY DESIGN AND METHODS Per-protocol tertiary analysis of a randomized controlled trial with the inclusion criteria as follow: BMI, ≥ 20 to ≤ 35 kg/m2; age, 18-75 years; apnea-hypopnea index (AHI) ≥ 15 events/h; Epworth sleepiness scale score, ≥ 6; as well as nonacceptance or nontolerance of positive airway pressure treatment. Patients were randomized to receive placebo (n = 22), sulthiame 200 mg (n = 12), or sulthiame 400 mg (n = 24) during 4 weeks of treatment. Polysomnography was applied twice at baseline and follow-up. Endotypic traits were determined from polysomnography tracings (PUPBeta). Sulthiame plasma concentration was analyzed. Differences from baseline to follow-up (Δs) were analyzed with the analysis of covariance or Kruskal-Wallis H test and Pearson (r) or Spearman correlations (rs). RESULTS Sulthiame (200-mg and 400-mg groups) consistently reduced loop gain (response to a 1-cycle/min disturbance, LG1; mean, -0.16 [95% CI, -0.18 to -0.13]; P < .05) in addition to increased ventilation at lowest decile of ventilatory drive (Vmin; median, +12 [95% CI, 4-20]; P < .05) and median ventilation at eupneic ventilatory drive (Vpassive; median, +4 [95% CI, 0-5]; P < .05). ΔLG1 correlated with ΔAHI percentage (200 mg: r = 0.65; P < .05). Vmin and Vpassive correlated with ΔAHI (all sulthiame: rs = -0.59 and rs = -0.65; P < .05 for all). The reduction of LG1 was seen already in the lower sulthiame concentration range, whereas changes in Vmin peaked in the higher range. INTERPRETATION The effect of sulthiame in OSA may be explained by a reduction of ventilatory instability (LG1) as well as upper airway collapsibility (Vmin and Vpassive). TRIAL REGISTRY European Union Drug Regulating Authorities Clinical Trials Database; No.: EudraCT 2017-004767-13; URL: https://www.clinicaltrialsregister.eu.
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Affiliation(s)
- Erik Hoff
- Centre for Sleep and Vigilance Disorders, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; Region Västra Götaland, Department of Infectious Diseases, Södra Älvsborgs Hospital, Borås, Sweden.
| | - Christian Strassberger
- Centre for Sleep and Vigilance Disorders, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Ding Zou
- Centre for Sleep and Vigilance Disorders, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Ludger Grote
- Centre for Sleep and Vigilance Disorders, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; Region Västra Götaland, Centre for Sleep Medicine, Department of Pulmonary Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kaj Stenlöf
- Centre for Sleep and Vigilance Disorders, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Jan Hedner
- Centre for Sleep and Vigilance Disorders, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; Region Västra Götaland, Centre for Sleep Medicine, Department of Pulmonary Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
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Bonsignore MR. Adaptive responses to chronic intermittent hypoxia: contributions from the European Sleep Apnoea Database (ESADA) Cohort. J Physiol 2023; 601:5467-5480. [PMID: 37218069 DOI: 10.1113/jp284108] [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: 02/01/2023] [Accepted: 05/18/2023] [Indexed: 05/24/2023] Open
Abstract
Obstructive sleep apnoea (OSA) is a common disease in the general population, and is associated with increased cardiovascular risk and several comorbidities. Obesity favours upper airway collapsibility, but other pathophysiological traits have been identified, i.e. upper airway muscle activity, modulation of the respiratory drive, and the arousal threshold. OSA causes chronic intermittent hypoxia, inflammatory activation and autonomic imbalance with diurnal and nocturnal sympathetic hyperactivity. Disentangling so many components to investigate the pathogenesis of OSA's consequences is very hard clinically. However, albeit imperfect, clinical medicine constitutes a major source of inspiration for basic research, and a mutual exchange of information is essential between clinicians and physiologists to improve our understanding of disease states. OSA is no exception, and this narrative review will summarize the results of clinical studies performed over the years by the European Sleep Apnoea Database (ESADA) Study Group, to explore the variables linked to markers of intermittent hypoxia as opposed to the traditional assessment of OSA severity based on the frequency of respiratory events during sleep (the Apnoea Hypopnoea Index). The results of the clinical studies indicate that intermittent hypoxia variables are associated with several comorbidities, although evidence of a cause-effect relationship is still missing in many cases. It is also possible that adaptive rather than maladaptive responses could be evoked by intermittent hypoxia. The intensity, duration and frequency of intermittent hypoxia episodes causing adaptive rather than maladaptive responses, and their clinical implications, deserve further investigation.
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Affiliation(s)
- Maria R Bonsignore
- PROMISE Department, University of Palermo, Palermo, Italy
- Sleep Disordered Breathing Clinic, Division of Pneumology, V. Cervello Hospital, Palermo, Italy
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Svedmyr S, Hedner J, Bailly S, Fanfulla F, Hein H, Lombardi C, Ludka O, Mihaicuta S, Parati G, Pataka A, Schiza S, Tasbakan S, Testelmans D, Zou D, Grote L. Blood pressure control in hypertensive sleep apnoea patients of the European Sleep Apnea Database cohort - effects of positive airway pressure and antihypertensive medication. EUROPEAN HEART JOURNAL OPEN 2023; 3:oead109. [PMID: 38035035 PMCID: PMC10686603 DOI: 10.1093/ehjopen/oead109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 09/27/2023] [Accepted: 10/10/2023] [Indexed: 12/02/2023]
Abstract
Aims We analysed longitudinal blood pressure (BP) data from hypertensive obstructive sleep apnoea (OSA) patients in the European Sleep Apnea Database cohort. The study investigated the interaction between positive airway pressure (PAP)-induced BP change and antihypertensive treatment (AHT). Methods and results Hypertensive patients with AHT [monotherapy/dual therapy n = 1283/652, mean age 59.6 ± 10.7/60.6 ± 10.3 years, body mass index (BMI) 34.2 ± 6.5/34.8 ± 7.0 kg/m2, apnoea-hypopnoea index 46 ± 25/46 ± 24 n/h, proportion female 29/26%, respectively] started PAP treatment. Office BP at baseline and 2- to 36-month follow-up were assessed. The interaction between AHT drug classes and PAP on BP was quantified and the influences of age, gender, BMI, co-morbidities, BP at baseline, and study site were evaluated. Following PAP treatment (daily usage, 5.6 ± 1.6/5.7 ± 1.9 h/day), systolic BP was reduced by -3.9 ± 15.5/-2.8 ± 17.7 mmHg in mono/dual AHT and diastolic BP by -3.0 ± 9.8/-2.7 ± 10.8 mmHg, respectively, all P < 0.0001. Systolic and diastolic BP control was improved following PAP treatment (38/35% to 54/46% and 67/67% to 79/74%, mono/dual AHT, respectively). PAP treatment duration predicted a larger BP improvement in the monotherapy group. Intake of renin-angiotensin blockers [angiotensin converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB)] alone or in any AHT combination was associated with better BP control. The AHT-dependent BP improvement was independent of confounders. Conclusion In this pan-European OSA patient cohort, BP control improved following initiation of PAP. Longer PAP treatment duration, was associated with a favourable effect on BP. Our study suggests that ACEI/ARB, alone or in combination with other drug classes, provides a particularly strong reduction of BP and better BP control when combined with PAP in OSA.
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Affiliation(s)
- Sven Svedmyr
- Department of Sleep Medicine, Sahlgrenska University Hospital, Blå stråket 5, 413 45 Gothenburg, Sweden
- Center for Sleep and Vigilance Disorders, Sahlgrenska Academy, Gothenburg University, Medicinaregatan 8B, Box 421, 405 30 Gothenburg, Sweden
| | - Jan Hedner
- Department of Sleep Medicine, Sahlgrenska University Hospital, Blå stråket 5, 413 45 Gothenburg, Sweden
- Center for Sleep and Vigilance Disorders, Sahlgrenska Academy, Gothenburg University, Medicinaregatan 8B, Box 421, 405 30 Gothenburg, Sweden
| | - Sebastien Bailly
- Université Grenoble Alpes, INSERM HP2 (U1042) and Grenoble University Hospital, Grenoble, France
| | - Francesco Fanfulla
- Unità Operativa di Medicina del Sonno, Istituto Scientifico di Pavia IRCCS, Pavia, Italy
| | - Holger Hein
- Sleep Disorders Center, St.Adolf Stift, Reinbeck, Germany
| | - Carolina Lombardi
- Cardiology Unit, Sleep Center, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Ondrej Ludka
- Department of Internal Medicine, University Hospital Brno, Brno, Czech Republic
| | - Stefan Mihaicuta
- Center for Research and Innovation in Precision Medicine and Pharmacy, ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, Romania
| | - Gianfranco Parati
- Cardiology Unit, Sleep Center, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Athanasia Pataka
- Respiratory Failure Unit, G. Papanikolaou Hospital, Aristotle University of Thessalonikii, Thessalonikii, Greece
| | - Sophia Schiza
- Sleep Disorders Unit, Department of Respiratory Medicine, School of Medicine, University of Crete, Crete, Greece
| | - Sezai Tasbakan
- Department of Chest Diseases, Ege University, Izmir, Turkey
| | - Dries Testelmans
- Sleep Disorders Centre, University Hospital Gasthuisberg, Leuven, Belgium
| | - Ding Zou
- Department of Sleep Medicine, Sahlgrenska University Hospital, Blå stråket 5, 413 45 Gothenburg, Sweden
- Center for Sleep and Vigilance Disorders, Sahlgrenska Academy, Gothenburg University, Medicinaregatan 8B, Box 421, 405 30 Gothenburg, Sweden
| | - Ludger Grote
- Department of Sleep Medicine, Sahlgrenska University Hospital, Blå stråket 5, 413 45 Gothenburg, Sweden
- Center for Sleep and Vigilance Disorders, Sahlgrenska Academy, Gothenburg University, Medicinaregatan 8B, Box 421, 405 30 Gothenburg, Sweden
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Song Y, Sun X, Ding L, Peng J, Song L, Zhang X. AHI estimation of OSAHS patients based on snoring classification and fusion model. Am J Otolaryngol 2023; 44:103964. [PMID: 37392727 DOI: 10.1016/j.amjoto.2023.103964] [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: 03/16/2023] [Revised: 06/13/2023] [Accepted: 06/17/2023] [Indexed: 07/03/2023]
Abstract
Obstructive sleep apnea-hypopnea syndrome (OSAHS) is a chronic and common sleep-breathing disease that could negatively influence lives of patients and cause serious concomitant diseases. Polysomnography(PSG) is the gold standard for diagnosing OSAHS, but it is expensive and requires overnight hospitalization. Snoring is a typical symptom of OSAHS. This study proposes an effective OSAHS screening method based on snoring sound analysis. Snores were labeled as OSAHS related snoring sounds and simple snoring sounds according to real-time PSG records. Three models were used, including acoustic features combined with XGBoost, Mel-spectrum combined with convolution neural network (CNN), and Mel-spectrum combined with residual neural network (ResNet). Further, the three models were fused by soft voting to detect these two types of snoring sounds. The subject's apnea-hypopnea index (AHI) was estimated according to these recognized snoring sounds. The accuracy and recall of the proposed fusion model achieved 83.44% and 85.27% respectively, and the predicted AHI has a Pearson correlation coefficient of 0.913 (R2 = 0.834, p < 0.001) with PSG. The results demonstrate the validity of predicting AHI based on analysis of snoring sound and show great potential for monitoring OSAHS at home.
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Affiliation(s)
- Yujun Song
- School of Physics and Optoelectronics, South China University of Technology, Guangzhou 510640, China
| | - Xiaoran Sun
- School of Physics and Optoelectronics, South China University of Technology, Guangzhou 510640, China.
| | - Li Ding
- School of Physics and Optoelectronics, South China University of Technology, Guangzhou 510640, China
| | - Jianxin Peng
- School of Physics and Optoelectronics, South China University of Technology, Guangzhou 510640, China.
| | - Lijuan Song
- State Key Laboratory of Respiratory Disease, Department of Otolaryngology-Head and Neck Surgery, Laboratory of ENT-HNS Disease, First Affiliated Hospital, Guangzhou Medical University, Guangzhou 510120, China
| | - Xiaowen Zhang
- State Key Laboratory of Respiratory Disease, Department of Otolaryngology-Head and Neck Surgery, Laboratory of ENT-HNS Disease, First Affiliated Hospital, Guangzhou Medical University, Guangzhou 510120, China
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Arterial bicarbonate is associated with hypoxic burden and uncontrolled hypertension in obstructive sleep apnea - The ESADA cohort. Sleep Med 2023; 102:39-45. [PMID: 36599194 DOI: 10.1016/j.sleep.2022.11.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Blood bicarbonate concentration plays an important role for obstructive sleep apnea (OSA) patients to maintain acid-base balance. We investigated the association between arterial standard bicarbonate ([HCO3-]) and nocturnal hypoxia as well as comorbid hypertension in OSA. METHODS A cross-sectional analysis of 3329 patients in the European Sleep Apnea Database (ESADA) was performed. Arterial blood gas analysis and lung function test were performed in conjunction with polysomnographic sleep studies. The 4% oxygen desaturation index (ODI), mean and minimum oxygen saturation (SpO2), and percentage of time with SpO2 below 90% (T90%) were used to reflect nocturnal hypoxic burden. Arterial hypertension was defined as a physician diagnosis of hypertension with ongoing antihypertensive medication. Hypertensive patients with SBP/DBP below or above 140/90 mmHg were classified as controlled-, uncontrolled hypertension, respectively. RESULTS The [HCO3-] level was normal in most patients (average 24.0 ± 2.5 mmol/L). ODI, T90% increased whereas mean and minimum SpO2 decreased across [HCO3-] tertiles (ANOVA, p = 0.030, <0.001, <0.001, and <0.001, respectively). [HCO3-] was independently associated with ODI, mean SpO2, minimum SpO2, and T90% after adjusting for confounders (β value [95%CI]: 1.21 [0.88-1.54], -0.16 [-0.20 to -0.11], -0.51 [-0.64 to -0.37], 1.76 [1.48-2.04], respectively, all p < 0.001). 1 mmol/L elevation of [HCO3-] was associated with a 4% increased odds of uncontrolled hypertension (OR: 1.04 [1.01-1.08], p = 0.013). CONCLUSION We first demonstrated an independent association between [HCO3-] and nocturnal hypoxic burden as well as uncontrolled hypertension in OSA patients. Bicarbonate levels as an adjunctive measure provide insight into the pathophysiology of hypertension in OSA.
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Svedmyr S, Hedner J, Bonsignore MR, Lombardi C, Parati G, Ludka O, Zou D, Grote L. Hypertension treatment in patients with sleep apnea from the European Sleep Apnea Database (ESADA) cohort - towards precision medicine. J Sleep Res 2022:e13811. [PMID: 36539972 DOI: 10.1111/jsr.13811] [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: 09/14/2022] [Revised: 10/26/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022]
Abstract
We recruited 5,970 hypertensive patients with obstructive sleep apnea (OSA) on current antihypertensive treatment from the European Sleep Apnea Database (ESADA) cohort. The group was subdivided into those receiving monotherapy (n = 3,594) and those receiving dual combined therapy (n = 2,376). We studied how major OSA confounders like age, gender, and body mass index as well as the degree of sleep apnea modified office systolic and diastolic blood pressure. Beta-blockers alone or in combination with a diuretic were compared with other antihypertensive drug classes. Monotherapy with beta-blocker was associated with lower systolic blood pressure, particularly in non-obese middle-aged males with hypertension. Conversely, the combination of a beta-blocker and a diuretic was associated with lower systolic and diastolic blood pressure in hypertensive patients with moderate-severe OSA. Systolic blood pressure was better controlled in female patients using this combined treatment. Our cross-sectional data suggest that specific clinical characteristics and type of antihypertensive medication influence the degree of blood pressure control in hypertensive OSA patients. Controlled trials are warranted.
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Affiliation(s)
- Sven Svedmyr
- Department of Sleep Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.,Center for Sleep and Vigilance Disorders, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Jan Hedner
- Department of Sleep Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.,Center for Sleep and Vigilance Disorders, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | | | - Carolina Lombardi
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural and Metabolic Sciences, St. Luke Hospital, Milan, Italy
| | - Gianfranco Parati
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural and Metabolic Sciences, St. Luke Hospital, Milan, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Ondrej Ludka
- Department of Internal, Geriatrics and Practical Medicine, University Hospital Brno and Medical Faculty, Masaryk University, Brno, Czech Republic
| | - Ding Zou
- Department of Sleep Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.,Center for Sleep and Vigilance Disorders, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Ludger Grote
- Department of Sleep Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.,Center for Sleep and Vigilance Disorders, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
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Øverby CT, Sutharshan P, Gulbrandsen P, Dammen T, Hrubos-Strøm H. Shared decision making: A novel approach to personalized treatment in obstructive sleep apnea. Sleep Med X 2022; 4:100052. [PMID: 36039181 PMCID: PMC9418975 DOI: 10.1016/j.sleepx.2022.100052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 07/22/2022] [Accepted: 07/25/2022] [Indexed: 12/25/2022] Open
Abstract
Study objectives i) To describe a novel approach of phenotyping by shared decision making (SDM) in obstructive sleep apnea (OSA) discharge consultations ii) to describe correlation between patient and observer based evaluations of SDM and iii) to describe treatment adherence. Methods Consecutive patients referred to the otorhinolaryngology department at Akershus University Hospital with suspected OSA between 2015 and 2016 participated. Patients with body mass index >30 were oversampled. Four male communication-trained doctors aged from 30 to 60 years participated. SDM was evaluated by modified content analysis and by the CollaboRATE self-report questionnaire and the "Observer OPTION (Young et al., 2008) [5]" rating scale. Positive airway pressure (PAP) treatment adherence and weight reduction was assessed by interview at six year follow-up. Results Eighteen consultations were video filmed. The content analysis revealed that the patient perspectives only briefly were explored. PAP was chosen by 17 of 18 patients. Median CollaboRATE questionnaire score was 29 (26, 30). Mean OPTION (Young et al., 2008) [5] score was 65.6 (SD 6.6, range 55-80). The correlation between SDM assessed by CollaboRATE self-report and by the "Observer OPTION (Young et al., 2008) [5]" rating scale was low (Pearson's r = 0.09). At follow up, 11 patients (64.7%) were PAP adherent and no one achieved 10% weight loss. Conclusions Despite a high degree of SDM compared to studies of non-OSA populations, the sub-optimal exploration of the patient perspective by communication-trained doctors precluded identification of patients willing to cope actively. SDM assessed by self-report and by a rating scale may represent two different constructs. PAP adherence was good.
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Affiliation(s)
- Caroline Tonje Øverby
- Division of Surgery, Department of Otolaryngology, Akershus University Hospital, Lørenskog, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway
| | - Prasanthy Sutharshan
- Division of Psychiatry, Department of Substance Abuse and Addiction, Akershus University Hospital, Åråsen, Norway
| | - Pål Gulbrandsen
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway
- HØKH, Department of Health Services Research, Akershus University Hospital, Lørenskog, Norway
| | - Toril Dammen
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway
- Division of Mental Health and Addiction, Department of Research and Innovation, Oslo University Hospital, Oslo, Norway
| | - Harald Hrubos-Strøm
- Division of Surgery, Department of Otolaryngology, Akershus University Hospital, Lørenskog, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway
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11
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Ulander M, Hedner J, Stillberg G, Sunnergren O, Grote L. Correlates of excessive daytime sleepiness in obstructive sleep apnea: Results from the nationwide SESAR cohort including 34,684 patients. J Sleep Res 2022; 31:e13690. [PMID: 35869576 PMCID: PMC9788005 DOI: 10.1111/jsr.13690] [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: 02/19/2022] [Revised: 06/20/2022] [Accepted: 06/21/2022] [Indexed: 12/30/2022]
Abstract
Excessive daytime sleepiness (EDS) is a hallmark symptom in obstructive sleep apnea (OSA). It is commonly eliminated by obstructive sleep apnea therapy and constitutes a major treatment indication. This study aimed to identify determinants of excessive daytime sleepiness by the Epworth Sleepiness Scale (ESS) scores in the large, representative national obstructive sleep apnea patient cohort of the Swedish Sleep Apnea Registry (SESAR, www.sesar.se). Data from 34,684 patients with obstructive sleep apnea recruited at 23 sites (33% females, mean age 55.7 ± 13.7 years, BMI 30.2 ± 6.3 kg/m2 , AHI 29.1 ± 22.3, and ODI 24.9 ± 21.4 events/h) had a mean ESS score in the mild to moderate excessive daytime sleepiness range (9.7 ± 4.9). The proportion of patients with excessive daytime sleepiness was 41.4% in men and 44.6% in women. Independent predictors of excessive daytime sleepiness included gender, age, and hypoxic markers (high ODI and low mean saturation). Univariate and multivariate analyses were used to identify significant predictors for the ESS score and for excessive daytime sleepiness (ESS ≥10) amongst anthropometric factors, sleep apnea frequency (apnea-hypopnea index (AHI)), markers of intermittent hypoxia (oxygen desaturation index (ODI), mean saturation (mSaO2 )), as well as prevalent comorbidities. Depression was associated with higher ESS scores and hypertension/atrial fibrillation with lower scores. The oxygen desaturation index provided a stronger predictor of excessive daytime sleepiness than the apnea-hypopnea index. The severity of obstructive sleep apnea, captured as the apnea-hypopnea index, was only weakly associated with daytime sleepiness in this representative obstructive sleep apnea patient cohort. Age had different effects in men and women.The impact of obstructive sleep apnea in a wider patient related perspective needs to be determined after the inclusion of factors other than the apnea-hypopnea index.
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Affiliation(s)
- Martin Ulander
- Department of Biomedical and Clinical Sciences, Faculty of MedicineLinköping UniversityLinköpingSweden,Department of Clinical NeurophysiologyLinköping University HospitalLinköpingSweden
| | - Jan Hedner
- Department Pulmonary MedicineSahlgrenska University HospitalGothenburgSweden,Centre for Sleep and Wake Disorders, Sahlgrenska AcademyGothenburg UniversityGothenburgSweden
| | | | - Ola Sunnergren
- Department of Otorhinolaryngology, Region Jönköping County, and Department of Biomedical and Clinical SciencesLinköping UniversityLinköpingSweden
| | - Ludger Grote
- Department Pulmonary MedicineSahlgrenska University HospitalGothenburgSweden,Centre for Sleep and Wake Disorders, Sahlgrenska AcademyGothenburg UniversityGothenburgSweden
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12
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Romero-Peralta S, García-Rio F, Resano Barrio P, Izquierdo Alonso JL, Viejo-Ayuso ME, Mediano San Andrés R, Silgado Martínez L, Álvarez Balado L, Naval JC, Fernández Francés J, Mediano O. Defining the Profile of Obstructive Sleep Apnea in Women Compared to Men. J Womens Health (Larchmt) 2022; 31:1782-1790. [PMID: 36166468 DOI: 10.1089/jwh.2021.0659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background: The importance of understanding the presentation of obstructive sleep apnea (OSA) in women has been increasingly recognized. Although there is some insight that there are significant differences in presentation between women and men, the consequences of such differences, particularly for treatment have not yet been fully identified. Thus, the objective of this study was to determine the phenotype of OSA in women. Materials and Methods: Study of a population-based clinical cohort of 2022 patients with OSA confirmed by polygraphy or polysomnography (apnea-hypopnea index [AHI] >5/hour). Comorbidities, symptoms, physical examination, current medical treatments, and sleep parameters were recorded. Results: A total of 709 women and 1313 men were included in this study. After adjustment for anthropometric characteristics, morphological alterations, and previous treatment, women were found to have lower AHI values (25.3 ± 1.2 vs. 35.0 ± 0.9; p < 0.001), desaturation index (24.4 ± 1.2 vs. 33.2 ± 0.9; p < 0.001), and saturation time <90% (18.8 ± 1.3 vs. 24.1 ± 1.0; p < 0.001) compared with men. Furthermore, women had a lower risk of witnessed apnea (odds ratio adjusted [ORa] for baseline characteristics and sleep parameters), (ORa: 0.53, 95% confidence interval [CI]: 0.40-0.71), reduced sensation of restful sleep (ORa: 0.50, 95% CI: 0.38-0.66), greater fatigue (ORa: 2.68, 95% CI: 1.86-3.86), headache (ORa: 3.00, 95% CI: 2.26-3.97), memory disorders (ORa: 1.836, 95% CI: 1.40-2.41), insomnia (ORa: 2.09, 95% CI: 1.50-2.93), and excessive daytime sleepiness (ORa: 1.41, 95% CI: 1.03-1.92), with interference in their daily activities (ORa: 1.54, 95% CI: 1.17-2.03). Likewise, after adjustment for anthropometric characteristics and sleep parameters, women also showed higher risk of depression (ORa: 4.31, 95% CI: 3.15-5.89) and anxiety (ORa: 3.18, 95% CI: 2.38-4.26). Conclusions: Our findings suggest that women present a specific OSA phenotype, with a probable implication for clinical, diagnostic, and therapeutic management.
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Affiliation(s)
- Sofia Romero-Peralta
- Sleep Unit, Pneumology Service, University Hospital of Guadalajara, Guadalajara, Spain.,Sleep Research Institute, Madrid, Spain
| | - Francisco García-Rio
- Pneumology Service, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Pilar Resano Barrio
- Sleep Unit, Pneumology Service, University Hospital of Guadalajara, Guadalajara, Spain
| | - Jose Luis Izquierdo Alonso
- Sleep Unit, Pneumology Service, University Hospital of Guadalajara, Guadalajara, Spain.,Department of Medicine and Specialties, University of Alcalá, Madrid, Spain
| | | | | | | | | | - Jorge Castelao Naval
- Sleep Unit, Pneumology Service, University Hospital of Guadalajara, Guadalajara, Spain
| | | | - Olga Mediano
- Sleep Unit, Pneumology Service, University Hospital of Guadalajara, Guadalajara, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.,Department of Medicine and Specialties, University of Alcalá, Madrid, Spain
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13
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Xu S, Faust O, Seoni S, Chakraborty S, Barua PD, Loh HW, Elphick H, Molinari F, Acharya UR. A review of automated sleep disorder detection. Comput Biol Med 2022; 150:106100. [PMID: 36182761 DOI: 10.1016/j.compbiomed.2022.106100] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 09/04/2022] [Accepted: 09/12/2022] [Indexed: 12/22/2022]
Abstract
Automated sleep disorder detection is challenging because physiological symptoms can vary widely. These variations make it difficult to create effective sleep disorder detection models which support hu-man experts during diagnosis and treatment monitoring. From 2010 to 2021, authors of 95 scientific papers have taken up the challenge of automating sleep disorder detection. This paper provides an expert review of this work. We investigated whether digital technology and Artificial Intelligence (AI) can provide automated diagnosis support for sleep disorders. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines during the content discovery phase. We compared the performance of proposed sleep disorder detection methods, involving differ-ent datasets or signals. During the review, we found eight sleep disorders, of which sleep apnea and insomnia were the most studied. These disorders can be diagnosed using several kinds of biomedical signals, such as Electrocardiogram (ECG), Polysomnography (PSG), Electroencephalogram (EEG), Electromyogram (EMG), and snore sound. Subsequently, we established areas of commonality and distinctiveness. Common to all reviewed papers was that AI models were trained and tested with labelled physiological signals. Looking deeper, we discovered that 24 distinct algorithms were used for the detection task. The nature of these algorithms evolved, before 2017 only traditional Machine Learning (ML) was used. From 2018 onward, both ML and Deep Learning (DL) methods were used for sleep disorder detection. The strong emergence of DL algorithms has considerable implications for future detection systems because these algorithms demand significantly more data for training and testing when compared with ML. Based on our review results, we suggest that both type and amount of labelled data is crucial for the design of future sleep disorder detection systems because this will steer the choice of AI algorithm which establishes the desired decision support. As a guiding principle, more labelled data will help to represent the variations in symptoms. DL algorithms can extract information from these larger data quantities more effectively, therefore; we predict that the role of these algorithms will continue to expand.
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Affiliation(s)
- Shuting Xu
- Cogninet Brain Team, Sydney, NSW, 2010, Australia
| | - Oliver Faust
- Anglia Ruskin University, East Rd, Cambridge CB1 1PT, UK.
| | - Silvia Seoni
- Department of Electronics and Telecommunications, Politecnico di Torino, Torino, Italy
| | - Subrata Chakraborty
- School of Science and Technology, Faculty of Science, Agriculture, Business and Law, University of New England, Armidale, NSW, 2351, Australia; Centre for Advanced Modelling and Geospatial Lnformation Systems (CAMGIS), Faculty of Engineer and Information Technology, University of Technology Sydney, Sydney, NSW, 2007, Australia
| | - Prabal Datta Barua
- Cogninet Brain Team, Sydney, NSW, 2010, Australia; Faculty of Engineering and Information Technology, University of Technology Sydney, Sydney, NSW, 2007, Australia; School of Business (Information System), University of Southern Queensland, Australia
| | - Hui Wen Loh
- School of Science and Technology, Singapore University of Social Sciences, 463 Clementi Road, 599494, Singapore
| | | | - Filippo Molinari
- Department of Electronics and Telecommunications, Politecnico di Torino, Torino, Italy
| | - U Rajendra Acharya
- School of Business (Information System), University of Southern Queensland, Australia; School of Science and Technology, Singapore University of Social Sciences, 463 Clementi Road, 599494, Singapore; Department of Computer Engineering, Ngee Ann Polytechnic, Singapore, Singapore; Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan.
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14
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McNicholas WT. Sleep medicine in Europe: 50 years of evolution. Breathe (Sheff) 2022; 18:220206. [PMID: 36340826 PMCID: PMC9584581 DOI: 10.1183/20734735.0206-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 08/22/2022] [Indexed: 11/07/2022] Open
Abstract
The evolution of sleep medicine in Europe over the past 50 years https://bit.ly/3AVexV8.
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Affiliation(s)
- Walter T. McNicholas
- School of Medicine, University College Dublin, Dublin, Ireland,Department of Respiratory and Sleep Medicine, St Vincent's Hospital Group, Dublin, Ireland,Corresponding author: Walter T. McNicholas ()
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15
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Abstract
Despite extensive research, there is currently no approved drug for obstructive sleep apnea (OSA) treatment. OSA is a heterogeneous condition that involves multiple dominating pathophysiological traits. Drug development in this field needs to address both pathophysiological mechanisms and associated comorbid conditions in order to meet requirements for long-term therapy in OSA. Several drug candidates have been proposed and ongoing phase II trials that target various forms of sleep-disordered breathing have been initiated. The field is moving toward tailored therapeutic approaches in patients with OSA.
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16
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Borsoi L, Armeni P, Donin G, Costa F, Ferini-Strambi L. The invisible costs of obstructive sleep apnea (OSA): Systematic review and cost-of-illness analysis. PLoS One 2022; 17:e0268677. [PMID: 35594257 PMCID: PMC9122203 DOI: 10.1371/journal.pone.0268677] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 05/03/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is a risk factor for several diseases and is correlated with other non-medical consequences that increase the disease's clinical and economic burden. However, OSA's impact is highly underestimated, also due to substantial diagnosis gaps. OBJECTIVE This study aims at assessing the economic burden of OSA in the adult population in Italy by performing a cost-of-illness analysis with a societal perspective. In particular, we aimed at estimating the magnitude of the burden caused by conditions for which OSA is a proven risk factor. METHODS A systematic literature review on systematic reviews and meta-analyses, integrated by expert opinion, was performed to identify all clinical and non-clinical conditions significantly influenced by OSA. Using the Population Attributable Fraction methodology, a portion of their prevalence and costs was attributed to OSA. The total economic burden of OSA for the society was estimated by summing the costs of each condition influenced by the disease, the costs due to OSA's diagnosis and treatment and the economic value of quality of life lost due to OSA's undertreatment. RESULTS Twenty-six clinical (e.g., diabetes) and non-clinical (e.g., car accidents) conditions were found to be significantly influenced by OSA, contributing to an economic burden ranging from €10.7 to €32.0 billion/year in Italy. The cost of impaired quality of life due to OSA undertreatment is between €2.8 and €9.0 billion/year. These costs are substantially higher than those currently borne to diagnose and treat OSA (€234 million/year). CONCLUSIONS This study demonstrates that the economic burden due to OSA is substantial, also due to low diagnosis and treatment rates. Providing reliable estimates of the economic impact of OSA at a societal level may increase awareness of the disease burden and help to guide evidence-based policies and prioritisation for healthcare, ultimately ensuring appropriate diagnostic and therapeutic pathways for patients.
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Affiliation(s)
- Ludovica Borsoi
- SDA Bocconi School of Management, Centre for Research on Health and Social Care Management (CERGAS), Milan, Italy
| | - Patrizio Armeni
- SDA Bocconi School of Management, Centre for Research on Health and Social Care Management (CERGAS), Milan, Italy
| | - Gleb Donin
- Department of Biomedical Technology, Czech Technical University in Prague, Kladno, Czech Republic
| | - Francesco Costa
- SDA Bocconi School of Management, Centre for Research on Health and Social Care Management (CERGAS), Milan, Italy
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17
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Palomäki M, Saaresranta T, Anttalainen U, Partinen M, Keto J, Linna M. Multimorbidity and overall comorbidity of sleep apnoea: a Finnish nationwide study. ERJ Open Res 2022; 8:00646-2021. [PMID: 35677395 PMCID: PMC9168083 DOI: 10.1183/23120541.00646-2021] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 03/25/2022] [Indexed: 11/23/2022] Open
Abstract
The prevalence of sleep apnoea is increasing globally; however, population-based studies have reported a wide variation of prevalence estimates, and data on incidence of clinically diagnosed sleep apnoea are scant. Data on the overall burden of comorbidities or multimorbidity in individuals with incident sleep apnoea are scarce, and the pathways to multimorbidity have only marginally been studied. To study the current epidemiology of sleep apnoea in Finland, overall burden of comorbidities, and multimorbidity profiles in individuals with incident sleep apnoea, we conducted a register-based, nationwide, retrospective study of data from January 2016 to December 2019. The prevalence of clinically diagnosed sleep apnoea was 3.7% in the Finnish adult population; 1-year incidence was 0.6%. Multimorbidity was present in 63% of individuals at the time of sleep apnoea diagnosis. Of those with incident sleep apnoea, 34% were heavily multimorbid (presenting with four or more comorbidities). The three most common chronic morbidities before sleep apnoea diagnosis were musculoskeletal disease, hypertension and cardiovascular disease. In multimorbid sleep apnoea patients, hypertension and metabolic diseases including obesity and diabetes, cardiovascular diseases, musculoskeletal diseases and dorsopathies, in different combinations, encompassed the most frequent disease pairs preceding a sleep apnoea diagnosis. Our study adds to the few population-based studies by introducing overall and detailed figures on the burden of comorbidities in sleep apnoea in a nationwide sample and provides up-to-date information on the occurrence of sleep apnoea as well as novel insights into multimorbidity in individuals with incident sleep apnoea. Two-thirds of individuals with sleep apnoea are multimorbid at diagnosis and one-third are heavily multimorbid. Dorsopathies, musculoskeletal diseases, hypertension and metabolic diseases are the most common comorbidities preceding sleep apnoea diagnosis.https://bit.ly/36WMlX1
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18
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Silveira MG, Sampol G, Mota-Foix M, Ferrer J, Lloberes P. Cluster-derived obstructive sleep apnea phenotypes and outcomes at 5-year follow-up. J Clin Sleep Med 2022; 18:597-607. [PMID: 34569926 PMCID: PMC8804983 DOI: 10.5664/jcsm.9674] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 09/15/2021] [Accepted: 09/16/2021] [Indexed: 02/03/2023]
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) is a heterogeneous, complex disease. We aimed to identify OSA phenotypes through cluster analysis and to perform a long-term follow-up to validate the phenotypes. METHODS We applied a partitioning around medioids technique in a cohort of 1,217 participants recently diagnosed with OSA. We performed a 5-year follow-up analyzing the incidence of comorbidities, chronic medication, hospital admissions, mortality, and the influence of continuous positive airway pressure treatment on mortality risk. RESULTS We identified three phenotypes: two predominantly male clusters, one composed of middle-aged participants with overweight, moderate OSA, and cardiovascular risk factors and the other consisting of older, obese participants with severe OSA, cardiovascular risk factors, ischemic heart disease (18.4%), and atrial fibrillation (9.7%). The third cluster was composed of 77% female participants with moderate OSA; cardiovascular risk factors; the highest prevalence of depression (15.7%); and high prescription of antidepressants (55.1%), anxiolytics (40.0%), hypnotics, sedatives (11.1%), nonsteroidal anti-inflammatory drugs (67.9%), and weak opioids (15.1%). The baseline characteristics of each cluster maintained the same trend over time regarding the incidence of new comorbidities, medication intake, hospitalization rates, and reasons for admission. The absence of continuous positive airway pressure treatment was associated with a significantly higher risk of all-cause mortality (hazard ratio 5.84, confidence interval 2.9-11.8), especially in the older men (hazard ratio 7.7, confidence interval 4.06-14.63) and predominantly female clusters (hazard ratio 2.79, confidence interval 1.34-5.79). CONCLUSIONS We identified three phenotypes with relevant clinical and prognostic implications in order to improve personalized strategies in OSA management. CITATION Silveira MG, Sampol G, Mota-Foix M, Ferrer J, Lloberes P. Cluster-derived obstructive sleep apnea phenotypes and outcomes at 5-year follow-up. J Clin Sleep Med. 2022;18(2):597-607.
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Affiliation(s)
- María Guadalupe Silveira
- Pneumology Department, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Gabriel Sampol
- Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
- Multidisciplinary Sleep Unit, Pneumology Department, Vall d’Hebron University Hospital, Barcelona, Spain
- Pneumology Department, Vall d’Hebron University Hospital, Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Instituto de la Salud Carlos III (ISCIIII), Madrid, Spain
| | - Miriam Mota-Foix
- Statistics and Bioinformatics Unit, Vall d’Hebron Research Institute, Barcelona, Spain
| | - Jaume Ferrer
- Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
- Pneumology Department, Vall d’Hebron University Hospital, Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Instituto de la Salud Carlos III (ISCIIII), Madrid, Spain
| | - Patricia Lloberes
- Multidisciplinary Sleep Unit, Pneumology Department, Vall d’Hebron University Hospital, Barcelona, Spain
- Pneumology Department, Vall d’Hebron University Hospital, Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Instituto de la Salud Carlos III (ISCIIII), Madrid, Spain
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A Fully Remote Diagnostic and Treatment Pathway in Patients with Obstructive Sleep Apnoea during the COVID-19 Pandemic: A Single Centre Experience. J Clin Med 2021; 10:jcm10194310. [PMID: 34640326 PMCID: PMC8509359 DOI: 10.3390/jcm10194310] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/19/2021] [Accepted: 09/20/2021] [Indexed: 12/12/2022] Open
Abstract
The COVID-19 pandemic led to significant delays in the diagnostic and management pathway of patients with obstructive sleep apnoea (OSA). During the first wave of COVID-19, our department adopted a fully remote diagnostic (home cardiorespiratory polygraphy) and treatment (autoset continuous positive airway pressure, CPAP) approach. As a novel mode of service delivery, our aim was to evaluate our pathway and analyse factors associated with adherence to CPAP. We analysed the first 300 patients (51 ± 13 years, 48% men) who were set up on remote CPAP between 20 May 2020 and 11 September 2020. The associations between CPAP usage at 90 days and age, gender, body mass index, disease severity, Epworth Sleepiness Scale and comorbidities were investigated with linear and logistic regression analyses. A total of 124 patients (41.3%) were fully-adherent to CPAP therapy, defined as CPAP usage ≥ 4 h on ≥ 70% of the days. Only driving status was associated with adherence to CPAP. Patients who were adherent at 28 days were more likely to stay adherent at 90 days (3.77 odd ratio /3.10-4.45/ 95% confidence interval). We have shown that a fully remote diagnostic and treatment pathway for patients with OSA can be successfully delivered, and our preliminary outcomes of adherence to CPAP are comparable with published data.
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20
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Bonsignore MR, Pepin JL, Cibella F, Barbera CD, Marrone O, Verbraecken J, Saaresranta T, Basoglu OK, Trakada G, Bouloukaki I, McNicholas WT, Bailly S, Pataka A, Kvamme JA, Hein H, Mihaicuta S, Grote L, Fanfulla F. Excessive Daytime Sleepiness in Obstructive Sleep Apnea Patients Treated With Continuous Positive Airway Pressure: Data From the European Sleep Apnea Database. Front Neurol 2021; 12:690008. [PMID: 34434158 PMCID: PMC8381644 DOI: 10.3389/fneur.2021.690008] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 05/31/2021] [Indexed: 12/17/2022] Open
Abstract
Excessive daytime sleepiness (EDS) is a symptom of obstructive sleep apnea (OSA) that resolves under treatment with continuous positive airway pressure (CPAP). In some patients, sleepiness persists despite CPAP treatment. We retrospectively analyzed data on subjective residual EDS, assessed as an Epworth Sleepiness Scale score (ESS) >10, in patients from the European Sleep Apnea Database (n = 4,853, mean age ± SD 54.8 ± 11.8 years, 26.1% females), at baseline and at the first visit (median follow-up: 5 months, interquartile range 3–13). An ESS > 10 occurred in 56% of patients at baseline and in 28.2% of patients at follow-up. Residual EDS was analyzed in 2,190 patients (age: 55.1 ± 12.0 years, 26.1% females) with sleep monitoring data (median follow-up: 3 months, interquartile range 1–15). Sleep studies during CPAP use were obtained in 58% of these patients; EDS was reported by 47.2% of patients at baseline and by 30.3% at follow-up. Residual OSA, defined as an apnea–hypopnea index >10/h, and insufficient CPAP adherence, defined as nightly use <4 h, occurred with similar frequency in patients with and without EDS at follow-up. Prevalence of residual EDS was highest (40%) in patients with a first follow-up visit at 0–3 months, then it was 13–19% in patients with a first follow-up visit after 4 months to 2 years. The change in ESS (n = 2,190) was weakly correlated with CPAP use (R2 = 0.023, p < 0.0001). Logistic regression showed that an ESS score >10 at the first follow-up visit was associated directly with ESS at baseline and inversely with duration of follow-up, and CPAP use (R2 of the model: 0.417). EDS showed heterogeneity in different European countries both at baseline and at the first follow-up visit, suggesting modulation by cultural and lifestyle factors. In conclusion, residual EDS in CPAP-treated OSA occurred in approximately one in four patients at follow-up; its prevalence was highest (40%) in the first 3 months of treatment and subsequently decreased. The finding of residual EDS in a significant percentage of optimally treated OSA patients suggests that wake-promoting agents may be useful, but their indication should be evaluated after at least 3 months of treatment.
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Affiliation(s)
- Maria R Bonsignore
- Sleep Disordered Breathing Clinic, Pulmonary Division, PROMISE Department, University of Palermo, Palermo, Italy.,National Research Council (CNR), Institute for Biomedical Research and Innovation (IRIB), Palermo, Italy
| | - Jean L Pepin
- HP2 Laboratory, U1042, INSERM, Grenoble Alpes University, Grenoble, France
| | - Fabio Cibella
- National Research Council (CNR), Institute for Biomedical Research and Innovation (IRIB), Palermo, Italy
| | - Calogero D Barbera
- Sleep Disordered Breathing Clinic, Pulmonary Division, PROMISE Department, University of Palermo, Palermo, Italy
| | - Oreste Marrone
- National Research Council (CNR), Institute for Biomedical Research and Innovation (IRIB), Palermo, Italy
| | - Johan Verbraecken
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital and University Hospital Antwerp, Antwerp, Belgium
| | - Tarja Saaresranta
- Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, Turku, Finland.,Department of Pulmonary Diseases and Clinical Allergology, Sleep Research Centre, University of Turku, Turku, Finland
| | - Ozen K Basoglu
- Department of Chest Diseases, Ege University Faculty of Medicine, Izmir, Turkey
| | - Georgia Trakada
- Division of Pulmonology, Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Izolde Bouloukaki
- Sleep Disorders Unit, Department of Respiratory Medicine, Medical School, University of Crete, Crete, Greece
| | - Walter T McNicholas
- Department of Respiratory and Sleep Medicine, School of Medicine, St. Vincent's Hospital Group, University College Dublin, Dublin, Ireland
| | - Sébastien Bailly
- HP2 Laboratory, U1042, INSERM, Grenoble Alpes University, Grenoble, France
| | - Athanasia Pataka
- Respiratory Failure Unit, G Papanikolaou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - John A Kvamme
- Ear, Nose and Throat-Department, Foerde Central Hospital, Foerde, Norway
| | - Holger Hein
- Private Practice and Sleep Lab for Internal Medicine, Pulmonary Medicine and Sleep Medicine, Geesthacht, Germany
| | - Stefan Mihaicuta
- Victor Babes University of Medicine and Pharmacy, CardioPrevent Foundation, Timisoara, Romania
| | - Ludger Grote
- Sleep Disorders Centre, Respiratory Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.,Centre for Sleep and Wake Disorders, Institute for Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Francesco Fanfulla
- Respiratory Function and Sleep Medicine Unit, Scientific Institutes of Pavia and Montescano, Istituti Clinici Scientifici Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Pavia, Italy
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21
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Mazzotti DR. Landscape of biomedical informatics standards and terminologies for clinical sleep medicine research: A systematic review. Sleep Med Rev 2021; 60:101529. [PMID: 34455108 DOI: 10.1016/j.smrv.2021.101529] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 05/14/2021] [Accepted: 07/03/2021] [Indexed: 12/31/2022]
Abstract
A systematic literature review was conducted to understand the current landscape of standards and terminologies used in clinical sleep medicine. Literature search on PubMed, EMBASE, Medline and Web of Science was performed in March 2021 using terms related to sleep, terminologies, standards, harmonization, semantics, ontology, and electronic health records (EHR). Systematic review was carried out according to PRISMA. Among 128 included studies, 35 were eligible for review. Articles were broadly classified into six topics: standard terminology efforts, reporting standards, databases and resources, data integration efforts, EHR abstraction and standards for automated sleep scoring. This review highlights the progress and challenges related to establishing computable terminologies in sleep medicine, and identifies gaps, limitations and research opportunities related to data integration that could improve adoption of clinical research informatics in this field. There is a need for the systematic adoption of standardized terminologies in all areas of sleep medicine. Existing data aggregation resources could be leveraged to support the development of an integrated infrastructure and subsequent deployment in EHR systems within sleep centers. Ultimately, the adoption of standardized practices for documenting sleep disorders and related traits facilitates data sharing, thus accelerating discovery and clinical translation of informatics approaches applied to sleep medicine.
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Affiliation(s)
- Diego R Mazzotti
- Division of Medical Informatics, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA.
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22
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Bouloukaki I, Grote L, McNicholas WT, Hedner J, Verbraecken J, Parati G, Lombardi C, Basoglu OK, Pataka A, Marrone O, Steiropoulos P, Bonsignore MR, Schiza SE. Mild obstructive sleep apnea increases hypertension risk, challenging traditional severity classification. J Clin Sleep Med 2021; 16:889-898. [PMID: 32043960 DOI: 10.5664/jcsm.8354] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The association of mild obstructive sleep apnea (OSA) with important clinical outcomes remains unclear. We aimed to investigate the association between mild OSA and systemic arterial hypertension (SAH) in the European Sleep Apnea Database cohort. METHODS In a multicenter sample of 4,732 participants, we analyzed the risk of mild OSA (subclassified into 2 groups: mildAHI 5-<11/h (apnea-hypopnea index [AHI], 5 to <11 events/h) and mildAHI 11-<15/h (AHI, ≥11 to <15 events/h) compared with nonapneic snorers for prevalent SAH after adjustment for relevant confounding factors including sex, age, smoking, obesity, daytime sleepiness, dyslipidemia, chronic obstructive pulmonary disease, type 2 diabetes, and sleep test methodology (polygraphy or polysomnography). RESULTS SAH prevalence was higher in the mildAHI 11-<15/h OSA group compared with the mildAHI 5-<11/h group and nonapneic snorers (52% vs 45% vs 30%; P < .001). Corresponding adjusted odds ratios for SAH were 1.789 (mildAHI 11-<15/h; 95% confidence interval [CI], 1.49-2.15) and 1.558 (mildAHI 5-<11/h; 95%, CI, 1.34-1.82), respectively (P < .001). In sensitivity analysis, mildAHI 11-<15/h OSA remained a significant predictor for SAH both in the polygraphy (odds ratio, 1.779; 95% CI, 1.403-2.256; P < .001) and polysomnography groups (odds ratio, 1.424; 95% CI, 1.047-1.939; P = .025). CONCLUSIONS Our data suggest a dose-response relationship between mild OSA and SAH risk, starting from 5 events/h in polygraphy recordings and continuing with a further risk increase in the 11- to <150-events/h range. These findings potentially introduce a challenge to traditional thresholds of OSA severity and may help to stratify participants with OSA according to cardiovascular risk.
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Affiliation(s)
- Izolde Bouloukaki
- Sleep Disorders Center, Department of Respiratory Medicine, University of Crete, Heraklion, Greece
| | - Ludger Grote
- Department of Sleep Medicine, Sahlgrenska University Hospital, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Walter T McNicholas
- Department of Respiratory and Sleep Medicine, St. Vincent's University Hospital, School of Medicine, University College, Dublin, Ireland
| | - Jan Hedner
- Department of Sleep Medicine, Sahlgrenska University Hospital, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Johan Verbraecken
- Antwerp University Hospital, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Gianfranco Parati
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Carolina Lombardi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Ozen K Basoglu
- Department of Chest Diseases, Ege University Faculty of Medicine, Izmir, Turkey
| | - Athanasia Pataka
- Department of Respiratory Medicine, Respiratory Failure Unit, G. Papanikolaou Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Oreste Marrone
- National Research Council (CNR), Istituto per la Ricerca e l'Innovazione Biomedica, Palermo, Italy
| | - Paschalis Steiropoulos
- Sleep Unit, Department of Pneumonology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Marisa R Bonsignore
- Dipartimento di Promozione della Salute, Materno-Infantile, Medicina Interna e Specialistica di Eccellenza (PROMISE), University of Palermo, Palermo, Italy; *Contributed equally
| | - Sophia E Schiza
- Sleep Disorders Center, Department of Respiratory Medicine, University of Crete, Heraklion, Greece
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23
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Meszaros M, Mathioudakis AG, Xanthoudaki M, Sircu V, Nena E, Vestbo J, Corlateanu A, Steiropoulos P, Bikov A. The association between beta-blocker therapy and daytime sleepiness in obstructive sleep apnoea. Sleep Biol Rhythms 2021. [DOI: doi.org/10.1007/s41105-021-00330-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AbstractDaytime sleepiness is a cardinal symptom of obstructive sleep apnoea (OSA) and a well-recognised side effect of beta-blockers, therefore patients with OSA under this treatment may have worse sleepiness. However, the interaction between daytime sleepiness and beta-blockers use has not been thoroughly investigated in patients with OSA before. We analysed the data of 2183 individuals (1852 patients with OSA and 331 snorer controls) from 3 countries (Greece, Hungary and Moldova). Medical history, including medication usage and the Epworth Sleepiness Scale (ESS) were recorded. Patients and controls were divided into somnolent (ESS ≥ 11) and non-somnolent (ESS < 11) groups, and the association between-blocker use with the somnolent group was investigated with multivariate logistic regression analysis adjusted for confounders. Sensitivity analyses were performed in each cohort, in the severity subgroups, in patients who did not take statins and in those who had polysomnography as a diagnostic test. There was no relationship between beta-blocker usage and the somnolent OSA (p = 0.24) or control (p = 0.64) groups. These results were similar in sensitivity analyses (all p > 0.05). ESS was related to BMI (ρ = 0.25), total sleep time (ρ = 0.07), AHI (ρ = 0.32), oxygen desaturation index (ρ = 0.33) and minimum oxygen saturation (ρ = – 0.32, all p < 0.05) in OSA, and was higher in patients with hypertension, diabetes and cerebro/cardiovascular disease and those who took statins (all p < 0.05). In general, beta-blockers are not associated with increased daytime sleepiness in OSA. Thus, the diagnosis of OSA should not discourage initiation of beta-blocker treatment, if it is clinically indicated.
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24
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Meszaros M, Mathioudakis AG, Xanthoudaki M, Sircu V, Nena E, Vestbo J, Corlateanu A, Steiropoulos P, Bikov A. The association between beta-blocker therapy and daytime sleepiness in obstructive sleep apnoea. Sleep Biol Rhythms 2021. [DOI: 10.1007/s41105-021-00330-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AbstractDaytime sleepiness is a cardinal symptom of obstructive sleep apnoea (OSA) and a well-recognised side effect of beta-blockers, therefore patients with OSA under this treatment may have worse sleepiness. However, the interaction between daytime sleepiness and beta-blockers use has not been thoroughly investigated in patients with OSA before. We analysed the data of 2183 individuals (1852 patients with OSA and 331 snorer controls) from 3 countries (Greece, Hungary and Moldova). Medical history, including medication usage and the Epworth Sleepiness Scale (ESS) were recorded. Patients and controls were divided into somnolent (ESS ≥ 11) and non-somnolent (ESS < 11) groups, and the association between-blocker use with the somnolent group was investigated with multivariate logistic regression analysis adjusted for confounders. Sensitivity analyses were performed in each cohort, in the severity subgroups, in patients who did not take statins and in those who had polysomnography as a diagnostic test. There was no relationship between beta-blocker usage and the somnolent OSA (p = 0.24) or control (p = 0.64) groups. These results were similar in sensitivity analyses (all p > 0.05). ESS was related to BMI (ρ = 0.25), total sleep time (ρ = 0.07), AHI (ρ = 0.32), oxygen desaturation index (ρ = 0.33) and minimum oxygen saturation (ρ = – 0.32, all p < 0.05) in OSA, and was higher in patients with hypertension, diabetes and cerebro/cardiovascular disease and those who took statins (all p < 0.05). In general, beta-blockers are not associated with increased daytime sleepiness in OSA. Thus, the diagnosis of OSA should not discourage initiation of beta-blocker treatment, if it is clinically indicated.
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25
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Tasbakan MS, Grote L, Hedner J, Kvamme JA, Verbraecken J, McNicholas WT, Roisman G, Tkacova R, Bonsignore MR, Saaresranta T, Steiropoulos P, Marrone O, Basoglu OK. Positive airway pressure (PAP) treatment reduces glycated hemoglobin (HbA1c) levels in obstructive sleep apnea patients with concomitant weight loss: Longitudinal data from the ESADA. J Sleep Res 2021; 30:e13331. [PMID: 33987873 DOI: 10.1111/jsr.13331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 02/13/2021] [Accepted: 02/19/2021] [Indexed: 11/28/2022]
Abstract
Patients with obstructive sleep apnea (OSA) are at increased risk of developing metabolic disease such as diabetes. The effects of positive airway pressure on glycemic control are contradictory. We therefore evaluated the change in glycated hemoglobin (HbA1c) in a large cohort of OSA patients after long-term treatment with positive airway pressure. HbA1c levels were assessed in a subsample of the European Sleep Apnea Database [n=1608] at baseline and at long-term follow up with positive airway pressure therapy (mean 378.9±423.0 days). In a regression analysis, treatment response was controlled for important confounders. Overall, HbA1c decreased from 5.98±1.01% to 5.93±0.98% (p=0.001). Patient subgroups with a more pronounced HbA1c response included patients with diabetes (-0.15±1.02, p=0.019), those with severe OSA baseline (-0.10±0.68, p=0.005), those with morbid obesity (-0.20±0.81, p<0.001). The strongest HbA1c reduction was observed in patients with a concomitant weight reduction >5 kilos (-0.38±0.99, p<0.001). In robust regression analysis, severe OSA (p=0.038) and morbid obesity (p=0.005) at baseline, and weight reduction >5 kilos (p<0.001) during follow up were independently associated with a reduction of HbA1c following PAP treatment. In contrast, PAP treatment alone without weight reduction was not associated with significant Hb1Ac reduction. In conclusion, positive airway pressure therapy is associated with HbA1c reduction in patients with severe OSA, in morbidly obese patients. and most obviously in those with significant weight lost during the follow-up. Our study underlines the importance to combine positive airway pressure use with adjustments in lifestyle to substantially modify metabolic complications in OSA.
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Affiliation(s)
| | - Ludger Grote
- Sleep Disorders Center, Center for Sleep and Wake Disorders, Sahlgrenska University Hospital, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Jan Hedner
- Sleep Disorders Center, Center for Sleep and Wake Disorders, Sahlgrenska University Hospital, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | | | - Johan Verbraecken
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium
| | - Walter T McNicholas
- Department of Respiratory Medicine, School of Medicine, St Vincent's Hospital Group, University College Dublin, Dublin, Ireland
| | - Gabriel Roisman
- Sleep Disorders Centre, Hospital Antoine-Beclere, Clamart, France
| | - Ruzena Tkacova
- Department of Respiratory Medicine and Tuberculosis, Faculty of Medicine, P.J. Safarik University, Kosice, Slovakia
| | | | - Tarja Saaresranta
- Division of Medicine, Department of Pulmonary Diseases, Department of Pulmonary Diseases and Clinical Allergology, Turku University Hospital and Sleep Research Centre, University of Turku, Turku, Finland
| | - Paschalis Steiropoulos
- Sleep Unit, Department of Pneumonology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Oreste Marrone
- National Research Council, Istituto per la Ricerca e l'Innovazione Biomedica, Palermo, Italy
| | - Ozen K Basoglu
- Department of Chest Diseases, Ege University Faculty of Medicine, Izmir, Turkey
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26
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Staats R, Bailly S, Bonsignore MR, Ryan S, Riha RL, Schiza S, Verbraecken J, Basoglu OK, Saaresranta T, Pataka A, Ludka O, Lombardi C, Hedner JA, Grote L. Impact of temperature on obstructive sleep apnoea in three different climate zones of Europe: Data from the European Sleep Apnoea Database (ESADA). J Sleep Res 2021; 30:e13315. [PMID: 33840143 DOI: 10.1111/jsr.13315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 01/17/2021] [Accepted: 02/02/2021] [Indexed: 12/30/2022]
Abstract
Recent studies indicate that ambient temperature may modulate obstructive sleep apnoea (OSA) severity. However, study results are contradictory warranting more investigation in this field. We analysed 19,293 patients of the European Sleep Apnoea Database (ESADA) cohort with restriction to the three predominant climate zones according to the Köppen-Geiger climate classification: Cfb (warm temperature, fully humid, warm summer), Csa (warm temperature, summer dry, hot summer), and Dfb (snow, fully humid, warm summer). Average outside temperature values were obtained and several hierarchical regression analyses were performed to investigate the impact of temperature on the apnea-hypopnea index (AHI), oxygen desaturation index (ODI), time of oxygen saturation <90% (T90) and minimum oxygen saturation (MinSpO2 ) after controlling for confounders including age, body mass index, gender, and air conditioning (A/C) use. AHI and ODI increased with higher temperatures with a standardised coefficient beta (β) of 0.28 for AHI and 0.25 for ODI, while MinSpO2 decreased with a β of -0.13 (all results p < .001). When adjusting for climate zones, the temperature effect was only significant in Cfb (AHI: β = 0.11) and Dfb (AHI: β = 0.08) (Model 1: p < .001). The presence of A/C (3.9% and 69.3% in Cfab and Csa, respectively) demonstrated only a minor increase in the prediction of the variation (Cfb: AHI, R2 +0.003; and Csa: AHI, R2 +0.007; both p < .001). Our present study indicates a limited but consistent influence of environmental temperature on OSA severity and this effect is modulated by climate zones.
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Affiliation(s)
- Richard Staats
- Department of Pneumology, University Hospital de Santa Maria, CHULN, Lisbon, Portugal.,Faculdade de Medicina, Instituto de Saúde Ambiental (ISAMB), Universidade de Lisboa, Lisbon, Portugal
| | - Sébastien Bailly
- Université Grenoble Alpes, INSERM HP2 (U1042) and Grenoble University Hospital, Grenoble, France
| | | | - Silke Ryan
- Pulmonary and Sleep Disorders Unit, School of Medicine, St. Vincent's University Hospital, University College Dublin, Dublin, Ireland
| | - Renata L Riha
- Department of Sleep Medicine, Royal Infirmary Edinburgh, Edinburgh, UK
| | - Sophia Schiza
- Sleep Disorders Unit, Department of Respiratory Medicine, Medical School, University of Crete, Heraklion, Greece
| | - Johan Verbraecken
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Antwerp, Belgium.,University of Antwerp, Antwerp, Belgium
| | - Ozen K Basoglu
- Department of Chest Diseases, Ege University, Izmir, Turkey
| | - Tarja Saaresranta
- Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, Turku, Finland.,Department of Pulmonary Diseases and Clinical Allergology, Sleep Research Centre, University of Turku, Turku, Finland
| | - Athanasia Pataka
- Respiratory Failure Unit, G. Papanikolaou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ondrej Ludka
- Department of Cardiology, University Hospital Brno, Brno, Czech Republic.,International Clinical Research Center, St. Ann's University Hospital, Brno, Czech Republic
| | - Carolina Lombardi
- Department of Cardiovascular, Neural Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, St. Luke Hospital, Milan, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Jan Anders Hedner
- Pulmonary Department, Sleep Disorders Center, Sahlgrenska University Hospital, Gothenbrug, Sweden.,Center of Sleep and Wake Disorders, Sahlgrenska Academy, Gothenburg University, Göteborg, Sweden
| | - Ludger Grote
- Pulmonary Department, Sleep Disorders Center, Sahlgrenska University Hospital, Gothenbrug, Sweden.,Center of Sleep and Wake Disorders, Sahlgrenska Academy, Gothenburg University, Göteborg, Sweden
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27
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Pengo MF, Faini A, Grote L, Ludka O, Joppa P, Pataka A, Dogas Z, Mihaicuta S, Hein H, Anttalainen U, Ryan S, Lombardi C, Parati G. Impact of Sleep Apnea on Cardioembolic Risk in Patients With Atrial Fibrillation: Data From the ESADA Cohort. Stroke 2020; 52:712-715. [PMID: 33272126 DOI: 10.1161/strokeaha.120.030285] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE An accurate determination of the cardioembolic risk in patients with atrial fibrillation (AF) is crucial to prevent consequences like stroke. Obstructive sleep apnea (OSA) is a known risk factor for both AF and stroke. We aim to explore a possible association between OSA and an increased cardioembolic risk in patients with AF. METHODS We assessed data from the ESADA (European Sleep Apnea Database) cohort where patients with known AF and OSA were included. Parameters of OSA severity and related hypoxia like lowest Spo2 and 4% oxygen desaturation index were analyzed. Patients were stratified according to their cardioembolic risk estimated with the CHA2DS2-VASc score. RESULTS From the initial cohort of 14 646 patients, a final set of 363 patients were included in the analysis. Indices of hypoxia during sleep were associated with increased CHA2DS2-VASc score (4% oxygen desaturation index 17.9 versus 29.6 versus 30.5 events/hour and the lowest Spo2 81.2 versus 77.8 versus 77.5% for low, moderate, and high cardioembolic risk, respectively, P<0.05). CONCLUSIONS These results support the potential role of OSA-related hypoxia in the risk for cardioembolic complications such as stroke in patients with AF.
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Affiliation(s)
- Martino F Pengo
- IRCCS Istituto Auxologico Italiano, Milan, Italy (M.F.P., A.F., C.L., G.P.)
| | - Andrea Faini
- IRCCS Istituto Auxologico Italiano, Milan, Italy (M.F.P., A.F., C.L., G.P.)
| | - Ludger Grote
- Sleep Disorders Center, Respiratory Medicine, Sahgrenska University Hospital, Gothenburg, Sweden (L.G.)
| | - Ondrej Ludka
- Department of Internal Medicine and Cardiology, University Hospital Brno (O.L.)
| | - Pavol Joppa
- University Hospital L. Pasteur Košice - Univerzitná nemocnica L. Pasteura Košice, Slovakia (P.J.)
| | - Athanasia Pataka
- Department of Respiratory Medicine, Respiratory Failure Unit, G.Papanikolaou Hospital, Aristotle University of Thessaloniki, Greece (A.P.)
| | - Zoran Dogas
- Sleep Medicine Center, Department of Neurosciences, University of Split School of Medicine, Split, Croatia (Z.D.)
| | - Stefan Mihaicuta
- Department of Pulmonology, CardioPrevent Foundation, University of Medicine and Pharmacy Victor Babes Timisoara, Romania (S.M.)
| | - Holger Hein
- Sleep Disorders Center, Reinbeck, Germany (H.H.)
| | - Ulla Anttalainen
- Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, University of Turku, Finland (U.A.)
| | - Silke Ryan
- Pulmonary and Sleep Disorders Unit, St Vincent's University Hospital and School of Medicine, University College Dublin, Ireland (S.R.)
| | - Carolina Lombardi
- IRCCS Istituto Auxologico Italiano, Milan, Italy (M.F.P., A.F., C.L., G.P.).,Department of Medicine and Surgery, University of Milan-Bicocca, Italy (C.L., G.P.)
| | - Gianfranco Parati
- IRCCS Istituto Auxologico Italiano, Milan, Italy (M.F.P., A.F., C.L., G.P.).,Department of Medicine and Surgery, University of Milan-Bicocca, Italy (C.L., G.P.)
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28
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Ogeil RP, Prasad S, O'Driscoll DM, Li WYH, Lubman DI, Young AC. Psychoactive drug and medication use among patients referred to a tertiary sleep laboratory population. Psychiatry Res 2020; 294:113545. [PMID: 33212412 DOI: 10.1016/j.psychres.2020.113545] [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: 02/25/2020] [Accepted: 10/24/2020] [Indexed: 11/30/2022]
Abstract
Psychoactive drugs including alcohol, caffeine, and prescription medications are commonly consumed to alter sleep/wake states, however the prevalence and impact of these drugs among populations seeking assessment from sleep physicians are unknown. We investigated the prevalence of commonly used drugs (alcohol and caffeine), and medications in a population (N=120; 50 females and 70 males) attending a tertiary sleep clinic for diagnostic polysomnography (PSG) assessment. In addition to objective sleep assessment, participants completed questionnaires assessing sleep quality (Pittsburgh Sleep Quality Index, PSQI), daytime sleepiness (Epworth Sleepiness Scale, ESS), depression and anxiety (Hospital Anxiety and Depression Scale, HADS), alcohol use (Alcohol Use Disorders Identification Test, AUDIT), caffeine and medication use, as well as their experience of adverse events (motor vehicle accidents and near-miss crashes). Caffeine was consumed by 90% of the population and was associated with a reduction in excessive sleepiness symptomology; while high AUDIT scores were associated with increased near-miss crashes. Polypharmacy was common, with a greater number of medications associated with poorer sleep quality, and changes in sleep architecture. This study maps commonly used drugs in those attending a tertiary sleep clinic, and demonstrates associations between drug use and sleep outcomes assessed objectively and subjectively.
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Affiliation(s)
- Rowan P Ogeil
- Eastern Health Clinical School, Monash University, 5 Arnold Street, Box Hill 3128, VIC, Australia; Turning Point, Eastern Health, 110 Church Street, Richmond 3121, VIC, Australia; Monash Addiction Research Centre (MARC), Monash University, Peninsula Campus, Level 3, Building G, Moorooduc Hwy, Frankston 3199, VIC, Australia.
| | - Shivonne Prasad
- Department of Respiratory and Sleep Medicine, Eastern Health, Melbourne, Australia
| | - Denise M O'Driscoll
- Eastern Health Clinical School, Monash University, 5 Arnold Street, Box Hill 3128, VIC, Australia; Department of Respiratory and Sleep Medicine, Eastern Health, Melbourne, Australia
| | - William Y H Li
- Department of Respiratory and Sleep Medicine, Eastern Health, Melbourne, Australia
| | - Dan I Lubman
- Eastern Health Clinical School, Monash University, 5 Arnold Street, Box Hill 3128, VIC, Australia; Turning Point, Eastern Health, 110 Church Street, Richmond 3121, VIC, Australia; Monash Addiction Research Centre (MARC), Monash University, Peninsula Campus, Level 3, Building G, Moorooduc Hwy, Frankston 3199, VIC, Australia
| | - Alan C Young
- Eastern Health Clinical School, Monash University, 5 Arnold Street, Box Hill 3128, VIC, Australia; Department of Respiratory and Sleep Medicine, Eastern Health, Melbourne, Australia
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29
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Obstructive sleep apnoea in adult patients post-tonsillectomy. Sleep Med 2020; 78:189-192. [PMID: 33453687 DOI: 10.1016/j.sleep.2020.11.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 11/11/2020] [Accepted: 11/19/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND The impact of removing the upper airway lymphoid tissue and in particular, tonsillectomy, in adults with OSA has not been demonstrated in large populations. AIMS To compare the severity of OSA and the prevalence of cardiovascular, metabolic and respiratory co-morbidities between patients with OSA who had undergone previous tonsillectomy and those who had not. METHODS The 19,711 participants in this study came from the European sleep apnea database (ESADA) which comprises data from unselected adult patients aged 18-80 years with a history of symptoms suggestive of OSA referred to sleep centers throughout Europe. RESULTS There were no differences between the two groups in terms of sex ratio and age (146 patients with previous tonsillectomy vs. 19565 patients without). Patients who had undergone tonsillectomy had a lower body mass index (29.3 ± 5.2 kg/m2 vs 32.2 ± 6.6 kg/m2, p < 0.001), lower subjective sleep latency (17.1 ± 17.8 min vs 25.5 ± 30.4 min, p = 0.001), lower ODI (15.7 ± 18.3 events/hour vs 30.7 ± 26.1 events/hour, p < 0.001), and SpO2<90% time during sleep (21.8 ± 47.5 min vs 52.6 ± 80.8 min, p < 0.001). OSA patients with tonsillectomy had a lower prevalence of Type II diabetes mellitus (p = 0.001), hypertension (p < 0.001) and a higher prevalence of hyperlipidemia (p < 0.001) and were less likely to be commenced on CPAP (p < 0.001). CONCLUSION In a large population of almost 20,000 OSA patients from across Europe, patients who had undergone tonsillectomy presented with less severe OSA at time of diagnosis, and had a lower prevalence of Type II diabetes mellitus and cardiovascular co-morbidities.
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Bikov A, Frent S, Pleava R, Kunos L, Bokhari S, Meszaros M, Mihaicuta S. The Burden of Associated Comorbidities in Patients with Obstructive Sleep Apnea-Regional Differences in Two Central-Eastern European Sleep Centers. J Clin Med 2020; 9:jcm9113583. [PMID: 33172084 PMCID: PMC7694741 DOI: 10.3390/jcm9113583] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/05/2020] [Accepted: 11/02/2020] [Indexed: 02/07/2023] Open
Abstract
Background: Obstructive sleep apnea (OSA) is usually associated with cardiovascular and cerebrovascular disease, metabolic syndrome and depression. Data on relevant OSA-associated comorbidities in Central–European populations are scarce. The aim of this study was to compare the prevalence of comorbidities in two OSA cohorts from Hungary and Romania. Methods: Data from 588 (282 from Hungary, 306 from Romania) untreated patients with OSA were retrospectively analyzed. The prevalence rates of hypertension, diabetes, dyslipidemia, allergic rhinitis, asthma, chronic obstructive pulmonary disease (COPD), osteoporosis, cerebrovascular and cardiovascular disease, arrhythmia and depression were compared between the two populations following adjustment for demographics, body mass index, smoking history, comorbidities and sleep parameters. Results: The prevalence rates of hypertension, arrhythmia, cerebrovascular and cardiovascular disease, diabetes and COPD in the whole study population were directly related to the severity of OSA. We found an inverse correlation between the prevalence of osteoporosis and OSA severity (all p < 0.05). Following adjustment, the prevalence of dyslipidemia was higher in the Hungarian cohort, whilst the prevalence of asthma, cardiovascular and cerebrovascular diseases was higher in the Romanian cohort (all p < 0.05). Conclusions: There was no difference in the prevalence rate of most comorbidities in patients with OSA from the two cohorts, except for dyslipidemia, asthma, cardiovascular and cerebrovascular disease.
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Affiliation(s)
- Andras Bikov
- Department of Pulmonology, Semmelweis University, Budapest 1085, Hungary; (A.B.); (L.K.); (M.M.)
- North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester M239LT, UK;
- Division of Infection, Immunity & Respiratory Medicine, University of Manchester, Manchester M239LT, UK
| | - Stefan Frent
- Department of Pulmonology, University of Medicine and Pharmacy, Timisoara 300041, Romania;
- Correspondence:
| | - Roxana Pleava
- Department of Cardiology, University of Medicine and Pharmacy, Timisoara 300041, Romania;
| | - Laszlo Kunos
- Department of Pulmonology, Semmelweis University, Budapest 1085, Hungary; (A.B.); (L.K.); (M.M.)
| | - Saba Bokhari
- North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester M239LT, UK;
| | - Martina Meszaros
- Department of Pulmonology, Semmelweis University, Budapest 1085, Hungary; (A.B.); (L.K.); (M.M.)
| | - Stefan Mihaicuta
- Department of Pulmonology, University of Medicine and Pharmacy, Timisoara 300041, Romania;
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Bailly S, Grote L, Hedner J, Schiza S, McNicholas WT, Basoglu OK, Lombardi C, Dogas Z, Roisman G, Pataka A, Bonsignore MR, Pepin JL. Clusters of sleep apnoea phenotypes: A large pan-European study from the European Sleep Apnoea Database (ESADA). Respirology 2020; 26:378-387. [PMID: 33140467 DOI: 10.1111/resp.13969] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/25/2020] [Accepted: 10/12/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND OBJECTIVE To personalize OSA management, several studies have attempted to better capture disease heterogeneity by clustering methods. The aim of this study was to conduct a cluster analysis of 23 000 OSA patients at diagnosis using the multinational ESADA. METHODS Data from 34 centres contributing to ESADA were used. An LCA was applied to identify OSA phenotypes in this European population representing broad geographical variations. Many variables, including symptoms, comorbidities and polysomnographic data, were included. Prescribed medications were classified according to the ATC classification and this information was used for comorbidity confirmation. RESULTS Eight clusters were identified. Four clusters were gender-based corresponding to 54% of patients, with two clusters consisting only of men and two clusters only of women. The remaining four clusters were mainly men with various combinations of age range, BMI, AHI and comorbidities. The preferred type of OSA treatment (PAP or mandibular advancement) varied between clusters. CONCLUSION Eight distinct clinical OSA phenotypes were identified in a large pan-European database highlighting the importance of gender-based phenotypes and the impact of these subtypes on treatment prescription. The impact of cluster on long-term treatment adherence and prognosis remains to be studied using the ESADA follow-up data set.
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Affiliation(s)
- Sébastien Bailly
- HP2 Laboratory, Grenoble Alpes University, INSERM U1042, Grenoble, France.,EFCR Laboratory, Grenoble Alpes University Hospital, Grenoble, France
| | - Ludger Grote
- Department of Sleep Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.,Sleep and Vigilance Laboratory, Internal Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Jan Hedner
- Department of Sleep Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.,Sleep and Vigilance Laboratory, Internal Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Sofia Schiza
- Sleep Disorders Unit, Department of Respiratory Medicine, Medical School, University of Crete, Crete, Greece
| | - Walter T McNicholas
- Department of Respiratory and Sleep Medicine, St. Vincent's Hospital Group, Dublin, Ireland.,Conway Research Institute, School of Medicine, University College Dublin, Dublin, Ireland
| | - Ozen K Basoglu
- Department of Chest Diseases, Ege University, Izmir, Turkey
| | - Carolina Lombardi
- Sleep Disorder Center, Cardiology Department, Istituto Auxologico Italiano IRCCS, Ospedale San Luca, University of Milano Bicocca, Milan, Italy
| | - Zoran Dogas
- Split Sleep Medicine Centre and Department of Neuroscience, University of Split School of Medicine, Split, Croatia
| | - Gabriel Roisman
- Sleep Disorders Centre, Antoine Béclère Hospital, Clamart, France
| | - Athanasia Pataka
- Respiratory Failure Unit, G Papanikolaou Hospital, Aristotle University, Thessaloniki, Greece
| | - Maria R Bonsignore
- Respiratory Medicine, PROMISE Department, University of Palermo and IRIB-CNR, Palermo, Italy
| | - Jean-Louis Pepin
- HP2 Laboratory, Grenoble Alpes University, INSERM U1042, Grenoble, France.,EFCR Laboratory, Grenoble Alpes University Hospital, Grenoble, France
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Gunduz C, Basoglu OK, Kvamme JA, Verbraecken J, Anttalainen U, Marrone O, Steiropoulos P, Roisman G, Joppa P, Hein H, Trakada G, Hedner J, Grote L, Steiropoulos P, Verbraecken J, Petiet E, Trakada G, Montserrat J, Fietze I, Penzel T, Ondrej L, Rodenstein D, Masa J, Bouloukaki I, Schiza S, Kent B, McNicholas W, Ryan S, Riha R, Kvamme J, Hein H, Schulz R, Grote L, Hedner J, Zou D, Pépin J, Levy P, Bailly S, Lavie L, Lavie P, Basoglu O, Tasbakan M, Varoneckas G, Joppa P, Tkacova R, Staats R, Barbé F, Lombardi C, Parati G, Drummond M, van Zeller M, Bonsignore M, Marrone O, Petitjean M, Roisman G, Pretl M, Vitols A, Dogas Z, Galic T, Pataka A, Anttalainen U, Saaresranta T, Plywaczewski R, Sliwinski P, Bielicki P. Long-term positive airway pressure therapy is associated with reduced total cholesterol levels in patients with obstructive sleep apnea: data from the European Sleep Apnea Database (ESADA). Sleep Med 2020; 75:201-209. [DOI: 10.1016/j.sleep.2020.02.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 02/02/2020] [Accepted: 02/25/2020] [Indexed: 12/18/2022]
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Abstract
AIMS Arterial hypertension is highly prevalent and difficult to control in patients with obstructive sleep apnea (OSA). High sympathoadrenergic activity is a hallmark physiological phenomenon in OSA. We hypothesized that an antihypertensive drug with inhibitory properties on this activity, such as beta blockers (BBs), may be particularly efficacious in OSA patients. METHODS Hypertensive OSA patients receiving blood pressure-lowing treatment in the European Sleep Apnea Database (ESADA) (n = 5818, 69% men, age 58 ± 11 years, body mass index 33 ± 7 kg/m2, apnea hypopnea index 34 ± 26 events/h) were analyzed. Reported medications [BB, diuretic, renin-angiotensin blocker (RAB), calcium channel blocker (CCB), and centrally acting antihypertensive (CAH)] were classified according to ATC code. Office blood pressure was compared in patients with monotherapy or combination therapy controlling for confounders. RESULTS Poorly controlled SBP according to the ESC/ESH guidelines was found in 66% of patients. Patients receiving monotherapy with RAB, CCB or CAH had 2.2 (95% CI 1.4-3.0), 3.0 (1.9-4.1) and 3.0 (1.7-4.7) mmHg higher SBP compared with those on BB (adjusted model, P = 0.007, 0.008 and 0.017, respectively). In those with a combination of two antihypertensive drugs, SBP was 5.5 (4.0-7.1), 5.1 (3.7-6.6), 4.3 (2.5-6.1) and 3.1 (1.6-4.6) mmHg higher in those on CCB/RAB, BB/RAB, BB/CCB or diuretic/RAB compared with those on BB/diuretic (adjusted model, P < 0.001, <0.001, 0.018 and 0.036, respectively). CONCLUSION Poorly controlled blood pressure was common in OSA patients with antihypertensive medication. Treatment with BB alone or BB in combination with a diuretic was associated with the lowest systolic pressure in this large clinical cohort.
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Marrone O, Cibella F, Roisman G, Sliwinski P, Joppa P, Basoglu OK, Bouloukaki I, Schiza S, Pataka A, Staats R, Verbraecken J, Hedner J, Grote L, Bonsignore MR. Effects of sleep apnea and kidney dysfunction on objective sleep quality in nondialyzed patients with chronic kidney disease: an ESADA study. J Clin Sleep Med 2020; 16:1475-1481. [PMID: 32364929 DOI: 10.5664/jcsm.8542] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
STUDY OBJECTIVES Patients with chronic kidney disease (CKD) often report poor sleep quality, but they commonly exhibit OSA. The aim of this study was to evaluate the influence of OSA severity and of estimated glomerular filtration rate impairment on objective sleep quality in nondialyzed patients with CKD, defined as an estimated glomerular filtration rate <60 mL/min/1.73m². METHODS Polysomnographic sleep characteristics were compared between patients with (n = 430) and without CKD (n = 6,639) in the European Sleep Apnea Database cohort. Comparisons were repeated in 375 patients with CKD and 375 control patients without CKD matched for sleep center, age, sex, and AHI, and in 310 matched CKD and non-CKD patients without psychiatric disturbances. RESULTS Among all patients with and without CKD, total sleep time was similar but sleep stage N1 (median 8.7% [IQR 4.8-18.0] vs 6.7% [3.6-12.7], respectively) and sleep stage R (12.6% [6.8-17.7] vs 14.2% [8.8-19.8], respectively) significantly differed (P < .0001). No difference in sleep characteristics was observed between matched patients either with or without psychiatric disturbances. After subdividing the matched patients according to AHI tertile (<25, ≥25 to <49, and ≥49 events/h) and estimated glomerular filtration rate (≥60, 45 to <60, <45 mL/min/1.73m²), we found a significant effect of AHI on sleep stages N2, N3, and R (P < .001), but there was no effect of CKD. CONCLUSIONS In nondialyzed patients with CKD, objective sleep quality is influenced similarly by AHI as in patients without CKD but is not affected by CKD severity. Previously reported poor sleep quality in CKD may partly result from the high prevalence of OSA in CKD.
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Affiliation(s)
- Oreste Marrone
- Istituto per la Ricerca e l'Innovazione Biomedica, National Research Council, Palermo, Italy
| | - Fabio Cibella
- Istituto per la Ricerca e l'Innovazione Biomedica, National Research Council, Palermo, Italy
| | - Gabriel Roisman
- Sleep Disorders Centre, Antoine-Béclère Hospital, Clamart, France
| | - Pawel Sliwinski
- Second Department of Respiratory Medicine, Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | - Pavol Joppa
- Department of Respiratory Medicine and Tuberculosis, P.J. Safarik University, Kosice, Slovakia
| | - Ozen K Basoglu
- Department of Chest Diseases, Ege University, Izmir, Turkey
| | - Izolde Bouloukaki
- Sleep Disorders Center, Department of Respiratory Medicine, University of Crete, Heraklion, Greece
| | - Sophia Schiza
- Sleep Disorders Center, Department of Respiratory Medicine, University of Crete, Heraklion, Greece
| | - Athanasia Pataka
- Respiratory Failure Unit, G. Papanikolaou Hospital, Aristotle University of Thessaloniki, Greece
| | - Richard Staats
- Department of Respiratory Medicine, Hospital de Santa Maria, CHULN, Lisbon, Portugal
| | - Johan Verbraecken
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Antwerp, Belgium
| | - Jan Hedner
- Department of Sleep Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ludger Grote
- Department of Sleep Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Maria R Bonsignore
- Istituto per la Ricerca e l'Innovazione Biomedica, National Research Council, Palermo, Italy.,Biomedical Department of Internal and Specialistic Medicine, University of Palermo, Italy
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Rolon R, Gareis I, Larrateguy L, Di Persia L, Spies R, Rufiner H. Automatic scoring of apnea and hypopnea events using blood oxygen saturation signals. Biomed Signal Process Control 2020. [DOI: 10.1016/j.bspc.2020.102062] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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36
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Lim DC, Mazzotti DR, Sutherland K, Mindel JW, Kim J, Cistulli PA, Magalang UJ, Pack AI, de Chazal P, Penzel T. Reinventing polysomnography in the age of precision medicine. Sleep Med Rev 2020; 52:101313. [PMID: 32289733 PMCID: PMC7351609 DOI: 10.1016/j.smrv.2020.101313] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 02/21/2020] [Accepted: 03/09/2020] [Indexed: 12/14/2022]
Abstract
For almost 50 years, sleep laboratories around the world have been collecting massive amounts of polysomnographic (PSG) physiological data to diagnose sleep disorders, the majority of which are not utilized in the clinical setting. Only a small fraction of the information available within these signals is utilized to generate indices. For example, the apnea-hypopnea index (AHI) remains the primary tool for diagnostic and therapeutic decision-making for obstructive sleep apnea (OSA) despite repeated studies showing it to be inadequate in predicting clinical consequences. Today, there are many novel approaches to PSG signals, making it possible to extract more complex metrics and analyses that are potentially more clinically relevant for individual patients. However, the pathway to implement novel PSG metrics/analyses into routine clinical practice is unclear. Our goal with this review is to highlight some of the novel PSG metrics/analyses that are becoming available. We suggest that stronger academic-industry relationships would facilitate the development of state-of-the-art clinical research to establish the value of novel PSG metrics/analyses in clinical sleep medicine. Collectively, as a sleep community, it is time to reinvent how we utilize the polysomnography to move us towards Precision Sleep Medicine.
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Affiliation(s)
- Diane C Lim
- Division of Sleep Medicine/Department of Medicine, University of Pennsylvania, United States.
| | - Diego R Mazzotti
- Division of Sleep Medicine/Department of Medicine, University of Pennsylvania, United States
| | - Kate Sutherland
- Charles Perkins Centre and Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Australia; Department Respiratory and Sleep Medicine, Royal North Shore Hospital, Australia
| | - Jesse W Mindel
- Division of Pulmonary, Critical Care and Sleep Medicine, The Ohio State University, Wexner Medical Center, United States
| | - Jinyoung Kim
- University of Pennsylvania School of Nursing, Philadelphia, PA, United States
| | - Peter A Cistulli
- Charles Perkins Centre and Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Australia; Department Respiratory and Sleep Medicine, Royal North Shore Hospital, Australia
| | - Ulysses J Magalang
- Division of Pulmonary, Critical Care and Sleep Medicine, The Ohio State University, Wexner Medical Center, United States
| | - Allan I Pack
- Division of Sleep Medicine/Department of Medicine, University of Pennsylvania, United States
| | - Philip de Chazal
- Charles Perkins Centre and School of Electrical and Information Engineering, Faculty of Engineering, University of Sydney, Australia
| | - Thomas Penzel
- Center for Sleep Medicine, Charite Universitätsmedizin, Berlin, Germany; Saratov State University, Saratov, Russia
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Grote L, McNicholas WT, Hedner J. Sleep apnoea management in Europe during the COVID-19 pandemic: data from the European Sleep Apnoea Database (ESADA). Eur Respir J 2020; 55:13993003.01323-2020. [PMID: 32366489 PMCID: PMC7236823 DOI: 10.1183/13993003.01323-2020] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 04/23/2020] [Indexed: 01/15/2023]
Abstract
Sleep disordered breathing (SDB) is highly prevalent, with a male to female predominance of two to one, and is more common in middle-aged and elderly subjects [1]. Affected patients often present with comorbidities such as obesity, cardiovascular disease (systemic hypertension, heart failure, atrial fibrillation) and diabetes mellitus type II [2]. The strong overlap between the profile for SDB patients and the identified risk factors for adverse outcomes of coronavirus disease 2019 (COVID-19) infection, which include age, male sex and cardiometabolic comorbidity [3], suggest that SDB patients may benefit from effective therapy if confronted with COVID-19 infection [4]. This study identified an 80% shutdown of sleep apnoea management throughout Europe. Most services have been limited to phone-based follow-up and the management of high-priority cases. Mitigation strategies appear to be insufficiently exploited.https://bit.ly/2KWf3IY
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Affiliation(s)
- Ludger Grote
- Centre for Sleep and Wake Disorders, Institute for Internal Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden .,Sleep Disorders Centre, Dept of Respiratory Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Walter T McNicholas
- Dept of Respiratory and Sleep Medicine, St Vincent's Hospital Group, School of Medicine, University College, Dublin, Ireland
| | - Jan Hedner
- Centre for Sleep and Wake Disorders, Institute for Internal Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Sleep Disorders Centre, Dept of Respiratory Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
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38
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Schiza SE, Randerath W, Sánchez-de-la-Torre M, Aliverti A, Bonsignore M, Simonds AK, Laveneziana P. Continuous professional development: elevating sleep andbreathing disorder education in Europe. Breathe (Sheff) 2020; 16:190336. [PMID: 32194769 PMCID: PMC7078742 DOI: 10.1183/20734735.0336-2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Sleep and breathing disorders are highly prevalent, representing a growing subspecialty of respiratory medicine. The term sleep disordered breathing (SDB) encompasses a range of conditions characterised by abnormal breathing during sleep, from chronic or habitual snoring, to frank obstructive sleep apnoea (OSA) or, in some cases, central sleep apnoea (CSA) and hypoventilation syndromes. OSA is the commonest form of SDB, leading to many potential consequences and adverse clinical outcomes, including excessive daytime sleepiness, impaired daytime function, metabolic dysfunction, and an increased risk of cardiovascular disease and mortality [1]. The estimated reported prevalence of moderate-to-severe SDB (≥15 events·h−1) was 23.4% in women and 49.7% in men, and the prevalence of symptomatic OSA was 9% and 13%, respectively [2]. However, in some populations, the prevalence of OSA is substantially higher, such as in patients been evaluated for bariatric surgery (estimated range 70–80%), in patients who have had a transient ischaemic attack or stroke (estimated range 60–70%) and in patients with cardiometabolic disease [3–6]. Limited data have been reported on CSA and non-obstructive sleep-related hypoventilation, which have received considerable interest in the sleep field within the past 10 years. Even if their prevalence was noted to be quite low relative to the prevalence of OSA [7], they are quite common in specific subpopulations [8–10]. The @EuroRespSoclaunches a new sleep and breathing disorders continuous professional development programmehttp://bit.ly/30PU01P
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Affiliation(s)
- Sophia E Schiza
- Sleep Disorders Unit, Dept of Respiratory Medicine, University General Hospital, Medical School of the University of Crete, Heraklion, Crete, Greece
| | - Winfried Randerath
- Institute of Pneumology at the University of Cologne, Bethanien Hospital, Clinic for Pneumology and Allergology, Centre of Sleep Medicine and Respiratory Care, Solingen, Germany
| | - Manuel Sánchez-de-la-Torre
- Group of Precision Medicine in Chronic Diseases, Hospital Arnau de Vilanova-Santa Maria, IRBLleida, Lleida, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Andrea Aliverti
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - MariaR Bonsignore
- Sleep and Chronic Respiratory Failure Clinic, University Hospital Paolo Giaccone, PROMISE Dept, University of Palermo, Palermo, Italy.,IRIB, National Research Council (CNR), Palermo, Italy
| | - Anita K Simonds
- Sleep and Ventilation Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Pierantonio Laveneziana
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie respiratoire Expérimentale et clinique, Paris, France.,AP-HP Sorbonne Université, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service des Explorations Fonctionnelles de la Respiration, de l'Exercice et de la Dyspnée du Département Médico-Universitaire "APPROCHES", Paris, France
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39
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Sex-specific sleep apnea screening questionnaires: closing the performance gap in women. Sleep Med 2020; 67:91-98. [DOI: 10.1016/j.sleep.2019.10.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 10/16/2019] [Accepted: 10/30/2019] [Indexed: 11/24/2022]
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40
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Huhtakangas JK, Huhtakangas J, Bloigu R, Saaresranta T. Unattended sleep study in screening for sleep apnea in the acute phase of ischemic stroke. Sleep Med 2020; 65:121-126. [DOI: 10.1016/j.sleep.2019.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 07/29/2019] [Accepted: 08/01/2019] [Indexed: 10/26/2022]
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Lombardi C, Parati G, Soranna D, Zambon A, Sliwinski P, Roisman G, Pepin J, Schiza S, Riha R, Joppa P, Fietze I, Hedner J, Grote L, U A, F B, MR B, OK B, P B, Z D, Z D, P E, I F, L G, J H, H H, P J, JA K, P L, C L, O M, JF M, WT M, JM M, G P, A P, T P, E P, JL P, R P, M P, RL R, G R, S R, T S, S S, R S, P S, JL P, MS T, R T, R S, P S, G V, J V. Periodic limb movements during sleep and blood pressure changes in sleep apnoea: Data from the European Sleep Apnoea Database. Respirology 2019; 25:872-879. [DOI: 10.1111/resp.13760] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 10/25/2019] [Accepted: 11/19/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Carolina Lombardi
- Sleep Disorders Center, Department of Cardiovascular, Neural and Metabolic SciencesSan Luca Hospital, Instituto Auxologico Italiano, IRCCS Milan Italy
- Department of Medicine and SurgeryUniversity of Milano‐Bicocca Milan Italy
| | - Gianfranco Parati
- Sleep Disorders Center, Department of Cardiovascular, Neural and Metabolic SciencesSan Luca Hospital, Instituto Auxologico Italiano, IRCCS Milan Italy
- Department of Medicine and SurgeryUniversity of Milano‐Bicocca Milan Italy
| | - Davide Soranna
- Sleep Disorders Center, Department of Cardiovascular, Neural and Metabolic SciencesSan Luca Hospital, Instituto Auxologico Italiano, IRCCS Milan Italy
| | - Antonella Zambon
- Sleep Disorders Center, Department of Cardiovascular, Neural and Metabolic SciencesSan Luca Hospital, Instituto Auxologico Italiano, IRCCS Milan Italy
- Department of Statistics and Quantitative MethodsUniversity of Milano‐Bicocca Milan Italy
| | - Paweł Sliwinski
- Second Department of Respiratory MedicineInstitute of Tuberculosis and Lung Diseases Warsaw Poland
| | - Gabriel Roisman
- Sleep Medicine Unit at Hôpital BéclèreHôpitaux Universitaires Paris‐Sud Paris France
| | - Jean‐Louis Pepin
- HP2 Laboratory, INSERM U1042University Grenoble Alpes Grenoble France
- EFCR Laboratory, Pole Thorax et VaisseauxGrenoble Alpes University Hospital Grenoble France
| | - Sophia Schiza
- Sleep Disorders Unit, Department of Respiratory Medicine, Medical SchoolUniversity of Crete Heraklion Greece
| | - Renata Riha
- Centre for Clinical Brain Sciences, Sleep Research Unit, Department of Sleep MedicineRoyal Infirmary of Edinburgh Edinburgh UK
| | - Pavol Joppa
- University Hospital L. Pasteur Košice – Univerzitnej nemocnice L. Pasteura Košice Košice Slovakia
| | - Ingo Fietze
- Department of Cardiology and Angiology, Center of Sleep MedicineCCM, Charité – Universitätsmedizin Berlin Berlin Germany
| | - Jan Hedner
- Sleep Disorders Center, Sahlgrenska University HospitalGothenburg University Gothenburg Sweden
- Center for Sleep and Wake Disorders, Sahlgrenska AcademyGothenburg University Gothenburg Sweden
| | - Ludger Grote
- Sleep Disorders Center, Sahlgrenska University HospitalGothenburg University Gothenburg Sweden
- Center for Sleep and Wake Disorders, Sahlgrenska AcademyGothenburg University Gothenburg Sweden
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Holmedahl NH, Fjeldstad OM, Engan H, Saxvig IW, Grønli J. Validation of peripheral arterial tonometry as tool for sleep assessment in chronic obstructive pulmonary disease. Sci Rep 2019; 9:19392. [PMID: 31852958 PMCID: PMC6920446 DOI: 10.1038/s41598-019-55958-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 12/04/2019] [Indexed: 11/15/2022] Open
Abstract
Obstructive sleep apnea (OSA) worsens outcomes in Chronic Obstructive Pulmonary Disease (COPD), and reduced sleep quality is common in these patients. Thus, objective sleep monitoring is needed, but polysomnography (PSG) is cumbersome and costly. The WatchPAT determines sleep by a pre-programmed algorithm and has demonstrated moderate agreement with PSG in detecting sleep stages in normal subjects and in OSA patients. Here, we validated WatchPAT against PSG in COPD patients, hypothesizing agreement in line with previous OSA studies. 16 COPD patients (7 men, mean age 61 years), underwent simultaneous overnight recordings with PSG and WatchPAT. Accuracy in wake and sleep staging, and concordance regarding total sleep time (TST), sleep efficiency (SE), and apnea hypopnea index (AHI) was calculated. Compared to the best fit PSG score, WatchPAT obtained 93% sensitivity (WatchPAT = sleep when PSG = sleep), 52% specificity (WatchPAT = wake when PSG = wake), 86% positive and 71% negative predictive value, Cohen’s Kappa (κ) = 0.496. Overall agreement between WatchPat and PSG in detecting all sleep stages was 63%, κ = 0.418. The mean(standard deviation) differences in TST, SE and AHI was 25(61) minutes (p = 0.119), 5(15) % (p = 0.166), and 1(5) (p = 0.536), respectively. We conclude that in COPD-patients, WatchPAT detects sleep stages in moderate to fair agreement with PSG, and AHI correlates well.
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Gunduz C, Basoglu OK, Hedner J, Bonsignore MR, Hein H, Staats R, Bouloukaki I, Roisman G, Pataka A, Sliwinski P, Ludka O, Pepin JL, Grote L. Hyperlipidaemia prevalence and cholesterol control in obstructive sleep apnoea: Data from the European sleep apnea database (ESADA). J Intern Med 2019; 286:676-688. [PMID: 31260567 DOI: 10.1111/joim.12952] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND OBJECTIVE Obstructive sleep apnoea (OSA) and hyperlipidaemia are independent risk factors for cardiovascular disease. This study investigates the association between OSA and prevalence of hyperlipidaemia in patients of the European Sleep Apnea Database (ESADA) cohort. METHODS The cross-sectional analysis included 11 892 patients (age 51.9 ± 12.5 years, 70% male, body mass index (BMI) 31.3 ± 6.6 kg/m2 , mean oxygen desaturation index (ODI) 23.7 ± 25.5 events/h) investigated for OSA. The independent odds ratio (OR) for hyperlipidaemia in relation to measures of OSA (ODI, apnoea-hypopnoea index, mean and lowest oxygen saturation) was determined by means of general linear model analysis with adjustment for important confounders such as age, BMI, comorbidities and study site. RESULTS Hyperlipidaemia prevalence increased from 15.1% in subjects without OSA to 26.1% in those with severe OSA, P < 0.001. Corresponding numbers in patients with diabetes were 8.5% and 41.5%, P < 0.001. Compared with ODI quartile I, patients in ODI quartiles II-IV had an adjusted OR (95% CI) of 1.33 (1.15-1.55), 1.37 (1.17-1.61) and 1.33 (1.12-1.58) (P < 0.001), respectively, for hyperlipidaemia. Obesity was defined as a significant risk factor for hyperlipidaemia. Subgroups of OSA patients with cardio-metabolic comorbidities demonstrated higher prevalence of HL. In addition, differences in hyperlipidaemia prevalence were reported in European geographical regions with the highest prevalence in Central Europe. CONCLUSION Obstructive sleep apnoea, in particular intermittent hypoxia, was independently associated with the prevalence of hyperlipidaemia diagnosis.
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Affiliation(s)
- C Gunduz
- From the, Department of Chest Diseases, Biruni University, Istanbul, Turkey.,Department of Chest Diseases, Ege University, Izmir, Turkey
| | - O K Basoglu
- Department of Chest Diseases, Ege University, Izmir, Turkey
| | - J Hedner
- Center for Sleep and Vigilance Disorders, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,Sleep Disorders Center, Pulmonary Department, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - M R Bonsignore
- Biomedical Department of Internal and Specialist Medicine (DiBiMIS), Section of Pneumology, University of Palermo, Palermo, Italy.,CNR Institute of Biomedicine and Molecular Immunology, Palermo, Italy
| | - H Hein
- Sleep Disorders Center, St. Adolf Stift, Reinbeck, Germany
| | - R Staats
- Department of Respiratory Medicine, Hospital de Santa Maria, Lisbon, Portugal
| | - I Bouloukaki
- Sleep Disorders Unit, Department of Respiratory Medicine, University of Crete, Heraklion, Greece
| | - G Roisman
- Sleep Disorders Center, Antoine-Beclere Hospital, Clamart, France
| | - A Pataka
- Respiratory Failure Unit, G. Papanikolaou Hospital, Thessaloniki, Greece
| | - P Sliwinski
- 2nd Department of Respiratory Medicine, Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | - O Ludka
- Department of Cardiology, University Hospital Brno, Brno, Czech Republic.,International Clinical Research Center, St. Ann's University Hospital, Brno, Czech Republic
| | - J L Pepin
- INSERM U1042, CHU de Grenoble, Université Grenoble Alpes, Grenoble, France
| | - L Grote
- Center for Sleep and Vigilance Disorders, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,Sleep Disorders Center, Pulmonary Department, Sahlgrenska University Hospital, Gothenburg, Sweden
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Marra S, Arnaldi D, Nobili L. The pharmacotherapeutic management of obstructive sleep apnea. Expert Opin Pharmacother 2019; 20:1981-1991. [DOI: 10.1080/14656566.2019.1652271] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Stefano Marra
- Department of Neuroscience, IRCCS, G. Gaslini Institute, Genoa, Italy
- Department of Neuroscience (DINOGMI), University of Genoa, Genoa, Italy
| | - Dario Arnaldi
- Department of Neuroscience (DINOGMI), University of Genoa, Genoa, Italy
- Neurology Unit, IRCCS San Martino Hospital, Genoa, Italy
| | - Lino Nobili
- Department of Neuroscience, IRCCS, G. Gaslini Institute, Genoa, Italy
- Department of Neuroscience (DINOGMI), University of Genoa, Genoa, Italy
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45
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Wächter M, Kantelhardt JW, Bonsignore MR, Bouloukaki I, Escourrou P, Fietze I, Grote L, Korzybski D, Lombardi C, Marrone O, Paranicova I, Pataka A, Ryan S, Schiza SE, Sliwinski P, Steiropoulos P, Verbraecken J, Penzel T. Unique sleep-stage transitions determined by obstructive sleep apnea severity, age and gender. J Sleep Res 2019; 29:e12895. [PMID: 31347213 DOI: 10.1111/jsr.12895] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 06/06/2019] [Accepted: 06/19/2019] [Indexed: 01/21/2023]
Abstract
In obstructive sleep apnea, patients' sleep is fragmented leading to excessive daytime sleepiness and co-morbidities like arterial hypertension. However, traditional metrics are not always directly correlated with daytime sleepiness, and the association between traditional sleep quality metrics like sleep duration and arterial hypertension is still ambiguous. In a development cohort, we analysed hypnograms from mild (n = 209), moderate (n = 222) and severe (n = 272) obstructive sleep apnea patients as well as healthy controls (n = 105) from the European Sleep Apnea Database. We assessed sleep by the analysis of two-step transitions depending on obstructive sleep apnea severity and anthropometric factors. Two-step transition patterns were examined for an association to arterial hypertension or daytime sleepiness. We also tested cumulative distributions of wake as well as sleep-states for power-laws (exponent α) and exponential distributions (decay time τ) in dependency on obstructive sleep apnea severity and potential confounders. Independent of obstructive sleep apnea severity and potential confounders, wake-state durations followed a power-law distribution, while sleep-state durations were characterized by an exponential distribution. Sleep-stage transitions are influenced by obstructive sleep apnea severity, age and gender. N2 → N3 → wake transitions were associated with high diastolic blood pressure. We observed higher frequencies of alternating (symmetric) patterns (e.g. N2 → N1 → N2, N2 → wake → N2) in sleepy patients both in the development cohort and in a validation cohort (n = 425). In conclusion, effects of obstructive sleep apnea severity and potential confounders on sleep architecture are small, but transition patterns still link sleep fragmentation directly to obstructive sleep apnea-related clinical outcomes like arterial hypertension and daytime sleepiness.
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Affiliation(s)
- Marcel Wächter
- Schlafmedizinisches Zentrum, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jan W Kantelhardt
- Institut für Physik, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
| | - Maria R Bonsignore
- PROMISE Department, University of Palermo, and National Research Council, IBIM, Palermo, Palermo, Italy
| | | | | | - Ingo Fietze
- Schlafmedizinisches Zentrum, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ludger Grote
- Sleep Medicine Center, Sahlgrenska University Hospital, Gothenborg, Sweden
| | - Damian Korzybski
- 2nd Department of Respiratory Medicine, Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | - Carolina Lombardi
- Istituto Auxologico Italiano, IRCCS-Milano Bicocca University, Milano, Italy
| | - Oreste Marrone
- PROMISE Department, University of Palermo, and National Research Council, IBIM, Palermo, Palermo, Italy
| | | | | | - Silke Ryan
- University College Dublin, Dublin, Ireland
| | | | - Pawel Sliwinski
- 2nd Department of Respiratory Medicine, Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | - Paschalis Steiropoulos
- Medical School, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Johan Verbraecken
- Antwerp University Hospital and University of Antwerp, Antwerp, Belgium
| | - Thomas Penzel
- Schlafmedizinisches Zentrum, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Dieltjens M, Verbraecken JA, Hedner J, Vanderveken OM, Steiropoulos P, Kvamme JA, Saaresranta T, Tkacova R, Marrone O, Dogas Z, Schiza S, Grote L, Steiropoulos P, Verbraecken J, Petiet E, Trakada G, Montserrat J, Fietze I, Penzel T, Ludka O, Rodenstein D, Masa J, Bouloukaki I, Schiza S, Kent B, McNicholas W, Ryan S, Riha R, Kvamme J, Schulz R, Grote L, Hedner J, Zou D, Pépin J, Levy P, Bailly S, Lavie L, Lavie P, Hein H, Basoglu O, Tasbakan M, Varoneckas G, Joppa P, Tkacova R, Staats R, Barbé F, Lombardi C, Parati G, Drummond M, van Zeller M, Bonsignore M, Marrone O, Escourrou P, Roisman G, Pretl M, Vitols A, Dogas Z, Galic T, Pataka A, Anttalainen U, Saaresranta T, Sliwinski P, Plywaczewski R, Bielicki P, Zielinski J. Use of the Clinical Global Impression scale in sleep apnea patients – Results from the ESADA database. Sleep Med 2019; 59:56-65. [DOI: 10.1016/j.sleep.2018.10.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 10/16/2018] [Accepted: 10/18/2018] [Indexed: 12/20/2022]
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Pataka A, Bonsignore MR, Ryan S, Riha RL, Pepin JL, Schiza S, Basoglu OK, Sliwinski P, Ludka O, Steiropoulos P, Anttalainen U, McNicholas WT, Hedner J, Grote L. Cancer prevalence is increased in females with sleep apnoea: data from the ESADA study. Eur Respir J 2019; 53:1900091. [PMID: 31109987 DOI: 10.1183/13993003.00091-2019] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 03/05/2019] [Indexed: 01/09/2023]
Affiliation(s)
- Athanasia Pataka
- Respiratory Failure Unit, G. Papanikolaou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria R Bonsignore
- Biomedical Dept of Internal and Specialistic Medicine (DiBiMIS), Section of Pneumology, University of Palermo and CNR Institute of Biomedicine and Molecular Immunology, Palermo, Italy
| | - Silke Ryan
- Pulmonary and Sleep Disorders Unit, St Vincent's University Hospital and School of Medicine, University College Dublin, Dublin, Ireland
| | - Renata L Riha
- Dept of Sleep Medicine, Royal Infirmary Edinburgh, Edinburgh, UK
| | - Jean-Louis Pepin
- University Grenoble Alpes, INSERM HP2 (U1042) and Grenoble University Hospital, Grenoble, France
| | - Sofia Schiza
- Sleep Disorders Unit, Dept of Respiratory Medicine, Medical School, University of Crete, Heraklion, Greece
| | - Ozen K Basoglu
- Dept of Chest Diseases, Ege University, Faculty of Medicine, Izmir, Turkey
| | - Pawel Sliwinski
- 2nd Dept of Respiratory Medicine, Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | - Ondrej Ludka
- Dept of Cardiology, University Hospital Brno and International Clinical Research Center, St. Ann's University Hospital, Brno, Czech Republic
| | - Paschalis Steiropoulos
- Sleep Unit, Dept of Pneumonology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Ulla Anttalainen
- Division of Medicine, Dept of Pulmonary Diseases, Turku University Hospital and Sleep Research Centre, Dept of Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland
| | - Walter T McNicholas
- Pulmonary and Sleep Disorders Unit, St Vincent's University Hospital and School of Medicine, University College Dublin, Dublin, Ireland
| | - Jan Hedner
- Pulmonary Dept, Sahlgrenska University Hospital, Gothenburg, Sweden
- Center for Sleep and Wake Disorders, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Ludger Grote
- Pulmonary Dept, Sahlgrenska University Hospital, Gothenburg, Sweden
- Center for Sleep and Wake Disorders, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
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Leo CG, Mincarone P, Bodini A, Sedile R, Guarino R, Tumolo MR, Malorgio R, Quitadamo M, Sabato E, Viegi G, Insalaco G, Sabina S. Obstructive sleep apnoea: Improving healthcare services by combining process modelling and population analysis. Int J Med Inform 2019; 127:43-51. [PMID: 31128831 DOI: 10.1016/j.ijmedinf.2019.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 04/01/2019] [Accepted: 04/09/2019] [Indexed: 01/06/2023]
Abstract
CONTEXT Disease management broke through in the early 1990s to counterbalance hyper-specialization with a more comprehensive approach. Its role became immediately relevant in chronic conditions and, consequently, in Obstructive Sleep Apnoea (OSA). This is a common chronic condition for which is important to organise services at the local level, taking into account organisational factors and the characteristics of the assisted population. OBJECTIVES The aim of this work is to propose and apply, coherently with a disease management approach, a combination of healthcare process modelling and population analysis as a way to identify critical issues and explore shared solutions. METHODS A multidisciplinary working group was created with scholars who are skilled in process analysis, statistics and medicine. Through semi-structured interviews and on-site meetings, healthcare processes were represented with a standard graphical language: Unified Modeling Language™. Population analysis was based on statistical analysis performed on a 5-year retrospective cohort assisted by a Community Pulmonary Service. RESULTS A shared graphic presentation of the current healthcare process and the results of the statistical analyses constituted the knowledge base to identify critical issues and recommend corresponding solutions, which include: a) refine the local patient database with additional details on comorbidities and risk factors; b) support a greater involvement of "gate-keepers" in the screening phase; c) provide practical tools for the definition of strategies to increment the adherence to therapy; d) include recommendations for physical exercise and interdisciplinary cooperation; and e) define process indicators for measuring the quality of the screening and therapeutic phases. CONCLUSION The concomitant analyses of formalised processes and critical risk factors represent a useful approach for systematically identifying areas of improvement in healthcare processes and allow us to discuss solutions. Moreover, the specific adoption of UML® for graphical modelling and representation of patient care processes allows us to formalise them by adopting a standard language that can be taken as the basis for implementing web services to support the execution of the modelled processes.
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Affiliation(s)
- Carlo Giacomo Leo
- National Research Council, Institute of Clinical Physiology, Branch of Lecce, c/o Ecotekne via Monteroni, 73100 Lecce, Italy.
| | - Pierpaolo Mincarone
- National Research Council Institute, for Research on Population and Social Policies, Research Unit of Brindisi, c/o ex Osp. Di Summa, Piazza Di Summa, 72100 Brindisi, Italy.
| | - Antonella Bodini
- National Research Council, Institute for Applied Mathematics and Information Technologies "Enrico Magenes", Branch of Milan, Via Bassini 15, 20133 Milan, Italy.
| | - Raffaella Sedile
- National Research Council, Institute of Clinical Physiology, Branch of Lecce, c/o Ecotekne via Monteroni, 73100 Lecce, Italy.
| | - Roberto Guarino
- National Research Council, Institute of Clinical Physiology, Branch of Lecce, c/o Ecotekne via Monteroni, 73100 Lecce, Italy.
| | - Maria Rosaria Tumolo
- National Research Council Institute, for Research on Population and Social Policies, Research Unit of Brindisi, c/o ex Osp. Di Summa, Piazza Di Summa, 72100 Brindisi, Italy.
| | - Roberto Malorgio
- Local Health Unit of Brindisi, Community Pulmonary Service, Via Dalmazia 3, 72100, Italy.
| | - Matteo Quitadamo
- Local Health Unit of Brindisi, Community Pulmonary Service, Via Dalmazia 3, 72100, Italy.
| | - Eugenio Sabato
- National Research Council Institute, for Research on Population and Social Policies, Research Unit of Brindisi, c/o ex Osp. Di Summa, Piazza Di Summa, 72100 Brindisi, Italy; Local Health Unit of Brindisi, "Perrino" Hospital, Pulmonary Department, S.S. 7 per Mesagne Brindisi, Italy.
| | - Giovanni Viegi
- National Research Council, Institute of Biomedicine and Molecular Immunology "Alberto Monroy", via U. La Malfa, 153, 90146 Palermo, Italy.
| | - Giuseppe Insalaco
- National Research Council, Institute of Biomedicine and Molecular Immunology "Alberto Monroy", via U. La Malfa, 153, 90146 Palermo, Italy.
| | - Saverio Sabina
- National Research Council, Institute of Clinical Physiology, Branch of Lecce, c/o Ecotekne via Monteroni, 73100 Lecce, Italy.
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Anýž J, Bakštein E, Dudysová D, Veldová K, Kliková M, Fárková E, Kopřivová J, Španiel F. No wink of sleep: Population sleep characteristics in response to the brexit poll and the 2016 U.S. presidential election. Soc Sci Med 2019; 222:112-121. [DOI: 10.1016/j.socscimed.2018.12.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 11/16/2018] [Accepted: 12/17/2018] [Indexed: 01/23/2023]
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50
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Anttalainen U, Grote L, Fietze I, Riha RL, Ryan S, Staats R, Hedner J, Saaresranta T. Insomnia symptoms combined with nocturnal hypoxia associate with cardiovascular comorbidity in the European sleep apnea cohort (ESADA). Sleep Breath 2018; 23:805-814. [PMID: 30467691 PMCID: PMC6700053 DOI: 10.1007/s11325-018-1757-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 10/01/2018] [Accepted: 11/13/2018] [Indexed: 01/03/2023]
Abstract
Purpose The aim of the current study was to further investigate the concept of previously reported high occurrence of comorbidities in obstructive sleep patients (OSA) with insomnia-like symptoms. We hypothesized that this finding at least partly is mediated by nocturnal hypoxia. Moreover, we speculated that the spectrum of the clinical OSA phenotypes differs between European geographical regions. Methods Cohort of the European Sleep Apnea Database (n = 17,325; 29.9% females) was divided into five subcohorts according to geographical region (North, East, South, West, Central) and further into four clinical presentation phenotypes based on daytime symptoms (EDS) and characteristics suggestive of insomnia. Results The insomnia phenotype (alone or together with EDS) dominated in all European regions. Isolated insomnia, however, was less common in the West. Insomnia phenotype was associated with the highest proportion of cardiovascular comorbidity (51.7% in the insomnia vs. 43.9% in the EDS type). Measures of nocturnal hypoxemia were independently associated with cardiovascular comorbidity in phenotypes with insomnia-like symptoms. The burden of comorbidities was high across all geographical regions and clinical phenotypes. Regional differences were clinically relevant for age (48 vs. 54 years), BMI (29 vs. 34 kg/m2), and ODI (15 vs. 32/h). Conclusion High prevalence of particularly cardiovascular comorbidity among patients with insomnia-like symptoms was linked to nocturnal hypoxemia. Considerable differences in clinical presentation were found among OSA patients across Europe. Our data underline that physicians should ask their patients with suspected OSA also for insomnia symptoms. It remains to be explored if a reduction of nocturnal hypoxemia predicts the improvement of insomnia symptoms. Electronic supplementary material The online version of this article (10.1007/s11325-018-1757-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ulla Anttalainen
- Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, P.O. Box 52, SF-20521, Turku, Finland.
- Sleep Research Centre, Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland.
| | - L Grote
- Department of Sleep Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - I Fietze
- Center of Sleep Medicine, Charité - Universitätsmedizin Berlin, Luisenstrasse 13, 101 17, Berlin, Germany
| | - R L Riha
- Department of Sleep Medicine, Royal Infirmary Edinburgh, 51 Little France Crescent EH, Edinburgh, 164 SA, Scotland
| | - S Ryan
- Department of Respiratory Medicine, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - R Staats
- Department of Respiratory Medicine, Hospital de Santa Maria, Lisbon, Portugal
| | - J Hedner
- Department of Sleep Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - T Saaresranta
- Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, P.O. Box 52, SF-20521, Turku, Finland
- Sleep Research Centre, Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland
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