The prevalence and comorbidities of obstructive sleep apnea in middle-aged men and women: the Busselton Healthy Ageing Study

Exploring the interplay of depression, sleep quality, and hearing in tinnitus-related handicap: insights from polysomnography and pure-tone audiometry

BACKGROUND

Tinnitus affects approximately 740 million adults globally, involving hearing, emotion, and sleep systems. However, studies using polysomnography and pure-tone audiometry (PTA) are limited. We aimed to assess the correlation between tinnitus and hearing, sleep quality, characteristics, and depression using polysomnography and PTA.

METHODS

In this cross-sectional study, we divided participants into tinnitus and non-tinnitus groups. We included 100 outpatients (65 with tinnitus, 35 without) from a medical center in Taiwan, who underwent polysomnography and completed rating scales including the Patient Health Questionnaire-9 (PHQ-9), Chinese version of the Pittsburgh Sleep Quality Index (PSQI), and Chinese-Mandarin version of the Tinnitus Handicap Inventory (THI-CM). We analyzed correlations, conducted group comparisons, assessed factors related to THI-CM scores, constructed ROC curves to predict depression in the tinnitus group, and performed multinomial and logistic regression to explore associations.

RESULTS

Descriptive statistics identified a cohort with mean age 53.9 ± 12.80 years, 63% exhibited PHQ-9 scores ≥ 10, and 66% had Apnea-Hypopnea Index (AHI) > 5. The ratio of rapid eye movement and deep sleep to stage 1 + 2 sleep was relatively low and non-significant. Likewise, leg movements was higher in the tinnitus group but not statistically significant. In the tinnitus group, 63.08% had depression, and 81.54% had AHI > 5. Univariate logistic regression linked tinnitus to AHI > 5 (Odds ratio (OR) 2.67, p = 0.026) and male sex (OR 2.49, p = 0.034). A moderate positive correlation was found between the THI-CM score and PHQ-9 score (rs = 0.50, p < 0.001). Further adjustment for obstructive sleep apnea showed associations between PHQ-9 (total score) or depression and THI-CM Grade 3-5 (OR = 1.28; OR = 8.68). Single- and multifactor regression analyses highlighted significant associations of PSQI scores > 13 (OR 7.06, p = 0.018) and THI-CM scores > 47 (OR 7.43, p = 0.002) with depression.

CONCLUSIONS

Our study recruited tinnitus participants with slight or mild hearing loss and mild tinnitus handicap. Depression was identified as a predominant factor in tinnitus-related handicap. The mild tinnitus handicap in tinnitus participants may explain the lack of significant differences in depression, sleep quality, and polysomnographic sleep characteristics between tinnitus and non-tinnitus groups. Further extensive and prospective studies are needed to elucidate the complex links among depression, sleep, and tinnitus.

Sex-dependent effects of chronic intermittent hypoxia: implication for obstructive sleep apnea

BACKGROUND

Obstructive sleep apnea (OSA) affects 10-26% of adults in the United States with known sex differences in prevalence and severity. OSA is characterized by elevated inflammation, oxidative stress (OS), and cognitive dysfunction. However, there is a paucity of data regarding the role of sex in the OSA phenotype. Prior findings suggest women exhibit different OSA phenotypes than men, which could result in under-reported OSA prevalence in women. To examine the relationship between OSA and sex, we used chronic intermittent hypoxia (CIH) to model OSA in rats. We hypothesized that CIH would produce sex-dependent phenotypes of inflammation, OS, and cognitive dysfunction, and these sex differences would be dependent on mitochondrial oxidative stress (mtOS).

METHODS

Adult male and female Sprague Dawley rats were exposed to CIH or normoxia for 14 days to examine the impact of sex on CIH-associated circulating inflammation (IL-1β, IL-6, IL-10, TNF-α), circulating steroid hormones, circulating OS, and behavior (recollective and spatial memory; gross and fine motor function; anxiety-like behaviors; and compulsive behaviors). Rats were implanted with osmotic minipumps containing either a mitochondria-targeting antioxidant (MitoTEMPOL) or saline vehicle 1 week prior to CIH initiation to examine how inhibiting mtOS would affect the CIH phenotype.

RESULTS

Sex-specific differences in CIH-induced inflammation, OS, motor function, and compulsive behavior were observed. In female rats, CIH increased inflammation (plasma IL-6 and IL-6/IL-10 ratio) and impaired fine motor function. Conversely, CIH elevated circulating OS and compulsivity in males. These sex-dependent effects of CIH were blocked by inhibiting mtOS. Interestingly, CIH impaired recollective memory in both sexes but these effects were not mediated by mtOS. No effects of CIH were observed on spatial memory, gross motor function, or anxiety-like behavior, regardless of sex.

CONCLUSIONS

Our results indicate that the impact of CIH is dependent on sex, such as an inflammatory response and OS response in females and males, respectively, that are mediated by mtOS. Interestingly, there was no effect of sex or mtOS in CIH-induced impairment of recollective memory. These results indicate that mtOS is involved in the sex differences observed in CIH, but a different mechanism underlies CIH-induced memory impairments.

Quality of Life in Metabolic Syndrome Patients Based on the Risk of Obstructive Sleep Apnea

Despite the impact of metabolic syndrome (MetS) and obstructive sleep apnea (OSA) on a sizeable proportion of the global population, the difference in the quality of life (QoL) between a group without risk factors for OSA and a group with risk factors for OSA among individuals with MetS is currently unclear. This study aimed to identify the determinants of QoL in patients with MetS with and without OSA risk factors and to analyze differences between these two groups. Data were extracted from the 2020 Korea National Health and Nutrition Examination Survey (KNHANES). The Rao-Scott χ2 test was performed to evaluate differences in baseline characteristics based on OSA risk factors. A t-test was performed to evaluate differences in the baseline QoL, and linear regression analysis was performed to identify the effect on the QoL of the two groups. The factors affecting QoL in the low-risk group included age, education level, and depression. The factors affecting QoL in the high-risk group were physical activity and depression. These results suggest that nursing interventions should be devised according to patients' characteristics to help improve their QoL.

Sex-dependent effects of chronic intermittent hypoxia: Implication for obstructive sleep apnea

Background Obstructive sleep apnea (OSA) affects 10-26% of adults in the United States with known sex differences in prevalence and severity. OSA is characterized by elevated inflammation, oxidative stress (OS), and cognitive dysfunction. However, there is a paucity of data regarding the role of sex in the OSA phenotype. Prior findings suggest women exhibit different OSA phenotypes than men, which could result in under-reported OSA prevalence in women. To examine the relationship between OSA and sex, we used chronic intermittent hypoxia (CIH) to model OSA in rats. We hypothesized that CIH would produce sex-dependent phenotypes of inflammation, OS, and cognitive dysfunction, and these sex differences would be dependent on mitochondrial oxidative stress (mtOS). Methods Adult male and female Sprague Dawley rats were exposed to CIH or normoxia for 14 days to examine the impact of sex on CIH-associated circulating inflammation (IL-1β, IL-4, IL-6, IL-10, TNF-α), circulating OS, and behavior (recollective and spatial memory; gross and fine motor function; anxiety-like behaviors; and compulsive behaviors). A subset of rats was implanted with osmotic minipumps containing either a mitochondria-targeting antioxidant (MitoTEMPOL) or saline vehicle 1 week prior to CIH initiation to examine how inhibiting mtOS would affect the CIH phenotype. Results Sex-specific differences in CIH-induced inflammation, OS, motor function, and compulsive behavior were observed. In female rats, CIH increased inflammation (plasma IL-6 and IL-6/IL-10 ratio) and impaired fine motor function. Conversely, CIH elevated circulating OS and compulsivity in males. These sex-dependent effects of CIH were blocked by inhibiting mtOS. Interestingly, CIH impaired recollective memory in both sexes but these effects were not mediated by mtOS. No effects of CIH were observed on spatial memory, gross motor function, or anxiety-like behavior, regardless of sex. Conclusions Our results indicate that the impact of CIH is dependent on sex, such as an inflammatory response and OS response in females and males, respectively, that are mediated by mtOS. Interestingly, there was no effect of sex or mtOS in CIH-induced impairment of recollective memory. These results indicate that mtOS is involved in the sex differences observed in CIH, but a different mechanism underlies CIH-induced memory impairments.

Associations Between Sleep Spindle Metrics, Age, Education and Executive Function in Young Adult and Middle-Aged Patients with Obstructive Sleep Apnea

Purpose

This study aimed to investigate the association between sleep spindle metrics and executive function in individuals with obstructive sleep apnea (OSA). Furthermore, we examined the association of age and education on executive function.

Patients and Methods

A total of 230 (40.90 ± 8.83 years, F/M = 45/185) participants were enrolled. Overnight electroencephalogram (C3-M2) recording detected sleep spindles by a novel U-Net-type neural network that integrates temporal information with time-frequency images. Sleep spindle metrics, including frequency (Hz), overall density (events/min), fast density (events/min), slow density (events/min), duration (sec) and amplitude (µV), were measured. Executive function was assessed using standardized neuropsychological tests. Associations between sleep spindle metrics, executive function, and demographic factors were analyzed using multivariate linear regression.

Results

In fully adjusted linear regression models, higher overall sleep spindle density (TMT-A, B=-1.279, p=0.009; TMT-B, B=-1.813, p=0.008), fast sleep spindle density (TMT-A, B=-1.542, p=0.048; TMT-B, B=-2.187, p=0.036) and slow sleep spindle density (TMT-A, B=-1.731, p=0.037; TMT-B, B=-2.449, p=0.034) were associated with better executive function. And the sleep spindle duration both during N2 sleep time (TMT-A, B=-13.932, p=0.027; TMT-B, B=-19.001, p=0.034) and N3 sleep time (TMT-B, B=-29.916, p=0.009; Stroop-incongruous, B=-21.303, p=0.035) was independently associated with better executive function in this population. Additionally, age and education were found to be highly associated with executive function.

Conclusion

Specific sleep spindle metrics, higher overall density, fast density and slow density during N2 sleep time, and longer duration during N2 and N3 sleep time, are independent and sensitive indicators of better executive function in young adult and middle-aged patients with OSA. Further research is needed to explore the underlying mechanisms and clinical implications of these findings.

Home Sleep Apnea Testing for Obstructive Sleep Apnea

Obstructive Sleep Apnea (OSA) is a major public health problem affecting almost one billion individuals worldwide. Ninety percent of patients with OSA are still undiagnosed. Although an attended polysomnography (PSG) testing is the gold standard to diagnose OSA, it is time-consuming and is associated with higher costs. The Home Sleep Apnea Testing (HSAT) is now available to diagnose OSA. Understanding the indications and limitations of HSAT is important to avoid misdiagnosis and improve patient outcomes.

Meta-analysis of the effects of CPAP therapy on estimated glomerular filtration rate in patients with obstructive sleep apnea

PURPOSE

Obstructive sleep apnea (OSA) is highly prevalent in patients with chronic kidney disease and may lead to a loss of kidney function. However, it remains unclear whether or not continuous positive airway pressure (CPAP) treatment improves the estimated glomerular filtration rate (eGFR) in patients with OSA. This meta-analysis was designed to investigate the effect of CPAP therapy on eGFR in patients with OSA.

METHODS

We searched the electronic databases Web of Science, Cochrane Library, PubMed, and Embase through June 1, 2022. Information about patients, CPAP duration, gender distribution, pre- and post-CPAP treatment eGFR, and age of patients were collected for further analysis. We applied the standardized mean difference (SMD) with a 95%confidence interval (CI) to analyze the pooled effects. Both Stata 12.0 software and Review Manager 5.2 software were employed for all statistical analyses.

RESULTS

A sample of 13 studies with 519 patients was included in the meta-analysis. There was no significant change of eGFR levels before and after CPAP usage for patients with OSA (SMD =  - 0.05, 95%CI: - 0.30 to 0.19, Z = 0.43, p = 0.67). However, subgroup analysis revealed that the level of eGFR was obviously decreased after CPAP therapy in patients with OSA and CPAP use duration > 6 months (SMD =  - 0.30, 95% CI =  - 0.49 to - 0.12, z = 3.20, p = 0.001), and elderly patients (> 60 years) (SMD =  - 0.32, 95% CI =  - 0.52 to - 0.11, z = 3.02, p = 0.002).

CONCLUSIONS

Meta-analysis confirmed that OSA treatment with CPAP has no clinically significant effect on eGFR.

Implementation of the Baveno Classification in Obstructive Sleep Apnea and Its Correlation with Symptoms of Anxiety and Depression

Background and Objectives: The Baveno classification represents a new approach to the assessment of the severity of OSA (Obstructive sleep apnea), which takes significant comorbidities into account: atrial fibrillation, arterial hypertension, heart failure, stroke, diabetes mellitus, and OSA symptoms expressed through the Epworth sleepiness scale (ESS). The authors believe that the Baveno classification facilitates a better stratification of patients with OSA and can be a good guide for deciding on the therapeutic approach and clinical monitoring of patients with OSA, compared to the AHI (apnea-hypopnea index) itself. The aim of this paper is to confirm the advantage of applying the Baveno classification to the evaluation of symptoms of anxiety and depression in the OSA patients compared to the application of the AHI as a single parameter. Materials and Methods: This research represents an observational retrospective study that was performed at the Pulmonology Clinic of the University Clinical Center in Kragujevac, Serbia. The study sample included 104 patients with diagnosed OSA. Patients were divided into four categories retrogradely according to the Baveno classification (A, B, C, and D). Statistical data processing was performed using the IBM SPSS Statistics version 25.0 program. Results: In our study, we proved that the Baveno classification is better at predicting the depressive disorder in OSA patients compared to the AHI itself, according to abnormal BDI-II (Beck Depression Inventory) score (value greater than ten) and HADS-D (Hospital anxiety and depression) scale (value greater than eight). The average AHI in the entire group of examined patients was 44.3 ± 19.8, while in category A the average AHI was 25.2 ± 10, in category B, 53.4 ± 20.6; in category C, 38.2 ± 18.5; and in category D, 48.1 ± 19.2. In the total sample, AHI did not correlate with the depressive episodes, but individually, the highest frequency of the depressive symptoms was precisely in the categories with the highest AHI (group D and B), where more than half of the subjects had an abnormal score. The frequency of the anxiety disorder (HADS-A) between the analyzed groups did not differ significantly, although the largest number of patients with significant anxiety were in category B, according to the Baveno classification. Conclusions: We proved that the Baveno classification is applicable in real life, and it is better at evaluating anxiety and depression using questionnaires and can identify new patients who need CPAP therapy, independently of other OSAS symptoms, primarily daytime sleepiness.

Causes of hypercapnic respiratory failure: a population-based case-control study

OBJECTIVE

There are no population-based data on the relative importance of specific causes of hypercapnic respiratory failure (HRF). We sought to quantify the associations between hospitalisation with HRF and potential antecedent causes including chronic obstructive pulmonary disease (COPD), obstructive sleep apnea, and congestive cardiac failure. We used data on the prevalence of these conditions to estimate the population attributable fraction for each cause.

METHODS

A case-control study was conducted among residents aged ≥ 40 years from the Liverpool local government area in Sydney, Australia. Cases were identified from hospital records based on PaCO2 > 45 mmHg. Controls were randomly selected from the study population using a cluster sampling design. We collected self-reported data on medication use and performed spirometry, limited-channel sleep studies, venous sampling for N-terminal pro-brain natriuretic peptide (NT-proBNP) levels, and sniff nasal inspiratory pressure (SNIP) measurements. Logistic regression analyses were performed using directed acyclic graphs to identify covariates.

RESULTS

We recruited 42 cases and 105 controls. HRF was strongly associated with post-bronchodilator airflow obstruction, elevated NT-proBNP levels, reduced SNIP measurements and self-reported opioid medication use. There were no differences in the apnoea-hypopnea index or oxygen desaturation index between groups. COPD had the highest population attributable fraction (42%, 95% confidence interval 18% to 59%).

CONCLUSIONS

COPD, congestive cardiac failure, and self-reported use of opioid medications, but not obstructive sleep apnea, are important causes of HRF among adults over 40 years old. No single cause accounts for the majority of cases based on the population attributable fraction.

AHI estimation of OSAHS patients based on snoring classification and fusion model

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.

Composite lipid indices in patients with obstructive sleep apnea: a systematic review and meta-analysis

BACKGROUND

One of the most prevalent sleep disorders affecting the individual's daily life is obstructive sleep apnea (OSA), for which obesity is a major risk factor. Several novel lipid indices have been suggested to have associations with OSA, among which visceral adiposity index (VAI), atherogenic index of plasma (AIP), and lipid accumulation product (LAP) are the most important ones. Herein, the current study aimed to systematically investigate the association between these indices and OSA.

METHODS

Four international databases, including PubMed, Scopus, the Web of Science, and Embase were searched in order to find relevant studies that investigated LAP, VAI, or AIP in OSA and compared them with non-OSA cases or within different severities of OSA. Random-effect meta-analysis was used to generate the standardized mean difference (SMD) and 95% confidence interval (CI) of the difference in lipid indices between OSA and non-OSA cases. Moreover, the pooled area under the receiver operating characteristic curves (AUCs) observed in individual studies for diagnosis of OSA based on these lipid indices were calculated by random-effect meta-analysis.

RESULTS

Totally 14 original studies were included, comprised of 14,943 cases. AIP, LAP, and VAI were assessed in eight, five, and five studies, respectively. Overall, these lipid indices had acceptable diagnostic ability (AUC 0.70, 95% CI 0.67 to 073). Meta-analysis revealed that AIP was significantly higher in patients with OSA (SMD 0.71, 95% CI 0.45 to 0.97, P < 0.01). Moreover, AIP also increased in higher severities of OSA. Regarding LAP, a higher LAP was observed in OSA/patients with high risk for OSA rather than in controls/low risk for OSA (SMD 0.53, 95% CI 0.25 to 0.81, P < 0.01). VAI was also increased in OSA based on results from two studies.

CONCLUSION

These findings suggest that composite lipid indices are increased in OSA. Also, these indices can have the potential beneficiary diagnostic and prognostic ability in OSA. Future studies can confirm these findings and enlighten the role of lipid indices in OSA.

The preventable productivity burden of sleep apnea in Australia: a lifetime modelling study

Obstructive sleep apnea (OSA) is a common disorder. OSA is associated with cardiovascular disease (CVD), type 2 diabetes mellitus (T2DM) and depression, among other comorbidities. We aim to determine the productivity burden of OSA in Australia using productivity-adjusted life-years (PALYs). Using life table modelling, we built a multistate Markov model to estimate the impact of moderate to severe OSA on the whole working-age Australian population in 2021 (aged 20-65 years) with OSA until retirement (aged 66 years). The model also captured the impact of OSA on CVD, T2DM, depression, and vehicle-related accidents. Data for OSA and comorbidities and Australian specific labour data, were extracted from published sources. A second cohort was then modelled to test the effect of a hypothetical intervention, assuming a 10% reduction in OSA prevalence and a 10% reduction in comorbidities in patients with OSA. The primary outcome of interest were PALYs accrued. All outcomes were discounted 5% annually. Over a lifetime, the Australian population with OSA accrued 193,713,441 years of life lived and 182,737,644 PALYs. A reduction of 10% in OSA prevalence and comorbidities would result in 45,401 extra years of life lived and 150,950 extra PALYs. This resulted in more than AU$25 billion of gained gross domestic product over the lifetime of the working population. Our study highlights the substantial burden of OSA on the Australian population and the need to tailor interventions at the population level to reduce the health and economic impacts.

Automated deep neural network analysis of lateral cephalogram data can aid in detecting obstructive sleep apnea

STUDY OBJECTIVES

Information on obstructive sleep apnea (OSA) is often latently detected in diagnostic tests conducted for other purposes, providing opportunities for maximizing value. This study aimed to develop a convolutional neural network (CNN) to identify the risk of OSA using lateral cephalograms.

METHODS

The lateral cephalograms of 5,648 individuals (mean age, 49.0 ± 15.8 years; men, 62.3%) with or without OSA were collected and divided into training, validation, and internal test datasets in a 5:2:3 ratio. A separate external test dataset (n = 378) was used. A densely connected CNN was trained to diagnose OSA using a cephalogram. Model performance was evaluated using the area under the receiver operating characteristic curve (AUROC). Gradient-weighted class activation mapping (Grad-CAM) was used to evaluate the region of focus, and the relationships between the model outputs, anthropometric characteristics, and OSA severity were evaluated.

RESULTS

The AUROC of the model for the presence of OSA was 0.82 (95% confidence interval, 0.80-0.84) and 0.73 (95% confidence interval, 0.65-0.81) in the internal and external test datasets, respectively. Grad-CAM demonstrated that the model focused on the area of the tongue base and oropharynx in the cephalogram. Sigmoid output values were positively correlated with OSA severity, body mass index, and neck and waist circumference.

CONCLUSIONS

Deep learning may help develop a model that classifies OSA using a cephalogram, which may be clinically useful in the appropriate context. The definition of ground truth was the main limitation of this study.

CITATION

Jeong H-G, Kim T, Hong JE, et al. Automated deep neural network analysis of lateral cephalogram data can aid in detecting obstructive sleep apnea. J Clin Sleep Med. 2023;19(2):327-337.

A Narrative Review of Sex and Gender Differences in Sleep Disordered Breathing: Gaps and Opportunities

INTRODUCTION

Sleep disordered breathing (SDB) is a common condition, associated with multiple comorbidities including cardiovascular and metabolic disease. It has been previously established that SDB is more prevalent in men than women, shifting the literature's focus away from the latter population. As such, underdiagnosis, and thus undertreatment, of SDB in women exists.

METHODS

To establish the differences in prevalence, clinical presentation, and pathophysiology of SDB between the two sexes, a narrative review of the current literature was performed.

RESULTS

Rates of SDB are higher among men, likely driven by differences in symptom presentation between men and women, with women presenting with more "atypical" symptoms, and lack of sensitivity in SDB screening tools to detect SDB in women. In addition to the cardiovascular risks of SDB, women with SDB may have worse quality of life, higher prevalence of insomnia, and respiratory issues.

DISCUSSION

More research is needed to better define the unique pathophysiology and clinical presentation of SDB in women. In addition, an increased awareness among health care providers and the lay public of the SDB-specific sex and gender differences will serve to minimize disparities in identification and treatment of SDB in women.

Mediating Effect of Self-Cognitive Oral Health Status on the Effect of Obstructive Sleep Apnea Risk Factors on Quality of Life (HINT-8) in Middle-Aged Korean Women: The Korea National Health and Nutrition Examination Survey

Background: Obstructive sleep apnea and oral health are highly correlated with quality of life. The purpose of this study is to determine the mediating effect of self-cognitive oral health status on the effect of obstructive sleep apnea (OSA) risk factors on quality of life in middle-aged Korean women using the 2019 National Health and Nutrition Examination Survey data. Methods: A hierarchical regression analysis was performed on the mediating effect of self-cognitive oral health status on the effects of OSA risk factors on health-related quality of life (Korean health-related quality of life instrument with 8 items; HINT-8). Results: Self-cognitive oral health status as a parameter had a significant effect on quality of life (β = 0.713, p < 0.001). Compared to the effect of the OSA risk factor of the second stage on the quality of life (β = −1.329, p < 0.001), the input of the third stage of self-cognitive oral health was partially mediated (β = −1.280, p <0.001). Conclusions: Therefore, if middle-aged women have OSA risk factors, they should try to improve their quality of life by managing oral health as well as OSA treatment.

Obstructive sleep apnea and right ventricular function: A meta-analysis of speckle tracking echocardiographic studies

The authors investigated the association between obstructive sleep apnea (OSA) and right ventricular (RV) systolic dysfunction trough a meta‐analysis of echocardiographic studies providing data on RV mechanics as assessed by longitudinal strain (LS). A systematic search was conducted using PubMed, OVID‐MEDLINE, and Cochrane library databases to search English‐language review papers published from inception to March 31, 2022. Only studies reporting data on RV free‐wall or global LS in patients with OSA of different severity and non‐OSA controls were reviewed. Data of interest were pooled to obtain standard means difference (SMD) with 95% confidence interval (CI). The meta‐analysis included 628 participants (436 with OSA and 192 controls) from eight studies. Compared to controls, RV free wall LS was significantly reduced in the pooled OSA group (SMD 1.02 ± .33, CI:.17/1.24, P < .002); this was also the case for RV global LS (SMD: .72 ± .11, CI: .50/.93, P < .0001). Notably, compared to patients with mild‐OSA those with moderate and severe OSA exhibited significantly lower RV free‐wall LS and global LS values; this was not the case for tricuspid annular plane excursion. In conclusions, both RV free‐wall and global LS are impaired in patients with OSA; deterioration of these indices, unlike TAPSE, was already evident in the early stages and was related to the severity of the syndrome. Thus, RV myocardial strain should be considered to be included in echocardiographic evaluation of OSA patients in order to detect subclinical cardiac damage in these patients regardless of its degree of severity.

Sleep Apnea Syndrome and Large Artery Subclinical Damage: Targeting Thoracic Aortic Dilatation

AIM

Whether obstructive sleep apnea (OSA) actually represents an independent risk factor for aortic dilation in the general population is unclear. We investigated this issue through a review and a meta-analysis of cardiac imaging studies that provided data on this vascular phenotype measured at the root or ascending tract level.

DESIGN

A computerized search was performed using Pub-Med, OVID, EMBASE, and Cochrane library databases from inception up to 30 November 2021. Studies were identified by using the following search terms: "aortic root," "ascending aorta," "vascular damage," "echocardiography," "computed tomography," "magnetic resonance imaging," "obstructive sleep apnea," "sleep disordered breathing."

RESULTS

Eleven studies including a total of 1,860 patients with OSA (without aortic aneurysms and connective tissue diseases) and 233 non-OSA controls were considered. Aortic diameter was significantly higher in patients with OSA than in non-OSA controls (standard means difference [SMD] = 0.73 ± 0.08, confidence interval [CI]: 0.57-0.88, P < 0.0001). This was also the case for patients with severe OSA as compared with their counterparts with mild OSA (SMD = 0.42 ± 0.07, CI: 0.28-0.56, P < 0.0001).

CONCLUSIONS

Our findings suggest an association between OSA and aortic enlargement and particularly in the severe OSA setting. However, this conclusion must be taken with caution in relation to 2 types of factors: (i) the paucity of available data, and (ii) the limits deriving from the methodological differences of the various studies. Larger prospective and carefully designed studies are needed to shed light on this relevant public health topic.

Sleep-disordered breathing was associated with lower health-related quality of life and cognitive function in a cross-sectional study of older adults

Background and objective

The clinical significance of sleep‐disordered breathing (SDB) in older age is uncertain. This study determined the prevalence and associations of SDB with mood, daytime sleepiness, quality of life (QOL) and cognition in a relatively healthy older Australian cohort.

Methods

A cross‐sectional analysis was conducted from the Study of Neurocognitive Outcomes, Radiological and retinal Effects of Aspirin in Sleep Apnoea. Participants completed an unattended limited channel sleep study to measure the oxygen desaturation index (ODI) to define mild (ODI 5–15) and moderate/severe (ODI ≥ 15) SDB, the Centre for Epidemiological Studies Scale, the Epworth Sleepiness Scale, the 12‐item Short‐Form for QOL and neuropsychological tests.

Results

Of the 1399 participants (mean age 74.0 years), 36% (273 of 753) of men and 25% (164 of 646) of women had moderate/severe SDB. SDB was associated with lower physical health‐related QOL (mild SDB: beta coefficient [β] −2.5, 95% CI −3.6 to −1.3, p < 0.001; moderate/severe SDB: β −1.8, 95% CI −3.0 to −0.6, p = 0.005) and with lower global composite cognition (mild SDB: β −0.1, 95% CI −0.2 to 0.0, p = 0.022; moderate/severe SDB: β −0.1, 95% CI −0.2 to 0.0, p = 0.032) compared to no SDB. SDB was not associated with daytime sleepiness nor depression.

Conclusion

SDB was associated with lower physical health‐related quality of life and cognitive function. Given the high prevalence of SDB in older age, assessing QOL and cognition may better delineate subgroups requiring further management, and provide useful treatment target measures for this age group.

The clinical implications for sleep‐disordered breathing (SDB) in older age remain uncertain. This study of healthy community‐dwelling older Australians reports significant associations between SDB and a lower physical health‐related quality of life, in contrast to other studies of SDB in older age, and between SDB and lower cognitive function.

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Comorbidities and quality of life in Australian men and women with diagnosed and undiagnosed high risk obstructive sleep apnea

STUDY OBJECTIVES

In a population-based survey, we determined sex-differences in health profiles and quality of life between individuals who have a confirmed diagnosis of obstructive sleep apnea (OSA) and those who are at high risk of OSA yet remain undiagnosed.

METHODS

An online survey of Australian adults ≥18 years (n= 3818) identified participants with self-reported diagnosed OSA (n=460) or high risk, undiagnosed OSA (OSA50 score ≥5, n=1015). Ever-diagnosed comorbidities, sociodemographic and quality of life (EQ-5D-5L, Functional Outcomes of Sleep Questionnaire-10) were assessed.

RESULTS

Females were more frequently represented in the high OSA risk group compared to diagnosed OSA (55.5%, n=563 cf 43%, n=198) p<0.001. In sex-specific logistic regression analyses, diagnosed OSA was associated with increased likelihoods of ≥1 cardiovascular condition (odds ratio:3.0, 95% CI:2.0-4.5), hypertension (1.9, 1.3-2.8), gout (1.8, 1.1-2.9) and COPD (3.8, 2.1-6.9) in males. In females an association with asthma (2.0, 1.3-3.0) was seen. Diabetes, arthritis, mental health conditions (ever-diagnosed) and all EQ-5D-5L dimensions were associated with an OSA diagnosis regardless of sex with the exception of EQ-5D-5L anxiety/depression which was only associated with an OSA diagnosis in females. A diagnosis of OSA was associated with sleepiness related impairment (lowest quartile of FOSQ-10) in males (1.6, 1.01-2.5) and females (2.2, 1.4-3.6).

CONCLUSIONS

Sex-specific health conditions may drive diagnosis of OSA however a clinical suspicion of OSA needs to be increased in men and women. The impaired quality of life and persistent sleepiness in participants with diagnosed OSA observed at a population level requires greater clinical attention.

Results of CPAP Titration and Short-Term Adherence Rates in Patients with Obesity Hypoventilation Syndrome and Mild/Moderate Obstructive Sleep Apnea

PURPOSE

No study has assessed the titration success of CPAP therapy in patients with obesity hypoventilation syndrome (OHS) and an apnea-hypopnea index (AHI) <30 event/h. This study aimed to assess the titration success of CPAP therapy under polysomnography and subsequent short-term adherence (1 month) in patients with OHS and an AHI <30 event/h.

METHODS

Consecutive OHS patients with an AHI <30 events/h between 2010 and 2019 were included (n=54). All OHS patients were first started on CPAP during the therapeutic sleep-study. If the therapeutic-study showed that the SpO2 remained < 90% for 20% of the total sleep time, a second therapeutic study was arranged with bi-level PAP (BPAP). Thirty patients agreed to participate in the 1-month follow-up adherence study. We applied the American-Thoracic-Society criteria for PAP adherence.

RESULTS

The mean age was 54.8±14.6 years, and the mean BMI was 45.9±12.2 kg/m². Successful titration on CPAP was attained in 36 (66.7%) patients, and 18 (33.3%) required BPAP. Patients who failed the CPAP trial had a significantly higher PaCO2 and bicarbonate, a more restrictive respiratory pattern on spirometry, and a significantly higher time with SpO2<90% (mins) during sleep. The only independent correlate of CPAP-titration success on the multivariable regression analysis was the desaturation index (OR: 1.33 [1.033-1.712]). More than 80% of the participants were using CPAP therapy after one-month with no differences in adherence between the CPAP and BPAP groups.

CONCLUSIONS

The current results suggest that CPAP therapy could be an acceptable alternative therapy to BPAP in patients with OHS without severe OSA.