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Wang H, Cade BE, Sofer T, Sands SA, Chen H, Browning SR, Stilp AM, Louie TL, Thornton TA, Johnson WC, Below JE, Conomos MP, Evans DS, Gharib SA, Guo X, Wood AC, Mei H, Yaffe K, Loredo JS, Ramos AR, Barrett-Connor E, Ancoli-Israel S, Zee PC, Arens R, Shah NA, Taylor KD, Tranah GJ, Stone KL, Hanis CL, Wilson JG, Gottlieb DJ, Patel SR, Rice K, Post WS, Rotter JI, Sunyaev SR, Cai J, Lin X, Purcell SM, Laurie CC, Saxena R, Redline S, Zhu X. Admixture mapping identifies novel loci for obstructive sleep apnea in Hispanic/Latino Americans. Hum Mol Genet 2019; 28:675-687. [PMID: 30403821 DOI: 10.1093/hmg/ddy387] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 11/05/2018] [Indexed: 01/11/2023] Open
Abstract
Obstructive sleep apnea (OSA) is a common disorder associated with increased risk of cardiovascular disease and mortality. Its prevalence and severity vary across ancestral background. Although OSA traits are heritable, few genetic associations have been identified. To identify genetic regions associated with OSA and improve statistical power, we applied admixture mapping on three primary OSA traits [the apnea hypopnea index (AHI), overnight average oxyhemoglobin saturation (SaO2) and percentage time SaO2 < 90%] and a secondary trait (respiratory event duration) in a Hispanic/Latino American population study of 11 575 individuals with significant variation in ancestral background. Linear mixed models were performed using previously inferred African, European and Amerindian local genetic ancestry markers. Global African ancestry was associated with a lower AHI, higher SaO2 and shorter event duration. Admixture mapping analysis of the primary OSA traits identified local African ancestry at the chromosomal region 2q37 as genome-wide significantly associated with AHI (P < 5.7 × 10-5), and European and Amerindian ancestries at 18q21 suggestively associated with both AHI and percentage time SaO2 < 90% (P < 10-3). Follow-up joint ancestry-SNP association analyses identified novel variants in ferrochelatase (FECH), significantly associated with AHI and percentage time SaO2 < 90% after adjusting for multiple tests (P < 8 × 10-6). These signals contributed to the admixture mapping associations and were replicated in independent cohorts. In this first admixture mapping study of OSA, novel associations with variants in the iron/heme metabolism pathway suggest a role for iron in influencing respiratory traits underlying OSA.
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Affiliation(s)
- Heming Wang
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA.,Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, USA.,Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA.,Broad Institute, Cambridge, MA 02142, USA
| | - Brian E Cade
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, USA.,Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA.,Broad Institute, Cambridge, MA 02142, USA
| | - Tamar Sofer
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, USA.,Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA.,Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Scott A Sands
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, USA.,Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - Han Chen
- Human Genetics Center, Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA.,Center for Precision Health, School of Public Health & School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Sharon R Browning
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Adrienne M Stilp
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Tin L Louie
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | | | - W Craig Johnson
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Jennifer E Below
- Vanderbilt Genetics Institute, Department of Medical Genetics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Matthew P Conomos
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Daniel S Evans
- California Pacific Medical Center Research Institute, San Francisco, CA, USA
| | - Sina A Gharib
- Computational Medicine Core, Center for Lung Biology, UW Medicine Sleep Center, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA, USA
| | - Xiuqing Guo
- Institute for Translational Genomics and Population Sciences, Los Angeles BioMedical Research Institute and Department of Pediatrics at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Alexis C Wood
- USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX, USA
| | - Hao Mei
- Department of Data Science, University of Mississippi Medical Center, Jackson, MS, USA
| | - Kristine Yaffe
- Departments of Psychiatry and Neurology, University of California, San Francisco, San Francisco, CA, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Jose S Loredo
- Division of Pulmonary Critical Care and Sleep Medicine, Department of Medicine, UC San Diego School of Medicine, La Jolla, CA, USA
| | - Alberto R Ramos
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Sonia Ancoli-Israel
- Departments of Medicine and Psychiatry, University of California, San Diego, CA, USA.,Department of Veterans Affairs, San Diego Center of Excellence for Stress and Mental Health, San Diego, CA, USA
| | - Phyllis C Zee
- Department of Neurology and Sleep Medicine Center, Northwestern University, Chicago, IL, USA
| | - Raanan Arens
- The Children's Hospital at Montefiore, Division of Respiratory and Sleep Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Neomi A Shah
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kent D Taylor
- Institute for Translational Genomics and Population Sciences, Los Angeles BioMedical Research Institute and Department of Pediatrics at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Gregory J Tranah
- California Pacific Medical Center Research Institute, San Francisco, CA, USA
| | - Katie L Stone
- California Pacific Medical Center Research Institute, San Francisco, CA, USA
| | - Craig L Hanis
- Human Genetics Center, Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - James G Wilson
- Physiology and Biophysics, University of Mississippi, Jackson, MS, USA
| | - Daniel J Gottlieb
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, USA.,Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA.,VA Boston Healthcare System, Boston, MA, USA
| | - Sanjay R Patel
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Ken Rice
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Wendy S Post
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, USA
| | - Jerome I Rotter
- Institute for Translational Genomics and Population Sciences, Los Angeles BioMedical Research Institute and Department of Pediatrics at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Shamil R Sunyaev
- Broad Institute, Cambridge, MA 02142, USA.,Division of Genetics, Brigham and Women's Hospital, Boston, MA, USA.,Division of Medical Sciences, Harvard Medical School, Boston, MA, USA
| | - Jianwen Cai
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC, USA
| | - Xihong Lin
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Shaun M Purcell
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, USA.,Broad Institute, Cambridge, MA 02142, USA.,Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Cathy C Laurie
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Richa Saxena
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, USA.,Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA.,Broad Institute, Cambridge, MA 02142, USA.,Center for Genomic Medicine and Department of Anesthesia, Pain, and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, USA.,Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA.,Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Xiaofeng Zhu
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
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2
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Cade BE, Chen H, Stilp AM, Louie T, Ancoli-Israel S, Arens R, Barfield R, Below JE, Cai J, Conomos MP, Evans DS, Frazier-Wood AC, Gharib SA, Gleason KJ, Gottlieb DJ, Hillman DR, Johnson WC, Lederer DJ, Lee J, Loredo JS, Mei H, Mukherjee S, Patel SR, Post WS, Purcell SM, Ramos AR, Reid KJ, Rice K, Shah NA, Sofer T, Taylor KD, Thornton TA, Wang H, Yaffe K, Zee PC, Hanis CL, Palmer LJ, Rotter JI, Stone KL, Tranah GJ, Wilson JG, Sunyaev SR, Laurie CC, Zhu X, Saxena R, Lin X, Redline S. Associations of variants In the hexokinase 1 and interleukin 18 receptor regions with oxyhemoglobin saturation during sleep. PLoS Genet 2019; 15:e1007739. [PMID: 30990817 PMCID: PMC6467367 DOI: 10.1371/journal.pgen.1007739] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 10/03/2018] [Indexed: 12/12/2022] Open
Abstract
Sleep disordered breathing (SDB)-related overnight hypoxemia is associated with cardiometabolic disease and other comorbidities. Understanding the genetic bases for variations in nocturnal hypoxemia may help understand mechanisms influencing oxygenation and SDB-related mortality. We conducted genome-wide association tests across 10 cohorts and 4 populations to identify genetic variants associated with three correlated measures of overnight oxyhemoglobin saturation: average and minimum oxyhemoglobin saturation during sleep and the percent of sleep with oxyhemoglobin saturation under 90%. The discovery sample consisted of 8,326 individuals. Variants with p < 1 × 10(-6) were analyzed in a replication group of 14,410 individuals. We identified 3 significantly associated regions, including 2 regions in multi-ethnic analyses (2q12, 10q22). SNPs in the 2q12 region associated with minimum SpO2 (rs78136548 p = 2.70 × 10(-10)). SNPs at 10q22 were associated with all three traits including average SpO2 (rs72805692 p = 4.58 × 10(-8)). SNPs in both regions were associated in over 20,000 individuals and are supported by prior associations or functional evidence. Four additional significant regions were detected in secondary sex-stratified and combined discovery and replication analyses, including a region overlapping Reelin, a known marker of respiratory complex neurons.These are the first genome-wide significant findings reported for oxyhemoglobin saturation during sleep, a phenotype of high clinical interest. Our replicated associations with HK1 and IL18R1 suggest that variants in inflammatory pathways, such as the biologically-plausible NLRP3 inflammasome, may contribute to nocturnal hypoxemia.
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Affiliation(s)
- Brian E. Cade
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA, United States of America
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, United States of America
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, United States of America
| | - Han Chen
- Human Genetics Center, Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX United States of America
- Center for Precision Health, School of Public Health and School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX United States of America
| | - Adrienne M. Stilp
- Department of Biostatistics, University of Washington, Seattle, WA United States of America
| | - Tin Louie
- Department of Biostatistics, University of Washington, Seattle, WA United States of America
| | - Sonia Ancoli-Israel
- Department of Psychiatry, University of California, San Diego, CA, United States of America
| | - Raanan Arens
- The Children’s Hospital at Montefiore, Division of Respiratory and Sleep Medicine, Albert Einstein College of Medicine, Bronx, NY, United States of America
| | - Richard Barfield
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Jennifer E. Below
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Jianwen Cai
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States of America
| | - Matthew P. Conomos
- Department of Biostatistics, University of Washington, Seattle, WA United States of America
| | - Daniel S. Evans
- California Pacific Medical Center Research Institute, San Francisco, CA, United States of America
| | - Alexis C. Frazier-Wood
- USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX, United States of America
| | - Sina A. Gharib
- Computational Medicine Core, Center for Lung Biology, UW Medicine Sleep Center, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle WA, United States of America
| | - Kevin J. Gleason
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA, United States of America
- Department of Public Health Sciences, University of Chicago, Chicago, IL, United States of America
| | - Daniel J. Gottlieb
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA, United States of America
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, United States of America
- VA Boston Healthcare System, Boston, MA, United States of America
| | - David R. Hillman
- Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - W. Craig Johnson
- Department of Biostatistics, University of Washington, Seattle, WA United States of America
| | - David J. Lederer
- Departments of Medicine and Epidemiology, Columbia University, New York, NY, United States of America
| | - Jiwon Lee
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA, United States of America
| | - Jose S. Loredo
- Division of Pulmonary Critical Care and Sleep Medicine, Department of Medicine, UC San Diego School of Medicine, La Jolla, CA, United States of America
| | - Hao Mei
- Department of Data Science, University of Mississippi Medical Center, Jackson, MS, United States of America
| | - Sutapa Mukherjee
- Sleep Health Service, Respiratory and Sleep Services, Southern Adelaide Local Health Network, Adelaide, South Australia
- Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia
| | - Sanjay R. Patel
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Wendy S. Post
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States of America
| | - Shaun M. Purcell
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA, United States of America
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, United States of America
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, United States of America
| | - Alberto R. Ramos
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Kathryn J. Reid
- Department of Neurology, Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Ken Rice
- Department of Biostatistics, University of Washington, Seattle, WA United States of America
| | - Neomi A. Shah
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Tamar Sofer
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA, United States of America
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, United States of America
- Department of Biostatistics, University of Washington, Seattle, WA United States of America
| | - Kent D. Taylor
- The Institute for Translational Genomics and Population Sciences, Departments of Pediatrics and Medicine, LABioMed at Harbor-UCLA Medical Center, Torrance, CA, United States of America
| | - Timothy A. Thornton
- Department of Biostatistics, University of Washington, Seattle, WA United States of America
| | - Heming Wang
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA, United States of America
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, United States of America
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, United States of America
| | - Kristine Yaffe
- Department of Psychiatry, Neurology, and Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA, United States of America
- San Francisco VA Medical Center, San Francisco, CA, United States of America
| | - Phyllis C. Zee
- Department of Neurology, Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Craig L. Hanis
- Human Genetics Center, Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX United States of America
| | - Lyle J. Palmer
- School of Public Health, University of Adelaide, South Australia, Australia
| | - Jerome I. Rotter
- The Institute for Translational Genomics and Population Sciences, Departments of Pediatrics and Medicine, LABioMed at Harbor-UCLA Medical Center, Torrance, CA, United States of America
| | - Katie L. Stone
- California Pacific Medical Center Research Institute, San Francisco, CA, United States of America
| | - Gregory J. Tranah
- California Pacific Medical Center Research Institute, San Francisco, CA, United States of America
| | - James G. Wilson
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson MS, United States of America
| | - Shamil R. Sunyaev
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, United States of America
- Division of Genetics, Brigham and Women's Hospital, Boston, MA, United States of America
- Division of Medical Sciences, Harvard Medical School, Boston, MA, United States of America
| | - Cathy C. Laurie
- Department of Biostatistics, University of Washington, Seattle, WA United States of America
| | - Xiaofeng Zhu
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, United States of America
| | - Richa Saxena
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA, United States of America
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, United States of America
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, United States of America
- Center for Genomic Medicine and Department of Anesthesia, Pain, and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Xihong Lin
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA, United States of America
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, United States of America
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
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Abbott SM, Weng J, Reid KJ, Daviglus ML, Gallo LC, Loredo JS, Nyenhuis SM, Ramos AR, Shah NA, Sotres-Alvarez D, Patel SR, Zee PC. Sleep Timing, Stability, and BP in the Sueño Ancillary Study of the Hispanic Community Health Study/Study of Latinos. Chest 2018; 155:60-68. [PMID: 30300651 DOI: 10.1016/j.chest.2018.09.018] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 07/23/2018] [Accepted: 09/05/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Timing and stability of the sleep-wake cycle are potential modifiable risk factors for cardiometabolic disease. The aim of this study was to evaluate the relationship between objective measures of sleep-wake timing and stability with cardiometabolic disease risk. METHODS In this multicenter, cross-sectional, population-based study, actigraphy data were obtained from the 2,156 adults, aged 18 to 64 years, recruited from the Sueño ancillary study of the Hispanic Community Health Study/Study of Latinos (2010-2013). These data were correlated with measures of cardiometabolic disease risk, including systolic and diastolic BPs, homeostatic assessment of insulin resistance, glycosylated hemoglobin, BMI, and hypertension and diabetes status. RESULTS Each 10% decrease in interdaily stability was associated with a 3.0% absolute increase in the prevalence of hypertension (95% CI, 0.6-5.3; P < .05), an increase in systolic BP by 0.78 mm Hg (95% CI, 0.12-1.45; P < .05) and an increase in diastolic BP by 0.80 mm Hg (95% CI, 0.28-1.32; P < .05). In addition, delaying the midpoint of sleep by 1 h was associated with an increase in systolic BP by 0.73 mm Hg (95% CI, 0.30-1.16; P < .01) and diastolic BP by 0.53 mm Hg (95% CI, 0.17-0.90; P < .01). These associations were not significant after adjusting for shift work status. No association was found between interdaily stability or sleep timing and diabetes, BMI, or insulin resistance. CONCLUSIONS These results suggest that beyond sleep duration, the timing and regularity of sleep-wake schedules are related to hypertension prevalence and BP.
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Affiliation(s)
- Sabra M Abbott
- Department of Neurology, Northwestern University, Chicago, IL.
| | - Jia Weng
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA
| | - Kathryn J Reid
- Department of Neurology, Northwestern University, Chicago, IL
| | - Martha L Daviglus
- Institute for Minority Health Research, University of Illinois at Chicago, Chicago, IL
| | - Linda C Gallo
- Department of Psychology, San Diego State University, San Diego, CA
| | - Jose S Loredo
- Division of Pulmonary and Critical Care Medicine, University of California San Diego, San Diego, CA
| | | | | | - Neomi A Shah
- Division of Pulmonary, Critical Care and Sleep, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Daniela Sotres-Alvarez
- Collaborative Studies Coordinating Center, Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Sanjay R Patel
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Phyllis C Zee
- Department of Neurology, Northwestern University, Chicago, IL
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4
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Chen H, Cade BE, Gleason KJ, Bjonnes AC, Stilp AM, Sofer T, Conomos MP, Ancoli-Israel S, Arens R, Azarbarzin A, Bell GI, Below JE, Chun S, Evans DS, Ewert R, Frazier-Wood AC, Gharib SA, Haba-Rubio J, Hagen EW, Heinzer R, Hillman DR, Johnson WC, Kutalik Z, Lane JM, Larkin EK, Lee SK, Liang J, Loredo JS, Mukherjee S, Palmer LJ, Papanicolaou GJ, Penzel T, Peppard PE, Post WS, Ramos AR, Rice K, Rotter JI, Sands SA, Shah NA, Shin C, Stone KL, Stubbe B, Sul JH, Tafti M, Taylor KD, Teumer A, Thornton TA, Tranah GJ, Wang C, Wang H, Warby SC, Wellman DA, Zee PC, Hanis CL, Laurie CC, Gottlieb DJ, Patel SR, Zhu X, Sunyaev SR, Saxena R, Lin X, Redline S. Multiethnic Meta-Analysis Identifies RAI1 as a Possible Obstructive Sleep Apnea-related Quantitative Trait Locus in Men. Am J Respir Cell Mol Biol 2018; 58:391-401. [PMID: 29077507 PMCID: PMC5854957 DOI: 10.1165/rcmb.2017-0237oc] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 10/24/2017] [Indexed: 12/19/2022] Open
Abstract
Obstructive sleep apnea (OSA) is a common heritable disorder displaying marked sexual dimorphism in disease prevalence and progression. Previous genetic association studies have identified a few genetic loci associated with OSA and related quantitative traits, but they have only focused on single ethnic groups, and a large proportion of the heritability remains unexplained. The apnea-hypopnea index (AHI) is a commonly used quantitative measure characterizing OSA severity. Because OSA differs by sex, and the pathophysiology of obstructive events differ in rapid eye movement (REM) and non-REM (NREM) sleep, we hypothesized that additional genetic association signals would be identified by analyzing the NREM/REM-specific AHI and by conducting sex-specific analyses in multiethnic samples. We performed genome-wide association tests for up to 19,733 participants of African, Asian, European, and Hispanic/Latino American ancestry in 7 studies. We identified rs12936587 on chromosome 17 as a possible quantitative trait locus for NREM AHI in men (N = 6,737; P = 1.7 × 10-8) but not in women (P = 0.77). The association with NREM AHI was replicated in a physiological research study (N = 67; P = 0.047). This locus overlapping the RAI1 gene and encompassing genes PEMT1, SREBF1, and RASD1 was previously reported to be associated with coronary artery disease, lipid metabolism, and implicated in Potocki-Lupski syndrome and Smith-Magenis syndrome, which are characterized by abnormal sleep phenotypes. We also identified gene-by-sex interactions in suggestive association regions, suggesting that genetic variants for AHI appear to vary by sex, consistent with the clinical observations of strong sexual dimorphism.
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Affiliation(s)
- Han Chen
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Human Genetics Center, Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health and
- Center for Precision Health, School of Public Health & School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Brian E. Cade
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts
| | - Kevin J. Gleason
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois
| | - Andrew C. Bjonnes
- Division of Genetics, Brigham and Women’s Hospital, Boston, Massachusetts
- Center for Genomic Medicine and Department of Anesthesia, Pain, and Critical Care Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Adrienne M. Stilp
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Tamar Sofer
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Matthew P. Conomos
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Sonia Ancoli-Israel
- Departments of Medicine and Psychiatry, University of California, San Diego, California
| | - Raanan Arens
- the Children’s Hospital at Montefiore, Division of Respiratory and Sleep Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Ali Azarbarzin
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts
| | - Graeme I. Bell
- Section of Adult and Pediatric Endocrinology, Diabetes, and Metabolism, the University of Chicago, Chicago, Illinois
| | - Jennifer E. Below
- Human Genetics Center, Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health and
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sung Chun
- Division of Genetics, Brigham and Women’s Hospital, Boston, Massachusetts
- Division of Medical Sciences, Harvard Medical School, Boston, Massachusetts
| | - Daniel S. Evans
- California Pacific Medical Center Research Institute, San Francisco, California
| | - Ralf Ewert
- Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | | | - Sina A. Gharib
- Computational Medicine Core, Center for Lung Biology, University of Washington Medicine Sleep Center, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington
| | - José Haba-Rubio
- Center of Investigation and Research on Sleep, Lausanne University Hospital, Lausanne, Switzerland
| | - Erika W. Hagen
- Department of Population Health Sciences, University of Wisconsin, Madison, Wisconsin
| | - Raphael Heinzer
- Center of Investigation and Research on Sleep, Lausanne University Hospital, Lausanne, Switzerland
| | - David R. Hillman
- Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - W. Craig Johnson
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Zoltan Kutalik
- Institute of Social and Preventive Medicine, University Hospital of Lausanne, Lausanne, Switzerland
- Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Jacqueline M. Lane
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts
- Center for Genomic Medicine and Department of Anesthesia, Pain, and Critical Care Medicine, Massachusetts General Hospital, Boston, Massachusetts
- Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts
| | - Emma K. Larkin
- Department of Medicine, Division of Allergy, Pulmonary, and Critical Care, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Seung Ku Lee
- Institute of Human Genomic Study, College of Medicine, Korea University Ansan Hospital, Jeokgum-ro, Danwon-gu, Ansan-si, Gyeonggi-Do, Republic of Korea
| | - Jingjing Liang
- Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Jose S. Loredo
- Division of Pulmonary Critical Care and Sleep Medicine, Department of Medicine, University of California San Diego School of Medicine, La Jolla, California
| | - Sutapa Mukherjee
- Adelaide Institute for Sleep Health, Flinders Centre of Research Excellence, Flinders University, Adelaide, South Australia, Australia
| | - Lyle J. Palmer
- School of Public Health, University of Adelaide, Adelaide, South Australia, Australia
| | - George J. Papanicolaou
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Thomas Penzel
- University Hospital Charité Berlin, Sleep Center, Berlin, Germany
| | - Paul E. Peppard
- Department of Population Health Sciences, University of Wisconsin, Madison, Wisconsin
| | - Wendy S. Post
- Division of Cardiology, Johns Hopkins University, Baltimore, Maryland
| | - Alberto R. Ramos
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida
| | - Ken Rice
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Jerome I. Rotter
- Institute for Translational Genomics and Population Sciences, Los Angeles BioMedical Research Institute and Department of Pediatrics at Harbor–University of California Los Angeles Medical Center, Torrance, California
| | - Scott A. Sands
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts
| | - Neomi A. Shah
- Division of Pulmonary, Critical Care, and Sleep, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Chol Shin
- Department of Pulmonary, Sleep, and Critical Care Medicine, College of Medicine, Korea University Ansan Hospital, Jeokgum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, Republic of Korea
| | - Katie L. Stone
- California Pacific Medical Center Research Institute, San Francisco, California
| | - Beate Stubbe
- Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Jae Hoon Sul
- Division of Genetics, Brigham and Women’s Hospital, Boston, Massachusetts
- Division of Medical Sciences, Harvard Medical School, Boston, Massachusetts
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, California
| | - Mehdi Tafti
- Center of Investigation and Research on Sleep, Lausanne University Hospital, Lausanne, Switzerland
- Department of Physiology, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Kent D. Taylor
- Institute for Translational Genomics and Population Sciences, Los Angeles BioMedical Research Institute and Department of Pediatrics at Harbor–University of California Los Angeles Medical Center, Torrance, California
| | - Alexander Teumer
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | | | - Gregory J. Tranah
- California Pacific Medical Center Research Institute, San Francisco, California
| | - Chaolong Wang
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Computational and Systems Biology, Genome Institute of Singapore, Singapore
| | - Heming Wang
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts
- Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Simon C. Warby
- Department of Psychiatry, University of Montreal, Montreal, Quebec, Canada
| | - D. Andrew Wellman
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts
| | - Phyllis C. Zee
- Department of Neurology and Sleep Medicine Center, Northwestern University, Chicago, Illinois
| | - Craig L. Hanis
- Human Genetics Center, Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health and
| | - Cathy C. Laurie
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Daniel J. Gottlieb
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts
- Veterans Affairs Boston Healthcare System, Boston, Massachusetts
| | - Sanjay R. Patel
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Xiaofeng Zhu
- Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Shamil R. Sunyaev
- Division of Genetics, Brigham and Women’s Hospital, Boston, Massachusetts
- Division of Medical Sciences, Harvard Medical School, Boston, Massachusetts
- Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts; and
| | - Richa Saxena
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts
- Center for Genomic Medicine and Department of Anesthesia, Pain, and Critical Care Medicine, Massachusetts General Hospital, Boston, Massachusetts
- Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts
| | - Xihong Lin
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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5
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Ramos AR, Weng J, Wallace DM, Petrov MR, Wohlgemuth WK, Sotres-Alvarez D, Loredo JS, Reid KJ, Zee PC, Mossavar-Rahmani Y, Patel SR. Sleep Patterns and Hypertension Using Actigraphy in the Hispanic Community Health Study/Study of Latinos. Chest 2018; 153:87-93. [PMID: 28970105 PMCID: PMC5812757 DOI: 10.1016/j.chest.2017.09.028] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 07/19/2017] [Accepted: 09/06/2017] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The aim of this study was to evaluate the association between actigraphy-based measures of sleep and prevalent hypertension in a sample of US Latinos. METHODS We analyzed data from 2,148 participants of the Sueño Sleep Ancillary Study of the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), who underwent 1 week of wrist actigraphy to characterize sleep duration, sleep efficiency, sleep fragmentation index, and daytime naps. Insomnia was defined as an Insomnia Severity Index ≥ 15. Hypertension was defined based on self-reported physician diagnosis. Survey linear regression was used to evaluate the association of sleep measures with hypertension prevalence. Sensitivity analyses excluded participants with an apnea-hypopnea index (AHI) ≥ 15 events/h. RESULTS The mean age was 46.3 ± 11.6 years, and 65% of the sample consisted of women. The mean sleep duration was 6.7 ± 1.1 hours. Thirty-two percent of the sample had hypertension. After adjusting for age, sex, ethnic background, site, and AHI, each 10% reduction in sleep efficiency was associated with a 7.5% (95% CI, -12.9 to -2.2; P = .0061) greater hypertension prevalence, each 10% increase in sleep fragmentation index was associated with a 5.2% (95% CI, 1.4-8.9; P = .0071) greater hypertension prevalence, and frequent napping was associated with a 11.6% greater hypertension prevalence (95% CI, 5.5-17.7; P = .0002). In contrast, actigraphy-defined sleep duration (P = .20) and insomnia (P = .17) were not associated with hypertension. These findings persisted after excluding participants with an AHI ≥ 15 events/h. CONCLUSIONS Independent of sleep-disordered breathing, we observed associations between reduced sleep continuity and daytime napping, but not short sleep duration, and prevalent hypertension.
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Affiliation(s)
- Alberto R Ramos
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL.
| | - Jia Weng
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA
| | - Douglas M Wallace
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL; Neurology Service, Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, FL
| | - Megan R Petrov
- College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ
| | - William K Wohlgemuth
- Neurology Service, Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, FL; Psychology Service, Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, FL
| | - Daniela Sotres-Alvarez
- Collaborative Studies Coordinating Center, Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Jose S Loredo
- Division of Pulmonary and Critical Care Medicine, University of California San Diego, San Diego, CA
| | - Kathryn J Reid
- Department of Neurology, Northwestern University, Chicago, IL
| | - Phyllis C Zee
- Department of Neurology, Northwestern University, Chicago, IL
| | - Yasmin Mossavar-Rahmani
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Sanjay R Patel
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA
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6
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Knutson KL, Wu D, Patel SR, Loredo JS, Redline S, Cai J, Gallo LC, Mossavar-Rahmani Y, Ramos AR, Teng Y, Daviglus ML, Zee PC. Association Between Sleep Timing, Obesity, Diabetes: The Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Cohort Study. Sleep 2017; 40:2962431. [PMID: 28329091 DOI: 10.1093/sleep/zsx014] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Study Objectives Recent studies implicate inadequate sleep duration and quality in metabolic disease. Fewer studies have examined the timing of sleep, which may be important because of its potential impact on circadian rhythms of metabolic function. We examined the association between sleep timing and metabolic risk among Hispanic/Latino adults. Methods Cross-sectional data from community-based study of 13429 participants aged 18-74 years. People taking diabetic medications were excluded. Sleep timing was determined from self-reported bedtimes and wake times. Chronotype was defined as the midpoint of sleep on weekends adjusted for sleep duration on weekdays. Other measurements included body mass index (BMI), fasting glucose levels, estimated insulin resistance (HOMA-IR), glucose levels 2 hours post oral glucose ingestion, and hemoglobin A1c. Survey linear regression models tested associations between sleep timing and metabolic measures. Analyses were stratified by diabetes status and age-group when significant interactions were observed. Results Among participants with diabetes, fasting glucose levels were positively associated with bedtime (approximately +3%/hour later, p < .01) and midpoint of sleep (approximately +2%/hour later, p < .05). In participants with and without diabetes combined, HOMA-IR was positively associated with midpoint of sleep (+1.5%/hr later, p < .05), and chronotype (+1.2%/hour later, p < .05). Associations differed by age-group. Among those < 36 years, later sleep timing was associated with lower BMI, lower fasting glucose, and lower HbA1c, but the opposite association was observed among older participants. Conclusions Later sleep timing was associated with higher estimated insulin resistance across all groups. Some associations between sleep timing and metabolic measures may be age-dependent.
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Affiliation(s)
- Kristen L Knutson
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University
| | - Donghong Wu
- Institute for Minority Health Research, University of Illinois at Chicago
| | - Sanjay R Patel
- Division of Pulmonary Allergy and Critical Care Medicine, University of Pittsburgh
| | - Jose S Loredo
- Department of Medicine, University of California San Diego
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital; Division of Pulmonary, Critical Care and Sleep, Beth Israel Deaconess Medical Center; Harvard Medical School
| | - Jianwen Cai
- Collaborative Studies Coordinating Center, Department of Biostatistics, University of North Carolina at Chapel Hill
| | - Linda C Gallo
- Department of Psychology, San Diego State University
| | - Yasmin Mossavar-Rahmani
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Alberto R Ramos
- Department of Neurology, University of Miami, Miller School of Medicine
| | - Yanping Teng
- Collaborative Studies Coordinating Center, Department of Biostatistics, University of North Carolina at Chapel Hill
| | - Martha L Daviglus
- Institute for Minority Health Research, University of Illinois at Chicago
| | - Phyllis C Zee
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University
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7
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Dudley KA, Weng J, Sotres-Alvarez D, Simonelli G, Cespedes Feliciano E, Ramirez M, Ramos AR, Loredo JS, Reid KJ, Mossavar-Rahmani Y, Zee PC, Chirinos DA, Gallo LC, Wang R, Patel SR. Actigraphic Sleep Patterns of U.S. Hispanics: The Hispanic Community Health Study/Study of Latinos. Sleep 2017; 40:2758299. [PMID: 28364514 DOI: 10.1093/sleep/zsw049] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Study objective To assess the extent to which objective sleep patterns vary among U.S. Hispanics/Latinos. Methods We assessed objective sleep patterns in 2087 participants of the Hispanic Community Health Study/Study of Latinos from 6 Hispanic/Latino subgroups aged 18-64 years who underwent 7 days of wrist actigraphy. Results The age- and sex-standardized mean (SE) sleep duration was 6.82 (0.05), 6.72 (0.07), 6.61 (0.07), 6.59 (0.06), 6.57 (0.10), and 6.44 (0.09) hr among individuals of Mexican, Cuban, Dominican, Central American, Puerto Rican, and South American heritage, respectively. Sleep maintenance efficiency ranged from 89.2 (0.2)% in Mexicans to 86.5 (0.4)% in Puerto Ricans, while the sleep fragmentation index ranged from 19.7 (0.3)% in Mexicans to 24.2 (0.7)% in Puerto Ricans. In multivariable models adjusted for age, sex, season, socioeconomic status, lifestyle habits, and comorbidities, these differences persisted. Conclusions There are important differences in actigraphically measured sleep across U.S. Hispanic/Latino heritages. Individuals of Mexican heritage have longer and more consolidated sleep, while those of Puerto Rican heritage have shorter and more fragmented sleep. These differences may have clinically important effects on health outcomes.
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Affiliation(s)
- Katherine A Dudley
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA.,Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston MA
| | - Jia Weng
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston MA
| | - Daniela Sotres-Alvarez
- Collaborative Studies Coordinating Center, Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Guido Simonelli
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston MA.,Walter Reed Army Institute of Research, Behavioral Biology Branch, Center for Military Psychiatry and Neuroscience, Silver Spring, MD
| | - Elizabeth Cespedes Feliciano
- Departments of Nutrition and Epidemiology, Harvard TH Chan School of Public Health, Boston, MA.,Kaiser Permanente, Division of Research, Oakland, CA
| | - Maricelle Ramirez
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston MA
| | | | - Jose S Loredo
- Division of Pulmonary and Critical Care Medicine, University of California San Diego, San Diego, CA
| | - Kathryn J Reid
- Department of Neurology, Northwestern University, Chicago, IL
| | - Yasmin Mossavar-Rahmani
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Phyllis C Zee
- Department of Neurology, Northwestern University, Chicago, IL
| | | | - Linda C Gallo
- Department of Psychology, San Diego State University, San Diego, CA
| | - Rui Wang
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston MA.,Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, MA
| | - Sanjay R Patel
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA.,Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston MA
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8
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Cade BE, Chen H, Stilp AM, Gleason KJ, Sofer T, Ancoli-Israel S, Arens R, Bell GI, Below JE, Bjonnes AC, Chun S, Conomos MP, Evans DS, Johnson WC, Frazier-Wood AC, Lane JM, Larkin EK, Loredo JS, Post WS, Ramos AR, Rice K, Rotter JI, Shah NA, Stone KL, Taylor KD, Thornton TA, Tranah GJ, Wang C, Zee PC, Hanis CL, Sunyaev SR, Patel SR, Laurie CC, Zhu X, Saxena R, Lin X, Redline S. Genetic Associations with Obstructive Sleep Apnea Traits in Hispanic/Latino Americans. Am J Respir Crit Care Med 2016; 194:886-897. [PMID: 26977737 PMCID: PMC5074655 DOI: 10.1164/rccm.201512-2431oc] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 03/14/2016] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Obstructive sleep apnea is a common disorder associated with increased risk for cardiovascular disease, diabetes, and premature mortality. Although there is strong clinical and epidemiologic evidence supporting the importance of genetic factors in influencing obstructive sleep apnea, its genetic basis is still largely unknown. Prior genetic studies focused on traits defined using the apnea-hypopnea index, which contains limited information on potentially important genetically determined physiologic factors, such as propensity for hypoxemia and respiratory arousability. OBJECTIVES To define novel obstructive sleep apnea genetic risk loci for obstructive sleep apnea, we conducted genome-wide association studies of quantitative traits in Hispanic/Latino Americans from three cohorts. METHODS Genome-wide data from as many as 12,558 participants in the Hispanic Community Health Study/Study of Latinos, Multi-Ethnic Study of Atherosclerosis, and Starr County Health Studies population-based cohorts were metaanalyzed for association with the apnea-hypopnea index, average oxygen saturation during sleep, and average respiratory event duration. MEASUREMENTS AND MAIN RESULTS Two novel loci were identified at genome-level significance (rs11691765, GPR83, P = 1.90 × 10-8 for the apnea-hypopnea index, and rs35424364; C6ORF183/CCDC162P, P = 4.88 × 10-8 for respiratory event duration) and seven additional loci were identified with suggestive significance (P < 5 × 10-7). Secondary sex-stratified analyses also identified one significant and several suggestive associations. Multiple loci overlapped genes with biologic plausibility. CONCLUSIONS These are the first genome-level significant findings reported for obstructive sleep apnea-related physiologic traits in any population. These findings identify novel associations in inflammatory, hypoxia signaling, and sleep pathways.
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Affiliation(s)
- Brian E. Cade
- Division of Sleep and Circadian Disorders and
- Division of Sleep Medicine and
| | - Han Chen
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Adrienne M. Stilp
- Department of Biostatistics, University of Washington, Seattle, Washington
| | | | - Tamar Sofer
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Sonia Ancoli-Israel
- Department of Medicine and
- Department of Psychiatry, University of California, San Diego, California
- Department of Veterans Affairs San Diego Center of Excellence for Stress and Mental Health, San Diego, California
| | - Raanan Arens
- The Children’s Hospital at Montefiore, Division of Respiratory and Sleep Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Graeme I. Bell
- Section of Adult and Pediatric Endocrinology, Diabetes, and Metabolism, The University of Chicago, Chicago, Illinois
| | - Jennifer E. Below
- Human Genetics Center, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Andrew C. Bjonnes
- Division of Genetics, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Sung Chun
- Division of Genetics, Brigham and Women’s Hospital, Boston, Massachusetts
- Division of Medical Sciences, Harvard Medical School, Boston, Massachusetts
| | - Matthew P. Conomos
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Daniel S. Evans
- California Pacific Medical Center Research Institute, San Francisco, California
| | - W. Craig Johnson
- Department of Biostatistics, University of Washington, Seattle, Washington
| | | | - Jacqueline M. Lane
- Division of Sleep and Circadian Disorders and
- Division of Sleep Medicine and
- Center for Human Genetic Research and Department of Anesthesia, Pain, and Critical Care Medicine, Massachusetts General Hospital, Boston, Massachusetts
- Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts
| | - Emma K. Larkin
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jose S. Loredo
- Division of Pulmonary Critical Care and Sleep Medicine, Department of Medicine, UC San Diego School of Medicine, La Jolla, California
| | - Wendy S. Post
- Division of Cardiology, Johns Hopkins University, Baltimore, Maryland
| | - Alberto R. Ramos
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida
| | - Ken Rice
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Jerome I. Rotter
- Institute for Translational Genomics and Population Sciences, Los Angeles BioMedical Research Institute at Harbor-UCLA Medical Center, Torrance, California
| | - Neomi A. Shah
- Department of Medicine, Montefiore Medical Center, Bronx, New York
| | - Katie L. Stone
- California Pacific Medical Center Research Institute, San Francisco, California
| | - Kent D. Taylor
- Institute for Translational Genomics and Population Sciences, Los Angeles BioMedical Research Institute at Harbor-UCLA Medical Center, Torrance, California
| | | | - Gregory J. Tranah
- California Pacific Medical Center Research Institute, San Francisco, California
| | - Chaolong Wang
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Genome Institute of Singapore, Singapore
| | - Phyllis C. Zee
- Department of Neurology and Sleep Medicine Center, Northwestern University, Chicago, Illinois
| | - Craig L. Hanis
- Human Genetics Center, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Shamil R. Sunyaev
- Division of Genetics, Brigham and Women’s Hospital, Boston, Massachusetts
- Division of Medical Sciences, Harvard Medical School, Boston, Massachusetts
- Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts
| | - Sanjay R. Patel
- Division of Sleep and Circadian Disorders and
- Division of Sleep Medicine and
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; and
| | - Cathy C. Laurie
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Xiaofeng Zhu
- Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Richa Saxena
- Division of Sleep and Circadian Disorders and
- Center for Human Genetic Research and Department of Anesthesia, Pain, and Critical Care Medicine, Massachusetts General Hospital, Boston, Massachusetts
- Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts
| | - Xihong Lin
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Susan Redline
- Division of Sleep and Circadian Disorders and
- Division of Sleep Medicine and
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; and
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9
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Barr RG, Avilés-Santa L, Davis SM, Aldrich TK, Gonzalez F, Henderson AG, Kaplan RC, LaVange L, Liu K, Loredo JS, Mendes ES, Ni A, Ries A, Salathe M, Smith LJ. Pulmonary Disease and Age at Immigration among Hispanics. Results from the Hispanic Community Health Study/Study of Latinos. Am J Respir Crit Care Med 2016; 193:386-95. [PMID: 26451874 DOI: 10.1164/rccm.201506-1211oc] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
RATIONALE Asthma has been reported to be more prevalent among Hispanics of Puerto Rican heritage than among other Hispanics and among Hispanics born in the United States or who immigrated as children than among those who came as adults; however, direct comparisons across Hispanic groups are lacking. OBJECTIVES To test whether asthma is more prevalent among Hispanics of Puerto Rican heritage than among other Hispanic groups, whether asthma is associated with age of immigration, and whether chronic obstructive pulmonary disease varies by heritage in a large, population-based cohort of Hispanics in the United States. METHODS The Hispanic Community Health Study/Study of Latinos researchers recruited a population-based probability sample of 16,415 Hispanics/Latinos, 18-74 years of age, in New York City, Chicago, Miami, and San Diego. Participants self-reported Puerto Rican, Cuban, Dominican, Mexican, Central American, or South American heritage; birthplace; and, if relevant, age at immigration. A respiratory questionnaire and standardized spirometry were performed with post-bronchodilator measures for those with airflow limitation. MEASUREMENTS AND MAIN RESULTS The prevalence of physician-diagnosed asthma among Puerto Ricans (36.5%; 95% confidence interval, 33.6-39.5%) was higher than among other Hispanics (odds ratio, 3.9; 95% confidence interval, 3.3-4.6). Hispanics who were born in the mainland United States or had immigrated as children had a higher asthma prevalence than those who had immigrated as adults (19.6, 19.4, and 14.1%, respectively; P < 0.001). Current asthma, bronchodilator responsiveness, and wheeze followed similar patterns. Chronic obstructive pulmonary disease prevalence was higher among Puerto Ricans (14.1%) and Cubans (9.8%) than among other Hispanics (<6.0%), but it did not vary across Hispanic heritages after adjustment for smoking and prior asthma (P = 0.22), by country of birth, or by age at immigration. CONCLUSIONS Asthma was more prevalent among Puerto Ricans, other Hispanics born in the United States, and those who had immigrated as children than among other Hispanics. In contrast, the higher prevalence of chronic obstructive pulmonary disease among Puerto Ricans and Cubans was largely reflective of differential smoking patterns and asthma.
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Affiliation(s)
- R Graham Barr
- 1 Department of Medicine and.,2 Department of Epidemiology, Columbia University Medical Center, New York, New York
| | - Larissa Avilés-Santa
- 3 Division of Cardiovascular Sciences, NHLBI, National Institutes of Health, Bethesda, Maryland
| | | | | | | | - Ashley G Henderson
- 6 Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Robert C Kaplan
- 7 Department of Epidemiology, Albert Einstein College of Medicine, Bronx, New York
| | | | - Kiang Liu
- 8 Department of Preventative Medicine and
| | - Jose S Loredo
- 9 Department of Medicine, University of California, San Diego, La Jolla, California; and
| | - Eliana S Mendes
- 10 Department of Medicine, University of Miami, Miami, Florida
| | - Ai Ni
- 4 Department of Biostatistics and
| | - Andrew Ries
- 9 Department of Medicine, University of California, San Diego, La Jolla, California; and
| | | | - Lewis J Smith
- 11 Department of Medicine, Northwestern University, Chicago, Illinois
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10
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Cespedes EM, Hu FB, Redline S, Rosner B, Alcantara C, Cai J, Hall MH, Loredo JS, Mossavar-Rahmani Y, Ramos AR, Reid KJ, Shah NA, Sotres-Alvarez D, Zee PC, Wang R, Patel SR. Comparison of Self-Reported Sleep Duration With Actigraphy: Results From the Hispanic Community Health Study/Study of Latinos Sueño Ancillary Study. Am J Epidemiol 2016; 183:561-73. [PMID: 26940117 DOI: 10.1093/aje/kwv251] [Citation(s) in RCA: 159] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 09/08/2015] [Indexed: 11/13/2022] Open
Abstract
Most studies of sleep and health outcomes rely on self-reported sleep duration, although correlation with objective measures is poor. In this study, we defined sociodemographic and sleep characteristics associated with misreporting and assessed whether accounting for these factors better explains variation in objective sleep duration among 2,086 participants in the Hispanic Community Health Study/Study of Latinos who completed more than 5 nights of wrist actigraphy and reported habitual bed/wake times from 2010 to 2013. Using linear regression, we examined self-report as a predictor of actigraphy-assessed sleep duration. Mean amount of time spent asleep was 7.85 (standard deviation, 1.12) hours by self-report and 6.74 (standard deviation, 1.02) hours by actigraphy; correlation between them was 0.43. For each additional hour of self-reported sleep, actigraphy time spent asleep increased by 20 minutes (95% confidence interval: 19, 22). Correlations between self-reported and actigraphy-assessed time spent asleep were lower with male sex, younger age, sleep efficiency <85%, and night-to-night variability in sleep duration ≥1.5 hours. Adding sociodemographic and sleep factors to self-reports increased the proportion of variance explained in actigraphy-assessed sleep slightly (18%-32%). In this large validation study including Hispanics/Latinos, we demonstrated a moderate correlation between self-reported and actigraphy-assessed time spent asleep. The performance of self-reports varied by demographic and sleep measures but not by Hispanic subgroup.
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Harmell AL, Neikrug AB, Palmer BW, Avanzino JA, Liu L, Maglione JE, Natarajan L, Corey-Bloom J, Loredo JS, Ancoli-Israel S. Obstructive Sleep Apnea and Cognition in Parkinson's disease. Sleep Med 2016; 21:28-34. [PMID: 27448468 DOI: 10.1016/j.sleep.2016.01.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 12/30/2015] [Accepted: 01/07/2016] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Obstructive sleep apnea (OSA) is very common in Parkinson's disease (PD). OSA is known to affect patients' cognition. The present study assessed whether PD patients with OSA (PD + OSA) score lower on cognitive measures than those without OSA (PD - OSA). In addition, this study evaluated whether treating the OSA with continuous positive airway pressure (CPAP) in PD + OSA patients results in an improved cognitive functioning. METHODS Eighty-six patients with PD underwent an overnight polysomnography screen for OSA and were administered the Mini-Mental Status Exam (MMSE) and the Montreal Cognitive Assessment (MoCA). This resulted in 38 patients with PD + OSA who were randomly assigned to receive either therapeutic CPAP for 6 weeks (n = 19) or placebo CPAP for three weeks followed by therapeutic CPAP for three weeks (n = 19). Intervention participants completed a neurocognitive battery at baseline and 3- and 6-week time-points. RESULTS Patients with PD + OSA scored significantly lower than PD - OSA on the MMSE and MoCA after controlling for age, education, and PD severity. OSA was a significant predictor of cognition (MMSE p <0.01; MoCA p = 0.028).There were no significant changes between groups in cognition when comparing three weeks of therapeutic CPAP with 3 weeks of placebo CPAP. Comparisons between pre-treatment and 3-week post-therapeutic CPAP for the entire sample also revealed no significant changes on overall neuropsychological (NP) scores. CONCLUSIONS Findings suggest that PD patients with OSA show worse cognitive functioning on cognitive screening measures than those without OSA. However, OSA treatment after three or six weeks of CPAP may not result in overall cognitive improvement in patients with PD.
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Affiliation(s)
- Alexandrea L Harmell
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA, USA
| | - Ariel B Neikrug
- Department of Anesthesiology, University of Utah, Salt Lake City, UT, USA
| | - Barton W Palmer
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA, USA; Stein Institute for Research on Aging, CA, USA; Veterans Administration Healthcare System, San Diego, CA, USA
| | - Julie A Avanzino
- Department of Psychiatry, University of California, San Diego, CA, USA; Stein Institute for Research on Aging, CA, USA
| | - Lianqi Liu
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Jeanne E Maglione
- Department of Psychiatry, University of California, San Diego, CA, USA; Stein Institute for Research on Aging, CA, USA; Veterans Administration Healthcare System, San Diego, CA, USA
| | - Loki Natarajan
- Department of Family and Preventative Medicine, University of California, San Diego, CA, USA
| | - Jody Corey-Bloom
- Department of Neurosciences, University of California, San Diego, CA, USA
| | - Jose S Loredo
- Veterans Administration Healthcare System, San Diego, CA, USA; Department of Medicine, University of California, San Diego, CA, USA
| | - Sonia Ancoli-Israel
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA, USA; Stein Institute for Research on Aging, CA, USA; Department of Medicine, University of California, San Diego, CA, USA.
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Patel SR, Weng J, Rueschman M, Dudley KA, Loredo JS, Mossavar-Rahmani Y, Ramirez M, Ramos AR, Reid K, Seiger AN, Sotres-Alvarez D, Zee PC, Wang R. Reproducibility of a Standardized Actigraphy Scoring Algorithm for Sleep in a US Hispanic/Latino Population. Sleep 2015; 38:1497-503. [PMID: 25845697 DOI: 10.5665/sleep.4998] [Citation(s) in RCA: 123] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 03/04/2015] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES While actigraphy is considered objective, the process of setting rest intervals to calculate sleep variables is subjective. We sought to evaluate the reproducibility of actigraphy-derived measures of sleep using a standardized algorithm for setting rest intervals. DESIGN Observational study. SETTING Community-based. PARTICIPANTS A random sample of 50 adults aged 18-64 years free of severe sleep apnea participating in the Sueño sleep ancillary study to the Hispanic Community Health Study/Study of Latinos. INTERVENTIONS N/A. MEASUREMENTS AND RESULTS Participants underwent 7 days of continuous wrist actigraphy and completed daily sleep diaries. Studies were scored twice by each of two scorers. Rest intervals were set using a standardized hierarchical approach based on event marker, diary, light, and activity data. Sleep/wake status was then determined for each 30-sec epoch using a validated algorithm, and this was used to generate 11 variables: mean nightly sleep duration, nap duration, 24-h sleep duration, sleep latency, sleep maintenance efficiency, sleep fragmentation index, sleep onset time, sleep offset time, sleep midpoint time, standard deviation of sleep duration, and standard deviation of sleep midpoint. Intra-scorer intraclass correlation coefficients (ICCs) were high, ranging from 0.911 to 0.995 across all 11 variables. Similarly, inter-scorer ICCs were high, also ranging from 0.911 to 0.995, and mean inter-scorer differences were small. Bland-Altman plots did not reveal any systematic disagreement in scoring. CONCLUSIONS With use of a standardized algorithm to set rest intervals, scoring of actigraphy for the purpose of generating a wide array of sleep variables is highly reproducible.
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Affiliation(s)
- Sanjay R Patel
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA.,Beth Israel Deaconess Medical Center, Boston, MA
| | - Jia Weng
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA
| | - Michael Rueschman
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA
| | - Katherine A Dudley
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA
| | | | | | | | | | | | - Ashley N Seiger
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA
| | - Daniela Sotres-Alvarez
- Collaborative Studies Coordinating Center, Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | | | - Rui Wang
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA
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13
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Sanders AE, Essick GK, Beck JD, Cai J, Beaver S, Finlayson TL, Zee PC, Loredo JS, Ramos AR, Singer RH, Jimenez MC, Barnhart JM, Redline S. Periodontitis and Sleep Disordered Breathing in the Hispanic Community Health Study/Study of Latinos. Sleep 2015; 38:1195-203. [PMID: 25669183 DOI: 10.5665/sleep.4890] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 12/18/2014] [Indexed: 01/05/2023] Open
Abstract
STUDY OBJECTIVES To investigate the association between sleep disordered breathing (SDB) and severe chronic periodontitis. DESIGN Cross-sectional data analysis from the Hispanic Community Health Study/Study of Latinos. SETTING Community-based setting with probability sampling from four urban US communities. PARTICIPANTS 12,469 adults aged 18-74 y. INTERVENTIONS None. MEASUREMENTS AND RESULTS Severe chronic periodontitis was defined using the Centers for Disease Control and Prevention/American Academy of Periodontology case classification based on full-mouth periodontal assessments performed by calibrated dentists. SDB was evaluated in standardized home sleep tests, and defined as the number of apnea plus hypopnea events associated with ≥ 3% desaturation, per hour of estimated sleep. SDB was quantified using categories of the apnea-hypopnea index (AHI): 0.0 events (nonapneic); 0.1-4.9 (subclinical); 5.0-14.9 (mild); and ≥ 15 (moderate/severe). Covariates were demographic characteristics and established periodontitis risk factors. C-reactive protein was a potential explanatory variable. Using survey estimation, multivariable binary logistic regression estimated odds ratios (OR) and 95% confidence limits (CL). Following adjustment for confounding, the SDB and periodontitis relationship remained statistically significant, but was attenuated in strength and no longer dose-response. Compared with the nonapneic referent, adjusted odds of severe periodontitis were 40% higher with subclinical SDB (OR = 1.4, 95% CL: 1.0, 1.9), 60% higher with mild SDB (OR = 1.6, 95% CL: 1.1, 2.2) and 50% higher with moderate/severe SDB (OR = 1.5, 95% CL: 1.0, 2.3) demonstrating an independent association between SDB and severe periodontitis. CONCLUSIONS This study identifies a novel association between mild sleep disordered breathing and periodontitis that was most pronounced in young adults.
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Affiliation(s)
- Anne E Sanders
- Department of Dental Ecology, University of North Carolina, Chapel Hill, NC
| | - Greg K Essick
- Department of Prosthodontics, Center for Pain Research and Innovation, University of North Carolina, Chapel Hill, NC
| | - James D Beck
- Department of Dental Ecology, University of North Carolina, Chapel Hill, NC
| | - Jianwen Cai
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC
| | | | - Tracy L Finlayson
- Graduate School of Public Health, San Diego State University, San Diego, CA
| | - Phyllis C Zee
- Center for Sleep and Circadian Biology, Northwestern University, Chicago, IL
| | - Jose S Loredo
- Sleep Medicine Center and VA Pulmonary Sleep Disorders laboratory, University of California San Diego School of Medicine, San Diego, CA
| | - Alberto R Ramos
- Sleep Medicine Center and VA Pulmonary Sleep Disorders laboratory, University of California San Diego School of Medicine, San Diego, CA
| | - Richard H Singer
- Department of Neurology, University of Miami, Miller School of Medicine, Miami, FL
| | - Monik C Jimenez
- Department of Public Health Sciences, University of Miami, Miller School of Medicine, Miami, FL and Brigham and Women's Hospital Harvard Medical School, Boston, MA
| | - Janice M Barnhart
- Albert Einstein College of Medicine of Yeshiva University, Bronx, NY
| | - Susan Redline
- Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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14
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Ramos AR, Tarraf W, Rundek T, Redline S, Wohlgemuth WK, Loredo JS, Sacco RL, Lee DJ, Arens R, Lazalde P, Choca JP, Mosley T, González HM. Obstructive sleep apnea and neurocognitive function in a Hispanic/Latino population. Neurology 2014; 84:391-8. [PMID: 25540308 DOI: 10.1212/wnl.0000000000001181] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE We evaluated the association between obstructive sleep apnea (OSA) and neurocognitive function among community-dwelling Hispanic/Latino individuals in the United States. METHODS Cross-sectional analysis of the Hispanic Community Health Study/Study of Latinos middle-aged and older adults, aged 45 to 74 years, with neurocognitive test scores at baseline measurements from 2008 to 2011. Neurocognitive scores were measured using the Word Fluency (WF) Test, the Brief-Spanish English Verbal Learning Test (SEVLT), and the Digit Symbol Substitution (DSS) Test. OSA was defined by the apnea-hypopnea index (AHI). Multivariable linear regression models were fit to evaluate relations between OSA and neurocognitive scores. RESULTS The analysis consisted of 8,059 participants, mean age of 56 years, 55% women, and 41% with less than high school education. The mean AHI was 9.0 (range 0-142; normal AHI <5/h). There was an association between the AHI and all 4 neurocognitive test scores: Brief-SEVLT-sum (β = -0.022) and -recall (β = -0.010), WF (β = -0.023), and DSS (β = -0.050) at p < 0.01 that was fully attenuated by age. In the fully adjusted regression model, female sex was a moderating factor between the AHI and WF (β = -0.027, p < 0.10), SVELT-sum (β = -0.37), SVELT-recall (β = -0.010), and DSS (β = -0.061) at p < 0.01. CONCLUSION OSA was associated with worse neurocognitive function in a representative sample of Hispanic/Latino women in the United States.
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Affiliation(s)
- Alberto R Ramos
- From the Departments of Neurology (A.R.R., T.R., R.L.S.) and Epidemiology and Public Health (T.R., R.L.S., D.J.L.), University of Miami, Miller School of Medicine, FL; Institute of Gerontology (W.T.), Wayne State University, Detroit, MI; Brigham and Women's Hospital and Beth Israel Deaconess Medical Center (S.R.), Harvard Medical School, Boston, MA; Bruce W. Carter Department of Veterans Affairs Medical Center (W.K.W.), Miami, FL; Department of Medicine (J.S.L.), University of California San Diego; The Children's Hospital at Montefiore (R.A.), Albert Einstein College of Medicine, Bronx, NY; HCHS/SOL Field Center (P.L.), San Diego State University, CA; Department of Psychology (J.P.C.), Roosevelt University, Chicago, IL; Department of Neurology (T.M.), University of Mississippi, Jackson; and Department of Epidemiology and Biostatistics (H.M.G.), Michigan State University, East Lansing
| | - Wassim Tarraf
- From the Departments of Neurology (A.R.R., T.R., R.L.S.) and Epidemiology and Public Health (T.R., R.L.S., D.J.L.), University of Miami, Miller School of Medicine, FL; Institute of Gerontology (W.T.), Wayne State University, Detroit, MI; Brigham and Women's Hospital and Beth Israel Deaconess Medical Center (S.R.), Harvard Medical School, Boston, MA; Bruce W. Carter Department of Veterans Affairs Medical Center (W.K.W.), Miami, FL; Department of Medicine (J.S.L.), University of California San Diego; The Children's Hospital at Montefiore (R.A.), Albert Einstein College of Medicine, Bronx, NY; HCHS/SOL Field Center (P.L.), San Diego State University, CA; Department of Psychology (J.P.C.), Roosevelt University, Chicago, IL; Department of Neurology (T.M.), University of Mississippi, Jackson; and Department of Epidemiology and Biostatistics (H.M.G.), Michigan State University, East Lansing
| | - Tatjana Rundek
- From the Departments of Neurology (A.R.R., T.R., R.L.S.) and Epidemiology and Public Health (T.R., R.L.S., D.J.L.), University of Miami, Miller School of Medicine, FL; Institute of Gerontology (W.T.), Wayne State University, Detroit, MI; Brigham and Women's Hospital and Beth Israel Deaconess Medical Center (S.R.), Harvard Medical School, Boston, MA; Bruce W. Carter Department of Veterans Affairs Medical Center (W.K.W.), Miami, FL; Department of Medicine (J.S.L.), University of California San Diego; The Children's Hospital at Montefiore (R.A.), Albert Einstein College of Medicine, Bronx, NY; HCHS/SOL Field Center (P.L.), San Diego State University, CA; Department of Psychology (J.P.C.), Roosevelt University, Chicago, IL; Department of Neurology (T.M.), University of Mississippi, Jackson; and Department of Epidemiology and Biostatistics (H.M.G.), Michigan State University, East Lansing
| | - Susan Redline
- From the Departments of Neurology (A.R.R., T.R., R.L.S.) and Epidemiology and Public Health (T.R., R.L.S., D.J.L.), University of Miami, Miller School of Medicine, FL; Institute of Gerontology (W.T.), Wayne State University, Detroit, MI; Brigham and Women's Hospital and Beth Israel Deaconess Medical Center (S.R.), Harvard Medical School, Boston, MA; Bruce W. Carter Department of Veterans Affairs Medical Center (W.K.W.), Miami, FL; Department of Medicine (J.S.L.), University of California San Diego; The Children's Hospital at Montefiore (R.A.), Albert Einstein College of Medicine, Bronx, NY; HCHS/SOL Field Center (P.L.), San Diego State University, CA; Department of Psychology (J.P.C.), Roosevelt University, Chicago, IL; Department of Neurology (T.M.), University of Mississippi, Jackson; and Department of Epidemiology and Biostatistics (H.M.G.), Michigan State University, East Lansing
| | - William K Wohlgemuth
- From the Departments of Neurology (A.R.R., T.R., R.L.S.) and Epidemiology and Public Health (T.R., R.L.S., D.J.L.), University of Miami, Miller School of Medicine, FL; Institute of Gerontology (W.T.), Wayne State University, Detroit, MI; Brigham and Women's Hospital and Beth Israel Deaconess Medical Center (S.R.), Harvard Medical School, Boston, MA; Bruce W. Carter Department of Veterans Affairs Medical Center (W.K.W.), Miami, FL; Department of Medicine (J.S.L.), University of California San Diego; The Children's Hospital at Montefiore (R.A.), Albert Einstein College of Medicine, Bronx, NY; HCHS/SOL Field Center (P.L.), San Diego State University, CA; Department of Psychology (J.P.C.), Roosevelt University, Chicago, IL; Department of Neurology (T.M.), University of Mississippi, Jackson; and Department of Epidemiology and Biostatistics (H.M.G.), Michigan State University, East Lansing
| | - Jose S Loredo
- From the Departments of Neurology (A.R.R., T.R., R.L.S.) and Epidemiology and Public Health (T.R., R.L.S., D.J.L.), University of Miami, Miller School of Medicine, FL; Institute of Gerontology (W.T.), Wayne State University, Detroit, MI; Brigham and Women's Hospital and Beth Israel Deaconess Medical Center (S.R.), Harvard Medical School, Boston, MA; Bruce W. Carter Department of Veterans Affairs Medical Center (W.K.W.), Miami, FL; Department of Medicine (J.S.L.), University of California San Diego; The Children's Hospital at Montefiore (R.A.), Albert Einstein College of Medicine, Bronx, NY; HCHS/SOL Field Center (P.L.), San Diego State University, CA; Department of Psychology (J.P.C.), Roosevelt University, Chicago, IL; Department of Neurology (T.M.), University of Mississippi, Jackson; and Department of Epidemiology and Biostatistics (H.M.G.), Michigan State University, East Lansing
| | - Ralph L Sacco
- From the Departments of Neurology (A.R.R., T.R., R.L.S.) and Epidemiology and Public Health (T.R., R.L.S., D.J.L.), University of Miami, Miller School of Medicine, FL; Institute of Gerontology (W.T.), Wayne State University, Detroit, MI; Brigham and Women's Hospital and Beth Israel Deaconess Medical Center (S.R.), Harvard Medical School, Boston, MA; Bruce W. Carter Department of Veterans Affairs Medical Center (W.K.W.), Miami, FL; Department of Medicine (J.S.L.), University of California San Diego; The Children's Hospital at Montefiore (R.A.), Albert Einstein College of Medicine, Bronx, NY; HCHS/SOL Field Center (P.L.), San Diego State University, CA; Department of Psychology (J.P.C.), Roosevelt University, Chicago, IL; Department of Neurology (T.M.), University of Mississippi, Jackson; and Department of Epidemiology and Biostatistics (H.M.G.), Michigan State University, East Lansing
| | - David J Lee
- From the Departments of Neurology (A.R.R., T.R., R.L.S.) and Epidemiology and Public Health (T.R., R.L.S., D.J.L.), University of Miami, Miller School of Medicine, FL; Institute of Gerontology (W.T.), Wayne State University, Detroit, MI; Brigham and Women's Hospital and Beth Israel Deaconess Medical Center (S.R.), Harvard Medical School, Boston, MA; Bruce W. Carter Department of Veterans Affairs Medical Center (W.K.W.), Miami, FL; Department of Medicine (J.S.L.), University of California San Diego; The Children's Hospital at Montefiore (R.A.), Albert Einstein College of Medicine, Bronx, NY; HCHS/SOL Field Center (P.L.), San Diego State University, CA; Department of Psychology (J.P.C.), Roosevelt University, Chicago, IL; Department of Neurology (T.M.), University of Mississippi, Jackson; and Department of Epidemiology and Biostatistics (H.M.G.), Michigan State University, East Lansing
| | - Raanan Arens
- From the Departments of Neurology (A.R.R., T.R., R.L.S.) and Epidemiology and Public Health (T.R., R.L.S., D.J.L.), University of Miami, Miller School of Medicine, FL; Institute of Gerontology (W.T.), Wayne State University, Detroit, MI; Brigham and Women's Hospital and Beth Israel Deaconess Medical Center (S.R.), Harvard Medical School, Boston, MA; Bruce W. Carter Department of Veterans Affairs Medical Center (W.K.W.), Miami, FL; Department of Medicine (J.S.L.), University of California San Diego; The Children's Hospital at Montefiore (R.A.), Albert Einstein College of Medicine, Bronx, NY; HCHS/SOL Field Center (P.L.), San Diego State University, CA; Department of Psychology (J.P.C.), Roosevelt University, Chicago, IL; Department of Neurology (T.M.), University of Mississippi, Jackson; and Department of Epidemiology and Biostatistics (H.M.G.), Michigan State University, East Lansing
| | - Patricia Lazalde
- From the Departments of Neurology (A.R.R., T.R., R.L.S.) and Epidemiology and Public Health (T.R., R.L.S., D.J.L.), University of Miami, Miller School of Medicine, FL; Institute of Gerontology (W.T.), Wayne State University, Detroit, MI; Brigham and Women's Hospital and Beth Israel Deaconess Medical Center (S.R.), Harvard Medical School, Boston, MA; Bruce W. Carter Department of Veterans Affairs Medical Center (W.K.W.), Miami, FL; Department of Medicine (J.S.L.), University of California San Diego; The Children's Hospital at Montefiore (R.A.), Albert Einstein College of Medicine, Bronx, NY; HCHS/SOL Field Center (P.L.), San Diego State University, CA; Department of Psychology (J.P.C.), Roosevelt University, Chicago, IL; Department of Neurology (T.M.), University of Mississippi, Jackson; and Department of Epidemiology and Biostatistics (H.M.G.), Michigan State University, East Lansing
| | - James P Choca
- From the Departments of Neurology (A.R.R., T.R., R.L.S.) and Epidemiology and Public Health (T.R., R.L.S., D.J.L.), University of Miami, Miller School of Medicine, FL; Institute of Gerontology (W.T.), Wayne State University, Detroit, MI; Brigham and Women's Hospital and Beth Israel Deaconess Medical Center (S.R.), Harvard Medical School, Boston, MA; Bruce W. Carter Department of Veterans Affairs Medical Center (W.K.W.), Miami, FL; Department of Medicine (J.S.L.), University of California San Diego; The Children's Hospital at Montefiore (R.A.), Albert Einstein College of Medicine, Bronx, NY; HCHS/SOL Field Center (P.L.), San Diego State University, CA; Department of Psychology (J.P.C.), Roosevelt University, Chicago, IL; Department of Neurology (T.M.), University of Mississippi, Jackson; and Department of Epidemiology and Biostatistics (H.M.G.), Michigan State University, East Lansing
| | - Thomas Mosley
- From the Departments of Neurology (A.R.R., T.R., R.L.S.) and Epidemiology and Public Health (T.R., R.L.S., D.J.L.), University of Miami, Miller School of Medicine, FL; Institute of Gerontology (W.T.), Wayne State University, Detroit, MI; Brigham and Women's Hospital and Beth Israel Deaconess Medical Center (S.R.), Harvard Medical School, Boston, MA; Bruce W. Carter Department of Veterans Affairs Medical Center (W.K.W.), Miami, FL; Department of Medicine (J.S.L.), University of California San Diego; The Children's Hospital at Montefiore (R.A.), Albert Einstein College of Medicine, Bronx, NY; HCHS/SOL Field Center (P.L.), San Diego State University, CA; Department of Psychology (J.P.C.), Roosevelt University, Chicago, IL; Department of Neurology (T.M.), University of Mississippi, Jackson; and Department of Epidemiology and Biostatistics (H.M.G.), Michigan State University, East Lansing
| | - Hector M González
- From the Departments of Neurology (A.R.R., T.R., R.L.S.) and Epidemiology and Public Health (T.R., R.L.S., D.J.L.), University of Miami, Miller School of Medicine, FL; Institute of Gerontology (W.T.), Wayne State University, Detroit, MI; Brigham and Women's Hospital and Beth Israel Deaconess Medical Center (S.R.), Harvard Medical School, Boston, MA; Bruce W. Carter Department of Veterans Affairs Medical Center (W.K.W.), Miami, FL; Department of Medicine (J.S.L.), University of California San Diego; The Children's Hospital at Montefiore (R.A.), Albert Einstein College of Medicine, Bronx, NY; HCHS/SOL Field Center (P.L.), San Diego State University, CA; Department of Psychology (J.P.C.), Roosevelt University, Chicago, IL; Department of Neurology (T.M.), University of Mississippi, Jackson; and Department of Epidemiology and Biostatistics (H.M.G.), Michigan State University, East Lansing.
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Neikrug AB, Avanzino JA, Liu L, Maglione JE, Natarajan L, Corey-Bloom J, Palmer BW, Loredo JS, Ancoli-Israel S. Parkinson's disease and REM sleep behavior disorder result in increased non-motor symptoms. Sleep Med 2014; 15:959-66. [PMID: 24938585 DOI: 10.1016/j.sleep.2014.04.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 04/25/2014] [Accepted: 04/29/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Rapid eye movement (REM)-sleep behavior disorder (RBD) is often comorbid with Parkinson's disease (PD). The current study aimed to provide a detailed understanding of the impact of having RBD on multiple non-motor symptoms (NMS) in patients with PD. METHODS A total of 86 participants were evaluated for RBD and assessed for multiple NMS of PD. Principal component analysis was utilized to model multiple measures of NMS in PD, and a multivariate analysis of variance was used to assess the relationship between RBD and the multiple NMS measures. Seven NMS measures were assessed: cognition, quality of life, fatigue, sleepiness, overall sleep, mood, and overall NMS of PD. RESULTS Among the PD patients, 36 were classified as having RBD (objective polysomnography and subjective findings), 26 as not having RBD (neither objective nor subjective findings), and 24 as probably having RBD (either subjective or objective findings). RBD was a significant predictor of increased NMS in PD while controlling for dopaminergic therapy and age (p=0.01). The RBD group reported more NMS of depression (p=0.012), fatigue (p=0.036), overall sleep (p=0.018), and overall NMS (p=0.002). CONCLUSION In PD, RBD is associated with more NMS, particularly increased depressive symptoms, sleep disturbances, and fatigue. More research is needed to assess whether PD patients with RBD represent a subtype of PD with different disease progression and phenomenological presentation.
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Affiliation(s)
- Ariel B Neikrug
- SDSU/UCSD Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Julie A Avanzino
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Lianqi Liu
- Department of Psychiatry, University of California, San Diego, CA, USA; Department of Veterans Affairs, San Diego Center of Excellence for Stress and Mental Health (CESAMH), San Diego, CA, USA
| | - Jeanne E Maglione
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Loki Natarajan
- Department of Family and Preventative Medicine, University of California, San Diego, CA, USA
| | - Jody Corey-Bloom
- Department of Neurosciences, University of California, San Diego, CA, USA
| | - Barton W Palmer
- SDSU/UCSD Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA, USA; Veterans Medical Research Foundation, San Diego, CA, USA
| | - Jose S Loredo
- Department of Medicine, University of California, San Diego, CA, USA
| | - Sonia Ancoli-Israel
- SDSU/UCSD Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA, USA; Department of Veterans Affairs, San Diego Center of Excellence for Stress and Mental Health (CESAMH), San Diego, CA, USA; Veterans Medical Research Foundation, San Diego, CA, USA; Department of Medicine, University of California, San Diego, CA, USA.
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Neikrug AB, Liu L, Avanzino JA, Maglione JE, Natarajan L, Bradley L, Maugeri A, Corey-Bloom J, Palmer BW, Loredo JS, Ancoli-Israel S. Continuous positive airway pressure improves sleep and daytime sleepiness in patients with Parkinson disease and sleep apnea. Sleep 2014; 37:177-85. [PMID: 24470706 DOI: 10.5665/sleep.3332] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA), common in Parkinson disease (PD), contributes to sleep disturbances and daytime sleepiness. We assessed the effect of continuous positive airway pressure (CPAP) on OSA, sleep, and daytime sleepiness in patients with PD. DESIGN This was a randomized placebo-controlled, crossover design. Patients with PD and OSA were randomized into 6 w of therapeutic treatment or 3 w of placebo followed by 3 w of therapeutic treatment. Patients were evaluated by polysomnography (PSG) and multiple sleep latency test (MSLT) pretreatment (baseline), after 3 w, and after 6 w of CPAP treatment. Analyses included mixed models, paired analysis, and within-group analyses comparing 3 w to 6 w of treatment. SETTING Sleep laboratory. PARTICIPANTS Thirty-eight patients with PD (mean age = 67.2 ± 9.2 y; 12 females). INTERVENTION Continuous positive airway pressure. MEASUREMENTS PSG OUTCOME MEASURES: sleep efficiency, %sleep stages (N1, N2, N3, R), arousal index, apnea-hypopnea index (AHI), and % time oxygen saturation < 90% (%time SaO2 < 90%). MSLT outcome measures: mean sleep-onset latency (MSL). RESULTS There were significant group-by-time interactions for AHI (P < 0.001), % time SaO2 < 90% (P = 0.02), %N2 (P = 0.015) and %N3 (P = 0.014). Subjects receiving therapeutic CPAP showed significant decrease in AHI, %time SaO2 < 90%, %N2, and significant increase in %N3 indicating effectiveness of CPAP in the treatment of OSA, improvement in nighttime oxygenation, and in deepening sleep. The paired sample analyses revealed that 3 w of therapeutic treatment resulted in significant decreases in arousal index (t = 3.4, P = 0.002). All improvements after 3 w were maintained at 6 w. Finally, 3 w of therapeutic CPAP also resulted in overall decreases in daytime sleepiness (P = 0.011). CONCLUSIONS Therapeutic continuous positive airway pressure versus placebo was effective in reducing apnea events, improving oxygen saturation, and deepening sleep in patients with Parkinson disease and obstructive sleep apnea. Additionally, arousal index was reduced and effects were maintained at 6 weeks. Finally, 3 weeks of continuous positive airway pressure treatment resulted in reduced daytime sleepiness measured by multiple sleep latency test. These results emphasize the importance of identifying and treating obstructive sleep apnea in patients with Parkinson disease.
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Affiliation(s)
- Ariel B Neikrug
- San Diego State University and University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA
| | - Lianqi Liu
- Department of Psychiatry, University of California San Diego, San Diego, CA
| | - Julie A Avanzino
- Department of Psychiatry, University of California San Diego, San Diego, CA
| | - Jeanne E Maglione
- Department of Psychiatry, University of California San Diego, San Diego, CA
| | - Loki Natarajan
- Department of Family and Preventive Medicine, University of California San Diego, San Diego, CA
| | - Lenette Bradley
- Department of Psychiatry, University of California San Diego, San Diego, CA
| | - Alex Maugeri
- Department of Psychiatry, University of California San Diego, San Diego, CA
| | - Jody Corey-Bloom
- Department of Neurosciences, University of California San Diego, San Diego, CA
| | - Barton W Palmer
- San Diego State University and University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA ; Department of Psychiatry, University of California San Diego, San Diego, CA ; Veterans Medical Research Foundation, San Diego, CA
| | - Jose S Loredo
- Department of Medicine, University of California San Diego, San Diego, CA
| | - Sonia Ancoli-Israel
- San Diego State University and University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA ; Department of Psychiatry, University of California San Diego, San Diego, CA ; Department of Medicine, University of California San Diego, San Diego, CA ; Veterans Affairs Center of Excellence for Stress and Mental Health, San Diego, CA
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Neikrug AB, Maglione JE, Liu L, Natarajan L, Avanzino JA, Corey-Bloom J, Palmer BW, Loredo JS, Ancoli-Israel S. Effects of sleep disorders on the non-motor symptoms of Parkinson disease. J Clin Sleep Med 2013; 9:1119-29. [PMID: 24235892 DOI: 10.5664/jcsm.3148] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To evaluate the impact of sleep disorders on non-motor symptoms in patients with Parkinson disease (PD). DESIGN This was a cross-sectional study. Patients with PD were evaluated for obstructive sleep apnea (OSA), restless legs syndrome (RLS), periodic limb movement syndrome (PLMS), and REM sleep behavior disorder (RBD). Cognition was assessed with the Montreal Cognitive Assessment and patients completed self-reported questionnaires assessing non-motor symptoms including depressive symptoms, fatigue, sleep complaints, daytime sleepiness, and quality of life. SETTING Sleep laboratory. PARTICIPANTS 86 patients with PD (mean age = 67.4 ± 8.8 years; range: 47-89; 29 women). INTERVENTIONS N/A. MEASUREMENTS AND RESULTS Having sleep disorders was a predictor of overall non-motor symptoms in PD (R(2) = 0.33, p < 0.001) while controlling for age, PD severity, and dopaminergic therapy. These analyses revealed that RBD (p = 0.006) and RLS (p = 0.014) were significant predictors of increased non-motor symptoms, but OSA was not. More specifically, having a sleep disorder significantly predicted sleep complaints (ΔR(2) = 0.13, p = 0.006), depressive symptoms (ΔR(2) = 0.01, p = 0.03), fatigue (ΔR(2) = 0.12, p = 0.007), poor quality of life (ΔR(2) = 0.13, p = 0.002), and cognitive decline (ΔR(2) = 0.09, p = 0.036). Additionally, increasing number of sleep disorders (0, 1, or ≥ 2 sleep disorders) was a significant contributor to non-motor symptom impairment (R(2) = 0.28, p < 0.001). CONCLUSION In this study of PD patients, presence of comorbid sleep disorders predicted more non-motor symptoms including increased sleep complaints, more depressive symptoms, lower quality of life, poorer cognition, and more fatigue. RBD and RLS were factors of overall increased non-motor symptoms, but OSA was not.
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Affiliation(s)
- Ariel B Neikrug
- SDSU/UCSD Joint Doctoral Program in Clinical Psychology, San Diego, CA ; Veterans Medical Research Foundation, San Diego, CA
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Maglione JE, Liu L, Neikrug AB, Poon T, Natarajan L, Calderon J, Avanzino JA, Corey-Bloom J, Palmer BW, Loredo JS, Ancoli-Israel S. Actigraphy for the assessment of sleep measures in Parkinson's disease. Sleep 2013; 36:1209-17. [PMID: 23904681 DOI: 10.5665/sleep.2888] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To assess the usefulness of actigraphy for assessment of nighttime sleep measures in patients with Parkinson's disease (PD). DESIGN Participants underwent overnight sleep assessment simultaneously by polysomnography (PSG) and actigraphy. SETTING Overnight sleep study in academic sleep research laboratory. PARTICIPANTS Sixty-one patients (mean age 67.74 ± 8.88 y) with mild to moderate PD. MEASUREMENTS Sleep measures including total sleep time (TST), sleep efficiency (SE), wake after sleep onset (WASO), and sleep onset latency (SOL) were calculated independently from data derived from PSG and from actigraphy. Different actigraphy scoring settings were compared. RESULTS No single tested actigraphy scoring setting was optimal for all sleep measures. A customized setting of an activity threshold of 10, with five consecutive immobile minutes for sleep onset, yielded the combination of mean TST, SE, and WASO values that best approximated mean values determined by PSG with differences of 6.05 ± 85.67 min for TST, 1.1 ± 0.641% for SE, and 4.35 ± 59.56 min for WASO. There were significant but moderate correlations between actigraphy and PSG measurements (rs = 0.496, P < 0.001 for TST, rs = 0.384, P = 0.002 for SE, and rs = 0.400, P = 0.001 for WASO) using these settings. Greater disease stage was associated with greater differences between TST (R(2) = 0.099, beta = 0.315, P = 0.018), SE (R(2) = 0.107, beta = 0.327, P = 0.014), and WASO (R(2) = 0.094, beta = 0.307, P = 0.021) values derived by actigraphy and PSG explaining some of the variability. Using a setting of 10 immobile min for sleep onset yielded a mean SOL that was within 1 min of that estimated by PSG. However SOL values determined by actigraphy and PSG were not significantly correlated at any tested setting. CONCLUSIONS Our results suggest that actigraphy may be useful for measurement of mean TST, SE, and WASO values in groups of patients with mild to moderate Parkinson's disease. However, there is a significant degree of variability in accuracy among individual patients. The importance of determining optimal scoring parameters for each population studied is underscored.
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Affiliation(s)
- Jeanne E Maglione
- Department of Psychiatry, University of California San Diego, San Diego, CA 92093-0733, USA.
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Covassin N, Neikrug AB, Liu L, Maglione J, Natarajan L, Corey-Bloom J, Loredo JS, Palmer BW, Redwine LS, Ancoli-Israel S. Relationships between clinical characteristics and nocturnal cardiac autonomic activity in Parkinson's disease. Auton Neurosci 2012; 171:85-8. [PMID: 23141523 DOI: 10.1016/j.autneu.2012.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Revised: 10/11/2012] [Accepted: 10/14/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND The aim of the present study was to explore the association between Parkinson's disease (PD) clinical characteristics and cardiac autonomic control across sleep stages. METHODS Frequency-domain heart rate variability (HRV) measures were estimated in 18 PD patients undergoing a night of polysomnography. RESULTS Significant relationships were found between PD severity and nocturnal HRV indices. The associations were restricted to rapid eye movement (R) sleep. CONCLUSIONS The progressive nocturnal cardiac autonomic impairment occurring with more severe PD can be subclinical emerging only during conditions requiring active modulation of physiological functions such as R-sleep.
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Affiliation(s)
- Naima Covassin
- Department of General Psychology, University of Padova, Italy
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20
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Tomfohr LM, Hemmen T, Natarajan L, Ancoli-Israel S, Loredo JS, Heaton RK, Bardwell W, Mills PJ, Lee RR, Dimsdale JE. Continuous positive airway pressure for treatment of obstructive sleep apnea in stroke survivors: what do we really know? Stroke 2012; 43:3118-23. [PMID: 23019248 PMCID: PMC3507471 DOI: 10.1161/strokeaha.112.666248] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Lianne M Tomfohr
- San Diego State University, Department of Medicine, 9500 Gilman Drive, MC 0804, La Jolla, CA 92093-0804, USA.
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Covassin N, Neikrug AB, Liu L, Corey-Bloom J, Loredo JS, Palmer BW, Maglione J, Ancoli-Israel S. Clinical correlates of periodic limb movements in sleep in Parkinson's disease. J Neurol Sci 2012; 316:131-6. [PMID: 22277375 PMCID: PMC3321115 DOI: 10.1016/j.jns.2012.01.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Revised: 11/21/2011] [Accepted: 01/04/2012] [Indexed: 10/14/2022]
Abstract
OBJECTIVE The aim of the current study was to investigate the frequency of periodic limb movements in sleep (PLMS) in Parkinson's disease (PD) and their impact on nocturnal sleep and daytime functioning. METHODS Forty-five PD patients (mean age 68.5 ± 8.7 years; 32 males) underwent one night of polysomnography (PSG). Clinical assessment and questionnaires evaluating sleep disturbance and quality of life (QoL) were completed. Patients were divided into two groups based on their PLMS index (PLMSI): PLMSI ≥ 15 (PLMS+) and PLMSI <15 (PLMS-). RESULTS There were 26 (57.8%) PD patients in the PLMS+group and 19 (42.2%) patients in the PLMS-group. Subjective assessment revealed an association between PLMS+status and greater PD symptom severity, more subjective sleep disturbance, and decreased QoL. All patients showed poor sleep, and no significant group differences were detected on PSG measures. CONCLUSION We observed that PLMS occurred frequently in PD and increased with more severe PD. Although PLMS did not affect objective sleep, it was associated with increased sleep complaints and reduced QoL. Overall, our findings support the association between PLMS and PD as well as the clinical relevance of sleep disturbances in PD.
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Affiliation(s)
| | | | - Lianqi Liu
- Department of Psychiatry, University of California San Diego
| | | | - Jose S. Loredo
- Department of Medicine, University of California San Diego
| | | | - Jeanne Maglione
- Department of Psychiatry, University of California San Diego
| | - Sonia Ancoli-Israel
- SDSU/UCSD Joint Doctoral Program in Clinical Psychology
- Department of Psychiatry, University of California San Diego
- Department of Medicine, University of California San Diego
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Abstract
It is unknown if fatigue measures like the Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF; Stein, Jacobsen, Blanchard, & Thors, 2004) appropriately describe fatigue in Hispanics or if acculturation plays a role in fatigue. This study compared fatigue in community samples of Hispanics and Anglos. The MFSI-SF and pertinent questionnaires were administered to adults in San Diego County via telephone survey. Some differences in fatigue were observed in initial comparisons between Hispanics and Anglos, including when acculturation was considered. When age and education were controlled, Hispanics reported less general fatigue than Anglos, regardless of acculturation status, p = < .01. Exploratory factor analyses indicate that the MFSI-SF general-fatigue subscale was problematic for Hispanics. Implications, limitations, and future directions are discussed.
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Lee IS, Bardwell WA, Kamat R, Tomfohr L, Heaton RK, Ancoli-Israel S, Loredo JS, Dimsdale JE. A Model for Studying Neuropsychological Effects of Sleep Intervention: The Effect of 3-week Continuous Positive Airway Pressure Treatment. ACTA ACUST UNITED AC 2011; 8:147-154. [PMID: 22140396 DOI: 10.1016/j.ddmod.2011.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
PURPOSE: Patients with obstructive sleep apnea (OSA) commonly have cognitive complaints. There are few randomized studies that have examined neuropsychological effects of continuous positive airway pressure (CPAP) treatment in patients with OSA. In this double-blind trial, we examined if a 3-week CPAP treatment compared with placebo CPAP treatment has specific therapeutic effects on cognitive impairments in patients with OSA and if there are specific domains of cognitive impairments sensitive to 3-week CPAP treatment. SUBJECTS AND METHODS: Thirty-eight newly diagnosed patients with untreated OSA underwent neuropsychological testing before and after 3-weeks CPAP or Placebo CPAP treatment. The two treatment groups (therapeutic CPAP, and placebo-CPAP) were compared using repeated measures analysis of variance (ANOVA). RESULTS AND CONCLUSION: Impairments in neuropsychological functioning ranged from 2.6% to 47.1% before treatment. In response to 3 weeks of treatment, there was no significant time by treatment interaction for a global deficit score of neuropsychological functioning. Only the Stroop Color (number correct) test showed significant improvement specific to CPAP treatment. The study demonstrates the importance of further randomized placebo controlled studies in this area.
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Affiliation(s)
- In-Soo Lee
- Department of Psychiatry, University of California San Diego
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Lee IS, Bardwell W, Ancoli-Israel S, Natarajan L, Loredo JS, Dimsdale JE. The Relationship between psychomotor vigilance performance and quality of life in obstructive sleep apnea. J Clin Sleep Med 2011; 7:254-60. [PMID: 21677894 DOI: 10.5664/jcsm.1064] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Patients with obstructive sleep apnea (OSA) commonly have cognitive complaints, particularly in attention, and report decreased quality of life. We examined how vigilance and sustained attention, as assessed by the Psychomotor Vigilance Task (PVT), were related to quality of life after controlling for apnea severity and depression in subjects with OSA. SUBJECTS AND METHODS Fifty-seven patients with newly diagnosed and untreated OSA had their sleep monitored with polysomnography. Quality of life was assessed by the Short Form-36 health survey questionnaire (SF-36). Mood was assessed by the Center for Epidemiologic Studies-Depression (CES-D) Scale. After sleep monitoring and psychological assessments were performed, the 10-minute PVT was administered. The main outcome variables were PVT lapse count and average response time (RT). Simple correlations and multiple linear regression were used to examine the association between PVT performance and age, body mass index, sleep variables, apnea hypopnea index, oxygen desaturation index, and CES-D. RESULTS AND CONCLUSION Both the PVT lapse count and RT were significantly associated with the SF-36 physical component summary score (PCS). In multiple linear regression, PVT RT was an independent predictor of the SF-36 PCS (full model R(2) = 0.331, p = 0.003). PVT lapse was also an independent predictor of the SF-36 PCS (full model R(2) = 0.320, p = 0.004). However, neither PVT RT nor lapse was a significant independent predictor of the SF-36 mental component summary score (MCS). Only CES-D was an individual predictor of the SF-36 MCS (β = -0.676, p < 0.001). Impairments in sustained attention and vigilance may underlie the limitations in physical health-related quality of life reported by people with OSA, even after controlling for demographic variables, apnea severity, and depression.
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Affiliation(s)
- In-Soo Lee
- Department of Psychiatry, University of California, San Diego, USA.
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Stepnowsky CJ, Palau JJ, Zamora T, Ancoli-Israel S, Loredo JS. Fatigue in sleep apnea: the role of depressive symptoms and self-reported sleep quality. Sleep Med 2011; 12:832-7. [PMID: 22014844 DOI: 10.1016/j.sleep.2011.07.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Revised: 07/14/2011] [Accepted: 07/15/2011] [Indexed: 10/16/2022]
Abstract
UNLABELLED OBJECTIVES OR BACKGROUND: Obstructive Sleep Apnea (OSA) is characterized by partial or complete cessation of breath during sleep. OSA is associated with increased cardiovascular risk as well as psychosocial complications such as daytime somnolence, depression, and fatigue. The goal of the present study was to better understand fatigue in OSA by examining self-reported sleep quality, depressive symptoms, excessive daytime sleepiness, and OSA severity in a group of newly diagnosed OSA patients. METHODS Two hundred and forty newly diagnosed OSA patients enrolled in the study. Participants completed several questionnaires at baseline. RESULTS Depressive symptoms accounted for 15% of variance in fatigue beyond that of demographics and OSA severity (p<0.001). Self-reported sleep quality accounted for 11% of variance beyond that of depressive symptoms (p<0.001). The total model accounted for 48% of the variance in fatigue. Post hoc analysis found that the total model accounted for only 14% of the variance in sleepiness (as measured by the Epworth Sleepiness Scale). CONCLUSION The current study confirms the findings of previous OSA studies, which found depressive symptoms have a greater association with fatigue than OSA disease severity variables. This study extends those findings by showing that self-reported sleep quality is independently associated with fatigue, even after taking into account demographic, comorbid conditions, OSA disease severity, sleepiness, and depressive symptoms. The role of sleep quality as an independent contributor to daytime fatigue in OSA may be under appreciated. Sleep quality should be closely followed in the clinical management of OSA.
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Affiliation(s)
- Carl J Stepnowsky
- Health Services Research & Development, VA San Diego Healthcare System, San Diego, CA 92161, USA.
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Edwards KM, Tomfohr LM, Mills PJ, Bosch JA, Ancoli-Israel S, Loredo JS, Dimsdale J. Macrophage migratory inhibitory factor (MIF) may be a key factor in inflammation in obstructive sleep apnea. Sleep 2011; 34:161-3. [PMID: 21286497 PMCID: PMC3022935 DOI: 10.1093/sleep/34.2.161] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES This study investigated the 24-hour variation of macrophage migratory inhibitory factor (MIF), a cytokine which induces insensitivity to the anti-inflammatory effects of glucocorticoids, in patients with untreated obstructive sleep apnea (OSA) as compared to healthy adults with no OSA. PARTICIPANTS Fifty-three men and women with OSA (mean apnea/hypopnea index [AHI] = 39.5) and 24 healthy adults (Non-OSA, AHI = 5.1). MEASUREMENTS Over a 24-h period, blood was collected every 2 h for MIF and cortisol determination. The following night, sleep was monitored with polysomnography. RESULTS MIF showed a strong 24-h variation, with a peak at 04:00 and a nadir at 22:00. Patients with OSA showed 25% higher MIF levels (area under the curve) over 24 h than healthy controls. Furthermore, MIF levels were significantly associated with AHI and total arousal index (ArI), even after adjusting for BMI. Cortisol showed the expected 24-h variation (peaking at 06:00), but no cortisol differences were observed between OSA and Non-OSA groups. CONCLUSION MIF is elevated in patients with OSA and is related to OSA severity, while there was no difference in cortisol levels. MIF is a pro-inflammatory cytokine which additionally inhibits the anti-inflammatory effects of glucocorticoids. Thus, elevated MIF levels in OSA may contribute to elevated inflammation.
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Affiliation(s)
- Kate M Edwards
- Department of Psychiatry, University of California-San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA.
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Tomfohr LM, Ancoli-Israel S, Loredo JS, Dimsdale JE. Effects of continuous positive airway pressure on fatigue and sleepiness in patients with obstructive sleep apnea: data from a randomized controlled trial. Sleep 2011; 34:121-6. [PMID: 21203367 PMCID: PMC3001790 DOI: 10.1093/sleep/34.1.121] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Complaints of fatigue are frequent in patients with obstructive sleep apnea (OSA); however, the impact of continuous positive airway pressure (CPAP) on fatigue remains unclear. METHODS Fifty-nine men and women with OSA were randomly assigned to therapeutic or placebo CPAP in a double-blind fashion for a 3-week intervention period. Four outcome measures were assessed: (1) fatigue/vigor measured with the Multidimensional Fatigue Symptom Inventory--Short Form (MFSI-sf), the (2) fatigue and (3) vigor subscales of the Profile of Mood States--Short Form (POMS), and (4) the Epworth Sleepiness Scale (ESS). Data were analyzed using repeated-measures analysis of variance. RESULTS Compared with patients receiving placebo CPAP, those patients treated with therapeutic CPAP showed significant reductions in the apnea-hypopnea index, as well as decreases in both measures of fatigue and increases in vigor (P values < 0.05). The beneficial effect of therapeutic treatment was most pronounced in patients with high levels of fatigue at study onset. Significant treatment effects in sleepiness scores were not observed in the entire sample (P > 0.05); however, in a subset of patients with excessive sleepiness at the onset of treatment, ESS scores were significantly reduced with use of therapeutic CPAP (P < 0.05). CONCLUSIONS Results suggest that 3 weeks of therapeutic CPAP significantly reduced fatigue and increased energy in patients with OSA. Therapeutic CPAP significantly reduced daytime sleepiness in patients who reported excessive sleepiness at the onset of treatment.
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Affiliation(s)
- Lianne M Tomfohr
- San Diego State University & University of California, San Diego, Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA.
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Abstract
The importance of sleep on health has only been recently recognized, and the general public and the medical community are not yet fully knowledgeable about this issue. The great majority of sleep research has been performed in whites of European descent and to a lesser extent in African Americans, making generalization of the findings to other ethnic and racial groups difficult. Very little sleep research has been done in U.S. Hispanics. However, based on the available literature and the high prevalence of risk factors in Hispanics, such as obesity, diabetes, living in the inner city, and use of alcohol, the prevalence of such important sleep disorders such as obstructive sleep apnea and sleep habits such as poor sleep hygiene are suspected to be high. There is also some evidence that acculturation to the U.S. life style may lead to worse sleep habits in Hispanics, including fewer hours of sleep. Two current large NIH sponsored studies of sleep in U.S. Hispanics promise to significantly add to the literature on various sleep disorders such as sleep disordered breathing, insomnia, restless legs syndrome, periodic limb movement disorder, and sleep habits such as short sleep duration and sleep hygiene.
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Affiliation(s)
- Jose S Loredo
- Department of Medicine, University of California, San Diego 92103-0804, USA.
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Cooke JR, Ancoli-Israel S, Liu L, Loredo JS, Natarajan L, Palmer BS, He F, Corey-Bloom J. Continuous positive airway pressure deepens sleep in patients with Alzheimer's disease and obstructive sleep apnea. Sleep Med 2009; 10:1101-6. [PMID: 19699148 DOI: 10.1016/j.sleep.2008.12.016] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2008] [Revised: 11/11/2008] [Accepted: 12/22/2008] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Patients with Alzheimer's disease (AD) and obstructive sleep apnea (OSA) experience disrupted sleep. This study examined the effect of continuous positive airway pressure (CPAP) on sleep parameters in AD patients with OSA. METHODS A randomized placebo-controlled trial of 3 weeks of therapeutic CPAP (tCPAP) vs. 3 weeks placebo CPAP (pCPAP) followed by 3 weeks tCPAP in patients with AD and OSA. Polysomnography data from screening after one night and after 3 weeks of treatment were analyzed. Records were scored for percent of each sleep stage, total sleep time (TST), sleep efficiency (SE), sleep period (SP), time in bed (TIB), sleep onset (SO), wake time after sleep onset (WASO), and arousals. A randomized design comparing one night of pCPAP to tCPAP and a paired analysis combining 3 weeks of tCPAP were performed. RESULTS Fifty-two participants (mean age=77.8 years, SD=7.3) with AD and OSA were included. After one treatment night, the tCPAP group had significantly less % Stage 1 (p=0.04) and more % Stage 2 sleep (p=0.02) when compared to the pCPAP group. In the paired analysis, 3 weeks of tCPAP resulted in significant decreases in WASO (p=0.005), % Stage 1 (p=0.001), arousals (p=0.005), and an increase in % Stage 3 (p=0.006). CONCLUSION In mild to moderate AD patients with OSA, the use of tCPAP resulted in deeper sleep after just one night, with improvements maintained for 3 weeks.
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Affiliation(s)
- Jana R Cooke
- Department of Medicine, University of California San Diego, La Jolla, Ca 92093-0733, USA
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Cooke JR, Ayalon L, Palmer BW, Loredo JS, Corey-Bloom J, Natarajan L, Liu L, Ancoli-Israel S. Sustained use of CPAP slows deterioration of cognition, sleep, and mood in patients with Alzheimer's disease and obstructive sleep apnea: a preliminary study. J Clin Sleep Med 2009; 5:305-309. [PMID: 19968005 PMCID: PMC2725246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
INTRODUCTION Obstructive sleep apnea (OSA) is common among patients with Alzheimer's disease (AD). Untreated OSA exacerbates the cognitive and functional deficits. Continuous positive airway pressure (CPAP) has recently been shown to have beneficial effects on cognition in AD. Little attention has focused on the long-term benefits of CPAP in these patients. METHODS This was an exploratory study of sustained CPAP use (mean use = 13.3 months, SD = 5.2) among a subset of participants from an initial 6-week randomized clinical trial (RCT) of CPAP in patients with mild to moderate AD. Follow-up included 5 patients who continued CPAP (CPAP+) after completion of the RCT and 5 patients who discontinued CPAP (CPAP-), matched by time of completion of the initial study. A neuropsychological test battery and sleep/mood questionnaires were administered and effect sizes were calculated. RESULTS Even with a small sample size, sustained CPAP use resulted in moderate-to-large effect sizes. Compared to the CPAP- group, the CPAP+ group showed less cognitive decline with sustained CPAP use, stabilization of depressive symptoms and daytime somnolence, and significant improvement in subjective sleep quality. Caregivers of the CPAP+ group also reported that their own sleep was better when compared to the final RCT visit and that their patients psychopathological behavior was improved. CONCLUSION The results of this preliminary study raise the possibility that sustained, long-term CPAP treatment for patients with AD and OSA may result in lasting improvements in sleep and mood as well as a slowing of cognitive deterioration. Prospective randomized controlled research trials evaluating these hypotheses are needed.
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Affiliation(s)
- Jana R. Cooke
- Department of Medicine
- Veterans Affairs San Diego Healthcare System, San Diego, CA
| | | | | | - Jose S. Loredo
- Department of Medicine
- Veterans Affairs San Diego Healthcare System, San Diego, CA
| | - Jody Corey-Bloom
- Department of Neurosciences, University of California, San Diego, CA
- Veterans Affairs San Diego Healthcare System, San Diego, CA
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Cooke JR, Ayalon L, Palmer BW, Loredo JS, Corey-Bloom J, Natarajan L, Liu L, Ancoli-Israel S. Sustained Use of CPAP Slows Deterioration of Cognition, Sleep, and Mood in Patients with Alzheimer's Disease and Obstructive Sleep Apnea: A Preliminary Study. J Clin Sleep Med 2009. [DOI: 10.5664/jcsm.27538] [Citation(s) in RCA: 150] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Jana R. Cooke
- Department of Medicine
- Veterans Affairs San Diego Healthcare System, San Diego, CA
| | | | | | - Jose S. Loredo
- Department of Medicine
- Veterans Affairs San Diego Healthcare System, San Diego, CA
| | - Jody Corey-Bloom
- Department of Neurosciences, University of California, San Diego, CA
- Veterans Affairs San Diego Healthcare System, San Diego, CA
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Norman D, Bardwell WA, Loredo JS, Ancoli-Israel S, Heaton RK, Dimsdale JE. Caffeine intake is independently associated with neuropsychological performance in patients with obstructive sleep apnea. Sleep Breath 2008; 12:199-205. [PMID: 17992551 DOI: 10.1007/s11325-007-0153-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
In healthy individuals, caffeine intake may improve performance on cognitive tests. Obstructive sleep apnea (OSA) is a disorder that has been associated with impaired cognitive function. In this study, we investigated whether increased caffeine intake in untreated patients with OSA is linked to better cognitive performance. Forty-five untreated OSA patients underwent baseline polysomnography after completing a survey of 24-h caffeine intake. Participants completed a battery of neuropsychological tests, then demographically corrected T scores and a global deficit score (GDS) were calculated on these tests. Partial correlation analysis was performed to compare daily caffeine intake with GDS, after controlling for body mass index (BMI) and sleep apnea severity. Analysis of covariance was done to examine differences in daily caffeine intake between cognitively impaired (GDS >or= 0.5) and non-impaired (GDS < 0.5) individuals. Seven out of the 45 subjects met the criteria (GDS >or= 0.5) for cognitive impairment. There was a significant inverse association between caffeine intake and the GDS, both when controlling for BMI (r =or -0.331, p = 0.04) and when controlling for BMI and apnea severity (r =or-0.500, p = 0.002); those with less impairment consumed more caffeine. Analysis of covariance demonstrated that cognitively impaired individuals consumed one-sixth as much caffeine as non-impaired individuals (p < 0.05). In patients with moderately severe OSA, higher average daily caffeine intake was associated with less cognitive impairment.
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Affiliation(s)
- Daniel Norman
- St. John's Medical Plaza Sleep Disorders Center, Santa Monica, CA, USA.
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Ancoli-Israel S, Palmer BW, Cooke JR, Corey-Bloom J, Fiorentino L, Natarajan L, Liu L, Ayalon L, He F, Loredo JS. Cognitive effects of treating obstructive sleep apnea in Alzheimer's disease: a randomized controlled study. J Am Geriatr Soc 2008; 56:2076-81. [PMID: 18795985 PMCID: PMC2585146 DOI: 10.1111/j.1532-5415.2008.01934.x] [Citation(s) in RCA: 246] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To examine whether treatment of obstructive sleep apnea (OSA) with continuous positive airway pressure (CPAP) in patients with Alzheimer's disease (AD) results in better cognitive function. DESIGN Randomized double-blind placebo-controlled trial. Participants were randomized to therapeutic CPAP for 6 weeks or placebo CPAP for 3 weeks followed by therapeutic CPAP for 3 weeks. SETTING General clinical research center. PARTICIPANTS Fifty-two men and women with mild to moderate AD and OSA. INTERVENTION CPAP. MEASUREMENTS A complete neuropsychological test battery was administered before treatment and at 3 and at 6 weeks. RESULTS A comparison of subjects randomized to 3 weeks of therapeutic versus placebo CPAP suggested no significant improvements in cognition. A comparison of pre- and posttreatment neuropsychological test scores after 3 weeks of therapeutic CPAP in both groups showed a significant improvement in cognition. The study was underpowered to make definitive statements about improvements within specific cognitive constructs, although exploratory post hoc examination of change scores for individual tests suggested improvements in episodic verbal learning and memory and some aspects of executive functioning such as cognitive flexibility and mental processing speed. CONCLUSION OSA may aggravate cognitive dysfunction in dementia and thus may be a reversible cause of cognitive loss in patients with AD. OSA treatment seems to improve some cognitive functioning. Clinicians who care for patients with AD should consider implementing CPAP treatment when OSA is present.
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Affiliation(s)
- Sonia Ancoli-Israel
- Department of Psychiatry, University of California, San Diego
- Veterans Affairs San Diego Healthcare System
| | - Barton W. Palmer
- Department of Psychiatry, University of California, San Diego
- Veterans Affairs San Diego Healthcare System
| | - Jana R. Cooke
- Veterans Affairs San Diego Healthcare System
- Department of Medicine, University of California, San Diego
| | - Jody Corey-Bloom
- Veterans Affairs San Diego Healthcare System
- Department of Neurosciences, University of California, San Diego
| | | | - Loki Natarajan
- Department of Family and Preventative Medicine, University of California, San Diego
| | - Lianqi Liu
- Department of Psychiatry, University of California, San Diego
- Veterans Affairs San Diego Healthcare System
| | - Liat Ayalon
- Department of Psychiatry, University of California, San Diego
| | - Feng He
- Department of Family and Preventative Medicine, University of California, San Diego
| | - Jose S. Loredo
- Veterans Affairs San Diego Healthcare System
- Department of Medicine, University of California, San Diego
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Nelson JA, Loredo JS, Acosta JA. The obesity-hypoventilation syndrome and respiratory failure in the acute trauma patient. J Emerg Med 2008; 40:e67-9. [PMID: 18757156 DOI: 10.1016/j.jemermed.2007.12.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2007] [Accepted: 12/20/2007] [Indexed: 10/21/2022]
Abstract
BACKGROUND The Emergency Department experience, for many patients, involves procedures and therapies that can compromise ventilation. In the acute trauma patient, these include spinal immobilization, supine positioning, and the administration of sedative and analgesic medications. Patients with the obesity-hypoventilation syndrome have a syndrome distinct from mere obesity, and are more sensitive to these insults. OBJECTIVE To describe a case of respiratory failure in a patient with the obesity-hypoventilation syndrome resulting from injuries and therapies that in any other patient would not be expected to cause respiratory failure. CASE REPORT A 59-year-old woman suffered a mechanical fall, fractured her T6 vertebral body and right proximal humerus, and, after spinal immobilization and the administration of routine doses of opioid analgesics, suffered significant hypoxemia and respiratory acidosis. Reversal agents were ineffective, but non-invasive mechanical ventilation restored adequate respiration. CONCLUSION Although obesity-hypoventilation syndrome occurs in only a minority of morbidly obese patients, it is important because the consequences of respiratory failure can be severe if not recognized and anticipated. Such patients will not be able to adequately increase ventilation in response to mounting hypercapnia. The condition is easily addressed through non-invasive ventilation.
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Affiliation(s)
- James A Nelson
- Department of Emergency Medicine, University of California San Diego Medical Center, San Diego, California 92103, USA
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Norman D, Bardwell WA, Arosemena F, Nelesen R, Mills PJ, Loredo JS, Lavine JE, Dimsdale JE. Serum aminotransferase levels are associated with markers of hypoxia in patients with obstructive sleep apnea. Sleep 2008; 31:121-6. [PMID: 18220085 PMCID: PMC2225546 DOI: 10.1093/sleep/31.1.121] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
STUDY OBJECTIVES Nonalcoholic fatty liver disease (NAFLD) is a disorder that often presents with elevated serum aminotransferase levels. Although it has classically been linked with the metabolic syndrome, recent studies suggest NAFLD may also be associated with obstructive sleep apnea (OSA). This study evaluates the association between serum aminotransferase levels and factors connected with: either the metabolic syndrome (elevated body mass index [BMI], lipid profile, blood pressure, fasting glucose), or with OSA severity (apnea hypopnea index, lowest oxygen saturation level, oxygen desaturation index, percent of time below 90% saturation [%T<90]). DESIGN Retrospective case series. PATIENTS AND SETTING 109 adult patients with OSA at a university hospital general clinical research center. MEASUREMENTS AND RESULTS Markers of hypoxia (lowest oxygen saturation level and %T<90), correlated significantly with aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels (Pearson's r = -0.31 to -0.38, P <0.003), while apnea hypopnea index, body mass index, blood pressure, fasting glucose, triglyceride, and cholesterol levels did not. Hierarchical linear regression was then done to determine the best predictors of aminotransferase levels. Markers of metabolic syndrome were entered as one block and markers of sleep apnea as another. Regression analyses explained 16.3% of the variance in AST and 18.9% of the variance in ALT, with %T<90 playing the largest role. CONCLUSIONS In patients with obstructive sleep apnea, serum aminotransferase levels are better predicted by markers of oxygen desaturation than by factors traditionally associated with the metabolic syndrome.
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Affiliation(s)
- Daniel Norman
- Department of Pulmonary and Critical Care Medicine, University of California at San Diego, San Diego, CA 92103-8383, USA.
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Lim W, Bardwell WA, Loredo JS, Kim EJ, Ancoli-Israel S, Morgan EE, Heaton RK, Dimsdale JE. Neuropsychological Effects of 2-Week Continuous Positive Airway Pressure Treatment and Supplemental Oxygen in Patients with Obstructive Sleep Apnea: A Randomized Placebo-Controlled Study. J Clin Sleep Med 2007. [DOI: 10.5664/jcsm.26860] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Weonjeong Lim
- Department of Psychiatry, University of California San Diego, La Jolla, CA
- Department of Psychiatry, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Wayne A. Bardwell
- Department of Psychiatry, University of California San Diego, La Jolla, CA
- Moores UCSD Cancer Center, La Jolla, CA
| | - Jose S. Loredo
- Department of Internal Medicine, University of California San Diego, La Jolla, CA
- Veterans Affairs San Diego Healthcare System, San Diego, CA
| | - Eui-Joong Kim
- Department of Psychiatry, University of California San Diego, La Jolla, CA
- Department of Psychiatry, Eulji University, Seoul, Korea
| | - Sonia Ancoli-Israel
- Department of Psychiatry, University of California San Diego, La Jolla, CA
- Moores UCSD Cancer Center, La Jolla, CA
- Veterans Affairs San Diego Healthcare System, San Diego, CA
| | - Erin E. Morgan
- Department of Psychiatry, University of California San Diego, La Jolla, CA
| | - Robert K. Heaton
- Department of Psychiatry, University of California San Diego, La Jolla, CA
| | - Joel E. Dimsdale
- Department of Psychiatry, University of California San Diego, La Jolla, CA
- Moores UCSD Cancer Center, La Jolla, CA
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Lim W, Bardwell WA, Loredo JS, Kim EJ, Ancoli-Israel S, Morgan EE, Heaton RK, Dimsdale JE. Neuropsychological effects of 2-week continuous positive airway pressure treatment and supplemental oxygen in patients with obstructive sleep apnea: a randomized placebo-controlled study. J Clin Sleep Med 2007; 3:380-6. [PMID: 17694727 PMCID: PMC1978310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
STUDY OBJECTIVES To determine predictors of neuropsychological functioning in patients with obstructive sleep apnea (OSA) and whether treatment with 2-week continuous positive airway pressure (CPAP) or supplemental oxygen would improve cognitive functioning. DESIGN Randomized placebo-controlled design. SETTING University-based clinical research center. PATIENTS Forty-six patients with untreated OSA. INTERVENTIONS Two-week CPAP, supplemental oxygen, or placebo-CPAP. MEASUREMENTS AND RESULTS Participants underwent polysomnography and completed a neuropsychological test battery before and after treatment. Prior to treatment, patients with OSA showed diffuse impairments, particularly in terms of speed of information processing, attention and working memory, executive functioning, learning and memory, as well as alertness and sustained attention. A global deficit score at baseline was positively correlated with percentage of stage 1 sleep (p = .049) only and was not correlated with obesity, daytime sleepiness, depression, fatigue, OSA severity, and the other polysomnography variables. The 3 treatment groups (therapeutic-CPAP, supplemental oxygen, and placebo-CPAP) were compared using repeated-measures analysis of variance (ANOVA). There was no significant Time x Treatment interaction for the global deficit score. When examining individual neuropsychological test scores, two thirds of them improved with time regardless of treatment, although only Digit Vigilance-Time (p = .020) showed significant improvement specific to CPAP treatment. CONCLUSION The present results suggest that Digit Vigilance-Time might be the most sensitive neuropsychological test for measuring the effects of the treatments. In general, 2 weeks of CPAP or oxygen-supplementation treatment was insufficient to show overall beneficial cognitive effects, as compared with placebo-CPAP. However, 2 weeks of CPAP treatment might be helpful in terms of speed of information processing, vigilance, or sustained attention and alertness.
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Affiliation(s)
- Weonjeong Lim
- Department of Psychiatry, University of California San Diego, La Jolla, CA
- Department of Psychiatry, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Wayne A. Bardwell
- Department of Psychiatry, University of California San Diego, La Jolla, CA
- Moores UCSD Cancer Center, La Jolla, CA
| | - Jose S. Loredo
- Department of Internal Medicine, University of California San Diego, La Jolla, CA
- Veterans Affairs San Diego Healthcare System, San Diego, CA
| | - Eui-Joong Kim
- Department of Psychiatry, University of California San Diego, La Jolla, CA
- Department of Psychiatry, Eulji University, Seoul, Korea
| | - Sonia Ancoli-Israel
- Department of Psychiatry, University of California San Diego, La Jolla, CA
- Moores UCSD Cancer Center, La Jolla, CA
- Veterans Affairs San Diego Healthcare System, San Diego, CA
| | - Erin E. Morgan
- Department of Psychiatry, University of California San Diego, La Jolla, CA
| | - Robert K. Heaton
- Department of Psychiatry, University of California San Diego, La Jolla, CA
| | - Joel E. Dimsdale
- Department of Psychiatry, University of California San Diego, La Jolla, CA
- Moores UCSD Cancer Center, La Jolla, CA
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Bardwell WA, Norman D, Ancoli-Israel S, Loredo JS, Lowery A, Lim W, Dimsdale JE. Effects of 2-week nocturnal oxygen supplementation and continuous positive airway pressure treatment on psychological symptoms in patients with obstructive sleep apnea: a randomized placebo-controlled study. Behav Sleep Med 2007; 5:21-38. [PMID: 17313322 DOI: 10.1207/s15402010bsm0501_2] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Psychological symptom improvement has been observed after continuous positive airway pressure (CPAP) treatment of obstructive sleep apnea (OSA). Because CPAP normalizes both sleep disruption and oxyhemoglobin desaturation, the mechanism of psychological symptom improvement is unclear. Using a 3-arm placebo-controlled design, we parsed out the separate effects of treatment on psychological symptoms. OSA patients (N = 38) were monitored 2 nights with polysomnography and then randomized to 2-weeks therapeutic CPAP, placebo CPAP, or O(2) supplementation. Pre and post-treatment, patients completed the Brief Symptom Inventory (BSI): Higher scores indicate greater severity. Repeated measures analysis of covariance reveals a Time x Treatment interaction for BSI Global Severity Index (GSI): significant pre- to post-treatment reductions in GSI with O(2) supplementation and therapeutic CPAP, but not placebo CPAP. A Time x Treatment interaction was also found for depression: Depression decreased with O(2) supplementation but not with therapeutic CPAP or placebo CPAP. Both therapeutic CPAP and O(2) supplementation resulted in decreased psychological symptoms. Results suggest hypoxemia may play a stronger role than sleep disruption vis-à-vis OSA related psychological distress.
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Affiliation(s)
- Wayne A Bardwell
- Department of Psychiatry, Moores UCSD Cancer Center, University of California, San Diego, La Jolla, CA 92093-0804, USA.
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Cooke JR, Liu L, Natarajan L, He F, Marler M, Loredo JS, Corey-Bloom J, Palmer BW, Greenfield D, Ancoli-Israel S. The effect of sleep-disordered breathing on stages of sleep in patients with Alzheimer's disease. Behav Sleep Med 2007; 4:219-27. [PMID: 17083302 DOI: 10.1207/s15402010bsm0404_2] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Patients with Alzheimer's disease (AD) commonly have poor sleep and a high reported incidence of sleep-disordered breathing (SDB). This study examined how the presence of SDB affected sleep stages in AD patients. Sixty-six volunteers with mild - moderate AD underwent home polysomnography. Results showed that patients with SDB spent less of the night in REM sleep than those with no SDB, but there were no differences in other sleep stages. The findings suggest that the decreased amount of REM sleep may be due to the presence of AD and SDB. Treating these patients' SDB may increase their amount of REM sleep, which may result in improved daytime functioning. Controlled trials of SDB treatment in AD are needed to answer this question.
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Affiliation(s)
- Jana R Cooke
- Department of Medicine, University of California, San Diego, Veterans Affairs San Diego Healthcare System, CA, USA
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Chong MS, Ayalon L, Marler M, Loredo JS, Corey-Bloom J, Palmer BW, Liu L, Ancoli-Israel S. Continuous positive airway pressure reduces subjective daytime sleepiness in patients with mild to moderate Alzheimer's disease with sleep disordered breathing. J Am Geriatr Soc 2006; 54:777-81. [PMID: 16696743 DOI: 10.1111/j.1532-5415.2006.00694.x] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Studies have reported that 33% to 70% of patients with Alzheimer's disease (AD) have sleep-disordered breathing (SDB). Continuous positive airway pressure (CPAP) treatment has been shown to reduce daytime sleepiness and improve health-related quality of life in nondemented older people with SDB. The effect of therapeutic CPAP treatment on daytime sleepiness in patients with mild-moderate AD with SDB was assessed. DESIGN Randomized, double-blind, placebo-controlled trial. SETTING Patients' home and the University of California San Diego, General Clinical Research Center, J. Christian Gillin Laboratory of Sleep and Chronobiology. PARTICIPANTS Thirty-nine community-dwelling elderly patients with mild-moderate probable AD with SDB. INTERVENTION Patients were randomly assigned to receive 6 weeks of therapeutic CPAP or 3 weeks of sham CPAP followed by 3 weeks of therapeutic CPAP. MEASUREMENTS Epworth Sleepiness Scale (ESS) was administered at baseline, 3 weeks, and 6 weeks. Changes in daytime sleepiness in subjects who received optimal therapeutic CPAP were compared with changes in the sham CPAP group. RESULTS Within the therapeutic CPAP group, ESS scores were reduced from 8.89 during baseline to 6.56 after 3 weeks of treatment (P=.04) and to 5.53 after 6 weeks of treatment (P=.004). In the sham CPAP group, there was no significant difference after 3 weeks of sham CPAP but a significant decrease from 7.68 to 6.47 (P=.01) after 3 weeks of therapeutic CPAP. CONCLUSION These data provide evidence of the effectiveness of CPAP in reducing subjective daytime sleepiness in patients with AD with SDB.
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Affiliation(s)
- Mei S Chong
- Department of Psychiatry, Univeristy of California at San Diego, San Diego, CA 92161, USA
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42
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Ayalon L, Ancoli-Israel S, Stepnowsky C, Marler M, Palmer BW, Liu L, Loredo JS, Corey-Bloom J, Greenfield D, Cooke J. Adherence to continuous positive airway pressure treatment in patients with Alzheimer's disease and obstructive sleep apnea. Am J Geriatr Psychiatry 2006; 14:176-80. [PMID: 16473983 DOI: 10.1097/01.jgp.0000192484.12684.cd] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This analysis examined whether patients with Alzheimer disease (AD) tolerate continuous positive airway pressure (CPAP). METHOD Thirty patients with AD were randomized to CPAP or sham CPAP and completed sleep, depression, and quality-of-life questionnaires. Participants could choose to continue treatment after the trial. RESULTS Patients wore CPAP for 4.8 hours per night. More depressive symptoms were associated with worse adherence (rS=-0.37; N=30, p<0.04). Patients who continued using CPAP had fewer depressive symptoms (t [19]=2.45, p=0.02) and better adherence (t [19]=2.32, p=0.03) during the trial. CONCLUSION Patients with AD with obstructive sleep apnea can tolerate CPAP. Adherence and long-term use may be more difficult among those patients with more depressive symptoms.
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Affiliation(s)
- Liat Ayalon
- Department of Psychiatry, University of California, San Diego, San Diego, CA, and Veterans Affairs San Diego Health Care System, San Diego, CA 92161, USA
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Cooke JR, Loredo JS, Liu L, Marler M, Corey-Bloom J, Fiorentino L, Harrison T, Ancoli-Israel S. Acetylcholinesterase Inhibitors and Sleep Architecture in Patients with Alzheimer???s Disease. Drugs Aging 2006; 23:503-11. [PMID: 16872233 DOI: 10.2165/00002512-200623060-00005] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND AND OBJECTIVE Studies suggest that some acetylcholinesterase inhibitors (AChEIs) increase rapid eye movement (REM) sleep and nightmares in patients with Alzheimer's disease (AD) but few have studied their effect on other sleep parameters. The objective of this study was to examine differences in sleep architecture in AD patients taking different AChEIs. METHODS 76 participants (51 men, 25 women) [mean age = 78.2 years; SD = 7.7] with mild to moderate AD underwent medication history screening as well as polysomnography to determine the percentage of each sleep stage. Participants were divided into groups based on AChEI used: donepezil (n = 41), galantamine (n = 15), rivastigmine (n = 8) or no AChEI (n = 12). General univariate linear model analyses were performed. RESULTS AChEI therapy had a significant effect on the percentage of stage 1 (p = 0.01) and stage 2 (p = 0.03) sleep. Patients in the donepezil group had a significantly lower percentage of stage 1 sleep than patients in the galantamine group (mean = 17.3%, SD = 11.7 vs 29.2%, SD = 15.0, respectively; p = 0.01), but there was no significant difference between the donepezil group and the rivastigmine (mean = 25.0%, SD = 12.3) or no AChEI groups (mean = 27.6%, SD = 17.7) in this respect. No significant differences in percentage of stage 1 between other groups were seen. Patients in the donepezil group also had a significantly higher percentage of stage 2 sleep than patients in the no AChEI group (mean = 63.6%, SD = 14.4 vs 51.4%, SD = 16.9, respectively; p = 0.04), but there was no significant difference between the donepezil group and either the galantamine group (mean = 56.5%, SD = 8.7) or the rivastigmine group (mean = 59.9%, SD = 8.4). There were no significant differences between groups in terms of percentage REM sleep or other sleep parameters. CONCLUSION Subgroups of AD patients (classified according to AChEI treatment) in this study differed with respect to the amount of stage 1 and stage 2 sleep experienced, with the donepezil-treated group having the lowest percentage of stage 1 sleep and the highest percentage of stage 2 sleep. There was no significant difference in the amount of REM sleep between the groups. Our data suggest that sleep architecture may be affected by the use of donepezil in patients with AD. Although not elicited in this study because of the small sample size, there may be a class effect of AChEIs on sleep architecture. Double-blind, placebo-controlled studies are needed to better understand causality and the effect of each AChEI on sleep architecture in patients with AD.
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Affiliation(s)
- Jana R Cooke
- Department of Medicine, University of California, San Diego, California, USA
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Mills PJ, Kennedy BP, Loredo JS, Dimsdale JE, Ziegler MG. Effects of nasal continuous positive airway pressure and oxygen supplementation on norepinephrine kinetics and cardiovascular responses in obstructive sleep apnea. J Appl Physiol (1985) 2006; 100:343-8. [PMID: 16357087 DOI: 10.1152/japplphysiol.00494.2005] [Citation(s) in RCA: 103] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Obstructive sleep apnea (OSA) is characterized by noradrenergic activation. Nasal continuous positive airway pressure (CPAP) is the treatment of choice and has been shown to effectively reduce elevated norepinephrine (NE) levels. This study examined whether the reduction in NE after CPAP is due to an increase in NE clearance and/or a decrease of NE release rate. Fifty CPAP-naive OSA patients with an apnea-hypopnea index >15 were studied. NE clearance and release rates, circulating NE levels, urinary NE excretion, and blood pressure and heart rate were determined before and after 14 days of CPAP, placebo CPAP (CPAP administered at ineffective pressure), or oxygen supplementation. CPAP led to a significant increase in NE clearance ( P ≤ 0.01), as well as decreases in plasma NE levels ( P ≤ 0.018) and daytime ( P < 0.001) and nighttime ( P < 0.05) NE excretion. NE release rate was unchanged with treatment. Systolic ( P ≤ 0.013) and diastolic ( P ≤ 0.026) blood pressure and heart rate ( P ≤ 0.014) were decreased in response to CPAP but not in response to oxygen or placebo CPAP treatment. Posttreatment systolic blood pressure was best predicted by pretreatment systolic blood pressure and posttreatment NE clearance and release rate ( P < 0.01). The findings indicate that one of the mechanisms through which CPAP reduces NE levels is through an increase in the clearance of NE from the circulation.
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Affiliation(s)
- Paul J Mills
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA.
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Hong S, Mills PJ, Loredo JS, Adler KA, Dimsdale JE. The association between interleukin-6, sleep, and demographic characteristics. Brain Behav Immun 2005; 19:165-72. [PMID: 15664789 DOI: 10.1016/j.bbi.2004.07.008] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2004] [Revised: 07/01/2004] [Accepted: 07/14/2004] [Indexed: 11/29/2022] Open
Abstract
We examined the relationship between the pro-inflammatory cytokine IL-6 and sleep architecture in 70 healthy men and women. Blood was drawn in the early morning for assessment of IL-6 followed by nocturnal sleep monitoring with polysomnography. Sleep records were scored for sleep stages using standard criteria. Morning IL-6 levels were positively correlated with REM latency after sleep onset [rho = .31, p = .01], percent (%) stage 1 sleep [rho = .23, p = .053], % wake after sleep onset (WASO) [rho = .29, p<.05]. IL-6 levels were negatively correlated with sleep efficiency [rho = -.36, p<.01] and slow wave sleep (SWS) [rho = -.26, p<.05]. After controlling for demographic variables including race, gender, age, and BMI, multiple hierarchical regression analyses revealed that morning IL-6 levels accounted for a significant portion of the variance of REM latency (p<.01), sleep efficiency (p<.01), and % WASO (p = .01). IL-6 was no longer associated with % stage 1 sleep, SWS, and total sleep time after controlling for the demographic characteristics. These findings suggest that the inflammatory marker IL-6 is associated with sleep quality and that certain individual characteristics such as race, gender, and age modify that relationship. Higher IL-6 levels were associated with lower quality of sleep among healthy asymptomatic men and women.
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Affiliation(s)
- Suzi Hong
- Department of Psychiatry, University of California, San Diego, USA.
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Bao X, Nelesen RA, Loredo JS, Dimsdale JE, Ziegler MG. Blood pressure variability in obstructive sleep apnea: role of sympathetic nervous activity and effect of continuous positive airway pressure. Blood Press Monit 2002; 7:301-7. [PMID: 12488649 DOI: 10.1097/00126097-200212000-00002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Many studies support a link between obstructive sleep apnea (OSA), increased blood pressure (BP) and/or BP variability, and sympathetic nervous system (SNS) activity. We assessed the relationship between SNS activity and 24-h BP variability in patients with OSA, and the effect of continuous positive airway pressure (CPAP) on BP variability. DESIGN Forty-one patients with a respiratory disturbance index (RDI) > 15 were randomized into CPAP or CPAP placebo groups for a 1-week trial. METHODS Ambulatory BP, 24-h urine norepinephrine (NE) and polysomnography were measured prior to treatment and after 1 and 7 days of treatment. RESULTS Neither RDI nor 24-h urine NE levels were related to 24-h mean BP levels. While RDI was associated only with night-time BP variability, daytime urine NE levels were associated with both night-time and daytime BP variability. After treatment, the BP variability decreased significantly but equally in both active and placebo CPAP groups. CONCLUSIONS Obstructive sleep apnea is more related to BP variability than BP. Sympathetic nervous activity, as inferred from daytime urine NE, is related to changes in BP variability in OSA patients. BP variability is not specifically affected by CPAP.
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Affiliation(s)
- Xuping Bao
- Department of Medicine, University of California San Diego, 92103-8341, USA
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Farag NH, Nelesen RA, Parry BL, Loredo JS, Dimsdale JE, Mills PJ. Autonomic and cardiovascular function in postmenopausal women: the effects of estrogen versus combination therapy. Am J Obstet Gynecol 2002; 186:954-61. [PMID: 12015521 DOI: 10.1067/mob.2002.122248] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study examined the effects of oral estrogen (ERT) alone versus oral estrogen/medroxyprogesterone acetate (HRT) therapy on cardiovascular function, as controlled by the autonomic nervous system. STUDY DESIGN Forty-three postmenopausal women received ERT, HRT, or a placebo for 3 months in a double-blind, randomized, placebo-controlled study. Cardiovascular hemodynamics and heart rate variability were assessed at rest and during stress. RESULTS After 3 months of therapy, oral HRT significantly increased high-frequency power (P =.0002) and decreased total peripheral resistance (P =.04). The changes were evident at rest and during stress. CONCLUSION Our findings suggest that combination therapy produces a more favorable alteration of autonomic cardiovascular function than estrogen alone (ie, combination therapy increases vagal activity).
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Affiliation(s)
- Noha H Farag
- Department of Psychiatry, University of California, San Diego, UCSD Medical Center, 92103-0804, USA.
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Abstract
BACKGROUND Obstructive sleep apnea (OSA) is associated with poor sleep quality and a high incidence of nondipping. The aim of this study was to determine the association of sleep quality and nocturnal blood pressure (BP) dipping in an OSA population. METHODS A total of 44 untreated subjects with mild to severe OSA underwent overnight-attended polysomnography and 24-h ambulatory BP monitoring. Subjects were off antihypertensive medication. The percentage of slow wave sleep, percentage of time awake after sleep onset during the sleep period, sleep efficiency, and arousal index were chosen as measurements of sleep quality. Dipping was evaluated using the change in systolic BP, diastolic BP, and mean arterial pressure. Patients were classified as dippers and nondippers based on a nocturnal drop in mean arterial pressure > 10%. Differences between groups were evaluated by independent sample t tests. Pearson correlation and linear regression were used to evaluate the association of sleep quality and dipping. RESULTS There were no differences between dippers and nondippers with regard to body mass index, age, or respiratory disturbance index. A total of 84% were nondippers. No difference was found between dippers and nondippers in sleep quality. None of the sleep quality measures correlated with the measurements of dipping. In multiple regression analyses, the percentage of slow wave sleep and arousal index each independently predicted only a small percentage of the variance (approximately 10%) of nocturnal DBP dipping. CONCLUSIONS The prevalence of nondipping was very high in a population of untreated patients with mild to severe OSA. Nonetheless, sleep quality did not appear to be related to BP dipping.
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Affiliation(s)
- J S Loredo
- Department of Medicine, University of California, San Diego 92103-8378, USA.
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Ziegler MG, Mills PJ, Loredo JS, Ancoli-Israel S, Dimsdale JE. Effect of continuous positive airway pressure and placebo treatment on sympathetic nervous activity in patients with obstructive sleep apnea. Chest 2001; 120:887-93. [PMID: 11555525 DOI: 10.1378/chest.120.3.887] [Citation(s) in RCA: 137] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES We studied the effect of continuous positive airway pressure (CPAP) treatment on sympathetic nervous activity in 38 patients with obstructive sleep apnea. DESIGN Randomized, placebo-controlled trial. SETTING Patients underwent polysomnography on three occasions in a clinical research center, and had BP monitored over 24 h at home. All of the patients had sleep apnea with a respiratory disturbance index (RDI) > 15. INTERVENTIONS The patients were randomized blindly to CPAP or placebo (CPAP at ineffective pressure) treatment. MEASUREMENTS AND RESULTS Prior to therapy, the number of apneas and the severity of nocturnal hypoxia correlated significantly with daytime urinary norepinephrine (NE) levels, but not nighttime urinary NE levels. CPAP treatment lowered daytime BP from 99 +/- 2 mm Hg to 95 +/- 3 mm Hg (mean +/- SEM) and nighttime BP from 93 +/- 3 mm Hg to 88 +/- 3 mm Hg. Placebo CPAP treatment decreased both day and night mean BP only 2 mm Hg. CPAP, but not placebo, treatment lowered daytime plasma NE levels by 23%, daytime urine NE levels by 36%, daytime heart rate by 2.6 beats/min, and increased lymphocyte beta(2)-adrenergic receptor sensitivity (all p < 0.05). The effect of CPAP treatment on nighttime urine NE levels and heart rate did not differ from placebo treatment. There was a suggestion of an effect of placebo CPAP treatment on nighttime measures, but not on daytime measures. CONCLUSION We conclude that daytime sympathetic nervous activation is greater with more severe sleep apnea. CPAP treatment diminished the daytime sympathetic activation; the potential nighttime effect of CPAP treatment was obscured by a small placebo effect.
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Affiliation(s)
- M G Ziegler
- Department of Medicine, University of California San Diego, San Diego, CA 92103, USA.
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Loredo JS, Clausen JL, Nelesen RA, Ancoli-Israel S, Ziegler MG, Dimsdale JE. Obstructive sleep apnea and hypertension: are peripheral chemoreceptors involved? Med Hypotheses 2001; 56:17-9. [PMID: 11133249 DOI: 10.1054/mehy.2000.1086] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The mechanism of pathogenesis of hypertension in patients with obstructive sleep apnea (OSA) is unknown. Many investigators point to the high sympathetic nervous system activity (SNS) observed in OSA patients. However, there is no clear explanation as to the mechanism for the development of SNS hyperactivity in these patients. A common feature of patients with OSA is repetitive bouts of transient hypoxemia during sleep. Repetitive transient hypoxemia in rats has resulted in hypertension. In OSA patients, resolution of nocturnal hypoxemia with CPAP has corrected nocturnal and diurnal hypertension. Also, exposure to hyperoxia reduces blood pressure and sympathetic activity in OSA patients, but not in normals. These data suggest a significant role of peripheral chemoreceptors in the regulation of vascular tone. We hypothesize that peripheral chemoreceptors significantly contribute to the pathogenesis of hypertension in patients with OSA and that this is associated with chemoreceptor hyperactivity. This implies that correcting the intermittent nocturnal hypoxemia alone may prevent the cardiovascular morbidity associated with obstructive sleep apnea.
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Affiliation(s)
- J S Loredo
- Department of Medicine, University of California, San Diego, California, USA.
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