Are questionnaires reliable in diagnosing sleep-disordered breathing in university students?

AbstractObjective:This study aimed to screen young adults for sleep-disordered breathing, and compare those with high and low risk for sleep-disordered breathing.Methods:A survey based on the Berlin questionnaire was completed by 330 university students, and the results were used to divide them into sleep-disordered breathing positive and sleep-disordered breathing negative groups. A representative group was selected from each cohort (positive group,n= 16; negative group,n= 21), and assessed with sleep study, ENT examination, the Nose Obstruction Symptom Evaluation scale, and the Epworth Sleepiness Scale.Results:Sleep-disordered breathing prevalence was 11.2 per cent in the questionnaire and 24 per cent according to the sleep study. The sleep-disordered breathing positive and negative groups significantly differed in terms of coexisting sleep-disordered breathing symptoms. There were no significant differences between the positive and negative groups with regard to sleep study parameters (apnoea/hypopnoea index, respiratory disturbance index, oxygen desaturation index, snoring intensity) and the Epworth Sleepiness Scale.Conclusion:Subjective and objective diagnostic tools revealed that sleep-disordered breathing is a common problem among young adults.

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Abstract TP208: Medullary Infarction is Associated with Severe Sleep Disordered Breathing

Stroke ◽

10.1161/str.44.suppl_1.atp208 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Shuichi Fujii ◽

Kensaku Shibazaki ◽

Kenichiro Sakai ◽

Junya Aoki ◽

Junichi Uemura ◽

...

Keyword(s):

Ischemic Stroke ◽

Multivariate Regression ◽

Sleep Disordered Breathing ◽

Multivariate Regression Analysis ◽

Stroke Patients ◽

Sleep Study ◽

Respiratory Disturbance ◽

The Relationship ◽

Medullary Infarction ◽

Disordered Breathing

Background and Purpose: A relationship between presence or severity of sleep disordered breathing (SDB) and site of lesion in ischemic stroke patients has been unclear. Our aim of the present study was to investigate the relationship between presence or severity of SDB and site of ischemic lesions in stroke patients. Subjects and Methods: Between April 2010 and March 2012, consecutive ischemic stroke patients within 24 hours of onset were prospectively enrolled. Ischemic lesions were identified by MRI on admission. Patient underwent sleep study to evaluate the presence and severity of SDB within 7 days after admission. SDB was defined as a respiratory disturbance index (RDI; apnea/hypopnea events per hour) ≥ 5, and severe SDB was defined as a RDI ≥ 40. We investigated the relationship between presence or severity of SDB and clinical characteristics including site of ischemic lesions. Results: A total of 214 patients (mean age 71.3, male 132) were enrolled. Supratentrial lesion was observed in 166 (77.6%) patients and right side lesion in 101 (47.2%) patients. Sites of ischemic lesions were as follows; cortex (n=11), subcortex (n=35), cortex plus subcortex (n=75), basal ganglia (n=57), thalamus (n=13), midbrain (n=3), pons (n=27), medulla (n=11), and cerebellum (n=22). Sleep study was performed at 4 days (median). The median RDI (IQR) was 20 (10-34). SDB patients were found in 187 (87%) patients. There were no significant differences in frequency of each site of lesions between SDB and non-SDB patients. Severe SDB was observed in 42 (19.6%) patients. Age (75 (70-83) vs. 72 (64-78), p=0.047), NIHSS score on admission (3 (1-10) vs. 7 (2-12), p=0.047), the frequency of atrial fibrillation (41% vs. 22%, p=0.012) and medullary lesions (12% vs. 4%, p=0.027) were significantly higher in severe SDB patients than non-severe SDB. Multivariate regression analysis demonstrated that medullary lesions (OR 5.5, 95%CI 1.41-21.8, p=0.014) was independently associated with severe SDB. Conclusions: Medullary lesion in stroke patients should be associated with severe SDB.

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Sleep Disordered Breathing Measures in Early Pregnancy Are Associated with Depressive Symptoms in Late Pregnancy

Diagnostics ◽

10.3390/diagnostics11050858 ◽

2021 ◽

Vol 11 (5) ◽

pp. 858

Author(s):

Margaret H. Bublitz ◽

Meghan Sharp ◽

Taylor Freeburg ◽

Laura Sanapo ◽

Nicole R. Nugent ◽

...

Keyword(s):

Depressive Symptoms ◽

Early Pregnancy ◽

Sleep Disordered Breathing ◽

Late Pregnancy ◽

Self Report ◽

Apnea Hypopnea Index ◽

Berlin Questionnaire ◽

Sleep Study ◽

Home Sleep Study ◽

Disordered Breathing

Sleep disordered breathing (SDB) and depression are both common complications of pregnancy and increase risk for adverse maternal and neonatal outcomes. SDB precedes onset of depression in non-pregnant adults; however, the longitudinal relationship has not been studied in pregnancy. The present research examined temporal associations between SDB and depressive symptoms in 175 pregnant women at risk for SDB (based on frequent snoring and obesity), but without an apnea hypopnea index of ≥5 events per hour at enrollment. Women completed a self-report assessments of depressive symptoms using PHQ-9 and in-home level III sleep apnea monitoring at approximately 12- and 32-weeks’ gestation. We also assessed the risk for SDB using the Berlin Questionnaire in early pregnancy. Results revealed that measures of SDB in early pregnancy as assessed by in-home sleep study, but not by self-reported SDB, predicted elevated depressive symptoms in late pregnancy. SDB in late pregnancy was not associated with depressive symptoms. To conclude, these findings suggest that SDB may increase the risk for elevated depressive symptoms as pregnancy progresses.

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Faculty Opinions recommendation of Nocturnal Arrhythmias across a spectrum of obstructive and central sleep-disordered breathing in older men: outcomes of sleep disorders in older men (MrOS sleep) study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.13277055.14635183 ◽

2011 ◽

Author(s):

Teofilo Lee-Chiong

Keyword(s):

Sleep Disorders ◽

Sleep Disordered Breathing ◽

Older Men ◽

Sleep Study ◽

Disordered Breathing

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569 Correlation between age and initial findings of sleep disordered breathing in children with achondroplasia

SLEEP ◽

10.1093/sleep/zsab072.567 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A224-A225

Author(s):

Fayruz Araji ◽

Cephas Mujuruki ◽

Brian Ku ◽

Elisa Basora-Rovira ◽

Anna Wani

Keyword(s):

Sleep Apnea ◽

Primary Care Physicians ◽

Sleep Disordered Breathing ◽

Upper Airway ◽

Sleep Study ◽

Surgical Interventions ◽

Screening Guidelines ◽

Obstructive Sleep ◽

Children’S Sleep ◽

Disordered Breathing

Abstract Introduction Achondroplasia (ACH) occurs approximately 1 in 20,000–30,000 live births. They are prone to sleep disordered breathing specifically due to the upper airway stenosis, enlarged head circumference, combined with hypotonia and limited chest wall size associated with scoliosis at times. The co-occurrence of sleep apnea is well established and can aide in the decision for surgical intervention, however it is unclear at what age children should be evaluated for sleep apnea. Screening is often delayed as during the daytime there is no obvious gas exchange abnormalities. Due to the rareness of this disease, large studies are not available, limiting the data for discussion and analysis to develop guidelines on ideal screening age for sleep disordered breathing in children with ACH. Methods The primary aim of this study is to ascertain the presence of sleep disorder breathing and demographics of children with ACH at time of first polysomnogram (PSG) completed at one of the largest pediatric sleep lab in the country. The secondary aim of the study is to identify whether subsequent polysomnograms were completed if surgical interventions occurred and how the studies differed over time with and without intervention. Retrospective review of the PSGs from patients with ACH, completed from 2017–2019 at the Children’s Sleep Disorders Center in Dallas, TX. Clinical data, demographics, PSG findings and occurrence of interventions were collected. Results Twenty-seven patients with the diagnosis of ACH met criteria. The average age at the time of their first diagnostic PSG was at 31.6 months of age (2.7 years), of those patients 85% had obstructive sleep apnea (OSA),51% had hypoxemia and 18% had hypercapnia by their first diagnostic sleep study. Of those with OSA, 50% were severe. Majority were females, 55%. Most of our patients were Hispanic (14%), Caucasian (9%), Asian (2%), Other (2%), Black (0%). Each patient had an average of 1.9 PSGs completed. Conclusion Our findings can help create a foundation for discussion of screening guidelines. These guidelines will serve to guide primary care physicians to direct these patients to an early diagnosis and treatment of sleep disordered breathing. Support (if any):

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Abstract 11556: Association of Sleep Disordered Breathing and ECG R-Wave to Radial Artery Pulse Delay: The MESA Study

Circulation ◽

10.1161/circ.130.suppl_2.11556 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Younghoon Kwon ◽

David R Jacobs ◽

Pamela L Lutsey ◽

Peter Hannan ◽

Julio A Chirinos ◽

...

Keyword(s):

Arterial Stiffness ◽

Radial Artery ◽

Sleep Disordered Breathing ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Apnea Hypopnea Index ◽

Sleep Study ◽

Ventricular Ejection Fraction ◽

Pulse Delay ◽

Disordered Breathing

Background: Arterial stiffness is a well-recognized predictor of cardiovascular disease (CVD). ECG R-wave to Radial artery pulse delay (RRD) is a novel hemodynamic index in which arterial stiffness is an important component (shorter delay = Higher arterial stiffness) and is obtainable from a single tonometric measurement at the radial artery with simultaneous ECG. Sleep disordered breathing (SDB) has emerged as a risk factor for CVD. The aim of the study was to determine the association of SDB with RRD. Methods: Multi-Ethnic Study of Atherosclerosis participants in 2010-2012 without overt CVD who underwent a sleep study, radial artery tonometry and cardiac MRI were eligible for this cross-sectional analysis (N = 1173, Mean [SD] age: 67.8 ± 8.8, Women: 55.4%). Independent associations between SDB indices including apnea hypopnea index (AHI) and oxygen (O2) desaturation index (ODI: events with more than 4% O2 desaturation), and RRD (transit time in msec) were examined. Model was constructed to adjust for isovolumetric contraction time, another component of RRD, by including measures of contractility and preload (left ventricular ejection fraction (LVEF) and left ventricular end diastolic volume (LVEDV) respectively). Results: Median [IQR] of AHI and ODI were 7.9/hr [2.9- 18.0] and 7.5/hr [3.0- 17.5] respectively. Adjusting for transit path length, demographic factors, BMI and CVD risk factors, both AHI and ODI were inversely associated with RRD (β= -50.3 msec per SD, p = 0.09 and β= -0.60.2 msec per SD, p = 0.04 respectively). In gender stratified analyses given presence of significant interaction, measures of SDB were predictive of RRD only in men. No significant associations were found with key nocturnal hypoxemia indices including mean O2 saturation (SpO2), percent time with SpO2less than 90 % and minimum SpO2. Men, older age, Asian race, high blood pressure, LVEF and LVEDV were also inversely associated with RRD. Conclusion: SDB was associated with shorter RRD implying higher arterial stiffness in men only. These findings suggest the importance of apnea related dynamic change in SpO2 (intermittent hypoxia and reoxygenation) in its potential link to arterial stiffness and also highlights effect modification by gender in the association between the two.

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Abstract WP357: Prevalence of Pre- and Post-intracerebral Hemorrhage Sleep-disordered Breathing

Stroke ◽

10.1161/str.48.suppl_1.wp357 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Richard V Scheer ◽

Lynda D Lisabeth ◽

Chengwei Li ◽

Erin Case ◽

Ronald D Chervin ◽

...

Keyword(s):

Ischemic Stroke ◽

Intracerebral Hemorrhage ◽

Mexican American ◽

Sleep Disordered Breathing ◽

Population Based ◽

Apnea Hypopnea Index ◽

Berlin Questionnaire ◽

Portable Monitor ◽

Before And After ◽

Disordered Breathing

Background: Sleep-disordered breathing (SDB) is an independent risk factor for stroke. The reported prevalence of SDB after stroke ranges from 60 to >70%, while the pre-stroke prevalence of SDB is less well described. Moreover, much of these data are derived from ischemic stroke or mixed ischemic stroke and intracerebral hemorrhage (ICH) cohorts. Studies that assess the prevalence of SDB before and after ICH are lacking, with only one prior study (n=32) that reported a post-ICH SDB prevalence of 78%. We report herein the results of a second, larger, prospective study that assessed the prevalence of pre- and post-ICH. Methods: Participants enrolled in the population-based stroke surveillance study, the Brain Attack Surveillance in Corpus Christi (BASIC) project, with ICH from 2010-2015 were screened for SDB with the well validated ApneaLink Plus portable monitor (SDB defined as apnea-hypopnea index (AHI) ≥10). The Berlin questionnaire was administered, with reference to the pre-ICH state, to assess for possible pre-stroke SDB. Results: Of the 60 ICH participants screened, the median age was 63 years (interquartile range (IQR): 55.5, 74.5). Twenty-one (35%) were female, 54 (90%) were Mexican American, and 53 (88%) had a history of hypertension. The median Glasgow Coma Scale score was 15.0 (IQR: 15.0, 15.0) and the median NIHSS was 5.5 (IQR: 1.5, 8.0). Post-ICH, the median AHI was 9.5 (IQR: 5.5, 19.0); almost half (46.7%) met criteria for SDB. Thirty-four participants (56.7%) screened as high risk for SDB pre-ICH. Conclusion: Sleep-disordered breathing was highly prevalent after ICH, and also likely common before ICH, in this mostly Mexican American, community-based sample. If SDB increases risk for ICH, the findings suggest a potential new treatment target to prevent ICH and recurrent ICH.

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0890 Sleep Disordered Breathing is Associated With Endothelial Dysfunction and Atherosclerosis in Young Adults: Preliminary Longitudinal Findings in the Penn State Child Cohort

SLEEP ◽

10.1093/sleep/zsaa056.886 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A339-A339

Author(s):

J Fernandez-Mendoza ◽

Z Gao ◽

K Brandt ◽

L Houser ◽

S L Calhoun ◽

...

Keyword(s):

Young Adults ◽

Endothelial Dysfunction ◽

Young Adulthood ◽

Sleep Disordered Breathing ◽

Population Based ◽

Apnea Hypopnea Index ◽

Penn State ◽

State Child ◽

Disordered Breathing

Abstract Introduction Sleep disordered breathing (SDB) in middle-age is an established risk factor for cardiovascular disease. However, population-based studies supporting its cardiovascular contribution at earlier stages of development are lacking, particularly with long-term follow-ups. Methods The Penn State Child Cohort is a population-based longitudinal sample of 700 children (8.7±1.7y), of whom 421 were followed-up 8.3 years later during adolescence (17.0±2.3y) with in-lab polysomnography (PSG). To date, 425 have been followed-up another 7.4 years later during young adulthood (24.4±2.6y) via a standardized survey and 136 of them (55.1% female, 21.3% racial/ethnic minority) have undergone a repeat of their PSG to ascertain apnea/hypopnea index. Subjects (n=121) also underwent Doppler ultrasounds to assess flow-mediated dilation (FMD) and carotid intima-media thickness (CIMT). Linear regression models stratified by body mass index in young adulthood. Results SDB was cross-sectionally associated with lower FMD (β=-0.239, p=0.008) and greater CIMT (β=0.330, p<0.001) in young adulthood. Longitudinally, childhood (n=121) and adolescence (n=90) SDB were significantly associated with CIMT (β=0.327, p<0.001 and β=0.286, p=0.006, respectively), but not with FMD (β=-0.158, p=0.08 and β=-0.101, p=0.35, respectively). These associations, particularly longitudinal ones between childhood and adolescence SDB with CIMT in young adulthood, were stronger in overweight than normal weight subjects (e.g., β=0.310, p=0.030 and β =0.089, p=0.582, respectively). Conclusion SDB and obesity appear to be synergistically associated with endothelial dysfunction and atherosclerosis in young adults from the general population. These data suggest that a childhood exposure to chronic SDB is associated with long-term atherosclerosis, while endothelial dysfunction may be a short-term outcome. This ongoing 16-year longitudinal study will test whether the natural history of SDB from childhood through adolescence into young adulthood shows differential trajectories for cardiovascular morbidity. Support National Institutes of Health (R01HL136587, R01HL97165, R01HL63772, UL1TR000127)

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