Sleep apnea phenotyping and relationship to disease in a large clinical biobank

Abstract Objective Sleep apnea is associated with a broad range of pathophysiology. While electronic health record (EHR) information has the potential for revealing relationships between sleep apnea and associated risk factors and outcomes, practical challenges hinder its use. Our objectives were to develop a sleep apnea phenotyping algorithm that improves the precision of EHR case/control information using natural language processing (NLP); identify novel associations between sleep apnea and comorbidities in a large clinical biobank; and investigate the relationship between polysomnography statistics and comorbid disease using NLP phenotyping. Materials and Methods We performed clinical chart reviews on 300 participants putatively diagnosed with sleep apnea and applied International Classification of Sleep Disorders criteria to classify true cases and noncases. We evaluated 2 NLP and diagnosis code-only methods for their abilities to maximize phenotyping precision. The lead algorithm was used to identify incident and cross-sectional associations between sleep apnea and common comorbidities using 4876 NLP-defined sleep apnea cases and 3× matched controls. Results The optimal NLP phenotyping strategy had improved model precision (≥0.943) compared to the use of one diagnosis code (≤0.733). Of the tested diseases, 170 disorders had significant incidence odds ratios (ORs) between cases and controls, 8 of which were confirmed using polysomnography (n = 4544), and 281 disorders had significant prevalence OR between sleep apnea cases versus controls, 41 of which were confirmed using polysomnography data. Discussion and Conclusion An NLP-informed algorithm can improve the accuracy of case-control sleep apnea ascertainment and thus improve the performance of phenome-wide, genetic, and other EHR analyses of a highly prevalent disorder.

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Depressive Symptoms in Comorbid Obstructive Sleep Apnea and Insomnia: An Integrative Review

Western Journal of Nursing Research ◽

10.1177/0193945921989656 ◽

2021 ◽

pp. 019394592198965

Author(s):

Bomin Jeon ◽

Faith S. Luyster ◽

Judith A. Callan ◽

Eileen R. Chasens

Keyword(s):

Obstructive Sleep Apnea ◽

Depressive Symptoms ◽

Sleep Apnea ◽

Control Design ◽

Case Control ◽

Integrative Review ◽

Study Quality ◽

Cross Sectional ◽

Obstructive Sleep ◽

The Relationship

The purpose of this integrative review was to synthesize evidence concerning the relationship between comorbid obstructive sleep apnea and insomnia (OSA+I), and depressive symptoms. OSA and insomnia are common sleep disorders, recently comorbid OSA+I has been recognized as prevalent in adults. Although each sleep disorder increases the risk and severity of depressive symptoms, the effect of comorbid OSA+I on depressive symptoms remains unclear. A systematic search of PubMed, CINAHL, and PsycINFO identified 15 data-based studies. All the studies were observational with either a cross-sectional (n = 14) or a case-control design (n = 1). Study quality was assessed. Most of the studies (n = 14) indicated that comorbid OSA+I had an additive role on depressive symptoms. Insomnia appeared to have a more important role than OSA in increasing the severity of depressive symptoms in persons with comorbid OSA+I.

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Obstructive Sleep Apnea and Periodontal Disease: A Systematic Review

Medicina ◽

10.3390/medicina57060640 ◽

2021 ◽

Vol 57 (6) ◽

pp. 640

Author(s):

Daniela Lembo ◽

Francesco Caroccia ◽

Chiara Lopes ◽

Francesco Moscagiuri ◽

Bruna Sinjari ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Periodontal Disease ◽

Quality Assessment ◽

Case Control ◽

Cochrane Library ◽

Case Control Studies ◽

Cross Sectional ◽

Obstructive Sleep

Background and Objectives: The objective of this study was to evaluate the association between periodontal disease and obstructive sleep apnea syndrome (OSAS). Materials and Methods: Electronic search using PubMed, Scopus, LILACS, and Cochrane library was carried out for randomized controlled trials, cohort, case-control, longitudinal and epidemiological studies on humans published from January 2009 until September 2020. The participants had to be male and female adults who were diagnosed with OSAS either by overnight polysomnography (carried out at a sleep laboratory or at home) or by a home sleep testing monitor (Apnea Risk Evaluation System). Methodological quality assessment was carried out using the Newcastle-Ottawa Quality Assessment Scale (NOS) for case-control studies while an adapted form of NOS was used for cross-sectional studies. Results: Ten studies fulfilled the inclusion criteria of our review, 5 were case-control studies, and 5 cross-sectional. Sample size ranged from 50 to 29,284 subjects, for a total of 43,122 subjects, 56% of them were male, their age ranged from 18 to 85 years old. The heterogeneity among the studies regarding the classification of periodontal disease, and the different methods for OSAS severity assessment, complicated the comparison among the studies. Conclusions: There is low evidence of a possible association between OSAS and periodontitis. The pathophysiological mechanism, cause-effect, or dose-response relationship are still unclear. Further studies are needed and should use a precise classification of OSAS subjects, while the new classification of periodontitis from the World Workshop of Chicago 2017 should be used for the periodontal assessment.

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Subcortical ischemic vascular disease and cognition: A systematic review

Dementia & Neuropsychologia ◽

10.1590/s1980-57642009dn20200002 ◽

2008 ◽

Vol 2 (2) ◽

pp. 82-90 ◽

Cited By ~ 7

Author(s):

Gilberto Sousa Alves ◽

Carlos Eduardo de Oliveira Alves ◽

Maria Elisa Lanna ◽

Denise Madeira Moreira ◽

Eliasz Engelhardt ◽

...

Keyword(s):

Vascular Disease ◽

Memory Retrieval ◽

White Matter Lesions ◽

Case Control ◽

Cognitive Status ◽

Independent Factor ◽

Case Control Studies ◽

Cross Sectional ◽

Cognitive Domains ◽

The Relationship

Abstract Subcortical Ischemic Vascular Disease (SIVD) is underdiagnosed. This review investigates the relationship among SIVD severity, cognitive status and neuroimaging markers. Methods: Cohort, cross-sectional and case control studies were searched on ISI, Medline, Scielo, PsychoInfo and LILACS databases published between 1995 and 2006. Results: The most impaired cognitive domains were executive, attentional and memory retrieval mechanisms. These cognitive features were frequently associated to White Matter Lesions (WML). Conclusions: WML is an independent factor in cognitive decline. However, the threshold for this impact is not yet clearly established.

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Tormented Sunrises

Sleep Disorders ◽

10.1093/med/9780190671099.003.0022 ◽

2019 ◽

pp. 418-434

Author(s):

Maha Alattar

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

General Population ◽

Sleep Disorders ◽

Headache Disorders ◽

Distinct Subset ◽

Obstructive Sleep ◽

High Prevalence ◽

The Relationship

This chapter covers the relationship between sleep-related headaches and sleep disorders such as obstructive sleep apnea (OSA). Sleep apnea headache (SAH), a type of sleep-related headache that is classified in the International Classification of Headache Disorders, is a distinct subset of headache that is caused by OSA and occurs distinctly on awakening. Once recognized, treatment of OSA is associated with significant improvement in, and often resolution of, SAH. Given the high prevalence of headaches in the general population, sleep disorders must be considered in the evaluation of patients with headaches. A comprehensive sleep evaluation should be an integral part of the assessment of headache disorders. Sleep apnea headache and other types of headaches associated with sleep are reviewed in this chapter.

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IS DISTRIBUTION OF PAIN RELATED WITH CENTRAL SENSITIZATION IN PATIENTS WITH LOWER LIMB OSTEOARTHRITIS?

Journal of Musculoskeletal Research ◽

10.1142/s0218957721500196 ◽

2021 ◽

pp. 2150019

Author(s):

Andriana Koufogianni ◽

Asimakis K. Kanellopoulos ◽

Konstantinos Vassis ◽

Ioannis A. Poulis

Keyword(s):

Lower Limb ◽

Central Sensitization ◽

Rating Scale ◽

Cross Sectional Study ◽

The Body ◽

Cross Sectional ◽

Numeric Pain Rating Scale ◽

The Relationship ◽

Pain Distribution

Design: Cross-sectional study. Background: Osteoarthritis is one of the most common conditions in our society. A growing number of studies suggest the existence of central sensitization (CS) in a subgroup of osteoarthritic patients. One of the criteria included for the classification of CS pain is the expanded distribution of pain. As this criterion is a well-recognized sign of CS, a digital pain drawing (DPD) analysis would be useful to easily identify possible extended areas of pain distribution (PD) in patients with OA. Objective: To study the relationship between the percentage of distribution of pain in the lower limb for both knee and hip, in patients before hip or knee arthroplasty, and the Central Sensitization Inventory Questionnaire. Methods: Twenty women (mean [Formula: see text] years) with diagnosed chronic (over 3 months) knee ([Formula: see text]) and hip ([Formula: see text]) OA participated in the study, with intensity of pain from mild to severe, meaning pain [Formula: see text]/10 using the Numeric Pain Rating Scale (NPRS). The PD was analyzed via software created for this research, called “Pain Distribution Application”. Results: A statistically significant positive correlation between CSI and PD to the lower extremity OA (hip and knee) ([Formula: see text], [Formula: see text]) was found. The distribution of pain has a linear correlation with the results in CSI, of patients who tested positive for CS, i.e. with a score of [Formula: see text]. Conclusions: As the distribution of pain on the surface of the body (diffusion) increases, so does the score of people who test positive for CSI. Our results showed that calculating the distribution of pain with our application may have a utility as a CS screening tool. The PD threshold of 10% of the body area is an index for CS for chronic pain lower limb OA patients.

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Abstract P116: Chronic Kidney Disease And Cardiac Arrhythmias: A Systematic Review and Meta-analysis

Circulation ◽

10.1161/circ.141.suppl_1.p116 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Esther D Kim ◽

Ning Ding ◽

Junichi Ishigami ◽

Xuejuan Ning ◽

Yijing Feng ◽

...

Keyword(s):

Atrial Fibrillation ◽

Systematic Review ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Prospective Studies ◽

Cardiac Arrhythmias ◽

Meta Analysis ◽

Case Control ◽

Cross Sectional ◽

The Relationship

Background: Chronic kidney disease (CKD) strongly predicts sudden cardiac death and may elevate the risk of certain cardiac arrhythmias like atrial fibrillation; however, the relationships between CKD and various types of arrhythmia are not well-characterized. Methods: We performed a systematic review and meta-analysis by searching Embase and PubMed for prospective, cross-sectional, and case-control studies examining the associations of two key CKD measures, estimated glomerular filtration rate (eGFR) and albuminuria, with arrhythmias in adults that were published until July 2018. We performed qualitative assessment of studies using the Newcastle Ottawa Quality Assessment Scale. We pooled the results using random-effects models. Results: Among 16,245 articles, we identified 34 prospective (n=24,213,233), 21 cross-sectional (n=253,328), and 4 case-control (n=1,694) studies that included diverse study populations from 19 countries and were mostly high quality. Most prospective studies examined the relationship between eGFR and atrial fibrillation (AF), and demonstrated that lower eGFR was associated with a higher risk of AF (pooled hazard ratio [HR] 1.72 [95% CI: 1.30, 2.27] comparing reduced vs. referent eGFR groups)[ Figure ]. A few studies examined albuminuria and demonstrated its associations with AF (pooled HR 2.16 [95% CI: 1.74, 2.67] comparing high vs. low albuminuria). Results were similar for cross-sectional studies. Four prospective studies reported a higher incidence of ventricular tachycardia resulting in ICD shock according to reduced eGFR (pooled HR 2.32 [95% CI: 1.74, 3.09] comparing reduced vs. referent eGFR groups). Limited number of studies examined other types of arrhythmia. Conclusion: We identified robust data on the relationship between CKD (eGFR and albuminuria) and AF. Reduced eGFR was associated with life-threatening ventricular arrhythmias. Our review highlights the need of future studies for non-AF arrhythmias, especially in the context of albuminuria.

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Association of Higher Circulating Insulin Antibody with Increased Mean Amplitude Glycemic Excursion in Patients with Type 2 Diabetes Mellitus: A Cross-Sectional, Retrospective Case-Control Study

Journal of Diabetes Research ◽

10.1155/2019/7304140 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7

Author(s):

Jian Zhu ◽

Lu Yuan ◽

Wen-ji Ni ◽

Yong Luo ◽

Jian-hua Ma

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Case Control Study ◽

Mean Amplitude ◽

Case Control ◽

Retrospective Case ◽

Cross Sectional ◽

The Relationship ◽

Control Study

Insulin antibody (IA) may potentially affect a patient’s glycemic control due to its variability in both binding and/or releasing insulin. However, the association between IA titer and daily glycemic variability (GV) is still unknown. We thus performed this cross-sectional, retrospective case-control study to assess the relationship between IA titer and mean amplitude glycemic excursion (MAGE) in type 2 diabetes mellitus (T2DM) patients using a continuous glucose monitoring (CGM) system. We recruited 100 eligible patients (IA>5%, IA positive) and divided them into two groups—a low (L) group and a high (H) group—based on their IA titer. The control (C) group consisted of 47 patients (IA≤5%, IA negative) matched for age, BMI, gender, and glycosylated hemoglobin A1c (HbA1c). The CGM determined the GV of enrolled patients. The primary outcome was the relationship between the IA titer and the MAGE, and the secondary outcome was the differences of GV among the three groups. We found that patients in the H group had higher levels of blood glucose fluctuation parameters than those in the L and C groups. The Ln(IA) was positively correlated with Ln(MAGE) even after adjusting for age, gender, BMI, HbA1c, and fasting and postprandial C-peptide(r=0.423, p<0.001). Multiple linear stepwise regression analysis revealed that Ln(IA) was an independent factor of Ln(MAGE) (beta=0.405, p<0.001). In conclusion, the higher circulating IA titer was associated with increased MAGE in T2DM patients, indicating that those patients with elevated IA titer should receive GV assessment and individualized treatment.

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The Relationship between Obstructive Sleep Apnea (OSA) and Adherence of Antihypertensive Consumption in Regular Hemodialysis Patient

Sumatera Medical Journal ◽

10.32734/sumej.v2i2.758 ◽

2019 ◽

Vol 2 (2) ◽

pp. 96-103

Author(s):

Afrilia Rosada Lubis ◽

Riri Andri Muzasti

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Antihypertensive Drugs ◽

Cross Sectional Study ◽

Secondary Hypertension ◽

Drug Consumption ◽

Bivariate Analysis ◽

Cross Sectional ◽

Obstructive Sleep ◽

The Relationship

Background. Based on the Indonesian Renal Registry (IRR) data in 2015, the highest incidence of comorbidities in hemodialysis patients in Indonesia was hypertension (50%). Obstructive Sleep Apnea (OSA) is one of the causes of secondary hypertension, the characteristics of hypertension in OSA are more resistant to treatment. One of the causes of resistant hypertension is patient non-compliance with the consumption of antihypertensive drugs. Aim. To determine the relationship of adherence of consumption of antihypertensive drugs with obstructive sleep apnea in regular HD patients. Method. This cross-sectional study involved 89 outpatients in HD units at the Rasyida Kidney Hospital in 2018. Data was obtained through interview using the STOP-BANG questionnaire to assess the of risk of OSA and using Morisky Medication Adherence Scale (MMAS) questionnaire to measure the compliance of drug consumption. Results.The prevalence of OSA in HD patients was (39.3%). There was no significant relationship between adherence with drug consumption and OSA risk, but in bivariate analysis, age (p = 0.0001), body mass index (BMI) (p = 0.001), and gender (p = 0.03) were significantly related to OSA. In multivariate, age and BMI were significantly associated with OSA (OR: 6.449, 95% CI 2.246 ± 18.520, p = 0.001; OR: 6.130, 95% CI 2.105 ± 17.849, p = 0.001). Conclusion. OSA was not statistically related to adherence to antihypertensive drug consumption in HD patients but was significantly associated with age and BMI. Keyword. Adherence to antihypertensive consumption, hemodialysis, obstructive sleep apnea.

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Acromegaly Disease Activity According to ACRODAT®, in Spain: ACROVAL Study

10.21203/rs.3.rs-627625/v1 ◽

2021 ◽

Author(s):

Monica Marazuela ◽

Concepción Blanco ◽

Ignacio Bernabeu ◽

Edelmiro Menendez ◽

Rocío Villar ◽

...

Keyword(s):

Disease Activity ◽

Clinical Evaluation ◽

Cross Sectional Study ◽

Patient Centered ◽

Cross Sectional ◽

Mild Disease ◽

Clinical Action ◽

The Relationship

Abstract Objectives: To evaluate disease activity status using the Acromegaly Disease Activity Tool (ACRODAT®) in a cohort of Spanish acromegaly patients, to assess the relationship between the level of disease activity according to both ACRODAT® and the physicians’ clinical evaluation, and to study the potential discrepancies in the perception of symptoms between physicians and patients.Design: Multicenter, observational, descriptive and cross-sectional study. Methods: Disease activity was assessed in adult patients with acromegaly under pharmacological treatment during at least 6 months using ACRODAT®.Results: According to ACRODAT®, 48.2%, 31.8% and 20.0% of a total of 111 patients were classified as having a stable disease (S), mild disease activity (M-DA) and significant disease activity (S-DA) respectively. ACRODAT® classification of disease activity significantly correlated with physicians’ opinion, with a moderate inter-rater agreement and a specificity of 92.45% (PPV=86.21%). No correlation was found between IGF-1 levels and severity of symptoms or quality of life (QoL). A decision to take clinical action was significantly more frequent in S-DA and M-DA patients than S patients but no action was taken on 5 (22.7%) and 27 (77.1%) S-DA and M-DA patients, respectivelyConclusions: ACRODAT® detected disease activity in 51.8% of patients. Interestingly, although M-DA and S-DA patients were likely to be in the process of being controlled, action was not always taken on these patients. ACRODAT® is a validated and highly specific tool that may be useful to routinely monitor acromegaly and to identify patients with non-obvious disease activity by incorporating “patient-centered” parameters like symptoms and QoL to the clinical evaluation of acromegaly.

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Investigating the relationship between Islamic lifestyle and general health in adolescents

International Journal of Adolescent Medicine and Health ◽

10.1515/ijamh-2018-0167 ◽

2019 ◽

Vol 0 (0) ◽

Cited By ~ 1

Author(s):

Fathola Mohamadian ◽

Mohammad Hosein Faryadi ◽

Milad Borji

Keyword(s):

General Health ◽

General Health Questionnaire ◽

Geographic Area ◽

Way Of Life ◽

School Students ◽

Cross Sectional ◽

Cluster Data ◽

The Relationship ◽

The City

Abstract Introduction Islamic lifestyle refers to a way of life, whose main source is extracted from the divine book and is done in accordance with the divine rules. Therefore, the present study was conducted to determine the relationship between lifestyle and general health of adolescents. Materials and methods This cross-sectional descriptive study was conducted in 2016 on 416 secondary school students in the city of Ilam. Sampling method was that Ilam city was divided into five clusters based on geographic area and two schools were included in the study from each cluster. Data were collected using an Islamic life style questionnaire and a general health questionnaire and they were analyzed using descriptive statistics tests and SPSS16 software. Results The findings showed that the mean SD of total score of Islamic lifestyle and general health was 162.48 (30.54) and 25.55 (11.13), respectively. In the classification of general health scores of adolescents, it was shown that 249 (59.9%) students had desirable general health; 165 (39.7%) of them had good general health and 2 (0.5%) of them had unfavorable general health. There was also a positive and significant relationship between Islamic lifestyle and general health (p < 0.001). Conclusion Considering the existence of the relationship between Islamic lifestyle and general health of adolescents, it is necessary to provide the needed context to increase their general health by maintaining and improving the Islamic lifestyle of adolescents.

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