0451 Fully Automatic Detection of Sleep Disordered Breathing Events

Abstract Introduction Evaluation of sleep apnea involves manual annotation of Polysomnography (PSG) file, a time-consuming process subject to interscorer variations. The DOSED algorithm has been shown to be helpful in detecting Central Sleep Apnea (CSA), Obstructive Sleep Apnea (OSA), and Hypopnea when merged into a single event type. This work uses a modified version of DOSED capable of detecting each event type separately. Methods The network consists of 3 blocks of 1D convolutional layers followed by 6 blocks of 2D convolutional layers. The network has 2 classification layers, one determines the probability of each class, and the other determines the start and duration time of the event with the highest probability. Four channels from nasal and mouth airflow and position of abdomen and thorax are used as input to the model. The model was trained using 2800 PSG from 4 different cohorts (MESA, MROS, SSC, WSC) and tested on 70 PSG, which have been scored by six technicians (Stanford, U Penn, St Louis). Results On an event by event basis, model F1-scores versus a weighted consensus score based on 6 technicians were 0.60 for OSA, 0.43 for CSA, and 0.34 for Hypopnea. Average F1-scores for the 6 technicians were 0.48 (std 0.04) for OSA, 0.29 (std 0.145) for CSA, and 0.54 (std 0.183) for Hypopnea, indicating that the model functions better on an event-by-event basis than an average technician. Correlations between indices/hr for central apnea, obstructive apnea, and hypopnea indicate excellent correlations for apneas, but poor correlation for hypopnea. We are now adding the snoring channel to explore if predictions can be improved. Conclusion The result shows that deep learning-based models can detect respiratory events with an accuracy similar to technicians. The poor agreement between technicians from different universities indicates that we need better definitions of hypopnea. Support

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827 Central Sleep Apnea in a patient with Multiple Sclerosis

SLEEP ◽

10.1093/sleep/zsab072.824 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A322-A323

Author(s):

Rahul Dasgupta ◽

Sonja Schütz ◽

Tiffany Braley

Keyword(s):

Multiple Sclerosis ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Sleep Disordered Breathing ◽

Central Sleep Apnea ◽

Progressive Multiple Sclerosis ◽

Obstructive Sleep ◽

Increased Risk ◽

Demyelinating Lesions ◽

The Brain

Abstract Introduction Sleep-disordered breathing is common in persons with multiple sclerosis (PwMS), and may contribute to debilitating fatigue and other chronic MS symptoms. The majority of research to date on SDB in MS has focused on the prevalence and consequences of obstructive sleep apnea; however, PwMS may also be at increased risk for central sleep apnea (CSA), and the utility of methods to assess CSA in PwMS warrant further exploration. We present a patient with secondary progressive multiple sclerosis who was found to have severe central sleep apnea on WatchPAT testing. Report of case(s) A 61 year-old female with a past medical history of secondary progressive multiple sclerosis presented with complaints of fragmented sleep. MRI of the brain, cervical spine, and thoracic spine showed numerous demyelinating lesions in the brain, brainstem, cervical, and thoracic spinal cord. Upon presentation, the patient noted snoring, witnessed apneas, and daytime sleepiness. WatchPAT demonstrated severe sleep apnea, with a pAHI of 63.3, and a minimum oxygen saturation of 90%. The majority of the scored events were non-obstructive in nature (73.1% of all scored events), and occurred intermittently in a periodic fashion. Conclusion The differential diagnosis of fatigue in PwMS should include sleep-disordered breathing, including both obstructive and central forms of sleep apnea. Demyelinating lesions in the brainstem (which may contribute to impairment of motor and sensory networks that control airway patency and respiratory drive), and progressive forms of MS, have been linked to both OSA and CSA. The present data illustrate this relationship in a person with progressive MS, and offer support for the WatchPAT as a cost-effective means to evaluate for both OSA and CSA in PwMS, while reducing patient burden. PwMS may be at increased risk for CSA. Careful clinical consideration should be given to ordering appropriate sleep testing to differentiate central from obstructive sleep apnea in PwMS, particularly for patients with demyelinating lesions in the brainstem. Support (if any) 1. Braley TJ, Segal BM, Chervin RD. Obstructive sleep apnea and fatigue in patients with multiple sclerosis. J Clin Sleep Med. 2014 Feb 15;10(2):155–62. doi: 10.5664/jcsm.3442. PMID: 24532998; PMCID: PMC3899317.

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Investigating the Association between Wake-Up Stroke and Obstructive Sleep Apnea: A Meta-Analysis

European Neurology ◽

10.1159/000517916 ◽

2021 ◽

pp. 1-10

Author(s):

Xin Lu ◽

Wenhong Liu ◽

Hui Wang

Keyword(s):

Sleep Apnea ◽

Sleep Disordered Breathing ◽

Meta Analysis ◽

Sleep Apnea Syndrome ◽

Stroke Patients ◽

Respiratory Effects ◽

Respiratory Events ◽

Obstructive Sleep ◽

Appropriate Therapy ◽

Meta Analyses

Background: Management of wake-up stroke (WUS) is always a challenge as no clear time of onset could be ascertained, and how to choose an appropriate therapy remains unclear. Sleep-disordered breathing (SDB) has been regarded as a potential risk factor to WUS, yet no consensus was achieved. Motivated by the need for a deeper understanding of WUS and its association with sleep apnea, meta-analyses summarizing the available evidence of respiratory events and indices were conducted, and sensitivity analysis was also used for heterogeneity. Methods: Electronic databases were systematically searched, and cross-checking was done for relevant studies. Collected data included demographic characteristics, and sleep apnea parameters were extracted with stroke patients divided into WUS and NWUS groups. Clinical data of stroke patients accompanied with sleep apnea syndrome (OSA, SAS, and severe SAS) were also extracted for meta-analysis. Results: A total of 13 studies were included in the analysis. The meta-analysis results showed that OSA, SAS, and severe SAS were significantly higher in WUS patients. A significantly higher AHI (WMD 7.74, 95% CI: 1.38–14.11; p = 0.017) and ODI (WMD of 3.85, 95% CI: 0.261–7.438; p = 0.035) than NWUS patients was also observed in the analysis of respiratory indices. Conclusion: WUS patients have severer SDB problems compared to NWUS patients suggesting that respiratory events during sleep might be underlying the induction of WUS. Besides, the induction of WUS was significantly associated with men rather than women. Therefore, early diagnosis and management of potential WUS patients should benefit from the detection of SDB status and respiratory effects.

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Neuropsychological Consequences of Sleep-Disordered Breathing

Cognitive and Behavioral Abnormalities of Pediatric Diseases ◽

10.1093/oso/9780195342680.003.0066 ◽

2010 ◽

Author(s):

Jennifer Janusz ◽

Ann Halbower

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Airway Obstruction ◽

Sleep Disordered Breathing ◽

Upper Airway ◽

Sleep Fragmentation ◽

Primary Snoring ◽

Respiratory Events ◽

Obstructive Sleep ◽

Disordered Breathing

Pediatric sleep disorders have been gaining awareness among practitioners due to their potential for cognitive, behavioral, and somatic effects (Gozal 2008; Moore et al. 2006). Sleep-disordered breathing (SDB) is commonly seen in children and encompasses a range of disorders, in primary snoring to obstructive sleep apnea (Marcus 2000). Sleep-disordered breathing is characterized by partial or complete upper airway obstruction during sleep due to collapse or narrowing of the pharynx. This can result in sleep fragmentation due to brief arousals during the night, as well as disruption or cessation of airflow (Blunden and Beebe 2006; Halbower and Mahone 2006). This chapter describes the neuropsychological and behavioral consequences of SDB, comorbid disorders, and effects of treatment. Sleep-disordered breathing is considered a spectrum of airflow limitation, from mild to severe. For instance, primary snoring (PS), defined as snoring without oxygen desaturation or sleep arousals, is at the mild end of the spectrum. Upper airway resistance syndrome (UARS), in the middle of the spectrum, is characterized by increased negative intrathoracic pressure with sleep arousals and sleep fragmentation but no oxygen desaturations (Bao and Guilleminault 2004; Garetz 2008; Lumeng and Chervin 2008). In obstructive sleep apnea (OSA), at the severe end of the spectrum, there are repeated episodes of blockage of the airway with changes in oxygenation. Obstructive sleep apnea results from a combination of factors, including anatomical obstruction from adenoids, tonsils, or a narrow pharynx, and decreased neuromuscular tone required to maintain airway patency (Arens and Marcus 2004). An overnight polysomnogram (PSG) completed in a sleep laboratory and measuring sleep–wake states, respiration, movement, blood levels of oxygen and carbon dioxide, and cardiac activity, is considered the “gold standard” for the diagnosis of OSA (American Academy of Pediatrics 2002). The PSG is used to diagnose respiratory events, cardiac changes, and arousals from different sleep states. Respiratory events include obstructive apneas and hypopneas. Obstructive apnea events are episodes of complete airway obstruction, while hypopneas are partial obstructions or airflow limitations (Garetz 2008; Redline et al. 2007).

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Acute stroke and TIA patients have specific polygraphic features of obstructive sleep apnea

Sleep And Breathing ◽

10.1007/s11325-019-02010-2 ◽

2020 ◽

Vol 24 (4) ◽

pp. 1495-1505 ◽

Cited By ~ 2

Author(s):

Akseli Leino ◽

Susanna Westeren-Punnonen ◽

Juha Töyräs ◽

Sami Myllymaa ◽

Timo Leppänen ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Ischemic Stroke ◽

Sleep Apnea ◽

Transient Ischemic Attack ◽

Sleep Disordered Breathing ◽

Apnea Hypopnea Index ◽

Stroke Patients ◽

Respiratory Events ◽

Obstructive Sleep ◽

Ischemic Attack

Abstract Purpose Obstructive sleep apnea (OSA) is associated with increased risk for stroke, which is known to further impair respiratory functions. However, it is unknown whether the type and severity of respiratory events are linked to stroke or transient ischemic attack (TIA). Thus, we investigate whether the characteristics of individual respiratory events differ between patients experiencing TIA or acute ischemic stroke and matched patients with clinically suspected sleep-disordered breathing. Methods Polygraphic data of 77 in-patients with acute ischemic stroke (n = 49) or TIA (n = 28) were compared to age, gender, and BMI-matched patients with suspected sleep-disordered breathing and no cerebrovascular disease. Along with conventional diagnostic parameters (e.g., apnea-hypopnea index), durations and severities of individual apneas, hypopneas and desaturations were compared between the groups separately for ischemic stroke and TIA patients. Results Stroke and TIA patients had significantly shorter apneas and hypopneas (p < 0.001) compared to matched reference patients. Furthermore, stroke patients had more central apnea events (p = 0.007) and a trend for higher apnea/hypopnea number ratios (p = 0.091). The prevalence of OSA (apnea-hypopnea index ≥ 5) was 90% in acute stroke patients and 79% in transient ischemic attack patients. Conclusion Stroke patients had different characteristics of respiratory events, i.e., their polygraphic phenotype of OSA differs compared to matched reference patients. The observed differences in polygraphic features might indicate that stroke and TIA patients suffer from OSA phenotype recently associated with increased cardiovascular mortality. Therefore, optimal diagnostics and treatment require routine OSA screening in patients with acute cerebrovascular disease, even without previous suspicion of OSA.

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Sleep-disordered Breathing in Uncontrolled Blood Pressure: Our Experience

Nepalese Medical Journal ◽

10.3126/nmj.v1i1.20398 ◽

2018 ◽

Vol 1 (1) ◽

pp. 36-38

Author(s):

Milesh Jung Sijapati ◽

Minalma Pandey ◽

Nirupama Khadka ◽

Poojyashree Karki

Keyword(s):

Blood Pressure ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Sleep Disordered Breathing ◽

Central Sleep Apnea ◽

Upper Airway Resistance Syndrome ◽

Uncontrolled Blood Pressure ◽

Antihypertensive Regimen ◽

Obstructive Sleep ◽

Disordered Breathing

Introduction: Sleep-disordered breathing is one of the greatest health problems. It comprises of obstructive sleep apnea, central sleep apnea, periodic breathing, and upper airway resistance syndrome. There are several studies reporting association of uncontrolled blood pressurewith individuals having sleep disordered breathing. Data regarding this were sparse in developing countries. Therefore this study was performed to find out the sleep-disordered breathing among uncontrolled hypertensive patients.Materials and Methods: Study was performed from January, 2014 to January, 2017 in sleep center in Kathmandu, Nepal. Patient with uncontrolled BP were included. Uncontrolled BP was defined as blood pressure>130/80mmHg not on intensive antihypertensive regimen and resistant elevated BP was defined as blood pressure >130/80 mmHg despite intensive antihypertensive regimen. These patients were subjected for polysomnography.Results: Three hundred patients were selected out of which 250 patients with uncontrolled blood pressure were included. They were subjected for overnight polysomnography. Among them, 70patients (28%)were found to have mild obstructive sleep apnea, 20 patients had moderate obstructive sleep apnea (8%)&15 had severe obstructive sleep apnea (6%).Conclusions: This study concludes that those individuals having uncontrolled blood pressure has obstructive sleep apnea and these individuals have to undergo polysomnography.Nepalese Medical Journal, vol.1, No. 1, 2018, page: 36-38

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Canadian Thoracic Society 2011 Guideline Update: Diagnosis and Treatment of Sleep Disordered Breathing

Canadian Respiratory Journal ◽

10.1155/2011/506189 ◽

2011 ◽

Vol 18 (1) ◽

pp. 25-47 ◽

Cited By ~ 56

Author(s):

John Fleetham ◽

Najib Ayas ◽

Douglas Bradley ◽

Michael Fitzpatrick ◽

Thomas K Oliver ◽

...

Keyword(s):

Sleep Apnea ◽

Continuous Positive Airway Pressure ◽

Airway Pressure ◽

Sleep Disordered Breathing ◽

Positive Airway Pressure ◽

Sleep Apnea Syndrome ◽

Central Sleep Apnea ◽

Diagnosis And Treatment ◽

Obstructive Sleep ◽

Disordered Breathing

The Canadian Thoracic Society (CTS) published an executive summary of guidelines for the diagnosis and treatment of sleep disordered breathing in 2006/2007. These guidelines were developed during several meetings by a group of experts with evidence grading based on committee consensus. These guidelines were well received and the majority of the recommendations remain unchanged. The CTS embarked on a more rigorous process for the 2011 guideline update, and addressed eight areas that were believed to be controversial or in which new data emerged. The CTS Sleep Disordered Breathing Committee posed specific questions for each area. The recommendations regarding maximum assessment wait times, portable monitoring, treatment of asymptomatic adult obstructive sleep apnea patients, treatment with conventional continuous positive airway pressure compared with automatic continuous positive airway pressure, and treatment of central sleep apnea syndrome in heart failure patients replace the recommendations in the 2006/2007 guidelines. The recommendations on bariatric surgery, complex sleep apnea and optimum positive airway pressure technologies are new topics, which were not covered in the 2006/2007 guidelines.

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Looking both ways before crossing the street: Assessing the benefits and risk of opioids in treating patients at risk of sleep disordered breathing for pain and dyspnea

Journal of Opioid Management ◽

10.5055/jom.2017.0385 ◽

2017 ◽

Vol 13 (3) ◽

pp. 183 ◽

Cited By ~ 7

Author(s):

Mellar P. Davis, MD, FCCP, FAAHPM ◽

Bertrand Behm, MD ◽

Diwakar Balachandran, MD

Keyword(s):

At Risk ◽

Sleep Apnea ◽

Cardiovascular Events ◽

Sleep Disordered Breathing ◽

Central Sleep Apnea ◽

Chronic Obstructive ◽

Chronic Noncancer Pain ◽

Obstructive Sleep ◽

Increased Risk ◽

Disordered Breathing

Opioids adversely influence respiration in five distinct ways. Opioids reduce the respiratory rate, tidal volume, amplitude, reflex responses to hypercapnia and hypoxia, and arousability related necessary for respiratory adaptive responses. Opioids cause impairment of upper pharyngeal dilator muscles leading to obstructive apnea. Opioids cause complex sleep disordered breathing (SDB) consisting of central sleep apnea and obstructive sleep apnea. Clinically opioids worsen preexisting SDB. Recent studies have shown increased morbidity and mortality in patients receiving opioids for chronic noncancer pain and chronic obstructive pulmonary disease, which appear to be related to cardiovascular events, not overdose. Both patient populations are at risk for sleep disordered breathing and increased risk for adverse cardiovascular events on opioids for dyspnea or pain. This review discusses the influence of opioids on respiration and SDB and will review the adverse respiratory and cardiovascular effects of opioid use in at risk populations. Recommendations regarding management will follow as a summary.

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Sleep-Disordered Breathing and Nocturnal Hypoxemia in Precapillary Pulmonary Hypertension: Prevalence, Pathophysiological Determinants, and Clinical Consequences

Respiration ◽

10.1159/000515602 ◽

2021 ◽

pp. 1-12

Author(s):

Jens Spiesshoefer ◽

Simon Herkenrath ◽

Katharina Harre ◽

Florian Kahles ◽

Anca Florian ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Sleep Apnea ◽

Sleep Quality ◽

Sleep Disordered Breathing ◽

Central Sleep Apnea ◽

Apnea Hypopnea Index ◽

Amino Terminal ◽

Nocturnal Hypoxemia ◽

Obstructive Sleep ◽

Disordered Breathing

Background and objective: The clinical relevance and interrelation of sleep-disordered breathing and nocturnal hypoxemia in patients with precapillary pulmonary hypertension (PH) is not fully understood. Methods: Seventy-one patients with PH (age 63 ± 15 years, 41% male) and 35 matched controls were enrolled. Patients with PH underwent clinical examination with assessment of sleep quality, daytime sleepiness, 6-minute walk distance (6MWD), overnight cardiorespiratory polygraphy, lung function, hypercapnic ventilatory response (HCVR; by rebreathing technique), amino-terminal pro-brain natriuretic peptide (NT-proBNP) levels, and cardiac MRI (n = 34). Results: Prevalence of obstructive sleep apnea (OSA) was 68% in patients with PH (34% mild, apnea-hypopnea index [AHI] ≥5 to <15/h; 34% moderate to severe, AHI ≥15/h) versus 5% in controls (p < 0.01). Only 1 patient with PH showed predominant central sleep apnea (CSA). Nocturnal hypoxemia (mean oxygen saturation [SpO2] <90%) was present in 48% of patients with PH, independent of the presence of OSA. There were no significant differences in mean nocturnal SpO2, self-reported sleep quality, 6MWD, HCVR, and lung and cardiac function between patients with moderate to severe OSA and those with mild or no OSA (all p > 0.05). Right ventricular (RV) end-diastolic (r = −0.39; p = 0.03) and end-systolic (r = −0.36; p = 0.04) volumes were inversely correlated with mean nocturnal SpO2 but not with measures of OSA severity or daytime clinical variables. Conclusion: OSA, but not CSA, is highly prevalent in patients with PH, and OSA severity is not associated with nighttime SpO2, clinical and functional status. Nocturnal hypoxemia is a frequent finding and (in contrast to OSA) relates to structural RV remodeling in PH.

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Sleep-disordered breathing in adult patients with mitochondrial diseases

Neurology ◽

10.1212/wnl.0000000000011005 ◽

2020 ◽

pp. 10.1212/WNL.0000000000011005

Author(s):

Guido Primiano ◽

Valerio Brunetti ◽

Catello Vollono ◽

Anna Losurdo ◽

Rossana Moroni ◽

...

Keyword(s):

Sleep Apnea ◽

Sleep Disordered Breathing ◽

Prospective Observational Study ◽

Central Sleep Apnea ◽

Mitochondrial Diseases ◽

Population Based ◽

Genotype Combination ◽

Obstructive Sleep ◽

Specific Subgroup ◽

Disordered Breathing

ObjectiveTo describe the prevalence and characteristics of sleep-disordered breathing (SDB) in a large cohort of patients with genetically confirmed mitochondrial diseases.MethodsThis is a prospective observational study performed at the Neurophysiopatology Unit of Fondazione Policlinico Universitario A. Gemelli IRCCS. All subjects had a defined mitochondrial disease and were investigated by full night polysomnography.Results103 consecutive patients were enrolled. SDB was demonstrated in 49 patients (47.6%). Regarding phenotypes, we found differences in distribution between the groups: patients affected by PEO with single or multiple mtDNA deletions frequently had obstructive apneas (50% and 43.8%) or REM-related hypoventilation when associated with m.3243A>G mutations (75%). Furthermore, a high percentage of subjects with MIDD and MERRF syndromes were characterized respectively by obstructive sleep apnea and REM-related hypoventilation. Differently from what is previously reported, central sleep apnea was rarely reported in our cohort.ConclusionsSDB has a higher prevalence in MDs compared to general population-based data. Overall, these results suggest that patients characterized by a specific phenotype-genotype combination are most at risk of developing a specific subgroup of SDB. The early identification of this disorder is crucial in the management of these fragile patients.

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Sleep-disordered breathing in patients on opioids for chronic pain

Regional Anesthesia and Pain Medicine ◽

10.1136/rapm-2020-101540 ◽

2020 ◽

Vol 45 (10) ◽

pp. 826-830

Author(s):

Janannii Selvanathan ◽

Philip W H Peng ◽

Jean Wong ◽

Clodagh M Ryan ◽

Frances Chung

Keyword(s):

Chronic Pain ◽

Sleep Apnea ◽

Sleep Disordered Breathing ◽

Clinical Care ◽

Central Sleep Apnea ◽

Well Being ◽

Pressure Therapy ◽

Obstructive Sleep ◽

Pain Clinics ◽

Disordered Breathing

The past two decades has seen a substantial rise in the use of opioids for chronic pain, along with opioid-related mortality and adverse effects. A contributor to opioid-associated mortality is the high prevalence of moderate/severe sleep-disordered breathing, including central sleep apnea and obstructive sleep apnea, in patients with chronic pain. Although evidence-based treatments are available for sleep-disordered breathing, patients are not frequently assessed for sleep-disordered breathing in pain clinics. To aid healthcare providers in this area of clinical uncertainty, we present evidence on the interaction between opioids and sleep-disordered breathing, and the prevalence and predictive factors for sleep-disordered breathing in patients on opioids for chronic pain. We provide recommendations on how to evaluate patients on opioids for risk of moderate/severe sleep-disordered breathing in clinical care, which could lead to earlier use of therapeutic interventions for opioid-associated sleep-disordered breathing, such as opioid cessation or positive airway pressure therapy. This would improve quality of life and well-being of patients with chronic pain.

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