scholarly journals 0609 Sleep Phenotypes in Middle-Aged and Older Hispanics/Latinos. Results from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A233-A233
Author(s):  
B Wu ◽  
W Tarraf ◽  
D M Wallace ◽  
A Stickel ◽  
N Schneiderman ◽  
...  
Keyword(s):  
Sleep Apnea ◽  
Sleep Duration ◽  
Latent Class ◽  
Rating Scale ◽  
Community Dwelling ◽  
Health Study ◽  
Apnea Hypopnea Index ◽  
Middle Aged ◽  
Targeted Interventions ◽  
Percent Time

Abstract Introduction Identifying sleep phenotypes in the diverse and understudied US Hispanic/Latino population is critical to developing interventions and mitigating distal clinical outcomes (e.g. dementias). Methods Using latent class analyses (LCA), we identify empirically derived and clinically meaningful sleep phenotypes using data on community dwelling middle-aged/older adults (ages ≥45-years) from the HCHS/SOL (2008-2011) - Investigation of Neurocognitive Aging (n=6,377). Sleep variables used included Apnea/Hypopnea Index (AHI), percent time SpO2<90%, Epworth Sleepiness Scale (ESS), Women’s Health Initiative Insomnia Rating Scale (WHIIRS), self-reported average sleep duration, restless legs symptoms, napping frequency, and sleep quality. Results Mean (M) age was 56.4±8.1 years, and 54.7% were female. Average AHI, ESS, WHIIRS, and sleep duration were 8.7±13.1, 6.0±5.0, 7.6±5.5, and 7.8±1.4, respectively, and 25.8% had zero percent time SpO2 <90%. Fit statistics indicated that a four-class solution provided the best data fit. The derived classes, adjusting for age, sex, income, and acculturation, corresponded with four clinically meaningful groups: (1) 28.8% were asymptomatic [(M) AHI=0.8; (M) ESS=5.6; (M)WHIIRS=7.6; (M) sleep duration=7.8; 0% SpO2<90%=74.1%], (2) 25.7 % were asymptomatic mild sleep apnea [(M) AHI=6.2; (M) ESS=3.8; (M) WHIIRS=2.9; (M) sleep duration=7.8; 0% SpO2<90%=8.8%], (3) 19.4% were symptomatic sleep apnea [(M) AHI=25.6; (M) ESS=8.5; (M) WHIIRS=7.2; (M) sleep duration=7.7; 0% SpO2<90%= 0.5%], and (4) 26.1% were insomnia [(M) AHI=5.7; (M) ESS=6.7; (M) WHIIRS=13.0; (M) sleep duration=7.8; 0% SpO2<90%=10.3%]. Classification into groups 3 and 4 were primarily driven by elevated AHI and WHIIRS scores, respectively. The distribution of scores in the derived groups suggest variations relative to current clinical thresholds. Conclusion We identified 4-groups using LCA in a community-based sample of diverse U.S. Hispanic/Latino adults. Better characterization of sleep phenotypes for Hispanics/Latinos can help in developing targeted interventions studies and ameliorate health disparities. Support 5R01AG048642-05; R21AG056952; R21HL140437.

0607 Clinical Phenotypes of OSA in Diverse Hispanics/Latinos: Results from the Hispanic Community Health Study/Study of Latinos

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A232-A232
Author(s):  
K T Gonzalez ◽  
W Tarraf ◽  
D M Wallace ◽  
A Stickel ◽  
N Schneiderman ◽  
...  
Keyword(s):  
Sleep Apnea ◽  
Community Health ◽  
Latent Class ◽  
Health Resources ◽  
Health Study ◽  
Clinical Samples ◽  
Apnea Hypopnea Index ◽  
Fit Statistics ◽  
Hispanic Community ◽  
Obstructive Sleep

Abstract Introduction Recent work on US non-Latino Whites and Europeans from clinical samples used obstructive sleep apnea (OSA) symptoms to generate OSA phenotypes for individuals with moderate-severe OSA and proposed between 3-5 clusters. Validating these clusters in a diverse Hispanic/Latino community-based population with different biopsychosocial characteristics is crucial for early OSA identification and more personalized treatment. Methods This work is based on baseline data from The Hispanic Community Health Study/Study of Latinos (HCHS/SOL). HCHS/SOL is a prospective cohort study designed using a multisite (Bronx, NY, Chicago, IL, Miami, FL, San Diego, CA) multistage probability sample. The subpopulation of interest included adults 18-74 years (unweighted n=1,623) meeting criteria for moderate-severe OSA symptoms (≥15 Apnea-Hypopnea index (AHI) events per hour). We performed latent class analysis (LCA) using 15 common OSA symptoms to identify phenotype clusters. Results Average age was 52.4 ± 13.9 years and 34.1% were female. Mean AHI was 33.8 ± 22.5 events per hour. Fit statistics and clinical significance suggested that a three-class solution provided best fit to the data. The symptom profiles were consistent with (1) a Minimally Symptomatic group (46.8%), (2) a Disturbed Sleep group (38.1%), and (3) a Daytime Sleepiness group (15.1%). Validation analyses using alternative hierarchical and partitioning algorithms also suggested support for a three-class solution. Conclusion Sleep apnea phenotypes among diverse Hispanics/Latinos were consistent with recent findings from the Sleep Apnea Global Interdisciplinary Consortium. However, we found notable differences in the prevalence of these clusters relative to Whites. This suggests that other biopsychosocial factors may be contributing to OSA phenotypes among Hispanics/Latinos. Identification of OSA phenotypes in Hispanics/Latinos could inform better sleep interventions and therapeutics and help better align public health resources. Support 5R01AG048642-05; R21AG056952; R21HL140437.

scholarly journals 0936 Sleep Disturbances in Wolfram Syndrome

SLEEP ◽  
2019 ◽  
Vol 42 (Supplement_1) ◽  
pp. A376-A377
Author(s):  
Amy K Licis ◽  
Gabriel Davis ◽  
Sarah Eisenstein ◽  
Heather Lugar ◽  
Tamara Hershey
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Sleep Quality ◽  
Rating Scale ◽  
Wolfram Syndrome ◽  
High Rate ◽  
Apnea Hypopnea Index ◽  
Diabetes Research ◽  
Sleep Study ◽  
Obstructive Sleep

Abstract Introduction Wolfram syndrome is a rare disorder associated with diabetes mellitus, diabetes insipidus, optic nerve atrophy, hearing and vision loss, and neurodegeneration. Sleep complaints are common but have not been studied with objective measures. Our goal was to assess rates of sleep apnea and objective and self-reported measures of sleep quality, and to determine the relationship of sleep pathology to other clinical variables in Wolfram syndrome patients. Methods Genetically confirmed Wolfram syndrome patients were evaluated at the 2015 and 2016 Washington University Wolfram Syndrome Research Clinics. Patients wore an actigraphy device and a type III ambulatory sleep study device and completed the Epworth Sleepiness Scale (ESS), the Pittsburgh Sleep Quality Index (PSQI) and/or the Pediatric Sleep Questionnaire (PSQ). PSQI and PSQ questionnaire data were compared to a previously collected group of controls. Patients were characterized clinically with the Wolfram Unified Rating Scale (WURS) and a subset underwent magnetic resonance imaging (MRI) for brain volume measurements. Results Twenty-one patients were evaluated ranging from age 8.9 - 29.7 years. Five of 17 (29%) adult patients fit the criteria for obstructive sleep apnea (OSA; apnea-hypopnea index [AHI] ≥ 5) and all 4 of 4 (100%) children aged 12 years or younger fit the criteria for obstructive sleep apnea (AHI’s ≥1). Higher AHI was related to greater disease severity (higher WURS Physical scores). Higher mixed apnea scores were related to lower brainstem and cerebellar volumes. Patients’ scores on the PSQ were higher than those of controls, indicating greater severity of childhood obstructive sleep-related breathing disorders. Conclusion Wolfram syndrome patients had a high rate of OSA. Further study would be needed to assess how these symptoms change over time. Addressing sleep disorders in Wolfram syndrome patients would likely improve their overall health and quality of life. Support (If Any) This work was supported by the NICHD (HD070855; Hershey, PI) and supported by CTSA (UL1 RR024992) and Diabetes Research Center (DK 020579).

Hemostatic Factors and Shortened Sleep

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 5137-5137
Author(s):  
Zehra Koktas ◽  
Loyda Vida ◽  
Peter John D De Chavez ◽  
Mercedes Carnethon ◽  
David Green
Keyword(s):  
Sleep Duration ◽  
Sleep Disturbances ◽  
Conflicts Of Interest ◽  
Population Sample ◽  
Community Dwelling ◽  
Apnea Hypopnea Index ◽  
Wrist Actigraphy ◽  
Hemostatic Factors ◽  
Pai 1 ◽  
Disordered Breathing

Abstract Abstract 5137 Introduction: Enhanced coagulation has been reported in persons with sleep disturbances and sleep apnea. However, it is unclear whether shortened sleep duration in the absence of disordered breathing is associated with higher levels of hemostatic factors. Methods: In this cross-sectional study, 582 community-dwelling adults were randomly sampled. They underwent polysomnography to determine the apnea hypopnea index (AHI), a measure of sleep disordered breathing, and wrist actigraphy for 7 nights to assess sleep duration. A morning blood sample was collected for measurements of factor VIII (FVIII), von Willebrand Factor (vWF), thrombin antithrombin complexes (TAT), and plasminogen activator inhibitor-1 (PAI-1). Logistic regression analyses were used to model the odds of being in the upper quintile of each hemostatic factor by AHI score or sleep duration. Results: Participant ages ranged from 35 to 65 (mean 48), with 57% women and 30% Blacks. Hypertension was present in 18% and diabetes in 6%. The mean (SD) sleep duration was 7 (1. 07) hours/day, and 34% had an AHI ≥5. Mean values (SD) for hemostatic factors were FVIII (U/ml), 1. 06 (0. 41); vWF (U/ml), 1. 21 (0. 51); TAT (ng/ml), 2. 66 (2. 25); and PAI-1(ng/ml), 23. 4 (21. 4). vWF increased with age and FVIII, vWF, and TAT were higher in Blacks vs Whites. Associations (odds ratio, 95% confidence interval) were observed for FVIII with diabetes (3. 16, 1. 36–7. 32) and PAI-1 with hypertension (1. 9, 1. 06–3. 41) and diabetes (2. 58, 1. 15–5. 76) after adjustment for demographic and cardiovascular covariates. In unadjusted analyses, participants with AHI ≥5 had elevated levels of FVIII and vWF, but this association was attenuated after adjustment for demographic and cardiovascular covariates (see Table). However, AHI ≥5 remained significantly associated with elevated PAI-1 in fully adjusted models. The majority of participants (90%) had a low likelihood of apnea (AHI <15), and their sleep duration showed no associations with hemostatic factors in any model. Conclusion: In a random population sample, we confirmed that mild apnea is associated with elevated PAI-1. However, among those persons free of apnea, there were no associations of sleep duration with FVIII, vWF, TAT or PAI-1. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Impact of Insomnia in the Elderly: The Correlation between Snoring and Apnea/Hypopnea Index

2021 ◽  
Author(s):  
Bing Tang
Keyword(s):  
Sleep Apnea ◽  
Sleep Disturbance ◽  
Case Series ◽  
Chronic Obstructive Lung Disease ◽  
Neural Model ◽  
The Elderly ◽  
Community Dwelling ◽  
Apnea Hypopnea Index ◽  
Chronic Obstructive ◽  
The Relationship

The purpose of this study was to examine the relationship between snoring and obstructive sleep apnea/hypopnea index in community dwelling older men and women. In this retrospective case-series study, the author was using a sequential collection of clinical datum design. There were 124 community-dwelling elders (mean age=71.85 years, Standard Deviation=4.85 years) with complaints of sleep disturbance. Including 46 females (F: M= 1:1.71), all the total subjects with sleep disturbance, after meeting the following criteria of exclusion: age below 65 years, heart failure, and chronic obstructive lung disease, were admitted to the sleep medicine laboratory where sleep questionnaire was used. They underwent in laboratory over-night polysomnography (PSG). The period of this study was 13 months; the total number of subjects whom took PSG in this Sleep Center Laboratory was 1,087 individuals during this period. The proposed neural model used is a generalized regression neural network (GRNN). This neural model has some advantages such as cost and time efficiencies in relation to experimental measurements. The training speed of the proposed technique is faster and the network architecture is simpler. In all likelihood, this model can be used in clinical applications that can reduce the necessity of in-laboratory nocturnal sleep studies since it has surpassed current classification approaches in terms of accuracy, simplicity, cost, time efficiency, and generalization. The correlation between snoring and AH1 was evaluated, though there was no measurement of vasopressin-positive and vasoactive-intestinal-polypeptide (AVP) neurons in postmortem examination of suprachiasmatic nucleus (SCN), as there was no death case. To the contrary, focus was set on the analysis of sleep disturbances that could be interpreted as the result of altered SCN function. The relationship between Snoring and AHI for the elderly with regard to its clue and impact on INSOMNIA is presented. The relationship between clinical sleep apnea and the physiological events surrounding the octogenarians was assessed. Clinically no indication for any brain tissue biopsy.

scholarly journals Obstructive Sleep Apnea, Sleep Duration, and Associated Mediators With Carotid Intima-Media Thickness

2021 ◽  
Author(s):  
Silvana P. Souza ◽  
Ronaldo B. Santos ◽  
Itamar S. Santos ◽  
Barbara K. Parise ◽  
Soraya Giatti ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Sleep Duration ◽  
Intima Media Thickness ◽  
Carotid Intima Media Thickness ◽  
R Package ◽  
Apnea Hypopnea Index ◽  
Sleep Study ◽  
Media Thickness ◽  
Obstructive Sleep

Objective: To elucidate the independent associations of obstructive sleep apnea (OSA) and sleep duration (SD) as well as the potential inflammatory and metabolic mediators on carotid intima-media thickness (CIMT) in a large cohort of adults. Approach and Results: Consecutive participants from the ELSA-Brasil performed a clinical evaluation, sleep study, 1-week actigraphy for defining SD and CIMT using standard techniques. Gamma regression models were used to explore the association between OSA and SD with CIMT. Mediation analysis was performed using the mediation R package. A total of 2009 participants were included in the main analysis. As compared with no OSA (apnea-hypopnea index [AHI] <5 events/hour; n=613), patients with mild (AHI, 5–14.9; n=741), moderate (AHI, 15–29.9; n=389), and severe OSA (AHI ≥30 events/hour; n=266) presented a progressive CIMT increase (0.690 [0.610–0.790], 0.760 [0.650–0.890], 0.810 [0.700–0.940], and 0.820 [0.720–0.958] mm; P <0.001). In contrast, CIMTs were similar for those with SD <6 hours (0.760 [0.650–0.888]), 6 to 8 hours (0.750 [0.640–0.880]) and >8 hours (0.740 [0.670–0.900]). All forms of OSA were independently associated with CIMT (mild: β: 0.019, SE 0.008; P =0.022; moderate: β: 0.025, SE 0.011; P =0.022; severe OSA: β: 0.040, SE 0.013; P =0.002). Moreover, the association of AHI with CIMT was mediated by increased C-reactive protein and triglycerides ( P <0.01). SD did not interact with OSA in the association with CIMT. Conclusions: OSA is independently associated with increased CIMT in a dose-response relationship. This association is partially mediated by inflammation and dyslipidemia. In contrast, SD is not associated nor interacted with OSA to increase CIMT.

scholarly journals Obstructive sleep apnea is associated with depressive symptoms in pregnancy

SLEEP ◽  
2019 ◽  
Vol 43 (5) ◽  
Author(s):  
Karen Redhead ◽  
Jennifer Walsh ◽  
Megan Galbally ◽  
John P Newnham ◽  
Stuart J Watson ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Depressive Symptoms ◽  
Sleep Apnea ◽  
Apnea Hypopnea Index ◽  
Targeted Interventions ◽  
Obstructive Sleep ◽  
History Of ◽  
Depressive Episodes ◽  
History Of Depression ◽  
In Pregnancy

Abstract Study Objectives In pregnancy, the prevalence of both obstructive sleep apnea (OSA) and depression increases. Research reveals an association in the general population with up to 45% of patients diagnosed with OSA having depressive symptoms. Therefore, this study aimed to investigate the relationship between OSA and depression in pregnant women. Methods One hundred and eighty-nine women ≥26 weeks pregnant were recruited from a tertiary perinatal hospital. This cross-sectional study measured OSA (Apnea Hypopnea Index, AHI, using an ApneaLink device) and symptoms of depression (Edinburgh Postnatal Depression Scale, EPDS). Data were collected from medical records including participant age, ethnicity, parity, BMI, smoking status, history of depression, and use of antidepressants. Results Of the consenting women, data from 124 were suitable for analysis. Twenty women (16.1%) had OSA (AHI ≥ 5 events/h) and 11 (8.8%) had depressive symptoms (EPDS &gt; 12). Women with OSA were more likely to have depressive symptoms after adjusting for covariates, odds ratio = 8.36, 95% CI [1.57, 44.46]. OSA was also related to higher EPDS scores and these were greater in women with a history of depression. Conclusions During late pregnancy women with OSA had eight times the odds of having depressive symptoms. Furthermore, an interaction was found between OSA and history of depression. Specifically, in women with no history of depression, OSA increases depressive symptoms. In women with a history of depression, OSA has an even stronger effect on depressive symptomology. This suggests screening for OSA in pregnancy may identify women prone to future depressive episodes and allow for targeted interventions.

358 Daridorexant Improves Sleep in Patients with Mild/Moderate Obstructive Sleep Apnea

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A143-A143
Author(s):  
Marie-Laure Boof ◽  
Ingo Fietze ◽  
Katharina Lederer ◽  
Anne-Sophie Guern ◽  
Vincent Lemoine ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Sleep Duration ◽  
Sleep Onset ◽  
Sleep Architecture ◽  
Sleep Stages ◽  
Apnea Hypopnea Index ◽  
Treatment Difference ◽  
Obstructive Sleep ◽  
Sleep Parameters

Abstract Introduction Daridorexant is a dual orexin receptor antagonist developed for the treatment of insomnia. The effect of the highest phase-3 dose of 50 mg daridorexant on nighttime respiratory function was evaluated in patients with mild/moderate obstructive sleep apnea (OSA). This study showed that repeated doses of daridorexant had no clinically meaningful effect on the apnea-hypopnea index (AHI) or on peripheral oxygen saturation. In the same study, the effect on objective sleep parameters was also explored by polysomnography (PSG). Methods In this randomized, double-blind, placebo-controlled, two-period, crossover study, daridorexant or placebo was administered in each period once daily for 5 consecutive nights to 28 patients. Treatment difference (daridorexant – placebo) for total sleep time (TST), latency to persistent sleep (LPS), and wake after sleep onset (WASO) was analyzed for Night 5 using linear mixed-effects modeling. In addition, sleep was further explored based on sleep duration during each hour of PSG recording, duration of the different sleep phases (rapid eye movement [REM], non-REM [including N1 to N3 sleep stages]), as well as number and mean/longest duration of awakenings. Results Of 28 patients enrolled, 25 completed the study and were included in the analysis (n=15/10 with mild/moderate OSA; mean [standard deviation] AHI: 16.3 [8.2] events/h). One patient had mild insomnia symptoms at baseline. Compared to placebo, daridorexant prolonged mean TST by 38.8 min (90% confidence interval: 19.7–57.9), shortened mean LPS by 17.2 min (-35.5–1.02), and reduced mean WASO by 31.0 min (-47.3 to 14.7). Sleep architecture was maintained as no treatment differences in the duration of the evaluated sleep stages were observed when normalized to TST. Sleep duration was prolonged in the second part of the night. mean and longest duration of awakenings were decreased by a mean (90% CI) of 2.0 min (-3.1 to 0.9) and 16.3 min (-24.1 to -8.6), respectively, without treatment difference for the total number of awakenings. Conclusion Daridorexant improved objective sleep parameters in patients with mild to moderate OSA without modifying sleep architecture. Support (if any) Funded by Idorsia Pharmaceuticals Ltd.

Abstract 17143: Obstructive and Central Sleep Apnea and Risk of Incident Atrial Fibrillation

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Patricia Tung ◽  
Yamini S Levitzky ◽  
Rui Wang ◽  
Stuart F Quan ◽  
Daniel J Gottlieb ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Sleep Apnea ◽  
Central Sleep Apnea ◽  
Health Study ◽  
Apnea Hypopnea Index ◽  
Community Based ◽  
Obstructive Sleep ◽  
History Of

INTRODUCTION: Prior studies have documented a higher prevalence of atrial fibrillation (AF) in those with obstructive sleep apnea (OSA). OSA has been associated with AF recurrence following cardioversion and ablation, and with prevalent and incident AF in cross-sectional and retrospective studies. Central sleep apnea (CSA) also has been associated with AF in patients with heart failure. However, data from prospective cohorts are sparse and few studies have evaluated the association of CSA with AF in population studies. METHODS: We assessed the association of OSA and CSA with incident AF among 3,420 subjects without a history of AF in the Sleep Heart Health Study (SHHS), a prospective, community-based study designed to evaluate the cardiovascular consequences of sleep disordered breathing. Subjects underwent overnight polysomnography at baseline and were followed over time for the development of incident AF, documented at any time after baseline polysomnogram until the end of follow-up. OSA was defined as an obstructive apnea-hypopnea index ≥ 5 and CSA was defined as a central apnea index ≥ 5. RESULTS: At baseline, the sample include 1499 men (44.4%) with a mean age of 62.4 (±10.9); 1569 (45.9%) subjects met criteria for mild to severe OSA and 54 (1.6%) for CSA. Over a mean follow-up of 8.2 years, 382 cases of incident AF were identified. The prevalence of both OSA and CSA was higher among those who developed AF compared to those who did not (OSA 49% vs 44%, p=0.001 and CSA 5% vs 1.2%, p=0.001). After adjustment for multiple AF risk factors, CSA was associated with an approximately 2-fold increased odds of incident AF (RR=2.38, 95% CI, 1.15-4.94; p = 0.02). The association persisted after exclusion of 258 subjects with a history of heart failure (RR=2.78, 95% CI, 1.28-6.04; p = 0.01). We did not find a significant association of OSA with incident AF (Table). CONCLUSION: In our prospective, community-based cohort baseline CSA was associated with incident AF.

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