446 Acute effect of acetazolamide in high loop gain sleep apnea

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A176-A176
Author(s):  
Yuenan Ni ◽  
Robert Thomas
Keyword(s):  
Logistic Regression ◽  
Sleep Apnea ◽  
Multiple Logistic Regression Analysis ◽  
Periodic Breathing ◽  
Acute Effect ◽  
Loop Gain ◽  
Multivariable Logistic Regression Model ◽  
Arousal Index ◽  
Obstructive Sleep ◽  
High Loop

Abstract Introduction Obstructive sleep apnea is a disease with different driver phenotypes, including high loop gain (HLG). Acetazolamide (AZT) reduces HLG through multiple mechanisms. The acute effect of AZT used during titration polysomnography in HLG sleep apnea (HLGSA, predominantly obstructive) is described here. HLGSA is a NREM-dominant disease. Methods HLGSA was identified by one or more of the following: 1) baseline or titration CAHI of 5 or more, baseline or titration periodic breathing, or high residual apnea on CPAP in the absence of large leak. Retrospective analysis of polysomnograms from patients with HLGSA who underwent a PAP titration study and took ATZ (125 or 250 mg) after a baseline component of PAP titration. A responder was defined as a minimum reduction of the AHI3% of 50%. Multivariable logistic regression model estimated responder predictors. Results Two hundred and thirty-six patients with a median age of 60 (50.25–68) years and 189 (80.1%) males, were included. 69 patients were given 125 mg ATZ and 157 patients took 250 mg after about 3 hours of initial drug-free titration. Compared to PAP alone, PAP plus ATZ reduced the breathing related arousal index (8.45[3.03–15.60] vs. 4.8[2.1–10.15], p<0.001), AHI3% (19.09[7.34–37.28] vs. 10.63[4.46–20.56], p<0.001), AHI4% (1.89[0.23–8.58] vs. 1.19 [0.42–4.70], p=0.001), RDI (24.01[10.55–41.46] vs. 13.55[7.24–25.66], p<0.001). ATZ minimally improved the Min SpO2 (90[87–92] vs. 91[88–92], p=0.014). 101 patients were responders. Multiple logistic regression analysis showed that the NREM AHI3% was the only predictor for responder status with ATZ exposure (OR 1.022, 95%CI [1.004–1.041], p=0.018) Conclusion ATZ acutely improves PAP efficacy in HLGSA. The NREM AHI3% is a predictor for the ATZ responders. Support (if any) This study was supported by American Academy of Sleep Medicine Foundation, category-I award to RJT

scholarly journals O013 The pathogenesis of obstructive sleep apnea in individuals with comorbid insomnia and obstructive sleep apnoea (COMISA)

2021 ◽  
Vol 2 (Supplement_1) ◽  
pp. A6-A7
Author(s):  
E Brooker ◽  
L Thomson ◽  
S Landry ◽  
B Edwards ◽  
S Drummond
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Upper Airway ◽  
Severity Index ◽  
Loop Gain ◽  
Comorbid Insomnia ◽  
Arousal Threshold ◽  
Obstructive Sleep ◽  
High Loop ◽  
Insomnia Severity

Abstract Obstructive sleep apnea (OSA) and Insomnia are prevalent sleep disorders which are highly comorbid. This frequent co-occurrence suggests a shared etiology may exist. OSA is caused by the interaction of four pathophysiological traits: a highly collapsible upper airway, elevated loop gain, a low arousal threshold, and poor muscle compensation. No study has ascertained whether these traits are influenced by insomnia. We aimed to quantify the four traits which contribute to OSA in individuals diagnosed with comorbid insomnia and OSA (COMISA). We non-invasively determined these traits in 52 COMISA patients (Age: 56±14 years) with mild-to-severe OSA (AHI=21.2±10.63 events/h) using polysomnography. Our results indicated that 83% of COMISA patients had a low arousal threshold and only 2% of patients exhibited a highly collapsible airway using previously defined thresholds. Multiple linear regression revealed the arousal threshold (b=0.24, 95%CI[0.11, 0.37], β=0.47, p<0.001) and loop gain (b=23.6, 95%CI[7.02, 40.18], β=0.33, p<0.01) were the strongest predictors of OSA severity in our sample. There was no significant relationship between the arousal threshold and insomnia severity measured by the insomnia severity index (ISI). Further work is being performed to compare these findings with a matched sample of OSA only participants. Our preliminary findings demonstrate OSA in COMISA is characterized by a mildly collapsible airway/low arousal threshold phenotype and is largely driven by non-anatomical factors including a low arousal threshold and high loop gain. OSA treatments which are effective in patients with mild anatomical compromise and raise the arousal threshold may provide therapeutic benefit in COMISA patients.

scholarly journals 475 Automatic detection of self-similarity and prediction of CPAP failure

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A187-A187
Author(s):  
Eline Oppersma ◽  
Wolfgang Ganglberger ◽  
Haoqi Sun ◽  
Robert Thomas ◽  
Michael Westover
Keyword(s):  
Sleep Apnea ◽  
Significant Risk ◽  
Periodic Breathing ◽  
Driving Mechanism ◽  
Central Apnea ◽  
Loop Gain ◽  
Breathing Patterns ◽  
Self Similarity ◽  
High Loop ◽  
Cpap Failure

Abstract Introduction Sleep disordered breathing is a significant risk factor for cardiometabolic and neurodegenerative diseases. Tolerance and efficacy of continuous positive airway pressure (CPAP), the primary form of therapy for sleep apnea, is often poor. High loop gain (HLG) is a driving mechanism of central sleep apnea or periodic breathing. The current study aimed to develop a computational approach to detect HLG based on self-similarity in respiratory oscillations during sleep solely using breathing patterns, measured via Respiratory Inductance Plethysmography (RIP). To quantify the potential utility of the developed similarity metric, the presented algorithm was used to predict acute CPAP failure. Methods We developed an algorithm for detecting apneas as periods with reduced breathing effort, manifested in the RIP signal as low signal amplitude. Our algorithm calculates self-similarity in breathing patterns between consecutive periods of apnea or hypopnea. Working under the assumption that high loop gain induces self-similar respiratory oscillations and increases the risk of failure during CPAP, the full night similarity, computed during diagnostic non-CPAP polysomnography (PSG), was used to predict failure of CPAP, which we defined as titration central apnea index (CAI)>10. Central apnea labels are obtained both from manual scoring by sleep technologists, and from an automated algorithm developed for this study. The Massachusetts General Hospital (MGH) sleep database was used, including 2466 PSG pairs of diagnostic and CPAP titration PSG recordings. Results Diagnostic CAI based on technologist labels predicted failure of CPAP with an AUC of 0.82 ±0.03. Based on automatically generated labels, the combination of full night similarity and automatically generated CAI resulted in an AUC of 0.85 ±0.02. A subanalysis was performed on a population with technologist labeled diagnostic CAI>5. Full night similarity predicted failure with an AUC of 0.57 ±0.07 for manual and 0.65 ±0.06 for automated labels. Conclusion This study showed that central apnea labels can be derived in an automated way. The proposed self-similarity feature, as a surrogate estimate of expressed respiratory high loop gain and computed from easily accessible effort signals, can detect periodic breathing regardless of admixed obstructive features such as flow-limitation, and can aid prediction of CPAP failure or success. Support (if any):

scholarly journals Obstructive Sleep Apnea as a Risk Factor for Intracerebral Hemorrhage

Stroke ◽  
2021 ◽  
Author(s):  
Jacqueline H. Geer ◽  
Guido J. Falcone ◽  
Kevin N. Vanent ◽  
Audrey C. Leasure ◽  
Daniel Woo ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Logistic Regression ◽  
Risk Factor ◽  
Sleep Apnea ◽  
Intracerebral Hemorrhage ◽  
Odds Ratio ◽  
Berlin Questionnaire ◽  
Multivariable Logistic Regression Model ◽  
Obstructive Sleep ◽  
Increased Risk

Background and Purpose: To determine whether obstructive sleep apnea (OSA) is associated with intracerebral hemorrhage (ICH) risk, we assessed premorbid OSA exposure of patients with nontraumatic ICH and matched controls. Methods: Ethnic/Racial Variations of Intracerebral Hemorrhage is a multicenter, case-control study evaluating risk factors for ICH that recruited 3000 cases with ICH and 3000 controls. OSA status was ascertained using the Berlin Questionnaire as a surrogate for premorbid OSA. We performed logistic regression analyses to evaluate the association between OSA and ICH. Results: Two thousand and sixty-four (71%) cases and 1516 (52%) controls were classified as having OSA by the Berlin Questionnaire. Cases with OSA were significantly more likely to be male and have hypertension, heart disease, hyperlipidemia, and higher body mass index compared with those without OSA. OSA was more common among cases compared with controls (71% versus 52%, odds ratio, 2.28 [95% CI, 2.05–2.55]). In a multivariable logistic regression model, OSA was associated with increased risk for ICH (odds ratio, 1.47 [95% CI, 1.29–1.67]). Conclusions: OSA is a risk factor for ICH.

scholarly journals 0704 Treatment-emergent Central Sleep Apnea Predicts Residual Respiratory Instability During Cpap Use At 6 Months

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A268-A268
Author(s):  
R J Thomas
Keyword(s):  
Sleep Apnea ◽  
Odds Ratio ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Medical Center ◽  
Central Sleep Apnea ◽  
Periodic Breathing ◽  
Arousal Index ◽  
High Loop ◽  
Central Apneas

Abstract Introduction The prevalence, severity, significance, and predictors of residual sleep apnea during use of continuous positive airway pressure (CPAP) remain uncertain. High loop gain is associated with or induces periodic breathing and central sleep apnea (CSA). Treatment-emergent CSA (TE-CSA) is often considered a transient phenomenon of no long-term clinical significance. Standard polysomnographic features were assessed as risk factors for high residual apnea during compliant CPAP use. Methods Patients with sleep apnea (mean AHI 53.6, SD:33/hour of sleep) who underwent split night studies were prospectively entered in a database. They were all treated with positive airway pressure at the Beth Israel Deaconess Medical Center (Boston) and tracked by the EncoreAnywhere system. Machine detected AHI (AHIm) was extracted for a week average at month 6. The manual scored AHI(AHIs) was calculated from the last waveform graph during every month. Logistic regression assessed predictors of elevated automated (5 or greater) or manual (10 or greater) residual events//hour of use. Results A total of 69 CPAP compliant (average of at least 4 hours) subjects were analyzed. Age: 59.5 (range 17-81), gender: 47/69 male. 44/69 had an elevated manual AHI, while 20/69 had an elevated autodetected AHI. The only predictors of high residual apnea were TE-CSA (5 or more central apneas and hypopneas/hour of sleep): Odds Ratio 3.6 (CI: 1.07-12-3), p: 0.39. and the treatment component arousal index: Odds Ratio 1.06 (CI: 1.01-1.11), p: 0.018. Machine estimated AHI, which under-detected events by a factor of 3 or more, was not associated with any measure. Conclusion Residual apnea is common after 6 months of compliant CPAP use, and the only predictors identified were TE-CSA and treatment component arousal index. Support This study is supported by American Academy of Sleep Medicine Foundation, Category-I award to RJT

scholarly journals O001 Reboxetine reduces obstructive sleep apnea severity: a randomized trial

2021 ◽  
Vol 2 (Supplement_1) ◽  
pp. A1-A1
Author(s):  
T Altree ◽  
A Aishah ◽  
K Loffler ◽  
R Grunstein ◽  
D Eckert
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Respiratory Control ◽  
Upper Airway ◽  
Apnea Hypopnea Index ◽  
Loop Gain ◽  
Double Blind ◽  
Obstructive Sleep ◽  
High Loop ◽  
Control Stability

Abstract Introduction Noradrenergic and muscarinic processes are crucial for pharyngeal muscle control during sleep. Selective norepinephrine reuptake inhibitors (SNRIs) such as reboxetine combined with an antimuscarinic reduce obstructive sleep apnea (OSA) severity. The effects of reboxetine alone on OSA severity are unknown. Methods Double-blind, placebo-controlled, three-way crossover trial in 16 people with OSA. Each participant completed three overnight polysomnograms (~1-week washout). Single doses of reboxetine 4mg, placebo, or reboxetine+oxybutynin 5mg were administered before sleep (randomized order). The primary outcome was apnea-hypopnea index (AHI). Secondary outcomes included other polysomnography parameters, next day sleepiness and alertness. Endotyping analysis was performed to determine the medications’ effects on OSA pathophysiological mechanisms. Results Reboxetine reduced the AHI by 5.4 [95% CI -10.4 to -0.3] events/h, P=0.03 (men: -24±27%; women: -0.7±32%). The addition of oxybutynin did not further reduce AHI. Reboxetine alone and reboxetine+oxybutynin reduced overnight hypoxemia versus placebo (e.g. 4% oxygen desaturation index 10.4±12.8 vs. 10.6±12.8 vs. 15.7±14.7 events/h, P=0.02). Mechanistically, reboxetine and reboxetine+oxybutynin improved pharyngeal collapsibility and respiratory control stability. Men had higher baseline loop gain. Larger reductions in AHI with reboxetine occurred in those with high loop gain. Neither drug intervention changed next day sleepiness or alertness. Discussion A single 4mg dose of reboxetine modestly reduces OSA severity without further improvement with the addition of an antimuscarinic. Reboxetine increases breathing stability via improvements in pharyngeal collapsibility and respiratory control. These findings provide new insight into the role of SNRIs on upper airway stability during sleep and have important implications for pharmacotherapy development for OSA.

scholarly journals Understanding the role of oxidative stress in the incidence of metabolic syndrome and obstructive sleep apnea

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Behnam Kargar ◽  
Zahra Zamanian ◽  
Majid Bagheri Hosseinabadi ◽  
Vahid Gharibi ◽  
Mohammad Sanyar Moradi ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Metabolic Syndrome ◽  
Obstructive Sleep Apnea ◽  
Logistic Regression ◽  
Sleep Apnea ◽  
International Diabetes Federation ◽  
Binary Logistic Regression ◽  
Stress Index ◽  
Obstructive Sleep

Abstract Background Understanding the causes and risk factors of metabolic syndrome is important for promoting population health. Oxidative stress has been associated with metabolic syndrome, and also obstructive sleep apnea. These are two diseases which have common prognostic characteristics for heart disease. The aim of this study was to examine the role of oxidative stress in the concurrent presence of metabolic syndrome and obstructive sleep apnea in a working population. Methods Participants were 163 artisan bakers in Shahroud, Iran, routinely exposed to significant heat stress and other oxidative stress indicators on a daily basis as part of their work. Using a cross-sectional design, data relevant to determining metabolic syndrome status according to International Diabetes Federation criteria, and the presence of obstructive sleep apnea according to the STOP-Bang score, was collected. Analyses included hierarchical binary logistic regression to yield predictors of the two diseases. Results Hierarchical binary logistic regression showed that oxidative stress – alongside obesity, no regular exercise, and smoking – was an independent predictor of metabolic syndrome, but not obstructive sleep apnea. Participants who were obese were 28 times more likely to have metabolic syndrome (OR 28.59, 95% CI 4.91–63.02) and 44 times more likely to have obstructive sleep apnea (OR 44.48, 95% CI 4.91–403.28). Participants meeting metabolic syndrome criteria had significantly higher levels of malondialdehyde (p <  0.05) than those who did not. No difference in oxidative stress index levels were found according to obstructive sleep apnea status. Conclusions Our findings suggest that oxidative stress contributes to the onset of metabolic syndrome, and that obstructive sleep apnea is involved in oxidative stress. Whilst obesity, exercise, and smoking remain important targets for reducing the incidence of metabolic syndrome and obstructive sleep apnea, policies to control risks of prolonged exposure to oxidative stress are also relevant in occupations where such environmental conditions exist.

scholarly journals The Specific Characteristics in Children with Obstructive Sleep Apnea and Cor Pulmonale

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Pi-Chang Lee ◽  
Betau Hwang ◽  
Wen-Jue Soong ◽  
C. C. Laura Meng
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Clinical Manifestations ◽  
Cor Pulmonale ◽  
Arousal Index ◽  
Obstructive Sleep ◽  
Hemodynamic Characteristics ◽  
Pulmonary Arterial

Background.The prevalence of obstructive sleep apnea (OSA) in the pediatric population is currently estimated at 1-2% of all children. The purpose of this study was to investigate the clinical and hemodynamic characteristics in pediatric patients with cor pulmonale and OSA.Methods.Thirty children with the diagnosis of OSA were included. These patients consisted of 26 male and 4 female children with a mean age of 7 ± 4 years old. Five of those children were found to be associated with cor pulmonale, and 25 had OSA but without cor pulmonale.Results.The arousal index was much higher in children with OSA and cor pulmonale. The children with OSA and cor pulmonale had much lower mean and minimal oxygen saturation and a higher incidence of bradycardia events. All 5 patients with OSA and cor pulmonale underwent an adenotonsillectomy, and the pulmonary arterial pressure dropped significantly after the surgery.Conclusion.This study demonstrated that the OSA pediatric patients with cor pulmonale had the different clinical manifestations and hemodynamic characteristics from those without cor pulmonale. The adenotonsillectomy had excellent results in both the OSA pediatric patients with and without cor pulmonale.

Bone Mineral Density Attenuation in Obstructive Sleep Apnea by Derived Computed Tomography Screening

2021 ◽  
Author(s):  
Sharon Daniel ◽  
Yafit Cohen-Freud ◽  
Ilan Shelef ◽  
Ariel Tarasiuk
Keyword(s):  
Computed Tomography ◽  
Bone Mineral Density ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Bone Mineral ◽  
Clinical Information ◽  
Mineral Density ◽  
Peak Voltage ◽  
Arousal Index ◽  
Obstructive Sleep

Abstract The association between obstructive sleep apnea (OSA) and bone mineral density (BMD) is poorly elucidated with contradictory findings. We retrospectively explored the association between OSA and BMD by examining abdominal computed tomography (CT) vertebrae images using clinical information. We included 315 subjects (174 with OSA and 141 without OSA) who performed at least two CT scans (peak voltage of 120 kV). Bone mineral density was attenuated in those with OSA and increased age. BMD attenuation was not associated with the apnea–hypopnea score, nocturnal oxygen saturation, or arousal index. A multivariate linear regression indicated that OSA is associated with BMD attenuation after controlling for age, gender, and cardiovascular diseases. Here, we report that OSA is associated with BMD attenuation. Further studies are required to untangle the complex affect of OSA on BMD loss and possible clinical implication of vertebra depressed fracture or femoral neck fracture.

Sign in / Sign up

Export Citation Format

Share Document