Obstructive Sleep Apnea and Risk of Suicide and Self-Harm: A Danish Nationwide Cohort Study

Abstract Study Objectives In this nationwide study, we used the unique Danish registries to estimate the risk of suicide and deliberate self-harm in patients with obstructive sleep apnea (OSA). Methods We identified all Danish citizens receiving a diagnosis of OSA between 1995 and 2015. As a reference cohort, we randomly selected 10 citizens for each patient, matched by sex and birth year. Using the Fine and Gray competing risk regression, we estimated the cumulative incidences of suicide, and Cox proportional regression analysis was used to compare the risk of suicide and deliberate self-harm in patients with OSA with the reference cohort. Results We identified 48,168 patients with OSA. A total of 135 patients had died by suicide, compared with 999 suicides in the reference cohort. Patients with OSA had an increased risk of dying by suicide when compared with the reference cohort (hazard ratio, 1.29; 95%CI, 1.07–1.55; and subhazard ratio, 1.23; 95%CI, 1.10-1.45). We identified 1,004 events of self-harm among patients with OSA, and 5,270 events in the reference group. The overall risk of self-harm was increased in patients with OSA when compared with the reference group (hazard ratio, 1.28; 95%CI, 1.19–1.37). Conclusion This is the first study to estimate the risk of suicide and deliberate self-harm in patients with OSA. We found that patients with OSA have an increased risk of both suicide and deliberate self-harm when compared with a large reference cohort, thereby highlighting the importance of a mental health screening in these patients.

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Abstract P346: Joint Associations of Obstructive Sleep Apnea and Excessive Daytime Sleepiness With Incident Cardiovascular Disease

Circulation ◽

10.1161/circ.137.suppl_1.p346 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Rachel P Ogilvie ◽

Kamakshi Lakshminarayan ◽

Sanjay R Patel ◽

Pamela L Lutsey

Keyword(s):

Cardiovascular Disease ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Excessive Daytime Sleepiness ◽

Daytime Sleepiness ◽

Hazard Ratio ◽

Cvd Risk ◽

Obstructive Sleep ◽

Increased Risk ◽

Incident Cases

Background: Although excessive daytime sleepiness (EDS) is a common symptom of obstructive sleep apnea (OSA), and both EDS and OSA have separately been associated with increased risk of cardiovascular disease (CVD), their joint association with CVD risk is unknown. Examining the association of EDS and OSA with CVD risk may help refine the OSA phenotype. Methods: Among 3,874 Sleep Heart Health Study participants without prevalent CVD, moderate to severe OSA was defined by an apnea hypopnea index (AHI) ≥ 15 events per hour on in-home polysomnography. EDS was defined as an Epworth Sleepiness Scale score ≥ 11. Incident CVD events included adjudicated myocardial infarction, coronary revascularization and stroke. Cox proportional hazards models adjusted for age, sex, alcohol, smoking, and body mass index. Results: Mean age was 63.0 years with 55.4% female, mean AHI 9.3 events/hour, and 23.4% with EDS. Over a median of 10.4 years of follow-up, we identified 653 incident cases of CVD. In adjusted analyses, EDS (Hazard ratio: 1.22, 95% CI 1.01-1.47) but not moderate-severe OSA (HR: 0.98, 0.81-1.20) was associated with incident CVD. In stratified analyses, the CVD incidence rate varied from 15.6/1000 person-years in those with no OSA or EDS to 26.0/1000 person-years in those with OSA and EDS (figure). In multivariable analyses, the hazard ratio for moderate-severe OSA and EDS compared to no OSA and no EDS was 1.26 (0.91-1.73). Formal tests of statistical significance of the OSA and EDS interaction were not significant on either the additive or multiplicative scales. Conclusions: Having both EDS and moderate-severe OSA was not associated with an increased risk of CVD in our data.

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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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Increased Risk of Parkinsonʼs Disease in Patients With Obstructive Sleep Apnea

Medicine ◽

10.1097/md.0000000000002293 ◽

2016 ◽

Vol 95 (2) ◽

pp. e2293 ◽

Cited By ~ 31

Author(s):

Nai-Cheng Yeh ◽

Kai-Jen Tien ◽

Chun-Ming Yang ◽

Jhi-Joung Wang ◽

Shih-Feng Weng

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Obstructive Sleep ◽

Increased Risk

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Compared to Individuals with Mild to Moderate Obstructive Sleep Apnea (OSA), Individuals with Severe OSA Had Higher BMI and Respiratory-Disturbance Scores

Life ◽

10.3390/life11050368 ◽

2021 ◽

Vol 11 (5) ◽

pp. 368

Author(s):

Leeba Rezaie ◽

Soroush Maazinezhad ◽

Donald J. Fogelberg ◽

Habibolah Khazaie ◽

Dena Sadeghi-Bahmani ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Multiple Regression ◽

Daytime Sleepiness ◽

Respiratory Disturbance Index ◽

Disturbance Index ◽

Related Data ◽

Obstructive Sleep ◽

Increased Risk ◽

Respiratory Disturbance

Objective: Individuals with obstructive sleep apnea (OSA) are at increased risk to suffer from further somatic and sleep-related complaints. To assess OSA, demographic, anthropometric, and subjective/objective sleep parameters are taken into consideration, but often separately. Here, we entered demographic, anthropometric, subjective, and objective sleep- and breathing-related dimensions in one model. Methods: We reviewed the demographic, anthropometric, subjective and objective sleep- and breathing-related data, and polysomnographic records of 251 individuals with diagnosed OSA. OSA was considered as a continuous and as categorical variable (mild, moderate, and severe OSA). A series of correlational computations, X2-tests, F-tests, and a multiple regression model were performed to investigate which demographic, anthropometric, and subjective and objective sleep dimensions were associated with and predicted dimensions of OSA. Results: Higher apnea/hypopnea index (AHI) scores were associated with higher BMI, higher daytime sleepiness, a higher respiratory disturbance index, and higher snoring. Compared to individuals with mild to moderate OSA, individuals with severe OSA had a higher BMI, a higher respiratory disturbance index (RDI) and a higher snoring index, while subjective sleep quality and daytime sleepiness did not differ. Results from the multiple regression analysis showed that an objectively shorter sleep duration, more N2 sleep, and a higher RDI predicted AHI scores. Conclusion: The pattern of results suggests that blending demographic, anthropometric, and subjective/objective sleep- and breathing-related data enabled more effective discrimination of individuals at higher risk for OSA. The results are of practical and clinical importance: demographic, anthropometric, and breathing-related issues derived from self-rating scales provide a quick and reliable identification of individuals at risk of OSA; objective assessments provide further certainty and reliability.

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Abstract P068: Obstructive Sleep Apnea is Associated with an Increase Risk of Osteoporosis

Circulation ◽

10.1161/circ.131.suppl_1.p068 ◽

2015 ◽

Vol 131 (suppl_1) ◽

Author(s):

Anawin Sanguankeo ◽

Sikarin Upala

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Primary Outcome ◽

Meta Analysis ◽

Systemic Disease ◽

Obstructive Sleep ◽

Increased Risk ◽

Increase Risk ◽

Osteoporosis Risk ◽

Stimulation Of

Background: Obstructive sleep apnea (OSA) is thought to be a systemic disease and has been associated with many disorders such as metabolic, endocrine, and especially cardiovascular diseases. One of the consequences of OSA is hypoxia, which can lead to a reduction in growth of osteoblast and a stimulation of osteoclast. Our meta-analysis was conducted to determine the risk of osteoporosis in patients with OSA compared to controls. Objectives: Eligible studies assessing the effects of obstructive sleep apnea on osteoporosis risk were comprehensively searched in PubMed/MEDLINE, EMBASE, and CENTRAL from their inception to September 2014. Two authors independently assessed article quality and extracted the data. Primary outcome were number of participants, prevalence, or risk ratio of osteoporosis in OSA and controls. Results: From 40 full-text articles, 3 studies involving 113,090 participants were included in the meta-analysis that were based on the random effects model. Compared with controls, participants who were diagnosed with obstructive sleep apnea had increased risk of osteoporosis (pooled risks ratio, 1.85; 95% CI, 1.34, 2.56). Conclusion: Patients with OSA had a higher risk of developing osteoporosis. Further study is needed to evaluate the possible mechanisms between these two conditions and to find potential treatment for OSA that could prevent osteoporosis.

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Increased Risk for Cancer in Young Patients with Severe Obstructive Sleep Apnea

Respiration ◽

10.1159/000486577 ◽

2018 ◽

Vol 97 (1) ◽

pp. 15-23 ◽

Cited By ~ 18

Author(s):

Ronen Brenner ◽

Shaye Kivity ◽

Marina Peker ◽

Daniel Reinhorn ◽

Lital Keinan-Boker ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Young Patients ◽

Severe Obstructive Sleep Apnea ◽

Obstructive Sleep ◽

Increased Risk

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Defining Risk of Postoperative Obstructive Sleep Apnea in Patients With 22q11.2DS Undergoing Pharyngeal Flap Surgery for Velopharyngeal Dysfunction Using Polysomnographic Evaluation

The Cleft Palate-Craniofacial Journal ◽

10.1177/1055665619900871 ◽

2020 ◽

Vol 57 (7) ◽

pp. 808-818

Author(s):

Alfred Lee ◽

Brian L. Chang ◽

Cynthia Solot ◽

Terrence B. Crowley ◽

Vamsee Vemulapalli ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Tertiary Care ◽

22Q11.2 Deletion Syndrome ◽

Deletion Syndrome ◽

Apnea Hypopnea Index ◽

Pressure Therapy ◽

Obstructive Sleep ◽

Increased Risk ◽

Pharyngeal Flap

Objective: To determine pre- and postoperative prevalence of obstructive sleep apnea (OSA) in patients with 22q11.2 deletion syndrome (DS) undergoing wide posterior pharyngeal flap (PPF) surgery for velopharyngeal dysfunction (VPD). Design: Retrospective study using pre- and postoperative polysomnography (PSG) to determine prevalence of OSA. Medical records were reviewed for patients’ medical comorbidities. Parents were surveyed about snoring. Setting: Academic tertiary care pediatric hospital. Patients: Forty patients with laboratory confirmed 22q11.2DS followed over a 6-year period. Interventions: Pre- and postoperative PSG, speech evaluation, and parent surveys. Main Outcome Measure: Severity and prevalence of OSA, defined by obstructive apnea hypopnea index (OAHI), before and after PPF surgery to determine whether PPF is associated with increased risk of OSA. Results: Mean OAHI did not change significantly after PPF surgery (1.1/h vs 2.1/h, P = .330). Prevalence of clinically significant OSA (OAHI ≥ 5) was identical pre- and postoperatively (2 of 40), with both cases having severe-range OSA requiring positive airway pressure therapy. All other patients had mild-range OSA. Nasal resonance was graded as severe preoperatively in 85% of patients. None were graded as severe postoperatively. No single patient factor or parent-reported concern predicted risk of OSA (OAHI ≥ 1.5). Conclusions: Patients with 22q11.2DS are medically complex and are at increased risk of OSA at baseline. Wide PPF surgery for severe VPD does not significantly increase risk of OSA. Careful perioperative planning is essential to optimize both speech and sleep outcomes.

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Sa1224 THE PRESENCE OF OBSTRUCTIVE SLEEP APNEA IS ASSOCIATED WITH INCREASED RISK FOR GERD AND BARRETT'S ESOPHAGUS

Gastroenterology ◽

10.1016/s0016-5085(20)31496-7 ◽

2020 ◽

Vol 158 (6) ◽

pp. S-318-S-319

Author(s):

Ahmad Alkaddour ◽

Muhammad Talal Sarmini ◽

Mohammad Maysara Asfari ◽

Kenneth J. Vega

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Barrett’S Esophagus ◽

Barrett's Esophagus ◽

Obstructive Sleep ◽

Increased Risk

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Obstructive sleep apnea: personal, societal, public health, and legal implications

Reviews on Environmental Health ◽

10.1515/reveh-2018-0068 ◽

2019 ◽

Vol 34 (2) ◽

pp. 153-169 ◽

Cited By ~ 13

Author(s):

Nesreen E. Morsy ◽

Nesrine S. Farrag ◽

Nevin F.W. Zaki ◽

Ahmad Y. Badawy ◽

Sayed A. Abdelhafez ◽

...

Keyword(s):

Public Health ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Motor Vehicle ◽

Work Productivity ◽

Legal Aspects ◽

Occupational Accidents ◽

Organ Systems ◽

Obstructive Sleep ◽

Increased Risk

Abstract Introduction Obstructive sleep apnea (OSA) is a widely prevalent sleep-related breathing disorder, which leads to several life-threatening diseases. OSA has systemic effects on various organ systems. Untreated OSA is associated with long-term health consequences including hypertension, heart disease, diabetes, depression, metabolic disorders, and stroke. In addition, untreated OSA is reported to be associated with cognitive dysfunction, impaired productivity at the workplace and in an increased risk of motor vehicle accidents (MVAs) resulting in injury and fatality. Other consequences of OSA include, but are not limited to, impaired vigilance, daytime somnolence, performance deficits, morning headaches, mood disturbances, neurobehavioral impairments, and general malaise. Additionally, OSA has become an economic burden on most health systems all over the world. Many driving license regulations have been developed to reduce MVAs among OSA patients. Methods Studies of the personal, societal, public health, and legal aspects of OSA are reviewed. Data were collected through the following databases: MEDLINE, Google Scholar, Scopus, SAGE Research Methods, and ScienceDirect. Conclusion OSA leads to worsening of patients’ personal relationships, decreasing work productivity, and increasing occupational accidents as well as MVAs. The costs of undiagnosed and untreated OSA to healthcare organizations are excessive. Thus, proper management of OSA will benefit not only the patient but will also provide widespread benefits to the society as a whole.

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Effects of Inhaled Corticosteroids and Particle Size on Risk of Obstructive Sleep Apnea: A Large Retrospective Cohort Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17197287 ◽

2020 ◽

Vol 17 (19) ◽

pp. 7287

Author(s):

Maria Paula Henao ◽

Jennifer L. Kraschnewski ◽

Matthew D. Bolton ◽

Faoud Ishmael ◽

Timothy Craig

Keyword(s):

Particle Size ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Fine Particle ◽

Inhaled Corticosteroids ◽

Multivariate Logistic Regression Analysis ◽

Upper Airway ◽

Act Scores ◽

Obstructive Sleep ◽

Increased Risk

Background: Inhaled corticosteroids (ICS) produce local effects on upper airway dilators that could increase the risk of developing obstructive sleep apnea (OSA). Given that the particle size of ICS changes their distribution, the particle size of ICS may impact the risk of developing OSA. Objectives: In this large retrospective study, we explore the relationship of ICS use and OSA in patients with asthma. In addition, we seek to determine if this relationship is affected by the particle size of ICS. Methods: Using electronic health records, we established a cohort of 29,816 asthmatics aged 12 and older with a diagnosis of asthma documented by ICD-9 or ICD-10 codes between January 2011 and August 2016. We performed analyses of variance and multivariate logistic regression analysis to determine the effects ICS on the diagnosis of OSA with sub-analysis by particle size of ICS. Results: Uncontrolled asthmatics showed increased odds of receiving a diagnosis of OSA whether when looking at ACT scores (adjusted odds ratio (aOR) 1.60, 95% CI 1.32–1.94) or PFT results (aOR 1.45, 95% CI 1.19–1.77). Users of ICS also had increased odds of OSA independent of asthma control (aOR 1.58, 95% CI 1.47–1.70). Notably, users of extra-fine particle ICS did not have significantly increased odds of having OSA compared to non-users of ICS (aOR 1.11, 95% CI 0.78–1.58). Conclusions: Use of ICS appears to be an independent risk factor for OSA. Notably, extra-fine particle size ICS do not appear to be associated with an increased risk of OSA.

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