Mesenteric fat thickness is associated with increased risk of obstructive sleep apnoea

Current diagnostic parameters estimating obstructive sleep apnoea (OSA) severity have a poor connection to the psychomotor vigilance of OSA patients. Thus, we aimed to investigate how the severity of apnoeas, hypopnoeas and intermittent hypoxaemia is associated with impaired vigilance.We retrospectively examined type I polysomnography data and corresponding psychomotor vigilance tasks (PVTs) of 743 consecutive OSA patients (apnoea–hypopnoea index (AHI) ≥5 events·h−1). Conventional diagnostic parameters (e.g. AHI and oxygen desaturation index (ODI)) and novel parameters (e.g. desaturation severity and obstruction severity) incorporating duration of apnoeas and hypopnoeas as well as depth and duration of desaturations were assessed. Patients were grouped into quartiles based on PVT outcome variables. The odds of belonging to the worst-performing quartile were assessed. Analyses were performed for all PVT outcome variables using binomial logistic regression.A relative 10% increase in median depth of desaturations elevated the odds (ORrange 1.20–1.37, p<0.05) of prolonged mean and median reaction times as well as increased lapse count. Similarly, an increase in desaturation severity (ORrange 1.26–1.52, p<0.05) associated with prolonged median reaction time. Female sex (ORrange 2.21–6.02, p<0.01), Epworth Sleepiness Scale score (ORrange 1.05–1.07, p<0.01) and older age (ORrange 1.01–1.05, p<0.05) were significant risk factors in all analyses. In contrast, increases in conventional AHI, ODI and arousal index were not associated with deteriorated PVT performance.These results show that our novel parameters describing the severity of intermittent hypoxaemia are significantly associated with increased risk of impaired PVT performance, whereas conventional OSA severity and sleep fragmentation metrics are not. These results underline the importance of developing the assessment of OSA severity beyond the AHI.

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Screening for obstructive sleep apnoea in professional drivers

Breathe ◽

10.1183/20734735.0364-2019 ◽

2020 ◽

Vol 16 (1) ◽

pp. 29364 ◽

Cited By ~ 2

Author(s):

Sophia E. Schiza ◽

Izolde Bouloukaki

Keyword(s):

Obstructive Sleep Apnoea ◽

Early Identification ◽

Sleep Apnoea ◽

Screening Tools ◽

List Type ◽

Objective Data ◽

Sleep Study ◽

Professional Drivers ◽

Obstructive Sleep ◽

Increased Risk

Professional drivers show a higher prevalence of obstructive sleep apnoea (OSA) compared with the general population. Furthermore, there is concern about the association between OSA and car crash risk given that drivers with OSA show an increased risk for car accidents. Despite this risk, OSA is often underdiagnosed and undertreated in this population, mainly due to lack of appropriate screening and sleep study referrals. Polysomnography (PSG), the gold standard test, is inappropriate for systematic screening because of its high expense, complexity and relative inaccessibility in this population. Therefore, there is a strong demand for good screening tools, including both subjective and objective data that may assist in early identification of possible OSA among professional drivers and, thus, aid in PSG examination referral and OSA management in an accredited sleep centre. However, there is considerable disagreement over screening methods and criteria for triggering a sleep study referral in different countries. There is also a strong need for further research in the area of OSA screening of commercial drivers in order to improve the diagnostic accuracy of screening tools and ensure that patients with OSA are accurately identified.Key pointsObstructive sleep apnoea (OSA) is often undiagnosed and undertreated in professional drivers.Professional drivers often under-report and are reluctant to report OSA symptoms.Barriers to OSA diagnosis include appropriate screening and sleep study referrals.Screening tools including both subjective and objective data may assist in early identification of possible OSA among professional drivers.Educational aimsTo evaluate screening instruments currently used to identify OSA risk in professional drivers.To provide guidance for developing an assessment strategy for OSA by professional driver medical examiners.

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Obstructive Sleep Apnoea and Type 2 Diabetes

European Endocrinology ◽

10.17925/ee.2014.10.01.43 ◽

2010 ◽

Vol 10 (1) ◽

pp. 43 ◽

Cited By ~ 5

Author(s):

Abd A Tahrani ◽

Asad Ali ◽

◽

Keyword(s):

Type 2 Diabetes ◽

Risk Factor ◽

Obstructive Sleep Apnoea ◽

Medical Condition ◽

Diabetes Type 2 ◽

Sleep Apnoea ◽

Obstructive Sleep ◽

Increased Risk ◽

The Impact

With the growing prevalence of obesity, the burden of type 2 diabetes is increasing. Obstructive sleep apnoea (OSA) is a very common medical condition that is associated with increased risk of cardiovascular disease and mortality. Obesity is a common risk factor for OSA and type 2 diabetes and hence it is not surprising that OSA and type 2 diabetes are interlinked. OSA has been shown to be an independent risk factor for the development of incident pre-diabetes/type 2 diabetes. OSA is also associated with worse glycaemic control and vascular disease in patients with type 2 diabetes. However, evidence for the benefits of OSA treatment in patients with type 2 diabetes is still lacking. The aim of this article is to provide an overview of OSA, the relationships between OSA and dysglycaemia and the impact of OSA in patients with type 2 diabetes, highlighting recent advances in the field.

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Effects of CPAP therapy on visceral fat thickness, carotid intima-media thickness and adipokines in patients with obstructive sleep apnoea

Respirology ◽

10.1111/resp.12963 ◽

2016 ◽

Vol 22 (4) ◽

pp. 786-792 ◽

Cited By ~ 10

Author(s):

Susanna S.S. Ng ◽

Eric K.H. Liu ◽

Ronald C.W. Ma ◽

Tat-On Chan ◽

Kin-Wang To ◽

...

Keyword(s):

Obstructive Sleep Apnoea ◽

Visceral Fat ◽

Intima Media Thickness ◽

Carotid Intima Media Thickness ◽

Sleep Apnoea ◽

Cpap Therapy ◽

Media Thickness ◽

Obstructive Sleep ◽

Fat Thickness

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Beyond Usual Care: A Multidisciplinary Approach Towards the Treatment of Obstructive Sleep Apnoea

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.747495 ◽

2022 ◽

Vol 8 ◽

Author(s):

Miuni Athauda Arachchige ◽

Joerg Steier

Keyword(s):

Obstructive Sleep Apnoea ◽

Upper Airway ◽

Sleep Apnoea ◽

Team Approach ◽

Cpap Therapy ◽

Management Options ◽

Airway Patency ◽

Obstructive Sleep ◽

Increased Risk

Obstructive Sleep Apnoea (OSA) is common and characterised by repeated apnoeas and hypopnoeas while asleep due to collapse of the upper airway. OSA can have a significant impact on physical and mental health and, when left untreated, is associated with increased risk of developing cardiovascular ill health. Besides cardiorespiratory implications excessive daytime sleepiness, morning headaches, limited memory function and lack of concentration are some further symptoms caused by OSA. Continuous Positive Airway Pressure (CPAP) therapy is the evidence-based treatment to maintain upper airway patency in patients with moderate to severe OSA. Proper adherence to CPAP therapy successfully abolishes nocturnal apnoeas and hypopnoeas, and diminishes consequences of uncontrolled OSA, such as treatment resistant hypertension. However, long term adherence to CPAP remains an unresolved limitation of this method. Although alternatives to CPAP therapy may be less efficacious, there is a variety of non-CPAP treatments that includes conventional lifestyle advice, postural advice, the use of mandibular advancement devices (MADs), surgical treatment options, such as uvulopalatopharyngoplasty, tonsillectomy, or maxillomandibular advancement, and the use of electrical stimulation of the upper airway dilator muscles. Hypoglossal Nerve Stimulation is available as an invasive (HNS) and a transcutaneous (TESLA) approach. For the management of “difficult-to-treat” patients with OSA, particularly in those in whom first line therapy proved to be unsuccessful, a multidisciplinary team approach may be helpful to incorporate the available options of non-CPAP therapy and provide appropriate choices. Symptom control, patient-related outcome measures and long-term cardiovascular health should be prioritised when choosing long-term therapies to treat OSA. The inclusion of patients in the choice of successful management options of their condition will facilitate better long-term adherence. Advancing clinical trials in the field will further help to resolve the relative lack of evidence for effective non-CPAP methods.

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New frontiers in obstructive sleep apnoea

Clinical Science ◽

10.1042/cs20140070 ◽

2014 ◽

Vol 127 (4) ◽

pp. 209-216 ◽

Cited By ~ 31

Author(s):

Najib T. Ayas ◽

Allen A. J. Hirsch ◽

Ismail Laher ◽

T. Douglas Bradley ◽

Atul Malhotra ◽

...

Keyword(s):

Animal Models ◽

Obstructive Sleep Apnoea ◽

Upper Airway ◽

Sleep Apnoea ◽

Sleep Fragmentation ◽

Current Evidence ◽

Respiratory Disorder ◽

Negative Consequences ◽

Obstructive Sleep ◽

Increased Risk

OSA (obstructive sleep apnoea), the most common respiratory disorder of sleep, is caused by the loss of upper airway dilating muscle activity during sleep superimposed on a narrow upper airway. This results in recurrent nocturnal asphyxia. Termination of these events usually requires arousal from sleep and results in sleep fragmentation and hypoxaemia, which leads to poor quality sleep, excessive daytime sleepiness, reduced quality of life and numerous other serious health consequences. Furthermore, patients with untreated sleep apnoea are at an increased risk of hypertension, stroke, heart failure and atrial fibrillation. Although there are many predisposing risk factors for OSA, including male gender, endocrine disorders, use of muscle relaxants, smoking, fluid retention and increased age, the strongest risk factor is obesity. The aim of the present review is to focus on three cutting-edge topics with respect to OSA. The section on animal models covers various strategies used to simulate the physiology or the effects of OSA in animals, and how these have helped to understand some of the underlying mechanisms of OSA. The section on diabetes discusses current evidence in both humans and animal models demonstrating that intermittent hypoxia and sleep fragmentation has a negative impact on glucose tolerance. Finally, the section on cardiovascular biomarkers reviews the evidence supporting the use of these biomarkers to both measure some of the negative consequences of OSA, as well as the potential benefits of OSA therapies.

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Outcomes in coronary artery disease patients with sleepy obstructive sleep apnoea on CPAP

European Respiratory Journal ◽

10.1183/13993003.00749-2017 ◽

2017 ◽

Vol 50 (6) ◽

pp. 1700749 ◽

Cited By ~ 4

Author(s):

Yüksel Peker ◽

Erik Thunström ◽

Helena Glantz ◽

Karl Wegscheider ◽

Christine Eulenburg

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Obstructive Sleep Apnoea ◽

Controlled Trial ◽

Artery Bypass ◽

Sleep Apnoea ◽

Obstructive Sleep ◽

Increased Risk ◽

Artery Disease ◽

Randomised Controlled

Coronary artery disease (CAD) patients with obstructive sleep apnoea (OSA) have increased risk for major adverse cardiovascular and cerebrovascular events (MACCEs) compared with CAD patients without OSA. We aimed to address if the risk is similar in both groups when OSA patients are treated.This study was a parallel observational arm of the RICCADSA randomised controlled trial, conducted in Sweden between 2005 and 2013. Patients with revascularised CAD and OSA (apnoea–hypopnoea index (AHI) ≥15 events·h−1) with daytime sleepiness (Epworth Sleepiness Scale score ≥10) were offered continuous positive airway pressure (CPAP) (n=155); CAD patients with no OSA (AHI <5 events·h−1) acted as controls (n=112), as a randomisation of sleepy OSA patients to no treatment would not be ethically feasible. The primary end-point was the first event of MACCEs. Median follow-up was 57 months.The incidence of MACCEs was 23.2% in OSA patientsversus16.1% in those with no OSA (adjusted hazard ratio 0.96, 95% CI 0.40–2.31; p=0.923). Age and previous revascularisation were associated with increased risk for MACCEs, whereas coronary artery bypass grafting at baseline was associated with reduced risk.We conclude that the risk for MACCEs was not increased in CAD patients with sleepy OSA on CPAP compared with patients without OSA.

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Obstructive sleep apnoea as a risk factor for incident metabolic syndrome: a joined Episono and HypnoLaus prospective cohorts study

European Respiratory Journal ◽

10.1183/13993003.01150-2018 ◽

2018 ◽

Vol 52 (5) ◽

pp. 1801150 ◽

Cited By ~ 10

Author(s):

Camila Hirotsu ◽

Jose Haba-Rubio ◽

Sonia M. Togeiro ◽

Pedro Marques-Vidal ◽

Luciano F. Drager ◽

...

Keyword(s):

Metabolic Syndrome ◽

Risk Factor ◽

General Population ◽

Obstructive Sleep Apnoea ◽

Arterial Oxygen Saturation ◽

Sleep Apnoea ◽

Arterial Oxygen ◽

Obstructive Sleep ◽

Increased Risk

Cross-sectional studies have demonstrated that obstructive sleep apnoea (OSA) and metabolic syndrome (MetS) are often associated, but whether a temporal relationship exists is unknown. We aimed to investigate the effect of OSA on the risk of developing MetS in the general population.A prospective study was conducted combining two population-based samples: Episono (Brazil) and HypnoLaus (Switzerland). MetS was assessed according to unified criteria. Polysomnography (PSG) was performed at baseline and follow-up in Episono, and at baseline in HypnoLaus. OSA was defined according to the apnoea–hypopnoea index as mild (≥5– <15 events h−1) and moderate-to-severe (≥15 events·h−1). We included 1853 participants (mean±sd age 52±13 years, 56% female) without MetS at baseline.After mean±sd 6±1 years, 318 (17.2%) participants developed MetS. Moderate-to-severe OSA was independently associated with incident MetS (OR 2.58, 95% CI 1.61–4.11) and increased the number of MetS components from baseline to follow-up through mediation of the percentage of time with arterial oxygen saturation <90%. Subset analysis in Episono confirmed that the increase in this parameter between baseline and follow-up PSGs represented a risk factor for incident MetS (OR 1.42, 95% CI 1.04–1.95, for each 10% increase).OSA is independently associated with an increased risk of developing MetS through mediation of nocturnal hypoxaemia in the general population.

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Association of epicardial fat thickness with clinical and polysomnographic parameters in non-obese obstructive sleep apnoea patients

The Journal of Laryngology & Otology ◽

10.1017/s0022215118000579 ◽

2018 ◽

Vol 132 (5) ◽

pp. 439-445 ◽

Cited By ~ 4

Author(s):

S Derin ◽

I Altun ◽

S Koseoglu ◽

C Sahin ◽

M Yilmaz ◽

...

Keyword(s):

Body Mass Index ◽

Body Mass ◽

Obstructive Sleep Apnoea ◽

Sleep Apnoea ◽

Oxygen Desaturation ◽

Epicardial Fat ◽

Epicardial Fat Thickness ◽

Oxygen Desaturation Index ◽

Obstructive Sleep ◽

Fat Thickness

AbstractObjectives:This study aimed to investigate the relationship of epicardial fat thickness with severity of obstructive sleep apnoea, and clinical and polysomnographic parameters, and to determine independent predictors for epicardial fat thickness.Methods:A total of 84 patients with a body mass index of less than 30 kg/m2 and suspected sleep-disordered breathing were included in the study. The correlations of epicardial fat thickness with polysomnographic and clinical data, and severity of obstructive sleep apnoea, were investigated.Results:Mean epicardial fat thickness was 3.75 ± 1.07 mm in the study group (n = 62) and 2.97 ± 0.62 mm in the control group (n = 22) (p < 0.001). There were significant positive correlations between epicardial fat thickness and: apnoea/hypopnoea index, oxygen desaturation index 3 and minimum oxygen saturation, as well as with age, body mass index, and neck and waist circumferences.Conclusion:Non-obese obstructive sleep apnoea patients have thicker epicardial fat compared to controls. Oxygen desaturation index 3 has a strong correlation with epicardial fat thickness and is an independent predictor of it.

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