Night-to-night variability of respiratory events in obstructive sleep apnoea: a systematic review and meta-analysis

Thorax ◽  
2020 ◽  
Vol 75 (12) ◽  
pp. 1095-1102 ◽  
Author(s):  
Maurice Roeder ◽  
Matteo Bradicich ◽  
Esther Irene Schwarz ◽  
Sira Thiel ◽  
Thomas Gaisl ◽  
...  
Keyword(s):  
Obstructive Sleep Apnoea ◽  
Evidence Synthesis ◽  
Meta Analysis ◽  
Sleep Apnoea ◽  
Study Data ◽  
Sleep Study ◽  
Diagnostic Threshold ◽  
Respiratory Events ◽  
Obstructive Sleep ◽  
Significant Difference

BackgroundIt is current practice to use a single diagnostic sleep study in the diagnostic workup of obstructive sleep apnoea (OSA). However, a relevant night-to-night variability (NtNV) of respiratory events has been reported.MethodsWe evaluated the NtNV of respiratory events in adults with suspected or already diagnosed OSA who underwent more than one diagnostic sleep study. Data sources were PubMed, Cochrane and Embase up to 23 January 2019. Random-effects models were used for evidence synthesis. For moderator analysis, mixed-effects regression analysis was performed. The study was registered with PROSPERO (CRD42019135277).ResultsOf 2143 identified papers, 24 studies, comprising 3250 participants, were included. The mean Apnoea-Hypopnoea Index (AHI) difference between the first and second night was −1.70/hour (95% CI −3.61 to 0.02). REM time differences (first to second night) were significantly positive associated with differences in mean AHI (β coefficient 0.262 (95% CI 0.096 to 0.428). On average, 41% (95% CI 27% to 57%) of all participants showed changes of respiratory events >10/hour from night to night. Furthermore, 49% (95% CI 32% to 65%) of participants changed OSA severity class (severity thresholds at 5/hour, 15/hour and 30/hour) at least once in sequential sleep studies. Depending on the diagnostic threshold (5/hour, 10/hour or 15/hour), on average 12% (95% CI 9% to 15%), 12% (95% CI 8% to 19%) and 10% (95% CI 8% to 13%) of patients would have been missed during the first night due to single night testing.ConclusionWhile there was no significant difference between mean AHI in two sequential study nights on a group level, there was a remarkable intraindividual NtNV of respiratory events, leading to misdiagnosis and misclassification of patients with suspected OSA.

Night-to-night variability of respiratory events in obstructive sleep apnoea: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Maurice Roeder ◽  
Matteo Bradicich ◽  
Thomas Gaisl ◽  
Sira Thiel ◽  
Esther Irene Schwarz ◽  
...  
Keyword(s):  
Systematic Review ◽  
Obstructive Sleep Apnoea ◽  
Meta Analysis ◽  
Sleep Apnoea ◽  
Respiratory Events ◽  
Obstructive Sleep

scholarly journals P088 Presence versus absence of flow limitation during stable breathing in patients with obstructive sleep apnoea

2021 ◽  
Vol 2 (Supplement_1) ◽  
pp. A49-A50
Author(s):  
D Mann ◽  
T Georgeson ◽  
S Landry ◽  
A Azarbarzin ◽  
D Vena ◽  
...  
Keyword(s):  
Obstructive Sleep Apnoea ◽  
Phenotypic Variability ◽  
Sleep Apnoea ◽  
Flow Limitation ◽  
Sleep Study ◽  
Respiratory Events ◽  
Obstructive Sleep ◽  
Ventilatory Drive ◽  
Clinical Scoring ◽  
Nasal Pressure

Abstract Introduction Flow limitation is the distinguishing characteristic of obstructive sleep apnoea. Critically, periods of flow limitation can occur without overt reductions in airflow (e.g. disproportionate increase in ventilatory drive vs. achieved ventilation), however, such periods are ignored by clinical scoring. Here we investigate flow limitation during so-called “stable breathing”, i.e. periods of sleep without scored events, by applying our recently-validated model to estimate flow limitation from the airflow signal. Methods Flow limitation was visually-scored (N=117,871 breaths) from N=40 participants attending an overnight sleep study for suspected sleep apnoea. Scoring was aided by physiological signals (e.g. intra-oesophageal diaphragm EMG). Model flow limitation classification used features extracted from the pneumotach signal (cross-validated accuracy=92.4%). We applied this method to investigate the occurrence of flow limitation during stable breathing, defined as periods of sleep >3 min duration without scored arousals or respiratory events. Results Model predicted flow limitation frequency was strongly correlated with visual scoring (R²=0.84 p<0.001). The median flow limitation frequency during stable breathing ranged from 8–91%, with an overall median of 59% (IQR 37%-75%). Flow limitation frequency during stable breathing was only modestly associated with the apnoea-hypopnea index (R²=0.12 p<0.05). Discussion Flow limitation occurs surprisingly frequently during stable breathing. While some individuals achieve stable breathing with minimal flow limitation, others demonstrate substantial flow limitation. Heterogeneity in frequency of flow limitation (within and between individuals) may provide further insights into emergent phenotypic variability within sleep disordered breathing. Finally, this model performed similarly in nasal pressure (88.2% accuracy), indicating potential application to clinical studies.

Modifying effects of the R389G β1-adrenoceptor polymorphism on resting heart rate and blood pressure in patients with obstructive sleep apnoea

2005 ◽  
Vol 110 (1) ◽  
pp. 117-123 ◽  
Author(s):  
Jan Börgel ◽  
Tino Schulz ◽  
Nina K. Bartels ◽  
Jörg T. Epplen ◽  
Nikolaus Büchner ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Obstructive Sleep Apnoea ◽  
Nervous Activity ◽  
Sleep Apnoea ◽  
Cpap Therapy ◽  
Pressure Therapy ◽  
Obstructive Sleep ◽  
Significant Difference ◽  
The Impact

OSA (obstructive sleep apnoea) stimulates sympathetic nervous activity and elevates resting HR (heart rate) and BP (blood pressure). In the present study in a cohort of 309 untreated OSA patients, the resting HR and BP during the daytime were correlated with AHI (apnoea/hypopnea index) and compared with patients with R389R (n=162), R389G (n=125) and G389G (n=22) genotypes of the β1-adrenoreceptor R389G polymorphism. We analysed the impact of the genotype on the decline of HR and BP in a subgroup of 148 patients (R389R, n=86; R389G, n=54; G389G, n=8) during a 6-month follow-up period under CPAP (continuous positive airway pressure) therapy during which cardiovascular medication remained unchanged. In untreated OSA patients, we found an independent relationship between AHI and resting HR (β=0.096, P<0.001), systolic BP (β=0.09, P=0.021) and diastolic BP (β=0.059, P=0.016). The resting HR/BP, however, did not differ among carriers with the R389R, R389G and G389G genotypes. CPAP therapy significantly reduced HR [−2.5 (−1.1 to −4.0) beats/min; values are mean difference (95% confidence intervals)] and diastolic BP [−3.2 (−1.5 to −5.0) mmHg]. The decline in HR was more significantly pronounced in the R389R group compared with the Gly389 carriers [−4.1 (−2.3 to −5.9) beats/min (P<0.001) compared with −0.2 (2.1 to −2.6) beats/min (P=0.854) respectively; Student's t test between groups, P=0.008]. Diastolic BP was decreased significantly (P<0.001) only in Gly389 carriers (R389G or G389G) compared with R389R carriers [−5.0 (−2.3 to −7.6) mmHg compared with −2.0 (0.4 to −4.3) mmHg respectively]. ANOVA revealed a significant difference (P=0.023) in HR reduction between the three genotypes [−4.1 (±8.4) beats/min for R389R, −0.5 (±9.3) beats/min for R389G and +1.9 (±7.2) beats/min for G389G]. In conclusion, although the R389G polymorphism of the β1-adrenoceptor gene did not influence resting HR or BP in untreated OSA patients, it may modify the beneficial effects of CPAP therapy on these parameters.

Immediate Effect of Acupuncture on the Sleep Pattern of Patients with Obstructive Sleep Apnoea

2010 ◽  
Vol 28 (3) ◽  
pp. 115-119 ◽  
Author(s):  
Anaflávia O Freire ◽  
Gisele C M Sugai ◽  
Sônia Maria Togeiro ◽  
Luiz Eugênio Mello ◽  
Sérgio Tufik
Keyword(s):  
Obstructive Sleep Apnoea ◽  
Placebo Treatment ◽  
Acute Effect ◽  
Sham Acupuncture ◽  
Sleep Apnoea ◽  
Sleep Pattern ◽  
Control Group ◽  
Respiratory Events ◽  
Obstructive Sleep ◽  
Before And After

Background Most patients with obstructive sleep apnoea (OSA) do not tolerate treatment with nasal continuous positive airway pressure, the ‘gold standard’ treatment for this condition. It was shown in a pilot study that acupuncture was more effective than placebo treatment (sham acupuncture) in producing significant changes in the respiratory events assessed by polysomnography (PSG). Objectives To investigate the immediate effect of manual acupuncture (MA) and electroacupuncture (EA) on the sleep pattern of patients presenting with moderate OSA. Methods 40 patients with an Apnoea–Hypopnoea Index (AHI) of 15–30/h were randomly allocated to MA treatment (n=10), EA 10 Hz treatment (n=10), EA 2 Hz treatment (n=10) and a no-treatment control group (n=10). The patients received MA or EA (2 or 10 Hz) just before the PSG study at 20:00. Results The AHI (p=0.005; p=0.005), the Apnoea Index (p=0.038; p=0.009) and the respiratory events (p=0.039; p=0.014) decreased significantly in the MA and EA 10 Hz groups, respectively (AHI (21.9, 11.2), Apnoea Index (5.15, 0.7), respiratory events (120.5, 61.0) in the MA group before and after. AHI (20.6, 9.9), Apnoea Index (8.2, 0.3), respiratory events (117.0, 56.0) in the EA 10 Hz group before and after). The micro-arousals decreased only in the MA group (146.0 vs 88.5, p=0.0002). There were no significant changes in the EA 2 Hz group or in the control group. Conclusion A single session of either MA or EA 10 Hz had an acute effect in reducing the AHI as well as the number of nocturnal respiratory events of patients presenting with moderate OSA.

Obstructive sleep apnoea and the incidence and mortality of cancer: a meta-analysis

2015 ◽  
Vol 26 (2) ◽  
pp. e12427 ◽  
Author(s):  
Xiao-Bin Zhang ◽  
Li-Hong Peng ◽  
Zhi Lyu ◽  
Xing-Tang Jiang ◽  
Yan-Ping Du
Keyword(s):  
Obstructive Sleep Apnoea ◽  
Meta Analysis ◽  
Sleep Apnoea ◽  
Obstructive Sleep ◽  
Incidence And Mortality

Effect of a 1-week intense myofunctional training on obstructive sleep apnoea in children with Down syndrome

2018 ◽  
Vol 104 (3) ◽  
pp. 275-279 ◽  
Author(s):  
Magnus von Lukowicz ◽  
Nina Herzog ◽  
Sebastian Ruthardt ◽  
Mirja Quante ◽  
Gabriele Iven ◽  
...  
Keyword(s):  
Down Syndrome ◽  
Obstructive Sleep Apnoea ◽  
Sleep Apnoea ◽  
Marginal Effect ◽  
Sleep Study ◽  
Desaturation Index ◽  
Intensive Training ◽  
Children With Down Syndrome ◽  
Training Camp ◽  
Obstructive Sleep

BackgroundObstructive sleep apnoea (OSA) is common in children with Down syndrome (DS), yet difficult to treat. As muscular hypotonia of the upper airway may cause OSA and is also common in DS, we tested whether intense myofunctional therapy improves OSA in children with DS.Patients and methodsForty-two children underwent cardiorespiratory sleep studies immediately before and after a 1-week intensive training camp consisting of three daily 45 min sessions of myofunctional exercises according to Padovan. Primary outcome was the mixed-obstructive-apnoea/hypopnoea index (MOAHI), secondary outcomes the ≤3% oxygen desaturation index (DI3), the ≤90% desaturation index (DI90) and the lowest pulse oximeter saturation (SpO2nadir).ResultsEighteen recordings had ≥3 hours of artefact-free recording in both the pretreatment and post-treatment sleep study and were therefore included in the analysis. Mean age was 6.3 years (SD 2.5); 83% had OSA prior to intervention. Mean MOAHI was 6.4 (SD 8.6) before and 6.4 (SD 10.8) after the intervention (p>0.05); the DI3 and SpO2nadir also did not change. Only the DI90 decreased significantly from 2.7 (SD 4.5) to 2.1 (SD 3.7) (p<0.05).ConclusionThe 1-week intense myofunctional training camp evaluated here in children with DS had only a marginal effect on OSA. Whether a longer follow-up period or duration of intervention would yield stronger effects remains to be determined.

scholarly journals Oral Appliance Therapy for Obstructive Sleep Apnoea: State of the Art

2019 ◽  
Vol 8 (12) ◽  
pp. 2121 ◽  
Author(s):  
Kate Sutherland ◽  
Peter A. Cistulli
Keyword(s):  
Health Outcomes ◽  
Obstructive Sleep Apnoea ◽  
Productivity Loss ◽  
Sleep Apnoea ◽  
World Health ◽  
Cardiometabolic Health ◽  
Accident Risk ◽  
Sleep Study ◽  
Pharyngeal Airway ◽  
Obstructive Sleep

Obstructive sleep apnoea (OSA) represents a significant global health burden, with impact on cardiometabolic health, chronic disease, productivity loss and accident risk. Oral appliances (OA) are an effective therapy for OSA and work by enlarging and stabilising the pharyngeal airway to prevent breathing obstructions during sleep. Although recommended in clinical guidelines for OSA therapy, they are often considered only as second-line therapy following positive airway pressure (PAP) therapy failure. There has been a long-standing barrier to selecting OA over PAP therapy due to the inability to be certain about the level of efficacy in individual OSA patients. A range of methods to select OSA patients for OA therapy, based on the outcome of a single sleep study night, have been proposed, although none has been widely validated for clinical use. Emergent health outcome data suggest that equivalent apnoea–hypopnea index reduction may not be necessary to produce the same health benefits of PAP. This may be related to the more favourable adherence to OA therapy, which can now be objectively verified. Data on longer term health outcomes are needed, and there are additional opportunities for device improvement and combination therapy approaches. OAs have an important role in precision care of OSA as a chronic disorder through a multi-disciplinary care team. Future studies on real-world health outcomes following OA therapy are needed.

1065 A Bout of Sleep Apnea or a Posttrauma Nightmare Occurrence?

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A405-A406
Author(s):  
W A Youngren ◽  
K Miller
Keyword(s):  
Sleep Apnea ◽  
Operational Definition ◽  
Self Report ◽  
Trauma Survivors ◽  
Chi Square ◽  
Sleep Study ◽  
Respiratory Events ◽  
Obstructive Sleep ◽  
Study Results ◽  
Significant Difference

Abstract Introduction The enigmatic nature of Posttrauma Nightmares (PTNs) has left research without an agreed upon operational definition. This is partially due to PTNs often containing well remembered content that is similar to the triggering trauma, but also manifesting as severe nighttime awakenings without a concise or remembered dream narrative. Given that recent research has linked episodes of Obstructive Sleep Apnea (OSA) to PTNs, this study aimed to examine if OSA could explain why some distressed awakenings occur without memory of nightmare content. Methods Participants included 36 trauma survivors who reported experiencing PTNs, recruited from a clinical referral or at a Veterans Affairs Hospital. Presence of OSA was captured from self-reports of previous polysomnography-based sleep study results. PTNs were measured via a self-report measure that assessed past month nightmare frequency and if the content was remembered upon awakening. Analysis included descriptive statistics and chi-square tests. Results Out of the group with a reported diagnosis of OSA (N = 8), 75% (n = 6) reported they did not remember the content of their nightmares upon awakening, whereas out of the group without a reported OSA diagnosis (N = 28), only 4% of participants (n = 1) reported not remembering the content of their nightmares. There was a significant difference between OSA diagnosis and remembering nightmare content (X2 = 57.83, p &lt; 0.001). Conclusion Individuals with diagnosed OSA commonly experienced nightmares that were often not remembered upon awakening, while the group without OSA most often remembered the content of their nightmares. Due to this relationship, it is possible that some PTNs experienced by the OSA group may instead be misinterpreted respiratory events. Understanding the relationship between OSA and PTNs is crucial for developing the most effective treatment course. Support None.

Rhinological interventions for obstructive sleep apnoea – a systematic review and descriptive meta-analysis

2019 ◽  
Vol 133 (03) ◽  
pp. 168-176 ◽  
Author(s):  
S Sharma ◽  
J C R Wormald ◽  
J M Fishman ◽  
P Andrews ◽  
B T Kotecha
Keyword(s):  
Systematic Review ◽  
Obstructive Sleep Apnoea ◽  
Surgical Intervention ◽  
Meta Analysis ◽  
Upper Airway ◽  
Sleep Apnoea ◽  
Current Evidence ◽  
Nasal Surgery ◽  
Surgical Interventions ◽  
Obstructive Sleep

AbstractObjectivesObstructive sleep apnoea is a common chronic sleep disorder characterised by collapse of the upper airway during sleep. The nasal airway forms a significant part of the upper airway and any obstruction is thought to have an impact on obstructive sleep apnoea. A systematic review was performed to determine the role of rhinological surgical interventions in the management of obstructive sleep apnoea.MethodsA systematic review of current literature was undertaken; studies were included if they involved comparison of a non-surgical and/or non-rhinological surgical intervention with a rhinological surgical intervention for treatment of obstructive sleep apnoea.ResultsSixteen studies met the selection criteria. The pooled data suggest that there are reductions in the apnoea/hypopnea index and respiratory disturbance index following nasal surgery. However, the current body of studies is too heterogeneous for statistically significant meta-analysis to be conducted.ConclusionNasal surgery may have limited benefit for a subset of patients based on current evidence.

Sign in / Sign up

Export Citation Format

Share Document