Severity of Central Sleep Apnea Does Not Affect Sleeping Oxygen Saturation During Ascent to High Altitude

2021 ◽  
Author(s):  
Jordan D. Bird ◽  
Anne Kalker ◽  
Alexander N Rimke ◽  
Jason S Chan ◽  
Garrick Chan ◽  
...  
Keyword(s):  
Sleep Apnea ◽  
Oxygen Saturation ◽  
High Altitude ◽  
Central Sleep Apnea ◽  
Periodic Breathing ◽  
Oxygen Desaturation ◽  
Apnea Hypopnea Index ◽  
Peripheral Oxygen Saturation ◽  
Oxyhemoglobin Saturation ◽  
Rapid Ascent

Central sleep apnea (CSA) is characterized by periodic breathing (PB) during sleep, defined as intermittent periods of apnea/hypopnea and hyperventilation, with associated acute fluctuations in oxyhemoglobin saturation (SO2). CSA has an incidence of ~50% in heart failure patients but is universal at high-altitude (HA; ≥2,500 m), increasing in severity with further ascent and/or time at altitude. However, whether PB is adaptive, maladaptive, or neutral with respect to sleeping SO2 at altitude is unclear. We hypothesized that PB severity would improve mean sleeping SO2 during acclimatization to HA due to relative, intermittent hyperventilation subsequent to each apnea. We utilized portable sleep monitors to assess the incidence and severity of CSA via apnea-hypopnea index (AHI) and oxygen desaturation index (ODI), and peripheral oxygen saturation (SpO2) during sleep during two ascent profiles to HA in native lowlanders: (I) rapid ascent to and residence at 3,800 m for 9 days/nights (n=21) and (II) incremental ascent to 5,160 m over 10 days/nights (n=21). In both ascent models, severity of AHI and ODI increased and mean sleeping SpO2 decreased, as expected. However, during sleep on the last night/highest altitude of both ascent profiles, neither AHI nor ODI were correlated with mean sleeping SpO2. In addition, mean sleeping SpO2 was not significantly different between high and low CSA. These data suggest that CSA is neither adaptive nor maladaptive with regard to mean oxygen saturation during sleep, owing to the relative hyperventilation between apneas, likely correcting transient apnea-mediated oxygen desaturation and maintaining mean oxygenation.

Worsening of central sleep apnea at high altitude—a role for cerebrovascular function

2013 ◽  
Vol 114 (8) ◽  
pp. 1021-1028 ◽  
Author(s):  
Keith R. Burgess ◽  
Samuel J. E. Lucas ◽  
Kelly Shepherd ◽  
Andrew Dawson ◽  
Marianne Swart ◽  
...  
Keyword(s):  
Sleep Apnea ◽  
High Altitude ◽  
Repeated Measures ◽  
Sleep Onset ◽  
Central Sleep Apnea ◽  
Blood Gases ◽  
Periodic Breathing ◽  
Apnea Hypopnea Index ◽  
Arterial Blood ◽  
Cerebrovascular Function

Although periodic breathing during sleep at high altitude occurs almost universally, the likely mechanisms and independent effects of altitude and acclimatization have not been clearly reported. Data from 2005 demonstrated a significant relationship between decline in cerebral blood flow (CBF) at sleep onset and subsequent severity of central sleep apnea that night. We suspected that CBF would decline during partial acclimatization. We hypothesized therefore that reductions in CBF and its reactivity would worsen periodic breathing during sleep following partial acclimatization. Repeated measures of awake ventilatory and CBF responsiveness, arterial blood gases during wakefulness. and overnight polysomnography at sea level, upon arrival (days 2–4), and following partial acclimatization (days 12–15) to 5,050 m were made on 12 subjects. The apnea-hypopnea index (AHI) increased from to 77 ± 49 on days 2–4 to 116 ± 21 on days 12–15 ( P = 0.01). The AHI upon initial arrival was associated with marked elevations in CBF (+28%, 68 ± 11 to 87 ± 17 cm/s; P < 0.05) and its reactivity to changes in PaCO2 [>90%, 2.0 ± 0.6 to 3.8 ± 1.5 cm·s−1·mmHg−1 hypercapnia and 1.9 ± 0.4 to 4.1 ± 0.9 cm·s−1·mmHg−1 for hypocapnia ( P < 0.05)]. Over 10 days, the increases resolved and AHI worsened. During sleep at high altitude large oscillations in mean CBF velocity (CBFv) occurred, which were 35% higher initially (peak CBFv = 96 cm/s vs. peak CBFv = 71 cm/s) than at days 12–15. Our novel findings suggest that elevations in CBF and its reactivity to CO2 upon initial ascent to high altitude may provide a protective effect on the development of periodic breathing during sleep (likely via moderating changes in central Pco2).

Severity of Central Sleep Apnea Does Not Improve Sleeping Oxygen Saturation During Ascent to High Altitude

2020 ◽  
Vol 34 (S1) ◽  
pp. 1-1
Author(s):  
Jordan Bird ◽  
A. Kalker ◽  
J. Chan ◽  
A. Rimke ◽  
G. Chan ◽  
...  
Keyword(s):  
Sleep Apnea ◽  
Oxygen Saturation ◽  
High Altitude ◽  
Central Sleep Apnea

scholarly journals Oxygen desaturation during flexible bronchoscopy with propofol sedation is associated with sleep apnea: the PROSA-Study

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Andrei M. Darie ◽  
Desiree M. Schumann ◽  
Marco Laures ◽  
Werner Strobel ◽  
Kathleen Jahn ◽  
...  
Keyword(s):  
Sleep Apnea ◽  
Conscious Sedation ◽  
Flexible Bronchoscopy ◽  
Oxygen Desaturation ◽  
Clinical Indication ◽  
Apnea Hypopnea Index ◽  
Berlin Questionnaire ◽  
Upper Airways ◽  
Peripheral Oxygen Saturation ◽  
Obstructive Sleep

Abstract Background Obstructive sleep apnea (OSA) is characterized by repetitive episodes of complete or partial obstruction of the upper airways during sleep. Conscious sedation for flexible bronchoscopy (FB) places patients in a sleep-like condition. We hypothesize that oxygen desaturation during flexible bronchoscopy may help to detect undiagnosed sleep apnea. Methods Single-centre, investigator-initiated and driven study including consecutive patients undergoing FB for clinical indication. Patients completed the Epworth Sleepiness Scale (ESS), Lausanne NoSAS score, STOP-BANG questionnaire and the Berlin questionnaire and underwent polygraphy within 7 days of FB. FB was performed under conscious sedation with propofol. Oxygen desaturation during bronchoscopy was measured with continuous monitoring of peripheral oxygen saturation with ixTrend (ixellence GmbH, Germany). Results 145 patients were included in the study, 62% were male, and the average age was 65.8 ± 1.1 years. The vast majority of patients (n = 131, 90%) proved to fulfill OSA criteria based on polygraphy results: 52/131 patients (40%) had mild sleep apnea, 49/131 patients (37%) moderate sleep apnea and 30/131 patients (23%) severe sleep apnea. Patients with no oxygen desaturation had a significantly lower apnea–hypopnea index than patients with oxygen desaturation during bronchoscopy (AHI 11.94/h vs 21.02/h, p = 0.011). This association remained significant when adjusting for the duration of bronchoscopy and propofol dose (p = 0.023; 95% CI 1.382; 18.243) but did not hold when also adjusting for age and BMI. Conclusion The severity of sleep apnea was associated to oxygen desaturation during flexible bronchoscopy under conscious sedation. Patients with oxygen desaturation during bronchoscopy might be considered for sleep apnea screening. Trial registration: The Study was approved by the Ethics Committee northwest/central Switzerland, EKNZ (EK 16/13) and was carried out according to the Declaration of Helsinki and Good Clinical Practice guidelines. Due to its observational character, the study did not require registration at a clinical trial registry.

scholarly journals Adaptive Servoventilation as Treatment for Central Sleep Apnea Due to High-Altitude Periodic Breathing in Nonacclimatized Healthy Individuals

2018 ◽  
Vol 19 (2) ◽  
pp. 178-184 ◽  
Author(s):  
Jeremy E. Orr ◽  
Erica C. Heinrich ◽  
Matea Djokic ◽  
Dillon Gilbertson ◽  
Pamela N. Deyoung ◽  
...  
Keyword(s):  
Sleep Apnea ◽  
High Altitude ◽  
Central Sleep Apnea ◽  
Periodic Breathing ◽  
Healthy Individuals ◽  
Adaptive Servoventilation

060 Challenging the current assessment criteria for scoring central sleep apnea at altitude

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A25-A25
Author(s):  
Jordan Bird ◽  
Jason Chan ◽  
Alexander Rimke ◽  
Anne Kalker ◽  
Garrick Chan ◽  
...  
Keyword(s):  
Sleep Apnea ◽  
High Altitude ◽  
Detection Threshold ◽  
Central Sleep Apnea ◽  
Upper Airway ◽  
Assessment Criteria ◽  
Apnea Hypopnea Index ◽  
Engineering Research ◽  
Obstructive Sleep ◽  
Underlying Mechanisms

Abstract Introduction Sleep disordered breathing comes in two forms: obstructive and central sleep apnea (SA). Obstructive sleep apnea (OSA) is caused by upper airway collapse during sleep, and is associated with increases in morbidity and mortality. Conversely, central sleep apnea (CSA) results from increases in respiratory chemosensitivity to blood gas challenges in the context of high-altitude ascent. CSA increases in severity and apneas shorten in duration with higher ascent and/or time spent at altitude. Although both types of SA are characterized by intermittent periods of apnea and hyperventilation, the underlying mechanisms and phenotypes between OSA and CSA are different. A universal scoring system for the two types of context-dependent SA may lead to errors in quantification. The American Association of Sleep Medicine (AASM) developed assessment criteria for SA, which are universally-utilized for all types of SA to quantify an apnea-hypopnea index (AHI; events/hour), where apneas are scored as cessation of breathing ≥10-sec. We aimed to assess the effect of reducing the apnea-detection threshold (ADT) to &lt;10-sec to quantitatively assess the extent that a shorter ADT affects the scoring of AHI in the context of high-altitude ascent, where CSA is universal. Methods We assessed CSA using portable polysomnography (ApneaLink, ResMed) during ascent to 5160m in the Nepal Himalaya over 10 days in 15 healthy participants. Files were archived digitally for later analysis using automated scoring software (ApneaLink Reporting Software, ResMed). We quantified and compared AHI using AASM criteria (i.e., 10-sec ADT) and a shorter 5-sec ADT. Results AHI was 3.9±4.1 events/hour at 1045m prior to ascent, with AHI increasing to 37.5±32.8 events/hour (P&lt;0.0001) at 5160m after 10 days of incremental ascent using AASM criteria (i.e., 10-sec ADT). When the ADT was reduced to 5-sec at 5160m, AHI was increased to 61.6±38.1 (+61%; P=0.0002). Conclusion This preliminary report suggests that the AASM criterion for scoring apneas, which is broadly applied to OSA at low altitude, may underestimate the assessment and quantification of CSA with ascent to and prolonged stays at high altitude. Development of distinct assessment criteria for OSA and CSA may be warranted. Support (if any) Natural Science sand Engineering Research Council of Canada

scholarly journals The effect of acetazolamide on sleep apnea at high altitude: a systematic review and meta-analysis

2016 ◽  
Vol 11 (1) ◽  
pp. 20-29 ◽  
Author(s):  
Hsin-Ming Liu ◽  
I-Jen Chiang ◽  
Ken N. Kuo ◽  
Cher-Ming Liou ◽  
Chiehfeng Chen
Keyword(s):  
Sleep Apnea ◽  
High Altitude ◽  
Meta Analysis ◽  
Periodic Breathing ◽  
Effect Sizes ◽  
Cochrane Library ◽  
Apnea Hypopnea Index ◽  
Obstructive Sleep ◽  
Daily Dose ◽  
Healthy Participants

Background: Acetazolamide has been investigated for treating sleep apnea in newcomers ascending to high altitude. This study aimed to assess the effect of acetazolamide on sleep apnea at high altitude, determine the optimal therapeutic dose, and compare its effectiveness in healthy trekkers and obstructive sleep apnea (OSA) patients. Methods: PubMed, Embase, Scopus, Cochrane Library, and Airiti Library databases were searched up to July 2015 for randomized controlled trials (RCTs) performed above 2500 m in lowlanders and that used acetazolamide as intervention in sleep studies. Studies including participants with medical conditions other than OSA were excluded. Results: Eight studies of 190 adults were included. In healthy participants, the pooled mean effect sizes of acetazolamide on Apnea–Hypopnea Index (AHI), percentage of periodic breathing time, and nocturnal oxygenation were 34.66 [95% confidence interval (CI) 25.01–44.30] with low heterogeneity ( p = 0.7, I2 = 0%), 38.56% (95% CI 18.92–58.19%) with low heterogeneity ( p = 0.24, I2 = 28%), and 4.75% (95% CI 1.35–8.15%) with high heterogeneity ( p < 0.01, I2 = 87%), respectively. In OSA patients, the pooled mean effect sizes of acetazolamide on AHI and nocturnal oxygenation were 13.18 (95% CI 9.25–17.1) with low heterogeneity ( p = 0.33, I2 = 0%) and 1.85% (95% CI 1.08–2.62%) with low heterogeneity ( P = 0.56, I2 = 0%). Conclusions: Acetazolamide improves sleep apnea at high altitude by decreasing AHI and percentage of periodic breathing time and increasing nocturnal oxygenation. Acetazolamide is more beneficial in healthy participants than in OSA patients, and a 250 mg daily dose may be as effective as higher daily doses for healthy trekkers.

scholarly journals Increasing Hypopnea in Sleep Breathing Disturbance Improves Postoperative Oxygen Saturation in Patients with Very Severe Obstructive Sleep Apnea

2020 ◽  
Vol 10 (18) ◽  
pp. 6539 ◽  
Author(s):  
Ethan I. Huang ◽  
Shu-Yi Huang ◽  
Yu-Ching Lin ◽  
Chieh-Mo Lin ◽  
Chin-Kuo Lin ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Oxygen Saturation ◽  
Pulse Oximetry ◽  
Apnea Hypopnea Index ◽  
Severe Obstructive Sleep Apnea ◽  
Oxyhemoglobin Saturation ◽  
Surgical Success ◽  
Obstructive Sleep ◽  
The Mean

In patients of very severe obstructive sleep apnea (OSA) with confined framework, reducing volume is difficult to achieve a postoperative apnea-hypopnea index (AHI) qualifying the classical surgical success. However, a higher AHI with a larger part of hypopneas may have similar or even less severity of oxygen (O2) desaturation, compared to a lower index mostly made of apneas. Here, in 27 consecutive enrolled patients, we show that besides the improvement of mean AHI, the multilevel surgery increased hypopnea in AHI from 29.1% to 77.3%, and improves postoperative O2 saturation by reducing desaturation frequency (mean desaturation index decreased from 62.5 to 24.4 events/h) and level (mean oxyhemoglobin saturation of pulse oximetry (SpO2) desaturation cut down from 10.0 to 5.8%). The mean SpO2 improved from 92.3% to 94.7%, and the improvement was positively related to the proportion increase of hypopnea/AHI. The results suggest that the non-framework surgery could help patients with very severe OSA whose AHIs are ≥60 events/h in terms of improving postoperative O2 saturation. Due to the improvement also presented in those not qualified as classical surgical success, further studies are needed to clarify the connection between O2 desaturation and various consequences to reconsider defining a surgical success.

Validation of a Wrist-Worn Reflectance Pulse Oximeter During Sleep and Prediction of Obstructive Sleep Apnea: A Proof-of-Concept Study (Preprint)

2021 ◽  
Author(s):  
Hyunjun Jung ◽  
Dongyeop Kim ◽  
Wonkyu Lee ◽  
Hyejung Seo ◽  
Jinwoo Seo ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Oxygen Saturation ◽  
Pulse Oximetry ◽  
Pulse Oximeter ◽  
Mean Squared Error ◽  
Oxygen Desaturation ◽  
Apnea Hypopnea Index ◽  
Obstructive Sleep ◽  
Reflectance Pulse Oximetry

BACKGROUND Obstructive sleep apnea (OSA) is a common sleep disorder characterized by repetitive upper airway obstruction during sleep, thereby resulting in oxygen desaturation, frequent arousals, and increased sympathetic activity. Wearable devices that measure peripheral oxygen saturation have been developed for the screening of OSA. OBJECTIVE This study aimed to validate and characterize the estimation function of oxygen saturation measured by wrist-worn reflectance pulse oximetry during sleep and to predict the derived OSA using the oxygen desaturation index (ODI). METHODS Oxygen saturation was simultaneously measured using reflectance pulse oximetry from the Samsung Galaxy Watch 4 series (SM-R890N, SM-R860N, Samsung Electronics Co.; GW4) and transmittance pulse oximetry from polysomnography as a reference (SpO2Ref). The performance was evaluated by the root mean squared error (RMSE) and coverage rate, and it was compared according to the apnea-hypopnea index (AHI). The GW4-ODI was used to predict moderate to severe OSA. RESULTS A total of 97 adults (44.4 ± 13.0 years; men 76.3%, women 23.7%) participated in this study. Depending on the AHI, participants were classified as either normal (n=18), mild (n=21), moderate (n=23), or severe OSA (n=35). Wrist-worn reflectance pulse oximetry showed an overall RMSE of 2.3% and negligible bias of -0.2%. A Bland-Altman density plot showed good agreement of oxygen saturation between GW4 and the reference pulse oximeter. RMSEs were 1.65 ± 0.57%, 1.76 ± 0.65%, 1.93 ± 0.54%, and 2.93 ± 1.71% for normal, mild, moderate, and severe OSA, respectively. GW4-ODI ≥5/h had the highest predictive ability for moderate to severe OSA with a sensitivity of 89.7%, a specificity of 64.1%, an accuracy of 79.4%, and an area under the curve of 0.908 (95% CI, 0.852–0.963). CONCLUSIONS GW4 was successfully validated for measuring oxygen saturation with reflectance pulse oximetry during sleep. This study demonstrates the feasibility of GW4 for screening moderate to severe OSA.

scholarly journals 0912 Central Sleep Apnea Patterns On Pediatric Polysomnograms

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A346-A347
Author(s):  
H S Rao
Keyword(s):  
Sleep Apnea ◽  
Oxygen Saturation ◽  
Rem Sleep ◽  
Pediatric Population ◽  
Central Sleep Apnea ◽  
Nrem Sleep ◽  
Apnea Hypopnea Index ◽  
Respiratory Drive ◽  
Periodic Limb Movement Disorder ◽  
Obstructive Sleep

Abstract Introduction Central sleep apneas (CA) are frequently seen on pediatric polysomnograms (PPSG) independently or in conjunction with obstructive sleep apnea (OSA). In the pediatric population, the AASM defines CA as the absence of chest and/or abdominal movement associated with a cessation of airflow of more than 20s or longer than 2 baseline respiratory cycles if associated with an arousal, an awakening or oxygen desaturation ≥ 3%. Scoring CAs on PPSG based on AASM definition can cause confusion among providers as CAs are generally associated with central nervous disorders causing reduced or absent respiratory drive. Methods Retrospective review of 71 consecutive diagnostic PPSGs to analyze patterns of CAs scored per AASM definition was performed. None of the children had a disorder causing reduced respiratory drive. Data on age, obstructive AHI (Apnea Hypopnea Index), CO2, Oxygen saturation, Central AHI and diagnosis were collected. Results 68 of 71 children had varying degree of OSA and CAs. Three main patterns of CAs were observed: occurring in NREM, following sigh breaths or arousals and CAs seen in REM sleep. CO2 and oxygen saturation were in the normal range. Conclusion In our study, CAs were more often seen in young children related to reduced functional residual capacity and immaturity of chest wall. CAs in REM sleep was seen more often in children with lung disorders and gastroesophageal reflux. CAs associated with arousals/awakenings were seen in conjunction with OSA or periodic limb movement disorder (PLMD). Though a finding of CAs &gt;5/hour is considered significant, the minimum number of events required to cause a specific disorder or syndrome remains elusive and may be different in different patient populations. As such, there is no threshold of the number of central apneas associated with disease. CAs associated with disorders causing reduced or absent respiratory drive are mostly seen in NREM sleep and associated with abnormal gas exchange. The context in which the CAs are seen on PPSGs should be clearly described to avoid confusion among ordering providers. In CAs associated with arousals/awakenings, it is important to target the cause of arousals such as OSA or PLMD. Support None

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