Determinants of CPAP Adherence in Hispanics with Obstructive Sleep Apnea

Purpose. We hypothesized that socioeconomic factors and a language barrier would impact adherence with continuous positive airway pressure (CPAP) among Hispanics with obstructive sleep apnea (OSA).Methods. Patients with OSA who were prescribed CPAP for at least 1 year and completed a questionnaire evaluating demographic data, socioeconomic status, and CPAP knowledge and adherence participated in the study.Results. Seventy-nine patients (26 males;53±11 yrs; body mass index(BMI)=45±9 kg/m2) with apnea-hypopnea index (AHI)33±30events/hr completed the study. Included were 25 Hispanics, 39 African Americans, and 15 Caucasians, with no difference in age, AHI, CPAP use, or BMI between the groups. While there was a difference in educational level (P=0.006), income level (P<0.001), and employment status (P=0.03) between the groups, these did not influence CPAP adherence. Instead, overall improvement in quality of life and health status and perceived benefit from CPAP influenced adherence, both for the group as a whole (P=0.03,P=0.004, andP=0.001, resp.), as well as in Hispanics (P=0.02,P=0.02,P=0.03, resp.).Conclusion. In Hispanic patients with OSA, perceived benefit with therapy, rather than socioeconomic status or a language barrier, appears to be the most important factor in determining CPAP adherence.

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393 Comparison of Oxygenation Abnormalities Between Obstructive Sleep Apnea and Central Sleep Apnea

SLEEP ◽

10.1093/sleep/zsab072.392 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A156-A157

Author(s):

Sikawat Thanaviratananich ◽

Hao Cheng ◽

Maria Pino ◽

Krishna Sundar

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Demographic Data ◽

Central Sleep Apnea ◽

Nrem Sleep ◽

Rate Of Change ◽

Apnea Hypopnea Index ◽

P Value ◽

Obstructive Sleep ◽

Cheyne Stokes Breathing

Abstract Introduction The apnea-hypopnea index (AHI) is used as a generic index to quantify both central sleep apnea (CSA) and obstructive sleep apnea (OSA) syndromes. Patterns of oxygenation abnormalities seen in CSA and OSA may be key to understanding differing clinical impacts of these disorders. Oxygen desaturation and resaturation slopes and durations in OSA and CSA were compared between OSA and CSA patients. Methods Polysomnographic data of patients aged 18 years or older with diagnosis of OSA and CSA, at University of Iowa Hospitals and Clinics, were analyzed and demographic data were collected. Oximetric changes during hypopneas and apneas were studied for desaturation/resaturation durations and desaturation/resaturation slopes. Desaturation and resaturation slopes were calculated as rate of change in oxygen saturation (ΔSpO2/Δtime). Comparison of hypoxemia-based parameters between patients with OSA and CSA was performed using unpaired t-test. Results 32 patients with OSA with median AHI of 15.4 (IQR 5.1 to 30.55) and median ODI of 15.47 (IQR 9.50 to 29.33) were compared to 15 patients with CSA with a median AHI of 20.4 (IQR 12.6 to 47.8) and median ODI of 27.56 (IQR 17.99 to 29.57). The mean number of desaturation and resaturation events was not significantly different between patients with OSA and CSA (OSA - 106.81±87.93; CSA - 130.67±76.88 with a p-value 0.1472). 4/15 CSA patients had Cheyne-Stokes breathing, 2/15 had treatment emergent central sleep apnea, 1/15 had methadone-associated CSA and for 8/15, no etiologies for CSA were found. Mean desaturation durations was significantly longer in OSA (20.84 s ± 5.67) compared to CSA (15.94 s ± 4.54) (p=0.0053) and consequently the desaturation slopes were steeper in CSA than OSA (-0.35%/sec ±0.180 vs. -0.243 ± 0.073; p=0.0064). The resaturation duration was not significantly longer in OSA (9.76 s ± 2.02) than CSA (9.057 s ± 2.17) (p=0.2857). Differences between desaturation duration and slopes between CSA and OSA persisted during REM and NREM sleep, and in supine sleep. Conclusion As compared to OSA, patients with CSA have different patterns of desaturations and resaturations with lesser hypoxic burden with CSA. This may have implications on the clinical outcomes seen between these two disorders. Support (if any):

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Relevance of obstructive sleep apnea and smoking: Obstructive sleep apnea and smoking

Family Practice ◽

10.1093/fampra/cmaa112 ◽

2020 ◽

Author(s):

Ayse Didem Esen ◽

Meltem Akpinar

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Rem Sleep ◽

Demographic Data ◽

Apnea Hypopnea Index ◽

Obstructive Sleep ◽

Study Results ◽

Significant Difference ◽

Study Population ◽

The Impact

Abstract Background The data concerning the association of smoking and obstructive sleep apnea (OSA) are limited. The effects of cigarette smoking on OSA still remain obscure. Objectives To reveal the impact of smoking on obstructive sleep apnea. Methods About 384 patients with the diagnosis of OSA through full night polysomnographic (PSG) examination were included to the study. The demographic data (age, sex and BMI), complaints and medical history, status of smoking as non-smokers and smokers, smoking frequency (cigarettes/day), polysomnograhic data comprising apnea hypopnea index (AHI), non-REM sleep AHI (NREM AHI), REM sleep AHI (REM AHI), minimum oxygen saturation (min SaO2) were recorded for all the subjects. Non-smokers and smokers were compared in terms of severity of OSA. Results The study population consisted of 384 subjects, 253 males and 131 females. Smoking frequency was not found correlated with OSA severity. Among smokers, males had higher severe OSA rate (P = 0.002, P < 0.05). In subjects with BMI < 30, severe OSA rate was higher in smokers (34.44% versus 21%) (P = 0.027, P < 0.05). Conclusions Our study detected higher rate of severe OSA in male smokers and smokers with BMI < 30. PSG data did not yield statistically significant difference in non-smokers and smokers. OSA severity was not found correlated with smoking frequency. Along with the study results, the impact of smoking on OSA is still controversial. Prospective studies with larger sample size may be contributive to further evaluation of the association of OSA with smoking.

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Plasma APRIL as a Potential Biomarker in the Diagnosis of Obstructive Sleep Apnea

10.21203/rs.2.23405/v1 ◽

2020 ◽

Author(s):

Wan-Wan Wen ◽

Hai-Li Sun ◽

Yun-Xiao Yang ◽

Yi-Fan Jia ◽

Meng-Ling Huang ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Plasma Levels ◽

Demographic Data ◽

Venous Blood ◽

Apnea Hypopnea Index ◽

Control Subjects ◽

Inflammatory Pathways ◽

Potential Biomarker ◽

Obstructive Sleep

Abstract Background: Obstructive sleep apnea (OSA) is the most common type of sleep breathing disorder and is characterized by chronic intermittent hypoxia, which could cause inflammation and NF-KB-dependent inflammatory pathways activation. Circulating APRIL might play an important role in promoting inflammation and NF-KB-dependent inflammatory pathways activation. We explored the role of APRIL as a potential mechanism of inflammation in OSA patients. Methods: After detailed sleep evaluated, venous blood and demographic data were collected from 155 subjects with varying severity of OSA and 52 control subjects. Plasma levels of APRIL were measured by human Magnetic Luminex assay. Results: Plasma APRIL levels were significantly higher in OSA subjects compared with control subjects. Categorization of the OSA subjects into mild, moderate, and severe OSA subgroups showed that plasma levels of APRIL increased with severity. After adjusting confounding factors, found that increased plasma APRIL levels were conferred a higher odds ratio (OR) of OSA. Moreover, plasma APRIL levels were positively associated with the apnea-hypopnea index. Furthermore, plasma APRIL showed higher discriminatory accuracy in predicting the presence of OSA. Conclusions:Plasma APRIL levels were significantly associated with the occurrence of OSA and its severity. APRIL could be a plasma biomarker with a positive diagnostic value for inflammation and NF-KB–dependent inflammatory pathways activation in subjects with OSA.

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Improvement in Obstructive Sleep Apnea (OSA) in Super Morbidly Obese Patients After Bariatric Surgery

Journal of the Medical Association of Thailand ◽

10.35755/jmedassocthai.2020.08.10650 ◽

2020 ◽

Vol 103 (8) ◽

pp. 725-728

Keyword(s):

Bariatric Surgery ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Lifestyle Modification ◽

Apnea Hypopnea Index ◽

Morbidly Obese ◽

Obese Patients ◽

Obstructive Sleep ◽

Objective Evidence

Background: Lifestyle modification is the mainstay therapy for obese patients with obstructive sleep apnea (OSA). However, most of these patients are unable to lose the necessary weight, and bariatric surgery (BS) has been proven to be an effective modality in selected cases. Objective: To provide objective evidence that BS can improve OSA severity. Materials and Methods: A prospective study was conducted in super morbidly obese patients (body mass index [BMI] greater than 40 kg/m² or BMI greater than 35 kg/m² with uncontrolled comorbidities) scheduled for BS. Polysomnography (PSG) was performed for preoperative assessment and OSA was treated accordingly. After successful surgery, patients were invited to perform follow-up PSG at 3, 6, and 12 months. Results: Twenty-four patients with a mean age of 35.0±14.0 years were enrolled. After a mean follow-up period of 7.8±3.4 months, the mean BMI, Epworth sleepiness scale (ESS), and apnea-hypopnea index (AHI) significantly decreased from 51.6±8.7 to 38.2±6.8 kg/m² (p<0.001), from 8.7±5.9 to 4.7±3.5 (p=0.003), and from 87.6±38.9 to 28.5±21.5 events/hour (p<0.001), respectively. Conclusion: BS was shown to dramatically improve clinical and sleep parameters in super morbidly obese patients. Keywords: Morbid obesity, Bariatric surgery, Obstructive sleep apnea (OSA)

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Aerodynamics Analysis of the Impact of Nasal Surgery on Patients with Obstructive Sleep Apnea and Nasal Obstruction

ORL ◽

10.1159/000516243 ◽

2021 ◽

pp. 1-8

Author(s):

Lifeng Li ◽

Demin Han ◽

Hongrui Zang ◽

Nyall R. London

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Nasal Obstruction ◽

Upper Airway ◽

Apnea Hypopnea Index ◽

Nasal Surgery ◽

Subjective Sleep Quality ◽

Obstructive Sleep ◽

Significant Difference ◽

The Impact

Objective: The purpose of this study was to evaluate the effects of nasal surgery on airflow characteristics in patients with obstructive sleep apnea (OSA) by comparing the alterations of airflow characteristics within the nasal and palatopharyngeal cavities. Methods: Thirty patients with OSA and nasal obstruction who underwent nasal surgery were enrolled. A pre- and postoperative 3-dimensional model was constructed, and alterations of airflow characteristics were assessed using the method of computational fluid dynamics. The other subjective and objective clinical indices were also assessed. Results: By comparison with the preoperative value, all postoperative subjective symptoms statistically improved (p < 0.05), while the Apnea-Hypopnea Index (AHI) changed little (p = 0.492); the postoperative airflow velocity and pressure in both nasal and palatopharyngeal cavities, nasal and palatopharyngeal pressure differences, and total upper airway resistance statistically decreased (all p < 0.01). A significant difference was derived for correlation between the alteration of simulation metrics with subjective improvements (p < 0.05), except with the AHI (p > 0.05). Conclusion: Nasal surgery can decrease the total resistance of the upper airway and increase the nasal airflow volume and subjective sleep quality in patients with OSA and nasal obstruction. The altered airflow characteristics might contribute to the postoperative reduction of pharyngeal collapse in a subset of OSA patients.

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High Plasma Cystine Levels Are Associated with Blood Pressure and Reversed by CPAP in Patients with Obstructive Sleep Apnea

Journal of Clinical Medicine ◽

10.3390/jcm10071387 ◽

2021 ◽

Vol 10 (7) ◽

pp. 1387

Author(s):

Raphael Boneberg ◽

Anita Pardun ◽

Lena Hannemann ◽

Olaf Hildebrandt ◽

Ulrich Koehler ◽

...

Keyword(s):

Blood Pressure ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Mononuclear Cells ◽

Vascular Risk Factor ◽

High Plasma ◽

Apnea Hypopnea Index ◽

Hypoxic Stress ◽

Peripheral Blood Mononuclear ◽

Obstructive Sleep

Obstructive sleep apnea (OSA) independent of obesity (OBS) imposes severe cardiovascular risk. To what extent plasma cystine concentration (CySS), a novel pro-oxidative vascular risk factor, is increased in OSA with or without OBS is presently unknown. We therefore studied CySS together with the redox state and precursor amino acids of glutathione (GSH) in peripheral blood mononuclear cells (PBMC) in untreated male patients with OSA (apnea-hypopnea-index (AHI) > 15 h−1, n = 28) compared to healthy male controls (n = 25) stratifying for BMI ≥ or < 30 kg m−2. Fifteen OSA patients were reassessed after 3–5-months CPAP. CySS correlated with cumulative time at an O2-saturation <90% (Tu90%) (r = 0.34, p < 0.05) beside BMI (r = 0.58, p < 0.001) and was higher in subjects with “hypoxic stress” (59.4 ± 2.0 vs. 50.1 ± 2.7 µM, p < 0.01) defined as Tu90% ≥ 15.2 min (corresponding to AHI ≥ 15 h−1). Moreover, CySS significantly correlated with systolic (r = 0.32, p < 0.05) and diastolic (r = 0.31, p < 0.05) blood pressure. CPAP significantly lowered CySS along with blood pressure at unchanged BMI. Unexpectedly, GSH antioxidant capacity in PBMC was increased with OSA and reversed with CPAP. Plasma CySS levels are increased with OSA-related hypoxic stress and associated with higher blood pressure. CPAP decreases both CySS and blood pressure. The role of CySS in OSA-related vascular endpoints and their prevention by CPAP warrants further studies.

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Altered K-complex morphology during sustained inspiratory airflow limitation is associated with next-day lapses in vigilance in obstructive sleep apnea

SLEEP ◽

10.1093/sleep/zsab010 ◽

2021 ◽

Author(s):

Ankit Parekh ◽

Korey Kam ◽

Anna E Mullins ◽

Bresne Castillo ◽

Asem Berkalieva ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Spectral Characteristics ◽

Sleep Time ◽

Airflow Limitation ◽

Apnea Hypopnea Index ◽

Complex Morphology ◽

Obstructive Sleep ◽

Inspiratory Airflow Limitation ◽

Psychomotor Vigilance

Abstract Study Objectives Determine if changes in K-complexes associated with sustained inspiratory airflow limitation (SIFL) during N2 sleep are associated with next-day vigilance and objective sleepiness. Methods Data from thirty subjects with moderate-to-severe obstructive sleep apnea who completed three in-lab polysomnograms: diagnostic, on therapeutic continuous positive airway pressure (CPAP), and on suboptimal CPAP (4 cmH2O below optimal titrated CPAP level) were analyzed. Four 20-min psychomotor vigilance tests (PVT) were performed after each PSG, every 2 h. Changes in the proportion of spontaneous K-complexes and spectral characteristics surrounding K-complexes were evaluated for K-complexes associated with both delta (∆SWAK), alpha (∆αK) frequencies. Results Suboptimal CPAP induced SIFL (14.7 (20.9) vs 2.9 (9.2); %total sleep time, p < 0.001) with a small increase in apnea–hypopnea index (AHI3A: 6.5 (7.7) vs 1.9 (2.3); p < 0.01) versus optimal CPAP. K-complex density (num./min of stage N2) was higher on suboptimal CPAP (0.97 ± 0.7 vs 0.65±0.5, #/min, mean ± SD, p < 0.01) above and beyond the effect of age, sex, AHI3A, and duration of SIFL. A decrease in ∆SWAK with suboptimal CPAP was associated with increased PVT lapses and explained 17% of additional variance in PVT lapses. Within-night during suboptimal CPAP K-complexes appeared to alternate between promoting sleep and as arousal surrogates. Electroencephalographic changes were not associated with objective sleepiness. Conclusions Sustained inspiratory airflow limitation is associated with altered K-complex morphology including the increased occurrence of K-complexes with bursts of alpha as arousal surrogates. These findings suggest that sustained inspiratory flow limitation may be associated with nonvisible sleep fragmentation and contribute to increased lapses in vigilance.

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Machine learning for image-based detection of patients with obstructive sleep apnea: an exploratory study

Sleep And Breathing ◽

10.1007/s11325-021-02301-7 ◽

2021 ◽

Author(s):

Satoru Tsuiki ◽

Takuya Nagaoka ◽

Tatsuya Fukuda ◽

Yuki Sakamoto ◽

Fernanda R. Almeida ◽

...

Keyword(s):

Neural Network ◽

Machine Learning ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Convolutional Neural Network ◽

Deep Convolutional Neural Network ◽

Apnea Hypopnea Index ◽

Cephalometric Analysis ◽

Obstructive Sleep ◽

Main Region

Abstract Purpose In 2-dimensional lateral cephalometric radiographs, patients with severe obstructive sleep apnea (OSA) exhibit a more crowded oropharynx in comparison with non-OSA. We tested the hypothesis that machine learning, an application of artificial intelligence (AI), could be used to detect patients with severe OSA based on 2-dimensional images. Methods A deep convolutional neural network was developed (n = 1258; 90%) and tested (n = 131; 10%) using data from 1389 (100%) lateral cephalometric radiographs obtained from individuals diagnosed with severe OSA (n = 867; apnea hypopnea index > 30 events/h sleep) or non-OSA (n = 522; apnea hypopnea index < 5 events/h sleep) at a single center for sleep disorders. Three kinds of data sets were prepared by changing the area of interest using a single image: the original image without any modification (full image), an image containing a facial profile, upper airway, and craniofacial soft/hard tissues (main region), and an image containing part of the occipital region (head only). A radiologist also performed a conventional manual cephalometric analysis of the full image for comparison. Results The sensitivity/specificity was 0.87/0.82 for full image, 0.88/0.75 for main region, 0.71/0.63 for head only, and 0.54/0.80 for the manual analysis. The area under the receiver-operating characteristic curve was the highest for main region 0.92, for full image 0.89, for head only 0.70, and for manual cephalometric analysis 0.75. Conclusions A deep convolutional neural network identified individuals with severe OSA with high accuracy. Future research on this concept using AI and images can be further encouraged when discussing triage of OSA.

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Short-Term HRV Analysis Using Nonparametric Sample Entropy for Obstructive Sleep Apnea

Entropy ◽

10.3390/e23030267 ◽

2021 ◽

Vol 23 (3) ◽

pp. 267

Author(s):

Duan Liang ◽

Shan Wu ◽

Lan Tang ◽

Kaicheng Feng ◽

Guanzheng Liu

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Sample Entropy ◽

Biomedical Signal Processing ◽

Apnea Hypopnea Index ◽

Short Term ◽

Autonomic Nervous System Dysfunction ◽

Obstructive Sleep ◽

Hrv Analysis ◽

Frequency Power

Obstructive sleep apnea (OSA) is associated with reduced heart rate variability (HRV) and autonomic nervous system dysfunction. Sample entropy (SampEn) is commonly used for regularity analysis. However, it has limitations in processing short-term segments of HRV signals due to the extreme dependence of its functional parameters. We used the nonparametric sample entropy (NPSampEn) as a novel index for short-term HRV analysis in the case of OSA. The manuscript included 60 6-h electrocardiogram recordings (20 healthy, 14 mild-moderate OSA, and 26 severe OSA) from the PhysioNet database. The NPSampEn value was compared with the SampEn value and frequency domain indices. The empirical results showed that NPSampEn could better differentiate the three groups (p < 0.01) than the ratio of low frequency power to high frequency power (LF/HF) and SampEn. Moreover, NPSampEn (83.3%) approached a higher OSA screening accuracy than the LF/HF (73.3%) and SampEn (68.3%). Compared with SampEn (|r| = 0.602, p < 0.05), NPSampEn (|r| = 0.756, p < 0.05) had a significantly stronger association with the apnea-hypopnea index (AHI). Hence, NPSampEn can fully overcome the influence of individual differences that are prevalent in biomedical signal processing, and might be useful in processing short-term segments of HRV signal.

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Endothelial dysfunction in obstructive sleep apnea patients

Sleep And Breathing ◽

10.1007/s11325-021-02382-4 ◽

2021 ◽

Author(s):

Michał Harańczyk ◽

Małgorzata Konieczyńska ◽

Wojciech Płazak

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Endothelial Dysfunction ◽

Right Ventricular ◽

Contractile Function ◽

Sleep Apnea Syndrome ◽

Apnea Hypopnea Index ◽

Endothelin 1 ◽

Obstructive Sleep

Abstract Purpose Obstructive sleep apnea syndrome (OSAS) is an independent risk factor for cardiovascular diseases. The aim of the study was to assess the influence of OSAS on endothelial dysfunction and thrombosis biomarkers and to evaluate the effect of treatment with continuous positive airway pressure (CPAP) on biomarker levels. Methods NT-proBNP, sICAM-1, endothelin-1, von Willebrand factor, D-dimers, and thrombin-antithrombin complex (TAT) were measured in 50 patients diagnosed with moderate-to-severe OSAS. All patients underwent transthoracic echocardiography, and 38 months after the inclusion, 16 CPAP users and 22 non-CPAP users were reassessed. Results Sleep-related indices of apnea-hypopnea index (AHI) and mean SpO2 were associated with higher sICAM-1 levels (AHI < 30: 7.3 ± 4.7 vs. AHI ≥ 30: 19.5 ± 19.4 mg/ml, p = 0.04; SpO2 ≥ 90%: 11.9 ± 9.3 vs. SpO2 < 90%: 23.6 ± 25.8, p = 0.04). sICAM-1 levels were significantly higher in obese patients, particularly with BMI ≥ 40. Plasma levels of TAT were significantly correlated with the increased right ventricular size (right ventricular diameter ≤ 37 mm: 0.86 ± 0.70 vs. > 37 mm: 1.96 ± 1.20 ng/ml, p = 0.04). Endothelin-1 levels were higher in patients with decreased right ventricular function (right ventricle TDI-derived S′ ≥ 12 cm/s: 11.5 ± 10.9 vs. < 12 cm/s: 26.0 ± 13.2 pg/ml, p = 0.04). An increase in NT-proBNP was related to impaired parameters of the right ventricular contractile function. There were no correlations between long-term CPAP therapy and the levels of biomarkers. Conclusion Severe OSAS influences endothelial damage as manifested by an increase in sICAM-1 levels. Changes in right ventricular structure and function, observed mainly in patients with higher TAT and endothelin-1 levels, are also manifested by an increase in NT-proBNP levels. Long-term CPAP treatment does not seem to influence biomarkers in patients with moderate-to-severe OSAS, which may help to explain the lack of influence of CPAP on cardiovascular risk reduction.

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