Association between Plasma Homocysteine Concentrations and the First Ischemic Stroke in Hypertensive Patients with Obstructive Sleep Apnea: A 7-Year Retrospective Cohort Study from China

Purpose. This study was aimed at investigating the association between baseline plasma homocysteine (Hcy) concentrations and the risk of the first ischemic stroke (IS) and at investigating any possible influential modifying factors in hypertensive patients with obstructive sleep apnea (OSA). Methods. Cox proportional hazards regression was employed to investigate the relationship between plasma Hcy concentration and the first IS. A generalized additive model was applied to determine the nonlinear relationship. In addition, we conducted subgroup analysis. Results. A total of 2350 hypertensive patients with OSA without a history of IS were enrolled in this study. At a median follow-up of 7.15 years, we identified 93 cases of the first IS. After adjusting for potential confounding, the findings revealed that plasma Hcy concentration was strongly and positively associated with the occurrence of the first IS (per SD increment; HR = 1.37 , 95% CI: 1.30-1.44). A nonlinear relationship was found between plasma Hcy concentration and the risk of developing the first IS with inflection points for plasma Hcy of 5 μmol/L. In stratified analysis, a greater positive correlation was found between baseline plasma Hcy concentrations and new-onset IS in patients with DBP ≥ 90 mmHg (per SD increment; HR = 1.48 , 95% CI: 1.33-1.65 vs. <90 mmHg: HR = 1.20 , 95% CI: 1.02-1.42; P ‐ interaction = 0.04 ) and BMI ≥ 24 and <28 kg/m2 (per SD increment; HR = 1.46 , 95% CI: 1.26-1.70 vs. <24 kg/m2: HR = 1.13 , 95% CI: 0.95-1.33 vs. ≥28 kg/m2: HR = 1.46 , 95% CI: 1.25-1.70; P ‐ interaction = 0.03 ). Conclusion. Elevated plasma Hcy concentrations are independently associated with the risk of the first IS in hypertensive patients with OSA. Plasma Hcy concentrations ≥ 5 μ mol / L surely increased the risk of the first IS in hypertensive patients with OSA.

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Assessment of Obstructive Sleep Apnea-Related Sleep Fragmentation Utilizing Deep Learning-Based Sleep Staging from Photoplethysmography

SLEEP ◽

10.1093/sleep/zsab142 ◽

2021 ◽

Author(s):

R Huttunen ◽

T Leppänen ◽

B Duce ◽

A Oksenberg ◽

S Myllymaa ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Deep Learning ◽

Sleep Apnea ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Sleep Fragmentation ◽

Sleep Staging ◽

Hazard Ratios ◽

Obstructive Sleep ◽

The Relationship

Abstract Study Objectives To assess the relationship between obstructive sleep apnea (OSA) severity and sleep fragmentation, accurate differentiation between sleep and wakefulness is needed. Sleep staging is usually performed manually using electroencephalography (EEG). This is time-consuming due to complexity of EEG setup and the amount of work in manual scoring. In this study, we aimed to develop an automated deep learning-based solution to assess OSA-related sleep fragmentation based on photoplethysmography (PPG)-signal. Methods A combination of convolutional and recurrent neural networks was used for PPG-based sleep staging. The models were trained using two large clinical datasets from Israel (n=2149) and Australia (n=877) and tested separately on three-class (wake/NREM/REM), four-class (wake/N1+N2/N3/REM), and five-class (wake/N1/N2/N3/REM) classification. The relationship between OSA severity categories and sleep fragmentation was assessed using survival analysis of mean continuous sleep. Overlapping PPG epochs were applied to artificially obtain denser hypnograms for better identification of fragmented sleep. Results Automatic PPG-based sleep staging showed accuracy of 83.3% on three-class, 74.1% on four-class, and 68.7% on five-class models. The hazard ratios for decreased mean continuous sleep compared to the non-OSA group obtained with Cox proportional hazards models with 5-second epoch-to-epoch intervals were 1.70, 3.30, and 8.11 for mild, moderate, and severe OSA, respectively. With manually scored EEG-based hypnograms, the corresponding hazard ratios were 1.18, 1.78, and 2.90. Conclusions PPG-based automatic sleep staging can be used to differentiate between OSA severity categories based on sleep continuity. The differences between the OSA severity categories become more apparent when a shorter epoch-to-epoch interval is used.

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0571 Repolarization Variability Predicts Cardiovascular Death in Obstructive Sleep Apnea

SLEEP ◽

10.1093/sleep/zsaa056.568 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A219-A219

Author(s):

S I Patel ◽

W Zareba ◽

J Couderc ◽

X Xia ◽

B LaFleur ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Proportional Hazards ◽

Area Under The Curve ◽

Cox Proportional Hazards ◽

Health Study ◽

P Value ◽

Obstructive Sleep ◽

Increased Risk ◽

Qt Variability

Abstract Introduction Patients with untreated obstructive sleep apnea (OSA) have a 2-3—fold increased risk of cardiovascular mortality (CVD) compared with individuals without OSA. QTc prolongation and increased QT variability among OSA patients may contribute to this association. Methods Patients with OSA from the Sleep Heart Health study were identified based on polysomnography criteria and their continuous electrocardiograms (ECG) analyzed for QTc duration and QT variability. Both Fridericia’s and Bazett’s heart rate corrections were used to calculate QTc. QT variability was measured as standard deviation of QT intervals (SDQT) and normalized QT interval variance (QTVN) at 1- and 5-minute intervals and short-term interval beat-to-beat QT variability (STVQT) was measured at 5-minute intervals. Lasso with elastic-net regularization was used as the variable/covariate selection method. Cox proportional hazards regression models were used to determine predictors of CVD. Results Data from 365 patients with OSA were screened. Ninety-seven patients were excluded from analysis due to low quality ECG data (n=50) or extremely high (> ln (10)) variability in QT/QTc and/or QT variability (n=12). Fifty two percent of the sample was male with mean age 65 years (±10). Fifty-six of these patients died of CVD. The mean (SD) QTc in the group that died was 411 (30) ms and 416 (34) ms compared to 406 (24) ms and 411 (25) ms using Fridericia (Cox LR p-value 0.055) and Bazett (p=0.090), respectively. Gender, age, race, diabetes, SDQT and STVQT were significant predictors for CVD. We fit models with the covariates and SDQT (at both 1 and 5 min) and STVQT as three models and demonstrate that both SDQT and STVQT are significantly associated with CVD death (p-values of 0.0048, 0.0089, and 0.0113, respectively) and all models had high area under the curve (0.8095, 0.8085, and 0.8125, respectively). Conclusion In patients with OSA, QT variability was associated with CVD. Support American Academy of Sleep Medicine Foundation

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Effects of continuous positive airway pressure on blood pressure in hypertensive patients with obstructive sleep apnea

Journal of Hypertension ◽

10.1097/hjh.0b013e32835bdcda ◽

2013 ◽

Vol 31 (2) ◽

pp. 352-360 ◽

Cited By ~ 22

Author(s):

Alexandros Kasiakogias ◽

Costas Tsioufis ◽

Costas Thomopoulos ◽

Dimitrios Aragiannis ◽

Manos Alchanatis ◽

...

Keyword(s):

Blood Pressure ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Continuous Positive Airway Pressure ◽

Airway Pressure ◽

Positive Airway Pressure ◽

Hypertensive Patients ◽

Obstructive Sleep

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Diastolic dysfunction in controlled hypertensive patients with mild–moderate obstructive sleep apnea

International Journal of Cardiology ◽

10.1016/j.ijcard.2015.02.037 ◽

2015 ◽

Vol 187 ◽

pp. 686-692 ◽

Cited By ~ 11

Author(s):

Elisabetta Lisi ◽

Andrea Faini ◽

Grzegorz Bilo ◽

Laura Maria Lonati ◽

Miriam Revera ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Diastolic Dysfunction ◽

Hypertensive Patients ◽

Obstructive Sleep

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Obstructive sleep apnea syndrome and sleep quality in hypertensive patients

Revista da Associação Médica Brasileira ◽

10.1590/1806-9282.63.12.1055 ◽

2017 ◽

Vol 63 (12) ◽

pp. 1055-1060 ◽

Cited By ~ 3

Author(s):

Marcelo Rodrigues Bacci ◽

Jonathan Naim Mora Emboz ◽

Beatriz da Costa Aguiar Alves ◽

Glaucia Luciano da Veiga ◽

Neif Murad ◽

...

Keyword(s):

Blood Pressure ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Sleep Quality ◽

High Blood Pressure ◽

Antihypertensive Drugs ◽

Poor Sleep ◽

Hypertensive Patients ◽

Group I ◽

Obstructive Sleep

Summary Introduction: Obstructive sleep apnea and hypopnea syndrome (OSAHS) is one of the developmental factors of high blood pressure (HBP), a relevant global public health problem. OSAHS is characterized by the reduction or complete cessation of respiratory airflow due to intermittent airway collapse. Additionally, significant changes in sleep rhythm and pattern are observed in these patients. Objective: To evaluate the association between OSAHS and sleep quality in essential and resistant hypertensives. Method: A cross-sectional, observational study evaluated 43 hypertensive patients treated at the outpatient clinics of the Faculdade de Medicina do ABC (FMABC) who were medicated with two or more antihypertensive drugs and divided into nonresistant or resistant to treatment. Results: Group I (using up to two antihypertensive agents – 60.47% of the sample) presented mean systolic blood pressure (SBP) of 127.5±6.4 mmHg, mean diastolic blood pressure (DBP) of 79.6±5.2 mmHg, mean body mass index (BMI) of 27.2±5.3 kg/m2 and mean age of 51.2±15.1 years. Group II (using more than two antihypertensive drugs – 37.2% of the sample) presented mean SBP of 132.1±9.3 mmHg, mean DBP of 84.5±5.8 mmHg, mean BMI of 27.2±7.2 kg/m2 and mean age of 55.5±13.4 years. The patients presented low quality of sleep/sleep disorder evaluated by the Pittsburgh Sleep Quality Index (PSQI), which represents a preponderant factor for OSAHS. Conclusion: Patients at high risk for OSAHS had poor sleep quality and high levels of DBP, suggesting a causal relation between these parameters. However, they did not present a higher prevalence of resistant high blood pressure (RHBP).

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Abstract TP221: Using Berlin Questionnaire and Epworth Sleepiness Scale to Identify Stroke Patients at Risk for the Sleep Apnea Syndrome

Stroke ◽

10.1161/str.44.suppl_1.atp221 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Millene Camilo ◽

Alan Eckeli ◽

Heidi Sander ◽

Regina Fernandes ◽

Joao Leite ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Ischemic Stroke ◽

Sleep Apnea ◽

Positive Predictive Value ◽

Negative Predictive Value ◽

Predictive Value ◽

Epworth Sleepiness Scale ◽

Berlin Questionnaire ◽

Stroke Patients ◽

Obstructive Sleep

Background: Sleep-disordered breathing (SDB) is frequent in the acute phase of stroke. Obstructive sleep apnea (OSA) has been found in 62% of stroke patients. The impact of OSA is significant after ischemic stroke, including early neurological deterioration, poor functional outcome and increased long-term mortality. However, performing polysomnography (PSG) for all patients with acute stroke for diagnose OSA is still impracticable. Therefore clinical tools to select patients at higher risk for OSA would be essential. The aim of this study was to determine the validity of the Berlin Questionnaire (BQ) and the Epworth Sleepiness Scale (ESS) to identify stroke patients in whom the PSG would be indicated. Methods: Subjects with ischemic stroke were stratified into high and low risk groups for SDB using a BQ. The ESS ≥ 10 was used to define excessive daytime sleepiness. The BQ and ESS were administered to the relatives of stroke patients at hospital admission. All patients were submitted to a full overnight PSG at the first night after symptoms onset. OSA severity was measured by the apnea-hypopnea index (AHI). Results: We prospectively studied 40 ischemic stroke patients. The mean age was 62 ± 12.1 years and the obstructive sleep apnea (AHI ≥ 15) was present in 67.5%. On stratifying risk of OSA in these patients based on the QB, 77.5% belonged to the high-risk and 50% to the ESS ≥ 10. The sensitivity of QB was 85%, the specificity 35%, the positive predictive value 74% and the negative predictive value 55%. For ESS was respectively 63%, 85%, 89% and 52%. The diagnostic value of the BQ and ESS in combination to predict OSA had a sensitivity of 58%, a specificity of 89%, a positive predictive value of 95% and a negative predictive value of 38%. Conclusions: The QB even applied to the bed-partners of stroke patients is a useful screening tool for OSA.

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