Abstract 17143: Obstructive and Central Sleep Apnea and Risk of Incident Atrial Fibrillation

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Patricia Tung ◽  
Yamini S Levitzky ◽  
Rui Wang ◽  
Stuart F Quan ◽  
Daniel J Gottlieb ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Sleep Apnea ◽  
Central Sleep Apnea ◽  
Health Study ◽  
Apnea Hypopnea Index ◽  
Community Based ◽  
Obstructive Sleep ◽  
History Of

INTRODUCTION: Prior studies have documented a higher prevalence of atrial fibrillation (AF) in those with obstructive sleep apnea (OSA). OSA has been associated with AF recurrence following cardioversion and ablation, and with prevalent and incident AF in cross-sectional and retrospective studies. Central sleep apnea (CSA) also has been associated with AF in patients with heart failure. However, data from prospective cohorts are sparse and few studies have evaluated the association of CSA with AF in population studies. METHODS: We assessed the association of OSA and CSA with incident AF among 3,420 subjects without a history of AF in the Sleep Heart Health Study (SHHS), a prospective, community-based study designed to evaluate the cardiovascular consequences of sleep disordered breathing. Subjects underwent overnight polysomnography at baseline and were followed over time for the development of incident AF, documented at any time after baseline polysomnogram until the end of follow-up. OSA was defined as an obstructive apnea-hypopnea index ≥ 5 and CSA was defined as a central apnea index ≥ 5. RESULTS: At baseline, the sample include 1499 men (44.4%) with a mean age of 62.4 (±10.9); 1569 (45.9%) subjects met criteria for mild to severe OSA and 54 (1.6%) for CSA. Over a mean follow-up of 8.2 years, 382 cases of incident AF were identified. The prevalence of both OSA and CSA was higher among those who developed AF compared to those who did not (OSA 49% vs 44%, p=0.001 and CSA 5% vs 1.2%, p=0.001). After adjustment for multiple AF risk factors, CSA was associated with an approximately 2-fold increased odds of incident AF (RR=2.38, 95% CI, 1.15-4.94; p = 0.02). The association persisted after exclusion of 258 subjects with a history of heart failure (RR=2.78, 95% CI, 1.28-6.04; p = 0.01). We did not find a significant association of OSA with incident AF (Table). CONCLUSION: In our prospective, community-based cohort baseline CSA was associated with incident AF.

Abstract 2360: Central Sleep Apnea with Nocturnal Hypoxia Promotes Increased Circulating Erythropoietin in Heart Failure

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Andrew D Calvin ◽  
Virend K Somers ◽  
Jennifer M Miller ◽  
David P Steensma ◽  
Lyle J Olson
Keyword(s):  
Heart Failure ◽  
Sleep Apnea ◽  
Nyha Class ◽  
Arterial Oxygen Saturation ◽  
Central Sleep Apnea ◽  
Arterial Oxygen ◽  
Apnea Hypopnea Index ◽  
Simple Linear Regression ◽  
Class Iii ◽  
Obstructive Sleep

Central sleep apnea (CSA) with nocturnal hypoxia is frequent in heart failure (HF). Hypoxia causes increased circulating erythropoietin (EPO) in healthy normals. EPO promotes increased vasoconstriction and exogenous EPO administration is associated with adverse cardiovascular events. No prior studies have related EPO concentration to apnea or hypoxia due to CSA. EPO is elevated in HF patients with nocturnal hypoxia due to CSA. Ambulatory, non-anemic HF patients (n = 29) with LVEF < 45% and healthy controls (n = 18) underwent polysomnography (PSG). Subjects with obstructive sleep apnea (OSA) were excluded. CSA was defined as apnea-hypopnea index (AHI) ≥ 15. Hypoxia was quantified as the proportion of sleep with arterial oxygen saturation < 90% (T90%). Blood for EPO was drawn post-PSG. Other clinical characteristics were summarized from the medical record. HF subjects and controls were similar age (54 vs 60 y, p = 0.09). CSA was present in 14 HF subjects; 13 were men compared to 8 of 15 without CSA (p = 0.04). HF subjects had 42% higher mean EPO than controls (p < 0.01) despite similar hemoglobin (13.9 vs 14.0 g/dL, p = 0.8). NYHA class III–IV HF subjects had 42% higher mean EPO than class I–II HF subjects (p = 0.05, figure ). EPO concentration was correlated with severity of nocturnal hypoxia by simple linear regression (r = 0.4; p = 0.02). By multivariate analysis, elevated EPO was associated with NYHA class III–IV HF and elevated AHI (p = 0.01 and 0.03, respectively; r = 0.6) after adjusting for age, gender, LVEF, renal function and hemoglobin. Nocturnal hypoxia due to CSA promotes increased endogenous EPO concentration in HF patients.

scholarly journals Ticagrelor could cause central sleep apnea after acute coronary syndrome in patients without left ventricular dysfunction or heart failure

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Meurin ◽  
A Ben Driss ◽  
C Defrance ◽  
N Renaud ◽  
R Dumaine ◽  
...  
Keyword(s):  
Heart Failure ◽  
Sleep Apnea ◽  
Left Ventricular Dysfunction ◽  
Ventricular Dysfunction ◽  
Central Sleep Apnea ◽  
Left Ventricular ◽  
Sleep Study ◽  
Coronary Syndrome ◽  
Obstructive Sleep ◽  
History Of

Abstract Background Although the prevalence of obstructive sleep apnea (OSA) syndrome is high in patients with acute coronary syndrome (ACS), little is known about central sleep apnea (CSA) in these patients, especially if they have no left ventricular dysfunction (indeed, it is well known that heart failure could be a confounding factor as it is an important cause of CSA). Furthermore, central apnea could be promoted by ticagrelor, a relatively new drug, already known to cause dyspnea (which could modify the apneic threshold) in some patients. Purpose To investigate the prevalence of central sleep apnea in patients without left ventricular dysfunction after ACS. Methods Monocentric prospective survey. All consecutive patients within 365 days after ACS were included if they had (1) left ventricular ejection fraction LVEF &gt;45%, (2) no history of heart failure, (3) systolic arterial pulmonary artery pressure &lt;45 mm Hg, and (4) no history of sleep apnea. After inclusion, patients underwent an overnight sleep study with a portable sleep monitor validated to differentiate central and obstructive apneas. Patients were then classified as “normal” patients if they had an AHI (apnea hypopnea index) &lt;15, “CSA patients” if they had an AHI &gt;15 with a majority of central sleep apneas and “OSA patients” if they had an AHI &gt;15 with a majority of obstructive sleep apneas. Results Between January 2018 and January, 2020, we included 115 consecutive patients (age 56.1±10.5, male 84%, mean body mass index 28.4±4.5, LVEF: 56±4%). Sleep study was performed 68±62 days (7–350 days) after ACS on average. All of the patients were receiving a single or (mostly) dual antiplatelet therapy: aspirin (n=114: 99%, ticagrelor (n=80: 69.5%), clopidogrel (n=28: 24%), prasugrel (n=4: 3.5%). Finally 80 patients were taking ticagrelor, while 35 were not. A total of 49/115 patients (42.6%) had a clinically significant (moderate to severe) sleep disordered breathing, with an AHI&gt;15: (CSA: n=27/115: 23.5%, OSA:n=22/115: 19%). Among them, 25/115 patients (22%) had a severe (AHI &gt;30) sleep disordered breathing: CSA 12% OSA: 10%. Among patients receiving ticagrelor, 24/80 (30%) had a CSA with an AHI &gt;15, while, in patients not taking ticagrelor only 3/35 (8.5%) had CSA with an AHI &gt;15 (p=0.04) Conclusion As expected, OSA is frequent after ACS, as in all types of coronary artery disease patients. High prevalence of CSA was less expected and seemed to be correlated with ticagrelor administration. This monocentric survey is a preliminary safety signal. Further studies are needed to investigate the exact incidence, the sustainability and the potential consequences of ticagrelor induced central sleep apnea. Funding Acknowledgement Type of funding source: None

Abstract 3145: Mortal Interaction of Sleep Apnea with Ischemic, But Not Non-Ischemic Heart Failure

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Dai Yumino ◽  
Hanqiao Wang ◽  
Gary E Newton ◽  
Susanna Mak ◽  
John D Paker ◽  
...  
Keyword(s):  
Heart Failure ◽  
New York ◽  
Sleep Apnea ◽  
Heart Association ◽  
Apnea Hypopnea Index ◽  
Risk Of Death ◽  
Obstructive Sleep ◽  
Increased Risk ◽  
Cox Analysis

Introduction: Past studies showed that in patients with heart failure (HF), sleep apnea (SA) increases mortality risk, but these patients were not characterized on the basis of HF etiology. Hypothesis: Since patients with ischemic HF may suffer greater adverse consequences of SA-related hypoxia and hypertension than those with non-ischemic HF, SA will increase risk of death in patients with ischemic, but not in those with non-ischemic HF. Methods: From 1997 to 2004, consecutive HF patients with ejection fraction (EF) ≤ 45% had sleep studies and were divided into those with SA (apnea-hypopnea index ≥ 15/hr of sleep) and those without SA. They were followed prospectively to determine all-cause mortality rate. Results: Of 218 patients enrolled, follow up data were obtained in 95%. Of these, 87 (40%) had ischemic HF. SA was found in 53% of those with ischemic HF and in 41% of those with non-ischemic HF. 14 patients with obstructive sleep apnea on CPAP therapy were excluded from the analysis. Of the remaining 193 patients, 34 (18%) died during a mean follow up of 32 months. In the non-ischemic HF group, there was no difference in mortality between those with, and those without SA (Figure ). In contrast, in the ischemic group, mortality was significantly higher in those with SA than those without it (18.9 vs. 4.6 deaths/100 patient-years, P = 0.003). After adjusting for age, EF, New York Heart Association class, β-blocker use, and the presence of diabetes using multivariate Cox analysis, SA remained a significant independent risk for death (HR 3.02, 95%CI 1.07– 8.59, P = 0.037). Conclusions: These data show that ischemic etiology identifies those HF patients with SA at increased risk of death.

scholarly journals The Profile of Romanian Patient with Central Sleep Apnea and Heart Failure

2021 ◽  
Vol 18 (5) ◽  
pp. 39-52
Author(s):  
Corina-Ioana Borcea ◽  
Oana Claudia Deleanu ◽  
Florin-Dumitru Mihălţan
Keyword(s):  
Heart Failure ◽  
Risk Factor ◽  
Sleep Apnea ◽  
Central Sleep Apnea ◽  
Apnea Hypopnea Index ◽  
High Morbidity ◽  
Respiratory Disorder ◽  
Patient Profile ◽  
Obstructive Sleep

Abstract Sleep-related breathing disorders are highly prevalent in patients with established cardiovascular disease, especially Heart failure (HF). Central sleep apnea (CSAS) share several pathophysiological features with obstructive sleep apnea, but each with a unique pathology and specific treatment. There are considerably fewer published patient profile reports in association with CSAS-HF. The treatment for association CSAS-HF varies and depends on the etiology of respiratory disorder and leaves considerable room for improvement for future investigations. Despite progress over the last 3 decades, HF continues to have high morbidity and mortality rates. At this time, it is also uncertain whether CSAS is a consequence of HF with reduced ejection fraction or it is in fact a risk factor for the evolution of underlying cardiac pathology. Therefore, this retrospective study highlights the interaction between CSA and HF, with particular attention to age differences, a frequent reported risk factor, in a Romanian large cohort. Were included adults > 18 years old, with sleep apnea syndrome (apnea-hypopnea index-AHI>5 per hour of sleep with at least 50% of central on polygraphy-PG and after on polysomnographic-PSGsleep study) in the presence of sleep symptoms, with known HF with preserved LVEF (>40%) in a previous internal/cardiology department. Were excluded those < 18years old, with other sleep apneas (obstructive, mixed or complex), other sleep disorders (by PSG), inadequate PSG records,or patient refusal. Anthropometric data, clinical findings, vital parameters, comorbidities, treatments and investigations (see below) were analyzed in the population and also in subgroups. The majority of this study population (12 patients) were male, older, with normal weight, symptomatic and comorbidities. As many as 90% of the patients presented severe CSAS and 77.8% associated Cheyne–Stokes respiration (CSR). The comparative analysis of the subgroups in which according to the literature the associated pathologies manifest differently showed that there have not been noted major differences or statistically significant correlation between these two groups and cardiac outcomes.Still, in the group over 65 years we found that people were more predisposed to suffer from high BP, judging by the elevated level of the systolic blood pressure value, and another relevant comorbidities were atrial fibrillation, had more apneas and hypopneas during sleep and severe CSA were the most common. Following titration, AHI, central apnea index, desaturation index decreased with clinically significant. This study appeals to the importance of sleep health, an even more important aspect for Romania, where this associations underreported and even unrecognized, and thus the general condition of patients can worsen. Further research, based on other criteria of difference, is needed as the evidence is still lacking regarding the long-term consequences of CSA and long-term impact of current strategies in HF population.

scholarly journals 0622 In-Depth Surveillance of Central Sleep Apnea in Patients with Stable Heart Failure

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A238-A238
Author(s):  
S Ibrahim ◽  
R Wharton ◽  
E Harmon ◽  
H Bonner ◽  
E Davis ◽  
...  
Keyword(s):  
Heart Failure ◽  
Multivariate Analysis ◽  
Sleep Apnea ◽  
Medical Therapy ◽  
Systolic Dysfunction ◽  
Central Sleep Apnea ◽  
Optimal Medical Therapy ◽  
Control Group ◽  
Apnea Hypopnea Index ◽  
Obstructive Sleep

Abstract Introduction Central sleep apnea (CSA) is unique sleep breathing phenotype in patients with advanced chronic heart failure (HF) and portend poor prognosis. The prevalence of CSA in HF patients under contemporary therapy is uncertain. Methods We reviewed consecutive HF patients on optimal medical therapy who underwent clinically indicated diagnostic in-lab polysomnography at a single academic center. Age, sex and BMI matched patients without HF were selected from sleep clinic as a control. Patients with atrial fibrillation were excluded from this study. Apnea subtypes were determined after careful scoring and confirmation by sleep physicians. ‘Any CSA’ was defined by central apnea index (CAI) &gt;5 and &gt;1/hr. ‘True CSA’ was defined if met both CAI≥5/hr and &gt; obstructive apnea index (OAI). Obstructive sleep apnea (OSA) was defined if apnea hypopnea index &gt;15 and OAI&gt;CAI. Multivariate analysis was performed using logistic regression adjusting for age, sex, HF and systolic dysfunction as appropriate. Results In patients with HF (N=95, mean age 59, female: 50%), CSA was low and was comparable to control group (N=94) (HF vs. Non-HF; CSA: 5.3 vs. 4.3%, P=NS; Any CSA 14.7 vs. 17%, P=NS). Only 3 patients with HF had true CSA. In contrast, OSA was common in both groups regardless of obesity status (52.3 vs. 55.3%). In patients with HF, Cheyne Stokes respiration was more frequent in patients with Any CSA vs. without Any CSA (13.3 vs. 3.8%, p=0.04). In multivariate analysis, presence of OSA, but not HF, was associated with Any CSA in entire cohort (Any CSA OR: 3.1 [1.3, 8.1], p=0.02). In patients with HF, male sex was associated with Any CSA (OR: 5.3 [1.1, 40.8], p=0.05). Exclusion of patients with high BMI did not change the results. Conclusion CSA was rare in patients with stable HF on contemporary optimal medical therapy. Support None

scholarly journals 1226 A Case of Hypoglossal Nerve Stimulation Induced Cheyne-Stoke Central Sleep Apnea

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A468-A468
Author(s):  
Talayeh Rezayat ◽  
Melisa Chang
Keyword(s):  
Heart Failure ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Nerve Stimulation ◽  
Hypoglossal Nerve ◽  
Central Sleep Apnea ◽  
Nerve Stimulator ◽  
Hypoglossal Nerve Stimulation ◽  
Obstructive Sleep ◽  
History Of

Abstract Introduction Treatment of obstructive sleep apnea (OSA) with positive airway pressure (PAP), mandibular advancement devices (MAD) and oral surgery have been reported to lead to emergent central sleep apnea (CSA). In this case report the emergence of CSA in a Cheyne-Stokes pattern following the use of hypoglossal nerve stimulator as a treatment modality for OSA is discussed. Report of Case A 70-year-old man with a history of hypothyroidism and severe OSA diagnosed via a home sleep apnea test with a respiratory event index (REI) of 38 events/ hr was intolerant of PAP therapy and an MAD did not effectively treat his OSA. He was deemed an appropriate candidate for hypoglossal nerve stimulation following a drug induced sleep endoscopy. Following implantation and activation, he developed a lip droop and was ruled out for a stroke. A polysomnogram was completed which showed significant improvement in his sleep apnea at a voltage range of 1.4-17V. At 1.8V he developed REM- supine central events. When the voltage was further increased to 1.9-2.0V non-REM supine central events arose. These events appeared to have Cheyne-Stoke morphology with a cycle duration of over 50s. He was set to an amplitude of 1.6 V with a positional belt for treatment of his OSA without any emergent CSA. Conclusion This patient developed central sleep apneas with Cheyne-Stoke morphology following treatment of obstructive sleep apnea using a hypoglossal nerve stimulator. The central events began at higher voltage settings (greater than 1.8V). He had no history of heart failure or arrhythmias. This higher voltage may lead to overshoot of the tongue out of the airway resulting in hyperpnea, hypocapnia and central apnea but the underlying pathophysiology for the Cheyne-Stoke pattern in the absence of heart failure remains unknown.

scholarly journals 1234 Constrictive Pericarditis, an unlikely cause of Central Sleep Apnea

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A471-A471
Keyword(s):  
Heart Failure ◽  
Sleep Apnea ◽  
Constrictive Pericarditis ◽  
Systolic Function ◽  
Nyha Class ◽  
Central Sleep Apnea ◽  
Apnea Hypopnea Index ◽  
Heart Catheterization ◽  
Post Discharge ◽  
Obstructive Sleep

Abstract Introduction Central sleep apnea (CSA) and Cheyne stokes respiration (CSR) is a well-recognized complication of heart failure across multiple New York Heart Association functional classes. We present a case of CSA associated with constrictive pericarditis and normal systolic function. Report of Case 43-year-old male with past medical history of severe obstructive sleep apnea noted to have high residual apnea-hypopnea index (AHi) while using automatic continuous positive airway pressure, suspected to be central events. The patient also had progressive dyspnea on exertion, chest pain, and bilateral transudative pleural effusions. Pulmonary function testing was normal. He underwent a split night PSG which demonstrated severe OSA with AHi 81/hour during baseline. With CPAP titration, AHi was 30/hr, with predominately central events. Transthoracic echocardiogram demonstrated reduced stroke volume (LVOT VTI .085), dilated IVC, and EF 55%, septa! bounce, and annulus reversus (possible constriction). Right and left heart catheterization showed equalization of the diastolic pressures (RA 35 mm Hg, RV 48/30, PA 49/30, PCWP 29, Cl 1.6, SVR 1118 dynes, PVR 216 dynes), no coronary disease, and codominant system. Technetium 99 pyrophosphate scan demonstrated symmetric uptake in left and right ventricles, but abnormal thickening of pericardium suspicious for constrictive pericarditis. His symptoms progressed despite aggressive medical therapy and he was ultimately taken to surgery for pericardiectomy where it was noted his pericardium was extremely thickened and densely adhered to the myocardium, consistent with constrictive pericarditis. There was immediate improvement in hemodynamic status post-operatively. At post discharge follow up, he was NYHA class I, with resolution of all signs of heart failure. Repeat polysomnogram demonstrated persistent OSA, but resolution of CSA at baseline and with CPAP. Conclusion Constrictive pericarditis has not previously been reported as a cause of CSA or CSR. This patient had complete resolution of his heart failure symptoms with definitive resection of his pericardium.

396 Ethnicity modifies the association between central sleep apnea and atrial fibrillation in older men: Kuakini HAAS and Mr.OS

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A157-A158
Author(s):  
Tagayasu Anzai ◽  
Andrew Grandinetti ◽  
Alan Katz ◽  
Eric Hurwitz ◽  
Yan Yan Wu ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sleep Apnea ◽  
Central Sleep Apnea ◽  
Older Men ◽  
Respiratory Pattern ◽  
Apnea Hypopnea Index ◽  
Japanese American ◽  
Sleep Study ◽  
Obstructive Sleep ◽  
The Impact

Abstract Introduction Several studies indicated there is an association between central sleep apnea (CSA) and atrial fibrillation (AF) in older populations. However, few studies assessed the impact of ethnicity on the association. We assessed the hypothesis that ethnicity modifies the association between CSA and AF in older men. Methods We did a cross-sectional analysis using two population studies of Japanese-American (JA) and White-American (WA) men. The Kuakini Honolulu-Asia Aging Study (HAAS) is a longitudinal cohort study of JA men living in Hawaii. Sleep data were collected between 1999–2000. The Osteoporotic Fractures in Men (Mr.OS) Sleep Study was conducted between 2003–2005 on the continental U.S. The majority of Mr.OS participants were WA. We selected 79–90 year old males, who had overnight polysomnography from both studies. Total participants were 690 JA and 871 WA men. Obstructive apnea-hypopnea index (OAHI) was the measure of the number of obstructive apneas and hypopneas with &gt;4% oxygen desaturation. Additionally, the central apnea index (CAI) was the measure of the number of central apneas. Obstructive sleep apnea (OSA) was categorized as none (OAHI &lt;5), mild (OAHI 5–14), moderate (OAHI 15–29), and severe (OAHI&gt;=30). CSA was defined by CAI&gt;=5. Cheyne-Stokes breathing (CSB) was defined as a minimum consecutive 5–10 minute period of a crescendo-decrescendo respiratory pattern associated with CSA. A board-certified physician confirmed AF by single lead electrocardiography of polysomnography. Results The prevalence of AF was 5.7% in JA and 9.1% in WA. The prevalence of CSA and CSB in WA were higher than in JA (11.5% vs 6.5% and 5.7% vs 3.3%, respectively). Conversely, the prevalence of severe OSA in JA (20.7%) was higher than in WA (11.8%). In multivariable-adjusted logistic regression models, CSA was associated with higher odds of AF, and the association was stronger in JA [Odds Ratio (OR)=4.77, 95% confidence interval (CI): 1.95–11.64] than in WA (OR=2.05, 95% CI: 1.07–3.94). CSB showed similar trends as CSA. In contrast, the severity of OSA was not significantly associated with AF in either ethnicity. Conclusion Ethnicity modifies the association between CSA and AF. In older JA and WA men, screening for CSA might be important to prevent AF. Support (if any):

scholarly journals Combination of Obstructive and Central Sleep Apnea as a Non-Sleepy Phenotype of Obstructive Sleep Apnea (OSA): A Case Report and Literature Review

2021 ◽  
Author(s):  
Ayeh Shamsadini ◽  
Somayeh Bagheri-Kelayeh
Keyword(s):  
Obstructive Sleep Apnea ◽  
Case Report ◽  
Sleep Apnea ◽  
Central Sleep Apnea ◽  
Poor Quality ◽  
Apnea Hypopnea Index ◽  
Obstructive Sleep ◽  
History Of ◽  
Sleep Talking ◽  
Audio Video

Background and Objective: Co-occurring central sleep apnea (CSA) and obstructive sleep apnea (OSA) are a developing apprehension because many patients referred to sleep studies have co-morbidities such as cardiovascular and/or neurological disorders which increase the possibility of central and obstructive episodes. Here, we report a patient without excessive daytime sleepiness and a combination of CSA and OSA. Case Report: We present a 16-year-old boy with a history of snoring, poor quality of sleep, nightmare, sleep walking, and sleep talking since he was two-years old. His STOP-Bang score was 7. Standard attended polysomnography (PSG) with audio-video monitoring was performed. The PSG results contained Apnea Hypopnea Index (AHI): 30.2 (number of OSAs was 50 and number of CSAs was 49 during sleep). Then, a titration study was performed and continuous positive airway pressure (CPAP) setting as low as eight cmH2O was effective in eliminating obstructive events, but there was emerging CSAs in favour of Treatment Emergent CSA (TCSA). Conclusion: This case represents a non-sleepy phenotype of OSA in combination with many CSAs in PSG. We suggest that further studies be performed on the association between the concomitant presence of CSA and OSA among nonsleepy patients with OSA.

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

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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