Abstract P544: Sleep Apnea Severity is More Strongly Associated With Cardiovascular Health Than a Composite Measure of Sleep Health in Adults With Sleep Apnea and Diabetes

Introduction: Sleep health is multi-dimensional. The RSATED Sleep Health composite score, hereafter referred to as RSATED, includes regularity, satisfaction, alertness, timing, efficiency, and duration. RSATED has been associated with cardiovascular (CV) health in a nationally representative sample. However, the association between RSATED and CV health in adults with obstructive sleep apnea (OSA) and type 2 diabetes mellitus (T2DM) have not been examined. Purpose: This secondary analysis examined the associations between RSATED and CV health measures including body mass index (BMI), lipid levels, and physical activity. Methods: We used baseline data from the Diabetes Sleep Treatment Trial, a randomized controlled trial that examined if adults with co-existing OSA and T2DM treated with continuous positive airway pressure had better glycemic control compared to participants that received a non-therapeutic treatment. Data collected included questionnaires, anthropometric measurements, a lipid panel, objective physical activity (PA) data (BodyMedia), apnea-hypopnea index (AHI; ApneaLink Pro), and a modified Consensus Sleep Diary. RSATED was calculated using up to 7 days of sleep data and Epworth Sleepiness Scale (ESS). Individual components were given a score of 0 or 1 with 1 representing “good” sleep. “Good” sleep was defined as: >80% of awakenings occurring during the same time range (regularity); mean sleep quality of “good” or “very good” (satisfaction); ESS total score ≤10 (alertness); >80% of sleep midpoint occurring between 2-4 am (timing); sleep efficiency ≥85% (efficiency); and mean sleep duration of 7-9 hrs/night (duration). The total score could range from 0-6; higher scores represented better sleep. The associations between RSATED and CV health measures were examined using linear regression models. All models were adjusted for AHI, marital status, race, age, and education. Results: A total of 350 individuals underwent screening. Of the 253 participants with complete data, the majority were female (52.2%) and white (54.2%) with a mean (± SD) age of 56.6 ± 10.5 yrs, BMI of 34.2 ± 7.1, and AHI of 14.1 ± 15.1. Mean RSATED was 2.8 ± 1.2 (range 0-5). The RSATED score was not associated with any of the CV health measures. However, there was a trend for significance for better sleep health to be associated with greater vigorous PA (b = 0.46, p = .08). Whereas, greater AHI was associated with higher BMI, higher total cholesterol, greater sedentary time, and less moderate- and vigorous-intensity PA (p-values from .05 to <.0001). Conclusions: Among adults with co-existing OSA and T2DM, AHI was more strongly associated with measures of CV health than RSATED. While sleep health is essential, the underlying impact of OSA on CV health and its treatment should remain a priority. Future studies should continue to examine the associations between sleep health and other measures of health and wellness.

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Subjective and Objective Appraisal of Activity in Adults with Obstructive Sleep Apnea

Journal of Aging Research ◽

10.4061/2011/751819 ◽

2011 ◽

Vol 2011 ◽

pp. 1-6 ◽

Cited By ~ 19

Author(s):

Eileen R. Chasens ◽

Susan M. Sereika ◽

Martin P. Houze ◽

Patrick J. Strollo

Keyword(s):

Physical Activity ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Epworth Sleepiness Scale ◽

Functional Outcomes ◽

Apnea Hypopnea Index ◽

Sleep Study ◽

Obstructive Sleep ◽

Subjective Sleepiness ◽

Aging Adults

Objective.This study examined the association between obstructive sleep apnea (OSA), daytime sleepiness, functional activity, and objective physical activity.Setting.Subjects (N=37) being evaluated for OSA were recruited from a sleep clinic.Participants. The sample was balanced by gender (53% male), middle-aged, primarily White, and overweight or obese with a mean BMI of 33.98 (SD=7.35;median BMI=32.30). Over 40% reported subjective sleepiness (Epworth Sleepiness Scale (ESS) ≥10) and had OSA (78% with apnea + hypopnea index (AHI) ≥5/hr).Measurements.Evaluation included questionnaires to evaluate subjective sleepiness (Epworth Sleepiness Scale (ESS)) and functional outcomes (Functional Outcomes of Sleep Questionnaire (FOSQ)), an activity monitor, and an overnight sleep study to determine OSA severity.Results.Increased subjective sleepiness was significantly associated with lower scores on the FOSQ but not with average number of steps walked per day. A multiple regression analysis showed that higher AHI values were significantly associated with lower average number of steps walked per day after controlling patient's age, sex, and ESS.Conclusion.Subjective sleepiness was associated with perceived difficulty in activity but not with objectively measured activity. However, OSA severity was associated with decreased objective physical activity in aging adults.

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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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Analysis of nocturnal desaturation waveforms using algorithms in patients with idiopathic pulmonary fibrosis

Sleep And Breathing ◽

10.1007/s11325-021-02456-3 ◽

2021 ◽

Author(s):

Yuichiro Yasuda ◽

Tatsuya Nagano ◽

Shintaro Izumi ◽

Mina Yasuda ◽

Kosuke Tsuruno ◽

...

Keyword(s):

Sleep Apnea ◽

Idiopathic Pulmonary Fibrosis ◽

Pulmonary Fibrosis ◽

Diagnostic Algorithm ◽

Sleep Time ◽

Periodic Pattern ◽

Apnea Hypopnea Index ◽

Apnea Test ◽

Eligibility Criteria ◽

Obstructive Sleep

Abstract Purpose Sleep-disordered breathing is recognized as a comorbidity in patients with idiopathic pulmonary fibrosis (IPF). Among them, nocturnal hypoxemia has been reported to be associated with poor prognosis and disease progression. We developed a diagnostic algorithm to classify nocturnal desaturation from percutaneous oxygen saturation (SpO2) waveform patterns: sustained pattern, periodic pattern, and intermittent pattern. We then investigated the prevalence of nocturnal desaturation and the association between the waveform patterns of nocturnal desaturation and clinical findings of patients with IPF. Methods We prospectively enrolled patients with IPF from seven general hospitals between April 2017 and March 2020 and measured nocturnal SpO2 and nasal airflow by using a home sleep apnea test. An algorithm was used to classify the types of nocturnal desaturation. We evaluated the association between sleep or clinical parameters and each waveform pattern of nocturnal desaturation. Results Among 60 patients (47 men) who met the eligibility criteria, there were 3 cases with the sustained pattern, 49 cases with the periodic pattern, and 41 cases with the intermittent pattern. Lowest SpO2 during sleep and total sleep time spent with SpO2 < 90% were associated with the sustained pattern, and apnea–hypopnea index was associated with the intermittent pattern. Conclusion We demonstrated the prevalence of each waveform and association between each waveform and sleep parameters in patients with IPF. This classification algorithm may be useful to predict the degree of hypoxemia or the complication of obstructive sleep apnea.

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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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Snoring: a source of noise pollution and sleep apnea predictor

SLEEP ◽

10.1093/sleep/zsz305 ◽

2019 ◽

Vol 43 (6) ◽

Cited By ~ 4

Author(s):

Mudiaga Sowho ◽

Francis Sgambati ◽

Michelle Guzman ◽

Hartmut Schneider ◽

Alan Schwartz

Keyword(s):

Sleep Apnea ◽

Operating Characteristic ◽

Area Under The Curve ◽

Noise Pollution ◽

Apnea Hypopnea Index ◽

Sleep Study ◽

Sound Levels ◽

Obstructive Sleep ◽

Single Night ◽

The Relationship

Abstract Snoring is a highly prevalent condition associated with obstructive sleep apnea (OSA) and sleep disturbance in bed partners. Objective measurements of snoring in the community, however, are limited. The present study was designed to measure sound levels produced by self-reported habitual snorers in a single night. Snorers were excluded if they reported nocturnal gasping or had severe obesity (BMI > 35 kg/m2). Sound was measured by a monitor mounted 65 cm over the head of the bed on an overnight sleep study. Snoring was defined as sound ≥40 dB(A) during flow limited inspirations. The apnea hypopnea index (AHI) and breath-by-breath peak decibel levels were measured. Snore breaths were tallied to determine the frequency and intensity of snoring. Regression models were used to determine the relationship between objective measures of snoring and OSA (AHI ≥ 5 events/h). The area under the curve (AUC) for the receiver operating characteristic (ROC) was used to predict OSA. Snoring intensity exceeded 45 dB(A) in 66% of the 162 participants studied, with 14% surpassing the 53 dB(A) threshold for noise pollution. Snoring intensity and frequency were independent predictors of OSA. AUCs for snoring intensity and frequency were 77% and 81%, respectively, and increased to 87% and 89%, respectively, with the addition of age and sex as predictors. Snoring represents a source of noise pollution in the bedroom and constitutes an important target for mitigating sound and its adverse effects on bed partners. Precise breath-by-breath identification and quantification of snoring also offers a way to risk stratify otherwise healthy snorers for 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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Association of sleep characteristics with adiposity markers in children

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2019-0517 ◽

2020 ◽

Vol 33 (7) ◽

pp. 845-852

Author(s):

Theresa Herttrich ◽

Johann Daxer ◽

Andreas Hiemisch ◽

Jens Kluge ◽

Andreas Merkenschlager ◽

...

Keyword(s):

Density Lipoprotein ◽

Hdl Cholesterol ◽

Normal Weight ◽

Overweight And Obesity ◽

Sleep Diary ◽

Apnea Hypopnea Index ◽

Prepubertal Children ◽

Arousal Index ◽

Obstructive Sleep ◽

Obesity In Children

AbstractBackgroundAccumulating evidence suggests a relationship between sleep alterations and overweight/obesity in children. Our aim was to investigate the association of sleep measures other than obstructive sleep apnea or sleep duration with overweight/obesity and metabolic function in children.MethodsWe conducted a prospective cohort study in school- aged children (aged 5 to 8 years, prepubertal, and 12 to 15 years, pubertal) with overweight/obesity and normal-weight children. All children underwent a standardized in-laboratory polysomnography followed by a fasting blood assessment for glucose and metabolic testing. Subjective sleep measures were investigated by a 7-day sleep diary and questionnaire. We analyzed prepubertal and pubertal groups separately using logistic regression and partial correlation analyses.ResultsA total of 151 participants were analyzed. Overweight/obese children had significantly higher odds for arousal index (prepubertal children: 1.28, Confidence interval (CI): 1.06, 1.67; pubertal children: 1.65, CI: 1.19, 2.29) than normal-weight children, independent of age and gender. In prepubertal children, arousal-index was positively associated with C-peptide (r=0.30, p=0.01), whereas Minimum O2 saturation was negatively associated with triglycerides (r=−0.34, p=0.005), adjusting for age and sex. However, associations were attenuated by further adjustment for body mass index standard deviation scores (BMI-SDS). In pubertal children, higher level of apnea-hypopnea-index and pCO2 predicted increased lipoprotein (a) levels (r=0.35, p=0.03 and r=0.40, p=0.01, respectively), independent of age, sex, and BMI-SDS. A negative association was found between pCO2 and high-density lipoprotein (HDL)-cholesterol (r=−0.40, p=0.01).ConclusionsOverall, we report that sleep quality as measured by arousal index may be compromised by overweight and obesity in children and warrants attention in future intervention programs.

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