Cancer risk in patients with sleep apnoea following adherent 5-year CPAP therapy

BackgroundIncreasing evidence suggests that obstructive sleep apnoea (OSA) contributes to cancer risk; however, limited data are available on the impact of continuous positive airway pressure (CPAP) therapy on cancer incidence. We aimed to determine whether adherence to CPAP therapy is associated with a reduction in all-cancer incidence compared to non-adherent patients with OSA.MethodsThe study relied on the data collected by the multicentre study Pays de la Loire Sleep Cohort, linked to health administrative data, such as to identify new-onset cancer. We included patients who were prescribed CPAP for OSA, with no history of cancer before the diagnostic sleep study or during the first year of CPAP. Patients with documented CPAP use for at least 4 h per night were defined as adherent. Those who discontinued or used CPAP less than 4 h at night constituted the non-adherent group. A propensity-score inverse probability of treatment weighting analysis was performed to assess the effect of CPAP adherence on cancer risk.ResultsAfter a median [inter-quartile range] follow-up of 5.4 [3.1–8.0] years, 437 (9.7%) of 4,499 patients developed cancer, 194 (10.7%) in the non-adherent group (n=1817) and 243 (9.1%) in adherent patients (n=2682). The final weighted model showed no significant impact of CPAP adherence on all-cause cancer risk (sub distribution hazard ratio [95% confidence interval]): 0.94 [0.78; 1.14]).ConclusionsAdherence to CPAP therapy in OSA patients was not associated with a reduction in all-cancer incidence. Whether adherent CPAP therapy of OSA might reduce the risk of specific cancer sites should be further evaluated.

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Modifying effects of the R389G β1-adrenoceptor polymorphism on resting heart rate and blood pressure in patients with obstructive sleep apnoea

Clinical Science ◽

10.1042/cs20050244 ◽

2005 ◽

Vol 110 (1) ◽

pp. 117-123 ◽

Cited By ~ 10

Author(s):

Jan Börgel ◽

Tino Schulz ◽

Nina K. Bartels ◽

Jörg T. Epplen ◽

Nikolaus Büchner ◽

...

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Obstructive Sleep Apnoea ◽

Nervous Activity ◽

Sleep Apnoea ◽

Cpap Therapy ◽

Pressure Therapy ◽

Obstructive Sleep ◽

Significant Difference ◽

The Impact

OSA (obstructive sleep apnoea) stimulates sympathetic nervous activity and elevates resting HR (heart rate) and BP (blood pressure). In the present study in a cohort of 309 untreated OSA patients, the resting HR and BP during the daytime were correlated with AHI (apnoea/hypopnea index) and compared with patients with R389R (n=162), R389G (n=125) and G389G (n=22) genotypes of the β1-adrenoreceptor R389G polymorphism. We analysed the impact of the genotype on the decline of HR and BP in a subgroup of 148 patients (R389R, n=86; R389G, n=54; G389G, n=8) during a 6-month follow-up period under CPAP (continuous positive airway pressure) therapy during which cardiovascular medication remained unchanged. In untreated OSA patients, we found an independent relationship between AHI and resting HR (β=0.096, P<0.001), systolic BP (β=0.09, P=0.021) and diastolic BP (β=0.059, P=0.016). The resting HR/BP, however, did not differ among carriers with the R389R, R389G and G389G genotypes. CPAP therapy significantly reduced HR [−2.5 (−1.1 to −4.0) beats/min; values are mean difference (95% confidence intervals)] and diastolic BP [−3.2 (−1.5 to −5.0) mmHg]. The decline in HR was more significantly pronounced in the R389R group compared with the Gly389 carriers [−4.1 (−2.3 to −5.9) beats/min (P<0.001) compared with −0.2 (2.1 to −2.6) beats/min (P=0.854) respectively; Student's t test between groups, P=0.008]. Diastolic BP was decreased significantly (P<0.001) only in Gly389 carriers (R389G or G389G) compared with R389R carriers [−5.0 (−2.3 to −7.6) mmHg compared with −2.0 (0.4 to −4.3) mmHg respectively]. ANOVA revealed a significant difference (P=0.023) in HR reduction between the three genotypes [−4.1 (±8.4) beats/min for R389R, −0.5 (±9.3) beats/min for R389G and +1.9 (±7.2) beats/min for G389G]. In conclusion, although the R389G polymorphism of the β1-adrenoceptor gene did not influence resting HR or BP in untreated OSA patients, it may modify the beneficial effects of CPAP therapy on these parameters.

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0677 Patient Preferences On Initiating Treatment With Continuous Positive Airway Pressure

SLEEP ◽

10.1093/sleep/zsaa056.673 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A258-A258

Author(s):

P V Borker ◽

C Wyland ◽

S R Patel

Keyword(s):

Continuous Positive Airway Pressure ◽

Patient Preference ◽

Airway Pressure ◽

Treatment Initiation ◽

Positive Airway Pressure ◽

Cpap Therapy ◽

Sleep Study ◽

Cpap Adherence ◽

Obstructive Sleep ◽

At Home

Abstract Introduction Clinical guidelines recommend continuous positive airway pressure (CPAP) therapy be initiated in patients with obstructive sleep apnea (OSA) either at home using an auto-titrating device or following manual titration in the sleep laboratory. Patient preference between these two options is unknown. Methods Patients newly prescribed CPAP therapy for the treatment of OSA at an academic sleep medicine clinic were surveyed by telephone within one month of initiating treatment. Data on demographics, disease severity and CPAP adherence were obtained from the medical record. Results A total of 75 participants (56% male, mean age 52±15 yrs, 48% moderate to severe OSA) were surveyed. Physicians prescribed home initiation of CPAP in 51%, lab initiation in 23%, and allowed the patient to choose in 27% of cases. Overall, 67% of participants (95% CI [56%-77%]) reported preference for home initiation. Preference for home initiation did not vary by age, sex, AHI, degree of sleepiness, or type of diagnostic study (home vs. lab sleep study) performed (p>0.10 for all). Convenience (44%) and starting treatment faster (44%) were the most common reasons provided for those favoring home initiation, while sleep technician availability (40%), optimization of pressure settings (32%), and ability to try multiple masks (28%) were cited by those favoring lab initiation. The prevalence of CPAP adherence at 90 days tended to be higher in those whose treatment was initiated aligned to preference (79% in those whose treatment initiation was concordant with preference vs. 64% in those whose treatment initiation was discordant, p=0.16). Conclusion Overall, two-thirds of patients with OSA prefer initiation of CPAP be done at home. This preference does not vary by demographics, OSA severity or diagnostic modality. Initiating treatment concordant with patient preference may lead to greater adherence. Support American Thoracic Society Academic Sleep Pulmonary Integrated Research/Clinical (ASPIRE) Fellowship, K24 HL127307

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Parapharyngeal mass presenting with sleep apnoea

The Journal of Laryngology & Otology ◽

10.1017/s0022215100110618 ◽

1989 ◽

Vol 103 (10) ◽

pp. 961-963 ◽

Cited By ~ 15

Author(s):

D. Veitch ◽

M. Rogers ◽

J. Blanshard

Keyword(s):

Salivary Gland ◽

Sleep Disturbance ◽

Obstructive Sleep Apnoea ◽

Current Literature ◽

Sleep Apnoea ◽

Salivary Gland Tumour ◽

Sleep Study ◽

Obstructive Sleep ◽

History Of ◽

Gland Tumour

AbstractA 60-year-old man presented with a history of progressive sleep disturbance due to an intraoral parapharyngeal salivary gland tumour.The sleep study performed post-operatively showed rapid resolution of nocturnal hypoxic episodes. This appears to be the first recorded case of a parapharyngeal mass causing sleep apnoea and we review the current literature on obstructive sleep apnoea.

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0717 Peer-intervention Can Reduce Health Disparities In Patients With Obstructive Sleep Apnea

SLEEP ◽

10.1093/sleep/zsaa056.713 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A273-A273

Author(s):

S I Patel ◽

D Combs ◽

N Provencio-Dean ◽

S Mashaqi ◽

S Bhattacharjee ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Health Disparities ◽

Attention Control ◽

Lower Income ◽

Cpap Therapy ◽

Sleep Study ◽

Cpap Adherence ◽

Obstructive Sleep ◽

Peer Intervention ◽

Peer Buddies

Abstract Introduction In patients with obstructive sleep apnea (OSA), adherence to continuous positive airway pressure (CPAP) therapy is a major problem. Moreover, up to 20% of patients with suspected OSA who are referred to sleep study testing do not adhere to such diagnostic work-up. Although, peer-driven intervention with an interactive voice response system (PDI-IVR) can improve CPAP adherence, whether such an intervention can improve adherence to sleep study testing is unknown. Also, there remain health disparities with greater levels of CPAP nonadherence disproportionately affecting individuals of lower socioeconomic status. We aimed to determine whether PDI-IVR can improve adherence to sleep study testing and CPAP adherence in a lower income population. Methods We performed a prospective, randomized, parallel group, controlled trial wherein patients with suspected OSA were randomly assigned to receive PDI-IVR or provided with educational information regarding OSA and CPAP therapy (attention-control group) while both groups received usual care. The PDI-IVR interactions aimed at promoting adherence to sleep study testing and in patients diagnosed with OSA the peer-intervention was focused on improving CPAP adherence. In the PDI-IVR group, trained peers (peer-buddies) with OSA were paired with randomized patients over a 6-month period combined with an ability to meet in-person, email, text message, or phone an inter-disciplinary team of providers. Results In this pilot study, there were 63 patients (48.4 ± 12.5 years; 30 men) who were randomized to intervention (n=31) and attention-control (n=32) arms. There were 36 peer-buddies who mentored the patients in the intervention group. Intention to treat analysis revealed that failure to undergo sleep study testing was 15.6% of patients in the attention-control arm and 9.7% in the PDI-IVR arm (P=0.7). Per protocol analysis revealed that failure to undergo sleep study testing was 18.4% of patients in the attention-control arm and 4% in the PDI-IVR arm (P=0.13). At 6 months, CPAP adherence was greater in PDI-IVR arm (290 ± 45 min [SE]) than attention-control arm (181 ± 43 min; P=0.01). Conclusion In a lower income population, PDI-IVR improved CPAP adherence with a tendency for better adherence to sleep-study testing. Peer-intervention can reduce sleep health disparities. Support HL138377

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The effect of uvulopalatopharyngoplasty without tonsillectomy using local anaesthesia: a prospective long-term follow-up

The Journal of Laryngology & Otology ◽

10.1017/s0022215100144445 ◽

1999 ◽

Vol 113 (6) ◽

pp. 542-547 ◽

Cited By ~ 10

Author(s):

Elisabeth Hultcrantz ◽

Kaarina Johansson ◽

Harriet Bengtson

Keyword(s):

Local Anaesthesia ◽

Sleep Apnoea ◽

Term Effect ◽

First Year ◽

Sleep Study ◽

Long Term Effect ◽

Obstructive Sleep ◽

Local Problems ◽

Long Term Follow Up

AbstractThis paper presents the long-term effect of restricted surgery for snoring and sleep apnoea. Patients with obstructive sleep apnoea (OSAS) (19) or heavy snoring (HS) (36) were studied prospectively for five to seven years after uvulopalatopharyngoplasty without tonsillectomy performed by regular surgical technique using local anaesthesia (LUPP). Five years after surgery, 90 per cent answered a questionnaire. All OSAS patients were offered a polysomnography, and the HS patients were offered a sleep study. Eighty per cent still showed a positive effect on daytime somnolence, and 77 per cent on snoring. Sideeffects were reported by 40 per cent; most common was choking (20 per cent) the first year. Eighteen per cent had local problems such as globus sensation. The polysomnography showed that 80 per cent were still ‘responders’ with an apnoea index (AI) reduction of >50 per cent. None of the HS patients had developed OSAS. In conclusion, LUPP in selected patients with OSAS or HS has a good long-term effect. Sideeffects are common, but diminish with time.

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The Management of Post-Tonsillectomy Morbidity in Patients With Sleep Apnoea

Revista de Chimie ◽

10.37358/rc.19.10.3738 ◽

2019 ◽

Vol 70 (10) ◽

pp. 3738-3740

Keyword(s):

Day Surgery ◽

Sleep Apnoea ◽

Integrative Approach ◽

Multicenter Studies ◽

Therapeutic Modalities ◽

Advantages And Disadvantages ◽

Obstructive Sleep ◽

Wide Range ◽

The Impact ◽

Surgery Center

The Tonsillectomy in children or adults is an intervention commonly encountered in the ENT (Ear Nose and Throat) and Head and Neck surgeon practice. The current tendency is to perform this type of surgery in major ambulatory surgery centers. Two objectives are thus pursued: first of all, the increase of the patient quality of life through the reintegration into the family as quickly as possible and secondly, the expenses associated with continuous hospitalization are reduced. Any tertiary (multidisciplinary) sleep center must ensure the complete diagnosis and treatment (including surgery) of sleep respiratory disorders. Under these conditions the selection of patients and especially the implementation of the specific protocols in order to control the postoperative complications it becomes essential. The present paper describes our experience of tonsillectomy as treatment for selected patients with chronic rhonchopathy (snoring) and mild to moderate obstructive sleep apnoea. It was presented the impact of antibiotics protocols in reducing the main morbid outcomes following tonsillectomy, in our day surgery center. The obtained results can also be a prerequisite for the integrative approach of the patients with sleep apnoea who were recommended surgical treatment. Considering the wide range of therapeutic modalities used in sleep apnoea, each with its specific advantages and disadvantages, more extensive and multicenter studies are needed. Keywords: post-tonsillectomy morbidity, day surgery center, sleep disorders

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Apnoea–hypopnoea indices determined via continuous positive airway pressure (AHI-CPAPflow) versus those determined by polysomnography (AHI-PSGgold): a protocol for a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2020-044499 ◽

2021 ◽

Vol 11 (5) ◽

pp. e044499

Author(s):

Fanny Bertelli ◽

Carey Meredith Suehs ◽

Jean Pierre Mallet ◽

Marie Caroline Rotty ◽

Jean Louis Pepin ◽

...

Keyword(s):

Systematic Review ◽

Continuous Positive Airway Pressure ◽

Airway Pressure ◽

Sleep Disordered Breathing ◽

Positive Airway Pressure ◽

Meta Analysis ◽

Sleep Apnoea ◽

Obstructive Sleep ◽

The Impact ◽

Disordered Breathing

Introduction To date, continuous positive airway pressure (CPAP) remains the cornerstone of obstructive sleep apnoea treatment. CPAP data describing residual sleep-disordered breathing events (ie, the CPAP-measured apnoea–hypopnoea indices (AHI-CPAPflow)) is difficult to interpret because it is an entirely different metric than the polysomnography (PSG) measured AHI gold standard (AHI-PSGgold). Moreover, manufacturer definitions for apnoea and hypopnoea are not only different from those recommended for PSG scoring, but also different between manufacturers. In the context of CPAP initiation and widespread telemedicine at home to facilitate sleep apnoea care, there is a need for concrete evidence that AHI-CPAPflow can be used as a surrogate for AHI-PSGgold. Methods and analysis No published systematic review and meta-analysis (SRMA) has compared the accuracy of AHI-CPAPflow against AHI-PSGgold and the primary objective of this study is therefore to do so using published data. The secondary objectives are to similarly evaluate other sleep disordered breathing indices and to perform subgroup analyses focusing on the inclusion/exclusion of central apnoea patients, body mass index levels, CPAP device brands, pressure titration modes, use of a predetermined and fixed pressure level or not, and the impact of a 4% PSG desaturation criteria versus 3% PSG on accuracy. The Preferred Reporting Items for SRMA protocols statement guided study design. Randomised controlled trials and observational studies of adult patients (≥18 years old) treated by a CPAP device will be included. The CPAP intervention and PSG comparator must be performed synchronously. PSGs must be scored manually and follow the American Academy of Sleep Medicine guidelines (2007 AASM criteria or more recent). To assess the risk of bias in each study, the Quality Assessment of Diagnostic Accuracy Studies 2 tool will be used. Ethics and dissemination This protocol received ethics committee approval on 16 July 2020 (IRB_MTP_2020_07_2020000404) and results will be disseminated via peer-reviewed publications. PROSPERO/Trial registration numbers CRD42020159914/NCT04526366; Pre-results

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419 STOP-Bang Score and History of Radiation Predicts Risk of Obstructive Sleep Apnea in Cancer Patients: A Machine Learning Study

SLEEP ◽

10.1093/sleep/zsab072.418 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A166-A166

Author(s):

Ankita Paul ◽

Karen Wong ◽

Anup Das ◽

Diane Lim ◽

Miranda Tan

Keyword(s):

Machine Learning ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Cancer Patients ◽

Prediction Accuracy ◽

Screening Tools ◽

Cancer Type ◽

Sleep Study ◽

Obstructive Sleep ◽

History Of

Abstract Introduction Cancer patients are at an increased risk of moderate-to-severe obstructive sleep apnea (OSA). The STOP-Bang score is a commonly used screening questionnaire to assess risk of OSA in the general population. We hypothesize that cancer-relevant features, like radiation therapy (RT), may be used to determine the risk of OSA in cancer patients. Machine learning (ML) with non-parametric regression is applied to increase the prediction accuracy of OSA risk. Methods Ten features namely STOP-Bang score, history of RT to the head/neck/thorax, cancer type, cancer stage, metastasis, hypertension, diabetes, asthma, COPD, and chronic kidney disease were extracted from a database of cancer patients with a sleep study. The ML technique, K-Nearest-Neighbor (KNN), with a range of k values (5 to 20), was chosen because, unlike Logistic Regression (LR), KNN is not presumptive of data distribution and mapping function, and supports non-linear relationships among features. A correlation heatmap was computed to identify features having high correlation with OSA. Principal Component Analysis (PCA) was performed on the correlated features and then KNN was applied on the components to predict the risk of OSA. Receiver Operating Characteristic (ROC) - Area Under Curve (AUC) and Precision-Recall curves were computed to compare and validate performance for different test sets and majority class scenarios. Results In our cohort of 174 cancer patients, the accuracy in determining OSA among cancer patients using STOP-Bang score was 82.3% (LR) and 90.69% (KNN) but reduced to 89.9% in KNN using all 10 features mentioned above. PCA + KNN application using STOP-Bang score and RT as features, increased prediction accuracy to 94.1%. We validated our ML approach using a separate cohort of 20 cancer patients; the accuracies in OSA prediction were 85.57% (LR), 91.1% (KNN), and 92.8% (PCA + KNN). Conclusion STOP-Bang score and history of RT can be useful to predict risk of OSA in cancer patients with the PCA + KNN approach. This ML technique can refine screening tools to improve prediction accuracy of OSA in cancer patients. Larger studies investigating additional features using ML may improve OSA screening accuracy in various populations Support (if any):

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European Respiratory Society Statement on Sleep Apnoea, Sleepiness and Driving Risk

European Respiratory Journal ◽

10.1183/13993003.01272-2020 ◽

2020 ◽

pp. 2001272

Author(s):

Maria R Bonsignore ◽

Winfried Randerath ◽

Sofia Schiza ◽

Johan Verbraecken ◽

Mark W Elliott ◽

...

Keyword(s):

At Risk ◽

Motor Vehicle ◽

Task Force ◽

Present Report ◽

Sleep Apnoea ◽

Accident Risk ◽

European Respiratory Society ◽

Obstructive Sleep ◽

Patients At Risk ◽

The Impact

Obstructive sleep apnoea (OSA) is highly prevalent and is a recognised risk factor for motor vehicle accidents (MVA). Effective treatment with continuous positive airway pressure (CPAP) has been associated with a normalisation of this increased accident risk. Thus, many jurisdictions have introduced regulations restricting the ability of OSA patients from driving until effectively treated. However, uncertainty prevails regarding the relative importance of OSA severity determined by the apnoea-hypopnoea frequency per hour and the degree of sleepiness in determining accident risk. Furthermore, the identification of subjects at risk for OSA and/or accident risk remains elusive. The introduction of official European regulations regarding fitness to drive prompted the European Respiratory Society to establish a Task Force to address the topic of sleep apnoea, sleepiness and driving with a view to providing an overview to clinicians involved in treating patients with the disorder. The present report evaluates the epidemiology of MVA in patients with OSA, the mechanisms involved in this association, the role of screening questionnaires, driving simulators and other techniques to evaluate sleepiness and/or impaired vigilance, the impact of treatment on MVA risk in affected drivers, and highlights the evidence gaps regarding the identification of OSA patients at risk for MVA.

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Cardiovascular outcomes of CPAP therapy in obstructive sleep apnea syndrome

AJP Regulatory Integrative and Comparative Physiology ◽

10.1152/ajpregu.00401.2007 ◽

2007 ◽

Vol 293 (4) ◽

pp. R1666-R1670 ◽

Cited By ~ 36

Author(s):

Walter T. McNicholas

Keyword(s):

Cardiovascular Disease ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Obstructive Sleep Apnea Syndrome ◽

Sleep Apnea Syndrome ◽

Cpap Therapy ◽

Obstructive Sleep ◽

Cardiovascular Morbidity And Mortality ◽

Apnea Syndrome ◽

The Impact

Considerable evidence is now available of an independent association between obstructive sleep apnea syndrome (OSAS) and cardiovascular disease. The association is particularly strong for systemic arterial hypertension, but there is growing evidence of an association with ischemic heart disease and stroke. The mechanisms underlying cardiovascular disease in patients with OSAS are still poorly understood. However, the pathogenesis is likely to be a multifactorial process involving a diverse range of mechanisms, including sympathetic overactivity, selective activation of inflammatory molecular pathways, endothelial dysfunction, abnormal coagulation, and metabolic dysregulation, the latter particularly involving insulin resistance and disordered lipid metabolism. Therapy with continuous positive airway pressure (CPAP) has been associated with significant benefits to cardiovascular morbidity and mortality, both in short-term studies addressing specific aspects of morbidity, such as hypertension, and more recently in long-term studies that have evaluated major outcomes of cardiovascular morbidity and mortality. However, there is a clear need for further studies evaluating the impact of CPAP therapy on cardiovascular outcomes. Furthermore, studies on the impact of CPAP therapy have provided useful information concerning the role of basic cell and molecular mechanisms in the pathophysiology of OSAS.

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