Predictors of obstructive sleep apnea misclassification using total bed time versus total sleep time: an evaluation using polysomnography data

2021 ◽  
Author(s):  
Wei Yang Lim ◽  
Kay Choong See
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Total Sleep Time ◽  
Significant Risk ◽  
Sleep Time ◽  
Tertiary Hospital ◽  
University Hospital ◽  
Obstructive Sleep ◽  
National University ◽  
Using Data

Abstract Background and Objective Obstructive sleep apnea (OSA) is a highly prevalent condition worldwide. Untreated, it is associated with multiple medical complications as well as a reduced quality of life. Home sleep apnea tests are increasingly used for its diagnosis and evaluation of severity, but using total bed time rather than total sleep time may underestimate OSA severity. We aim to uncover the extent and predictors of OSA misclassification when using total bed time. Methods A retrospective observational study was conducted using data from the sleep laboratory of the National University Hospital, Singapore, a tertiary hospital with 1200 beds. Misclassification of OSA was defined as any OSA severity that was less severe using total bed time versus total sleep time. Logistic regression was used to identify predictors of OSA misclassification.Results A total of 1621 patients were studied (mean age 45.6 + 15.9 years; 73.4% male). 300 (18.5%) patients were misclassified. Risk factors for OSA misclassification included age (OR 1.02, 95% CI 1.01-1.03, P=0.001) and body-mass index (BMI) (OR 0.97,95% CI 0.95-0.99, P=0.015). Risk for misclassification was significant in patients aged>57 years old, with BMI<32.3 kg/m2. Conclusion Using total bed time rather than total sleep time to quantify OSA severity was associated with a significant risk of misclassification, particularly in patients aged >57 years old, with BMI <32.3 kg/m2. This was a novel finding that has not been previously reported.

scholarly journals Predictors of obstructive sleep apnea misclassification when using total bed time versus total sleep time

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Wei Yang Lim ◽  
Kay Choong See
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Total Sleep Time ◽  
Significant Risk ◽  
Sleep Time ◽  
Tertiary Hospital ◽  
University Hospital ◽  
Obstructive Sleep ◽  
National University ◽  
Using Data

AbstractObstructive sleep apnea (OSA) is a highly prevalent condition worldwide. Untreated, it is associated with multiple medical complications as well as a reduced quality of life. Home sleep apnea tests are increasingly used for its diagnosis and evaluation of severity, but using total bed time rather than total sleep time may underestimate OSA severity. We aim to uncover the extent and predictors of OSA misclassification when using total bed time. A retrospective observational study was conducted using data from the sleep laboratory of the National University Hospital, Singapore, a tertiary hospital with 1200 beds. Misclassification of OSA was defined as any OSA severity that was less severe using total bed time versus total sleep time. Logistic regression was used to identify predictors of OSA misclassification. A total of 1621 patients were studied (mean age 45.6 ± 15.9 years; 73.4% male). 300 (18.5%) patients were misclassified. Risk factors for OSA misclassification included age (OR 1.02, 95% CI 1.01–1.03, P = 0.001) and body-mass index (BMI) (OR 0.97, 95% CI 0.95–0.99, P = 0.015). Risk for misclassification was significant in patients aged ≥ 57 years old, with BMI < 32.3 kg/m2. Using total bed time rather than total sleep time to quantify OSA severity was associated with a significant risk of misclassification, particularly in patients aged ≥ 57 years old, with BMI < 32.3 kg/m2.

scholarly journals 0567 Hypoxic Burden and Apnea-Hypopnea Duration in Patients with Positional Obstructive Sleep Apnea

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A217-A218
Author(s):  
J A Ramzy ◽  
R Rengan ◽  
M Mandal ◽  
S Rani ◽  
M E Vega Sanchez ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Total Sleep Time ◽  
Sleep Time ◽  
Apnea Hypopnea Index ◽  
Apnea Test ◽  
Positional Obstructive Sleep Apnea ◽  
Obstructive Sleep ◽  
Respiratory Event ◽  
The Mean

Abstract Introduction Recently, the measurement of the hypoxic burden and apnea-hypopnea duration has been shown to correlate with mortality in patients with obstructive sleep apnea (OSA). We hypothesized that in patients with mild positional OSA (apnea-hypopnea index [AHI] &lt; 5 events/hr in the non-supine position) the hypoxic burden would be increased and apnea-hypopnea duration shortened and similar to patients with non-positional OSA. Methods Fourteen patients with positional OSA and 24 patients non-positional OSA with similar severity of OSA based on the respiratory event index (REI) were included. All patients had a home sleep apnea test for suspected OSA. The hypoxic burden was calculated by the multiplication of REI and the mean area under the desaturation curves. Results Thirty-eight patients [12 (35%) males, 50±12 yrs, BMI 35±7 kg/m2, Epworth Sleepiness Scale (ESS) 11±8, REI 10±3 events/hr, apnea-hypopnea duration 19±4 sec, mean SaO2 94±2%, lowest SaO2 79±8%, % total sleep time (TST) SaO2 &lt; 90% 11±16%, hypoxic burden 30±17 %min/hr] completed the study. Fourteen patients [9 (64%) males, 46±14 yrs, BMI 31±6 kg/m2, ESS 7±5, REI 9±3 events/hr, mean SaO2 94±2%, lowest SaO2 81±6%, %TST SaO2 &lt; 90% 4±6%] had positional OSA (supine REI 16±7 events/hr, non-supine REI 3±1 events/hr) and 24 patients had non-positional OSA [3 (13%) males, 52±10 yrs, BMI 38±7 kg/m2, ESS 12±9, REI 10±3 events/hr, mean SaO2 94±2%, lowest SaO2 77±9%, %TST SaO2 &lt; 90% 14±19%]. The hypoxic burden was elevated in both the positional and non-positional OSA patients with no difference between the groups (26±19 %min/hr and 32±15 %min/hr, respectively, p=0.13). The apnea-hypopnea duration was similar in positional and non-positional OSA patients (20±3 sec and 18±4 sec, respectively, p=0.08 sec). Conclusion In patients with mild positional OSA the hypoxic burden, which has been associated with cardiovascular mortality, is elevated and similar to patients with non-positional OSA. Support None

scholarly journals 0722 The Association Between Obstructive Sleep Apnea and Neurobehavioural Function in Men: A Large, Population-Based Cohort Study

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A274-A275
Author(s):  
J L Parker ◽  
R J Adams ◽  
S L Appleton ◽  
Y A Melaku ◽  
A Vakulin
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Total Sleep Time ◽  
Sleep Time ◽  
Inspection Time ◽  
Sleep Disruption ◽  
Clinical Samples ◽  
Apnea Hypopnea Index ◽  
Cross Sectional ◽  
Obstructive Sleep

Abstract Introduction Obstructive sleep apnea (OSA) is linked with impaired vigilance, attention, memory and executive function. However, this evidence largely comes from small experimental studies or larger studies in clinical samples and therefore the scope and magnitude of OSA driven neurobehavioural dysfunction in the general population remains unclear. This study aimed to examine the cross-sectional association between OSA and neurobehavioural function in a large community sample of men. Methods A total of 837 participants from the Men Androgen Inflammation Lifestyle Environment and Stress (MAILES) study, a longitudinal cohort of men 40+ years, underwent full overnight polysomnography. Participants completed the inspection time (IT) test, mini-mental state examination (MMSE), Fuld object memory evaluation (FOME), and trail-making test (TMT) part A (TMT-A) and part B (TMT-B). Using regression models adjusted for multiple important covariates, we examined the association between neurobehavioural function scores, clinical metrics of OSA severity (Apnea-Hypopnea Index (AHI); percentage total sleep time with oxygen saturation &lt;90% (TST90), and measures of sleep disruption (duration of rapid eye movement (REM) and non-REM (NREM) sleep; and total sleep time (TST). Results In multivariable linear regressions, greater TST was associated with worse IT scores (B=13.688, 95% CI [0.134, 27.241], P=0.048) and TMT-B scores (B=19.255, 95% CI [0.931, 37.578], P=0.040). In logistic regressions, greater TST was associated with better MMSE scores (Odds ratio [OR]=0.440, 95% CI [0.194, 0.997], P=0.049); and higher AHI was strongly associated with worse FOME scores in fully adjusted models (OR=1.358, 95% CI [1.252, 1.472], P&lt;0.001). Conclusion The AHI and TST were positively, significantly associated with neurobehavioural function across different domains. This cross-sectional data shows that neurobehavioural function deficits in OSA are directly related to sleep and breathing disruptions. Future large prospective studies are needed to determine if OSA and sleep disruption predict future onset of neurobehavioural dysfunction and cognitive decline. Support National Health and Medical Research Council and the Adelaide Institute for Sleep Health.

scholarly journals Obstructive sleep apnea is an independent risk factor for severe COVID-19: a population-based study

SLEEP ◽  
2021 ◽  
Author(s):  
Kristján Godsk Rögnvaldsson ◽  
Elías Sæbjörn Eyþórsson ◽  
Össur Ingi Emilsson ◽  
Björg Eysteinsdóttir ◽  
Runólfur Pálsson ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Risk Factor ◽  
Sleep Apnea ◽  
Population Based ◽  
Community Dwelling ◽  
University Hospital ◽  
Logistic Regression Models ◽  
Icelandic Population ◽  
Obstructive Sleep ◽  
National University

Abstract Study Objectives Obstructive sleep apnea (OSA) has been proposed as a risk factor for severe COVID-19. Confounding is an important consideration as OSA is associated with several known risk factors for severe COVID-19. Our aim was to assess the association of OSA with hospitalization due to COVID-19 using a population-based cohort with detailed information on OSA and comorbidities. Methods Included were all community-dwelling Icelandic citizens 18 years of age and older diagnosed with SARS-CoV-2 infection in 2020. Data on demographics, comorbidities, and outcomes of COVID-19 was obtained from centralized national registries. Diagnosis of OSA was retrieved from the centralized Sleep Department Registry at Landspitali–The National University Hospital. Severe COVID-19 was defined as the composite outcome of hospitalization and death. The associations between OSA and the outcome were expressed as odds ratios (OR) with 95% confidence intervals (95% CI), calculated using logistic regression models and inverse probability weighting. Results A total of 4,756 individuals diagnosed with SARS-CoV-2 infection in Iceland were included in the study (1.3% of the Icelandic population), of whom 185 had a diagnosis of OSA. In total, 238 were hospitalized or died, 38 of whom had OSA. Adjusted for age, sex, and BMI, OSA was associated with poor outcome (OR 2.2, 95% CI 1.4 -3.5). This association was slightly attenuated (OR 2.0, 95% CI 2.0, 1.2-3.2) when adjusted for demographic characteristics and various comorbidities. Conclusions OSA was associated with twofold increase in risk of severe COVID-19, and the association was not explained by obesity or other comorbidities.

scholarly journals Characteristics of Obstructive Sleep Apnea Patients With Hypertension and Factors Associated With Autotitration Acceptance

2022 ◽  
Vol 12 ◽  
Author(s):  
Xuan Zhang ◽  
Ning Zhang ◽  
Yang Yang ◽  
Shuo Wang ◽  
Ping Yu ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Eye Movement ◽  
Total Sleep Time ◽  
Sleep Time ◽  
Sleep Efficiency ◽  
Apnea Hypopnea Index ◽  
Rapid Eye Movement ◽  
Obstructive Sleep ◽  
Severe Group

In order to explore the characteristics and treatment status of obstructive sleep apnea (OSA) patients with hypertension, a retrospective study was conducted on 306 patients admitted from October 2018 to December 2019. According to the apnea hypopnea index (AHI), OSA patients with hypertension were divided into three groups. 69 cases were mild OSA (5 ≤ AHI &lt; 15), 86 cases were moderate (15 ≤ AHI &lt; 30), and 151 cases were severe (AHI ≥ 30). Compared with patients in the mild and moderate groups, the severe group had more male patients, with higher body mass index (BMI) and non-rapid eye movement stage 1 accounted for total sleep time (N1%), and lower non-rapid eye movement stage 2 accounted for total sleep time (N2%), average and minimum blood oxygen. Among all the patients, those who underwent the titration test accounted for 20.6% (63/306). Multivariate analysis showed that sleep efficiency (p &lt; 0.001) and AHI (p &lt; 0.001) were independent factors for patients to accept titration test. OSA patients with hypertension had a low acceptance of titration therapy. These people with higher sleep efficiency and AHI were more likely to receive autotitration.

Sleep Parameters after Surgery for Obstructive Sleep Apnea

1986 ◽  
Vol 95 (1) ◽  
pp. 23-28 ◽  
Author(s):  
Brian W. Blakley ◽  
Robert H. Maisel ◽  
Mark Mahowald ◽  
Milton Ettinger
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Total Sleep Time ◽  
Sleep Time ◽  
Symptomatic Improvement ◽  
Obstructive Sleep ◽  
Before And After ◽  
Sleep Parameters ◽  
Type Of Surgery

Obstructive sleep apnea (OSA) is a disorder that is frequently treated surgically. Few reports in the literature give objective reports of the effect of such treatment on polysomnographic parameters before and after treatment, although symptomatic improvement is common. This article reviews total sleep time (TST) spent in apnea, number of apneic episodes per hour or sleep apnea index (SAI), and oxygen desaturations in such patients treated with tracheostomy, uvulopalatopharyngoplasty (UPP), and combinations of these. Although improvement is noted in these parameters after UPP, this is not as impressive as some reports in the literature indicate. Our suggested indications for this type of surgery are discussed.

scholarly journals Sleep Architecture in Children With Down Syndrome With and Without Obstructive Sleep Apnea

2020 ◽  
pp. 019459982096045
Author(s):  
Christine H. Heubi ◽  
Philip Knollman ◽  
Susan Wiley ◽  
Sally R. Shott ◽  
David F. Smith ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Down Syndrome ◽  
Sleep Apnea ◽  
Rem Sleep ◽  
Total Sleep Time ◽  
Sleep Time ◽  
Sleep Architecture ◽  
Children With Down Syndrome ◽  
Arousal Index ◽  
Obstructive Sleep

Objective To characterize polysomnographic sleep architecture in children with Down syndrome and compare findings in those with and without obstructive sleep apnea. Study Design Case series with retrospective review. Setting Single tertiary pediatric hospital (2005-2018). Methods We reviewed the electronic health records of patients undergoing polysomnography who were referred from a specialized center for children with Down syndrome (age, ≥12 months). Continuous positive airway pressure titration, oxygen titration, and split-night studies were excluded. Results A total of 397 children were included (52.4% male, 81.6% Caucasian). Mean age at the time of polysomnography was 4.7 years (range, 1.4-14.7); 79.4% had obstructive sleep apnea. Sleep variables were reported as mean (SD) values: sleep efficiency, 85% (11%); sleep latency, 29.8 minutes (35.6); total sleep time, 426 minutes (74.6); rapid eye movement (REM) latency, 126.8 minutes (66.3); time spent in REM sleep, 22% (7%); arousal index, 13.3 (5); and time spent supine, 44% (28%). There were no significant differences between those with obstructive sleep apnea and those without. Sleep efficiency <80% was seen in 32.5%; 34.3% had a sleep latency >30 minutes; 15.9% had total sleep time <360 minutes; and 75.6% had an arousal index >10/h. Overall, 69.2% had ≥2 metrics of poor sleep architecture. REM sleep time <20% was seen in 35.3%. REM sleep time decreased with age. Conclusion In children with Down syndrome, 32.5% had sleep efficiency <80%; 75.6% had an elevated arousal index; and 15.9% had total sleep time <360 minutes. More than a third of the patients had ≥3 markers of poor sleep architecture. There was no difference in children with or without obstructive sleep apnea.

scholarly journals Sleep Bruxism Episodes in Patients with Obstructive Sleep Apnea Syndrome Determined by In-Laboratory Polysomnography

2020 ◽  
Vol 10 (23) ◽  
pp. 8587
Author(s):  
Dong Hyun Kim ◽  
Sang Hwa Lee ◽  
Sang Haak Lee
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Obstructive Sleep Apnea Syndrome ◽  
Supine Position ◽  
Total Sleep Time ◽  
Sleep Apnea Syndrome ◽  
Sleep Time ◽  
Sleep Bruxism ◽  
Obstructive Sleep ◽  
Apnea Syndrome

Findings on sleep bruxism (SB) in patients with obstructive sleep apnea syndrome (OSAS) are controversial, and some of these findings have relied on in-laboratory polysomnography (PSG). We aimed to identify the factors associated with SB episodes in 100 patients with OSAS using in-laboratory PSG records. Subjects with OSAS were divided into those with and without SB episodes. We analyzed the differences in patient characteristics and PSG indices. Age, gender, height, weight, body mass index, neck, waist, and hip circumferences, and the rates of hypertension and diabetes mellitus were not significantly different between the two groups. A greater proportion of stage N2 sleep in the total sleep time, longer total sleep time, longer sleep time in a supine position, shorter sleep time in a nonsupine position, lower apnea–hypopnea index (AHI), lower AHI regardless of sleeping position, lower AHI during nonrapid eye movement sleep, and higher mean oxygen saturation level were associated with SB episodes in patients with OSAS. Among these factors, longer sleep time in a supine position remained a statistically significant factor in multivariate analysis. We conclude that longer sleep time in a supine position (especially >280 min) might be associated with SB episodes in patients with OSAS.

scholarly journals 1197 Utility of Fitbit Charge 2 for Sleep Monitoring in Patients With Obstructive Sleep Apnea

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A458-A458
Author(s):  
D Kim ◽  
W Shin ◽  
J Byun
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Total Sleep Time ◽  
Sleep Stage ◽  
Sleep Time ◽  
Wearable Devices ◽  
Sleep Stages ◽  
Sleep Monitoring ◽  
Obstructive Sleep ◽  
Single Center Observational Study

Abstract Introduction The wearable device may be useful in monitoring sleep. Many studies reported reliable data in detecting sleep-wake states and sleep stage proportion in healthy adults, However, only a few validation studies were performed evaluating sleep using the wearable devices in patients with obstructive sleep apnea(OSA), which showed insufficient accuracy. We aimed to evaluate the reliability of multi-sensory wristband (Fitbit Charge 2) in patients with OSA. Methods This was a preliminary analysis of a prospective single-center observational study. Consecutive patients underwent standard Polysomnography (PSG) for evaluation of OSA with Fitbit Charge 2. Sleep data from PSG and Fitbit charge 2 were compared using paired t-tests and Bland-Altman plots. Results A total of eighty-six patients were analyzed. Four of them had poor data quality, 18 of them did not show sleep stages. Compared with the PSG, Fitbit Charge 2 showed higher total sleep time (419.1±194.0 vs 269.8±22.6, p&lt;0.001) and sleep efficiency (95.8±2.5 vs 84.6±7.1, p&lt;0.001). Those with sleep stage data showed higher sleep efficacy (87.7±5.5 vs 82.37.5, p=0.024) and a lower proportion of N1 sleep (33.7±19.9 vs 65.3±38.8, p=0.01). Conclusion Fitbit Charge 2 showed limited utility in monitoring sleep in patients with obstructive sleep apnea. Support none

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