scholarly journals Longer and Deeper Desaturations Are Associated With the Worsening of Mild Sleep Apnea: The Sleep Heart Health Study

2021 ◽  
Vol 15 ◽  
Author(s):  
Tuomas Karhu ◽  
Sami Myllymaa ◽  
Sami Nikkonen ◽  
Diego R. Mazzotti ◽  
Juha Töyräs ◽  
...  
Keyword(s):  
Sleep Apnea ◽  
Early Stage ◽  
Essential Feature ◽  
Linear Regression Analysis ◽  
Health Study ◽  
Heart Health ◽  
Blood Oxygen Saturation ◽  
Study Participants ◽  
Stratified Analysis

Study ObjectivesObesity, older age, and male sex are recognized risk factors for sleep apnea. However, it is unclear whether the severity of hypoxic burden, an essential feature of sleep apnea, is associated with the risk of sleep apnea worsening. Thus, we investigated our hypothesis that the worsening of sleep apnea is expedited in individuals with more severe desaturations.MethodsThe blood oxygen saturation (SpO2) signals of 805 Sleep Heart Health Study participants with mild sleep apnea [5 ≤ oxygen desaturation index (ODI) < 15] were analyzed at baseline and after a mean follow-up time of 5.2 years. Linear regression analysis, adjusted for relevant covariates, was utilized to study the association between baseline SpO2-derived parameters and change in sleep apnea severity, determined by a change in ODI. SpO2-derived parameters, consisting of ODI, desaturation severity (DesSev), desaturation duration (DesDur), average desaturation area (avg. DesArea), and average desaturation duration (avg. DesDur), were standardized to enable comparisons between the parameters.ResultsIn the group consisting of both men and women, avg. DesDur (β = 1.594, p = 0.001), avg. DesArea (β = 1.316, p = 0.004), DesDur (β = 0.998, p = 0.028), and DesSev (β = 0.928, p = 0.040) were significantly associated with sleep apnea worsening, whereas ODI was not (β = −0.029, p = 0.950). In sex-stratified analysis, avg. DesDur (β = 1.987, p = 0.003), avg. DesArea (β = 1.502, p = 0.024), and DesDur (β = 1.374, p = 0.033) were significantly associated with sleep apnea worsening in men.ConclusionLonger and deeper desaturations are more likely to expose a patient to the worsening of sleep apnea. This information could be useful in the planning of follow-up monitoring or lifestyle counseling in the early stage of the disease.

Abstract 14725: Association of Adipokines With Subclinical Myocardial Dysfunction - The Multi-Ethnic Study of Atherosclerosis (MESA)

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Mohammad R Ostovaneh ◽  
Bharath Ambale Venkatesh ◽  
Kihei Yoneyama ◽  
Shishir Sharma ◽  
Matthew A Allison ◽  
...  
Keyword(s):  
Myocardial Fibrosis ◽  
T1 Mapping ◽  
Myocardial Dysfunction ◽  
Linear Regression Analysis ◽  
Normal Weight ◽  
Lower Degree ◽  
Current Analysis ◽  
Tnf Α ◽  
Stratified Analysis

Background: Adipokines such as adiponectin, leptin and resistin have been associated with heart failure. We explore the association of adipokines and myocardial fibrosis as MRI-derived measure of subclinical myocardial dysfunction. Methods: For the current analysis, we studied MESA subjects who had adiponectin, leptin, resistin and TNF-α measured at second/third follow-up exams (2003-2005) and underwent post gadolinium MRI T1 mapping at 25 minutes for assessment of myocardial fibrosis at the fifth follow-up exam (2010 -2012). Linear regression analysis was used to evaluate the association of log-transformed adipokine levels with T1 time. BMI-stratified analysis was performed when the interaction term of BMI and adipokines was significant. Lower T1 time reflects greater myocardial fibrosis. Results: Four hundred and twenty three subjects (mean age: 61.4(8.1), 187 females) were included in the analysis. Median values of adiponectin, leptin, resistin and TNF-α were 16.9 μg/ml (IQR: 11-25), 11.1 ng/ml (IQR:5-25), 14 ng/ml(IQR:11-17) and 4.5 pg/ml(IQR:3.5-5.9). Higher adiponectin was associated with lower degree of myocardial fibrosis in subjects with BMI<25 (p = 0.005). Higher leptin in individuals with BMI≥30 (p<0.001) and higher resistin in those with BMI<25 (p=0.02) was associated with greater myocardial fibrosis. Conclusion: Higher adiponectin is associated with lower degree of myocardial fibrosis in normal weight subjects. Leptin in obese individuals and resistin in those with normal BMI are positively associated with myocardial fibrosis.

Physical activity, sedentary behavior, and incidence of obstructive sleep apnea in three prospective US cohorts

2021 ◽  
pp. 2100606
Author(s):  
Yue Liu ◽  
Lin Yang ◽  
Meir J. Stampfer ◽  
Susan Redline ◽  
Shelley S. Tworoger ◽  
...  
Keyword(s):  
Physical Activity ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Sedentary Behavior ◽  
Sitting Time ◽  
Health Study ◽  
Metabolic Factors ◽  
Obstructive Sleep ◽  
Watching Tv

Reduced physical activity and increased sedentary behavior may independently contribute to development of obstructive sleep apnea (OSA) through increased adiposity, inflammation, insulin resistance and body fluid retention. However, epidemiologic evidence remains sparse, and is primarily limited to cross-sectional studies.We prospectively followed 50 332 women from the Nurses’ Health Study (2002–2012), 68 265 women from the Nurses’ Health Study II (1995–2013), and 19 320 men from the Health Professionals Follow-up Study (1996–2012). Recreational physical activity (quantified by metabolic equivalent of task [MET]-hours/week) and sitting time spent watching TV and at work/away from home were assessed by questionnaires every 2–4 years. Physician-diagnosed OSA was identified by validated self-report. Cox models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for OSA incidence associated with physical activity and sedentary behavior.During 2 004 663 person-years of follow-up, we documented 8733 incident OSA cases. After adjusting for potential confounders, the pooled HR for OSA comparing participants with ≥36.0 versus <6.0 MET-hours/week of physical activity was 0.46 (95% CI: 0.43, 0.50; ptrend<0.001). Compared with participants spending <4.0 h/week sitting watching TV, the multivariable-adjusted HR (95% CI) was 1.78 (1.60, 1.98) for participants spending ≥28.0 h/week (ptrend<0.001). The comparable HR (95% CI) was 1.49 (1.38, 1.62) for sitting hours at work/away from home (ptrend<0.001). With additional adjustment for several metabolic factors including BMI and waist circumference, the associations with physical activity and sitting hours at work/away from home were attenuated but remained significant (ptrend<0.001), whereas the association with sitting hours watching TV was no longer statistically significant (ptrend=0.18).Higher levels of physical activity and fewer sedentary hours were associated with lower OSA incidence. The potential mediating role of metabolic factors in the association between sedentary behavior and OSA incidence may depend on type of sedentary behavior. Our results suggest that promoting an active lifestyle may reduce OSA incidence.

scholarly journals 0572 Using Anthropometric Measures to Screen for Obstructive Sleep Apnea in the Sleep Heart Health Study Cohort

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A219-A219
Author(s):  
K D Vana ◽  
G E Silva ◽  
J D Carreon ◽  
S F Quan
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Screening Tool ◽  
Health Study ◽  
Heart Health ◽  
Height Ratio ◽  
Cut Point ◽  
Proxy Variables ◽  
Obstructive Sleep ◽  
Significant Difference

Abstract Introduction Individuals at high risk for obstructive sleep apnea (OSA) may not access sleep clinics for reasons including immobility, transportation difficulties, or living in rural areas. An easy-to-administer OSA screening tool for different body types, independent of witnessed apneas or body mass index (BMI), is lacking to identify this group quickly. We compared the sensitivities (SNs), specificities (SPs), and receiving operator curves (ROCs) of the neck circumference/height ratio (NHR) and waist circumference/height ratio (WHR) in predicting moderate and severe OSA (apnea-hypopnea index [AHI] ≥15/hr) with the SN, SP, and ROC of the derived Stop-Bang Questionnaire (dSBQ), which was created from proxy variables from the Sleep Heart Health Study (SHHS). Methods Data from the SHHS baseline evaluation were used and included participants (N=5431) who completed polysomnograms and had neck and waist circumferences, height measurements, and the SHHS proxy variables. This data then was divided randomly into 1/3 for derivation and 2/3 for validation analyses. Results No statistical differences were seen for gender, age, or ethnicity between the derivation and validation samples. In the validation sample (n=3621), the NHR cut-point of 0.21 resulted in a SN of 91% and a SP of 26% for AHI ≥15/hr. The WHR cut-point of 0.51 resulted in a SN of 91% and a SP of 21% for AHI ≥15/hr. Comparing the validation NHR and the dSBQ ROC curves showed no significant difference (AUCs=0.69 and 0.70, respectively; p=0.22). However, the ROC curve for WHR was significantly lower than for the dSBQ (AUCs=0.63 and 0.70, respectively; p&lt;0.0001). Comparing the derivation and validation ROCs showed no significant differences between NHR ROCs, p=0.81, or between WHR ROCs, p=0.67. Conclusion The NHR is a viable screening tool, independent of witnessed apneas and BMI, that can be used for different body types and is statistically comparable to the dSBQ. Support This work was supported by U01HL53938 and U01HL53938-07S (University of Arizona).

scholarly journals Comparison of treatment of early-stage breast cancer among Nurses’ Health Study participants and other Medicare beneficiaries

2019 ◽  
Vol 174 (3) ◽  
pp. 759-767 ◽  
Author(s):  
Andrea M. Austin ◽  
Nirav S. Kapadia ◽  
Gabriel A. Brooks ◽  
Tracy L. Onega ◽  
A. Heather Eliassen ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Early Stage ◽  
Early Stage Breast Cancer ◽  
Health Study ◽  
Medicare Beneficiaries ◽  
Study Participants

scholarly journals SELF-REPORTED WALKING PACE AND ALL-CAUSE MORTALITY AMONG CANCER SURVIVORS IN THE NIH-AARP DIET AND HEALTH STUDY

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S387-S388
Author(s):  
Elizabeth Salerno ◽  
Pedro Saint Maurice ◽  
Erik Willis ◽  
Loretta DiPietro ◽  
Charles Matthews
Keyword(s):  
Physical Activity ◽  
Cancer Survivors ◽  
Lower Risk ◽  
Health Study ◽  
Cancer Type ◽  
Study Enrollment ◽  
All Cause Mortality ◽  
After Cancer ◽  
Study Participants

Abstract We examined the association between self-reported walking pace and all-cause mortality among cancer survivors in the NIH-AARP Diet and Health Study. Participants included 30,110 adults (Mage=62.4+/-5.14 years) diagnosed with cancer between study enrollment and follow-up, when they self-reported walking pace. Individuals were followed until death or administrative censoring in 2011. We estimated the hazards ratios (HR) and 95% confidence intervals (CI) for walking pace and all-cause mortality adjusting for age, sex, race, BMI, health status, physical activity and cancer type. Cancer survivors reporting faster walking paces had significantly reduced mortality risk. Relative to those reporting an ‘easy’ walking pace, walking at a ‘normal,’ ‘brisk,’ or ‘very brisk’ pace was associated with significantly lower risk: [HR=0.74 (0.70,0.78)], [HR=0.66 (0.61,0.71)], and [HR=0.73 (0.60,0.89)], respectively. Being ‘unable to walk’ was associated with 30% increased mortality [HR=1.30 (1.15,1.46)]. These findings provide novel support for the association between self-reported walking pace and survival after cancer.

Frequency of Clonal Evolution by FISH in Untreated, Early Stage Patients with CLL: A Prospective, Longitudinal Study with Long Clinical Follow-Up.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 2098-2098 ◽  
Author(s):  
Tait D. Shanafelt ◽  
Stephanie Fink ◽  
Tom E. Witzig ◽  
Sarah F. Paternoster ◽  
Stephanie Smoley ◽  
...  
Keyword(s):  
Overall Survival ◽  
Median Time ◽  
Early Stage ◽  
Clonal Evolution ◽  
Normal Karyotype ◽  
Risk Category ◽  
Fish Analysis ◽  
Cytogenetic Abnormalities ◽  
Study Participants

Abstract Background: Using fluorescent in-situ hybridization (FISH), a number of investigators have identified specific cytogenetic abnormalities that identify CLL patients with a more aggressive (17p-, 11q-) or indolent (13q-) disease course. Some have suggested patients who initially have a normal karyotype may acquire new chromosome abnormalities during the course of their disease. Since patients with specific cytogenetic abnormalities (17p-, 11q-) are less likely to respond to purine nucleoside analogues, such clonal evolution has potential implications for treatment as well as prognosis. No study has prospectively investigated the frequency of clonal evolution in a cohort of patients with newly diagnosed untreated CLL. Methods: Between 1994 and 2000, we enrolled 167 patients with previously untreated CLL seen at Mayo Clinic in a prospective trial evaluating the prognostic importance of cytogenetic abnormalities and clonal evolution detected by FISH. All patients provided a baseline blood specimen for FISH testing and follow-up specimens over the following 24 months. Other research samples from later timepoints were tested where available. Study participants were contacted by mail in 2004 to update vital and treatment status. Of 83 living responders, 70 (84%) indicated they would be willing to provide an additional follow-up sample for cytogenetic analysis of whom 48 have returned a sample to date. Results of clinical FISH testing during the follow-up interval were also abstracted. FISH was performed on interphase nuclei from blood as we have previously described (BJH 121:287). Results: Median age at diagnosis was 64. Median time from diagnosis to study enrollment was 3.3 months. 94% of patients had early stage disease at enrollment (88 Rai 0; 48 Rai I, 18 Rai II, 2 Rai III; 8 Rai IV). Median follow-up time from diagnosis for all 164 eligible study participants was 8.5 years (range: 0.33–22.9 yrs). As of last follow-up, 48% of patients have received treatment and 57 (35%) have died. 75% of patients had chromosome abnormalities on FISH testing at baseline. The frequency of individual cytogenetic abnormalities on baseline FISH analysis along with overall survival by hierarchical FISH risk category are shown in Table I. 106 patients had sequential samples for FISH analysis at least 2 years apart, 61 had samples at least 5 years apart, and 22 had samples at least 10 years apart. 15 patients had evidence of clonal evolution during follow up as evidenced by a new FISH anomaly not present on the baseline specimen. No clonal evolution was observed in the first 2 years of follow-up (n=106), however of 61 patients with samples at least 5 years apart, 14 (23%) had evidence of clonal evolution. Median time for development of a new cytogenetic abnormality among these patients was 9.3 years. Conclusions: Clonal evolution occurs during the course of disease for approximately 25% of patients with early stage CLL. Clonal evolution appears to occur at low frequency during the first 2 years of follow-up but increases in frequency after 5 years. This finding has potentially significant implications for prognosis and treatment of patients with CLL. FISH Risk Category* N (Baseline) Median Overall Survival (Years) * Difference between groups significant p=0.0038 13q- x 1 37 14.4 13q- x2 35 17 Normal Karyotype 40 13.2 12+ 24 11.1 11q- 12 8.6 17p- 10 10.5 6q- 2 4.1 Other 2 Not reached

scholarly journals The Association Between Obstructive Sleep Apnea Defined by 3 Percent Oxygen Desaturation or Arousal Definition and Self-Reported Cardiovascular Disease in the Sleep Heart Health Study

2020 ◽  
Vol 21 (4) ◽  
pp. 86-103
Author(s):  
Stuart Quan ◽  
◽  
Rohit Budhiraja ◽  
Sogol Javaheri ◽  
Sairam Parthasarathy ◽  
...  
Keyword(s):  
Heart Failure ◽  
Coronary Bypass ◽  
Oxygen Desaturation ◽  
Health Study ◽  
Heart Health ◽  
Logistic Regression Models ◽  
Obstructive Sleep ◽  
Causal Pathway ◽  
Parsimonious Model ◽  
Study Participants

Background: Studies have established that OSA defined using a hypopnea definition requiring a >4% oxygen desaturation (AHI4%) is associated with cardiovascular (CVD) or coronary heart (CHD) disease. This study determined whether OSA defined using a hypopnea definition characterized by a >3% oxygen desaturation or an arousal (AHI3%A) is associated with CVD/CHD. Methods: Data were analyzed from 6307 Sleep Heart Health Study participants who had polysomnography. Self-reported CVD included angina, heart attack, heart failure, stroke or previous coronary bypass surgery or angioplasty. Self-reported CHD included the aforementioned conditions but not stroke or heart failure. The association between OSA and CVD/CHD was examined using logistic regression models with stepwise inclusion of demographic, anthropometric, social/behavioral and co-morbid medical conditions. A parsimonious model in which diabetes and hypertension were excluded because of their potential to be on the causal pathway between OSA and CVD/CHD also was constructed. Results: For CVD, the odds ratios and 95% confidence intervals for AHI3%A >30/hour were 1.39 (1.03-1.87) and 1.45 (1.09-1.94) in the fully adjusted and parsimonious models. Results for CHD were 1.29 (0.96-1.74) and 1.36 (0.99-1.85). In participants without OSA according to more stringent AHI4% criteria but with OSA using the AHI3%A definition, similar findings were observed. Conclusion: OSA defined using an AHI3%A is associated with both CVD and CHD. Use of a more restrictive AHI4% definition will misidentify a large number of individuals with OSA who have CVD or CHD. These individuals may be denied access to therapy, potentially worsening their underlying CVD or CHD.

Sign in / Sign up

Export Citation Format

Share Document