Intensity of Respiratory Cortical Arousals Is a Distinct Pathophysiologic Feature and Is Associated with Disease Severity in Obstructive Sleep Apnea Patients

Background: We investigated whether the number, duration and intensity of respiratory arousals (RA) on C3-electroencephalographic (EEG) recordings correlate with polysomnography (PSG)-related disease severity in obstructive sleep apnea (OSA) patients. We also investigated if every patient might have an individual RA microstructure pattern, independent from OSA-severity. Methods: PSG recordings of 20 OSA patients (9 female; age 27–80 years) were analyzed retrospectively. Correlation coefficients were calculated between RA microstructure (duration, EEG-intensity) and RA number and respiratory disturbance index (RDI), oxygen desaturation index (ODI) and arousal index (AI). Intraclass correlations (ICC) for both RA duration and intensity were calculated. Sleep stage-specific and apnea- and hypopnea-specific analyses were also done. The probability distributions of duration and intensity were plotted, interpolated with a kernel which fits the distribution. A Bayesian posterior distribution analysis and pair-wise comparisons of each patient with all other 19 patients were performed. Results: Of the analyzed 2600 RA, strong positive correlations were found between average RA intensity and both RDI and AI. The number of PSG-recorded RA was strongly positively correlated with RDI. Significant correlations between average RA intensity in REM, NREM2 and NREM3 sleep stages and total ODI were identified. No sleep stage-specific correlations of arousal microstructure with age, sex, RDI or AI were identified. Although between-subjects ICC values were <0.25, within-subject ICC values were all >0.7 (all p < 0.05). While apnea-related RA duration did not differ from hypopnea-related RA duration, RA intensity was significantly higher (p = 0.00135) in hypopneas than in apneas. A clear individual pattern of arousal duration for each patient was made distinct. For arousal intensity, a Gaussian distribution was identified in most patients. The Bayesian statistics regarding the arousal microstructure showed significant differences between each pair of patients. Conclusions: Each individual patient with OSA might have an individual pattern of RA intensity and duration indicating a distinct individual pathophysiological feature. Arousal intensity was significantly higher in hypopneic than in apneic events and may be related causally to the diminished (compared to apneas) respiratory distress associated with hypopneas. RA intensity in REM, NREM2 and NREM3 strongly correlated with ODI.

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nCPAP Treatment of Obstructive Sleep Apnea Increases Slow Wave Sleep in Prefrontal EEG

Clinical EEG and Neuroscience ◽

10.1177/155005940703800311 ◽

2007 ◽

Vol 38 (3) ◽

pp. 148-154 ◽

Cited By ~ 4

Author(s):

Veera Eskelinen ◽

Toomas Uibu ◽

Sari-Leena Himanen

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Treatment Period ◽

Slow Wave ◽

Slow Wave Sleep ◽

Sleep Stage ◽

Sleep Eeg ◽

Sleep Stages ◽

Obstructive Sleep ◽

Sleep Stage Scoring

According to standard sleep stage scoring, sleep EEG is studied from the central area of parietal lobes. However, slow wave sleep (SWS) has been found to be more powerful in frontal areas in healthy subjects. Obstructive sleep apnea syndrome (OSAS) patients often suffer from functional disturbances in prefrontal lobes. We studied the effects of nasal Continuous Positive Airway Pressure (nCPAP) treatment on sleep EEG, and especially on SWS, in left prefrontal and central locations in 12 mild to moderate OSAS patients. Sleep EEG was recorded by polysomnography before treatment and after a 3 month nCPAP treatment period. Recordings were classified into sleep stages. No difference was found in SWS by central sleep stage scoring after the nCPAP treatment period, but in the prefrontal lobe all night S3 sleep stage increased during treatment. Furthermore, prefrontal SWS increased in the second and decreased in the fourth NREM period. There was more SWS in prefrontal areas both before and after nCPAP treatment, and SWS increased significantly more in prefrontal than central areas during treatment. Regarding only central sleep stage scoring, nCPAP treatment did not increase SWS significantly. Frontopolar recording of sleep EEG is useful in addition to central recordings in order to better evaluate the results of nCPAP treatment.

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

SLEEP ◽

10.1093/sleep/zsaa056.1191 ◽

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<0.001) and sleep efficiency (95.8±2.5 vs 84.6±7.1, p<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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392 Effect of Obstructive Sleep Apnea Severity, Sleep Stage and Position on Patterns of Oximetric Desaturations and Resaturations

SLEEP ◽

10.1093/sleep/zsab072.391 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A156-A156

Author(s):

Sikawat Thanaviratananich ◽

Hao Cheng ◽

Maria Pino ◽

Krishna Sundar

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Sleep Stage ◽

Rate Of Change ◽

Sleep Stages ◽

Sleep Position ◽

Apnea Hypopnea Index ◽

P Value ◽

Obstructive Sleep ◽

Significant Difference

Abstract Introduction Obstructive sleep apnea (OSA) severity based upon the apnea-hypopnea index (AHI) ignores many characteristics such as the duration of apnea-hypopneas, the duration and degree of oxygen desaturations (SpO2) etc. While hypoxemic burden has received increased attention given its relationship with cardiovascular outcomes, the role of oximetric resaturation vs. desaturation times is not understood. Resaturation times tend to be constant in contrast to desaturation durations. This study was done to assess desaturation and resaturation indices in patients with different OSA severity in differing sleep stages and positions. Methods Oximetric desaturation and resaturation slopes were calculated in patients with different OSA severities as rate of change in oxygen saturations (ΔSpO2/Δtime). Results 33 patients with OSA were studied (11 in each OSA severity group). Mean desaturation duration was 20.12 ±1.10 seconds with shorter NREM desaturation times (mean 19.07 ±1.11 seconds) as compared to REM desaturation durations (mean 26.66 ±2.69 seconds) (p-value 0.009). Non-supine and supine mean desaturation durations were similar (19.59 ±1.77 and 18.73 ±1.18 seconds respectively). Mean resaturation durations were shorter than desaturation durations at 12.46 ±0.84 seconds and was significantly lower in NREM sleep than in REM sleep (9.32 ±0.41 seconds vs 12.50 ±0.75 seconds p-value 0.002). Resaturation slopes (0.44 %/second (±0.028 %/second)) were steeper as compared to desaturation slopes (-0.26 %/second (±0.02 %/second)) without significant difference between NREM vs. REM desaturation or resaturation slopes. While desaturation slopes were not affected by sleep position, resaturation slopes were significantly steeper in supine compared to non-supine sleep (p-value 0.0046). Desaturation durations increased with OSA severity, but resaturation times decreased (resaturation slopes became steeper) with significant differences between patients with different OSA severity. Conclusion This study demonstrated that oxygen resaturation slopes varied according to different OSA severity and sleep position. Given that faster resaturation rates may reflect the possibility of higher degrees of reoxygenation-related oxidative stress, this should be assessed as a novel index to predicate OSA outcomes. Support (if any):

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Obstructive sleep apnea related to rapid-eye-movement or non-rapid-eye-movement sleep: comparison of demographic, anthropometric, and polysomnographic features

Jornal Brasileiro de Pneumologia ◽

10.1590/s1806-37562016000000012 ◽

2016 ◽

Vol 42 (1) ◽

pp. 48-54 ◽

Cited By ~ 6

Author(s):

Aysel Sunnetcioglu ◽

Bunyamin Sertogullarından ◽

Bulent Ozbay ◽

Hulya Gunbatar ◽

Selami Ekin

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Eye Movement ◽

Sleep Stage ◽

Treatment Modalities ◽

Sleep Stages ◽

Apnea Hypopnea Index ◽

Rapid Eye Movement ◽

Obstructive Sleep ◽

The Mean

Objective : To determine whether there are significant differences between rapid-eye-movement (REM)-related obstructive sleep apnea (OSA) and non-REM (NREM)-related OSA, in terms of the demographic, anthropometric, and polysomnographic characteristics of the subjects. Methods : This was a retrospective study of 110 patients (75 males) with either REM-related OSA (n = 58) or NREM-related OSA (n = 52). To define REM-related and NREM-related OSA, we used a previously established criterion, based on the apnea-hypopnea index (AHI): AHI-REM/AHI-NREM ratio > 2 and ≤ 2, respectively. Results : The mean age of the patients with REM-related OSA was 49.5 ± 11.9 years, whereas that of the patients with NREM-related OSA was 49.2 ± 12.6 years. The overall mean AHI (all sleep stages combined) was significantly higher in the NREM-related OSA group than in the REM-related OSA group (38.6 ± 28.2 vs. 14.8 ± 9.2; p < 0.05). The mean AHI in the supine position (s-AHI) was also significantly higher in the NREM-related OSA group than in the REM-related OSA group (49.0 ± 34.3 vs. 18.8 ± 14.9; p < 0.0001). In the NREM-related OSA group, the s-AHI was higher among the men. In both groups, oxygen desaturation was more severe among the women. We found that REM-related OSA was more common among the patients with mild-to-moderate OSA, whereas NREM-related OSA was more common among those with severe OSA. Conclusions : We found that the severity of NREM-related OSA was associated mainly with s-AHI. Our findings suggest that the s-AHI has a more significant effect on the severity of OSA than does the AHI-REM. When interpreting OSA severity and choosing among treatment modalities, physicians should take into consideration the sleep stage and the sleep posture.

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EEG microstate in obstructive sleep apnea patients

Scientific Reports ◽

10.1038/s41598-021-95749-2 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Xin Xiong ◽

Yuyan Ren ◽

Shenghan Gao ◽

Jianhua Luo ◽

Jiangli Liao ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Correlation Analysis ◽

Transition Probability ◽

Transient State ◽

Sample Entropy ◽

Sleep Stages ◽

Fluctuation Analysis ◽

Alpha Power ◽

Obstructive Sleep

AbstractObstructive sleep apnea (OSA) is a common sleep respiratory disease. Previous studies have found that the wakefulness electroencephalogram (EEG) of OSA patients has changed, such as increased EEG power. However, whether the microstates reflecting the transient state of the brain is abnormal is unclear during obstructive hypopnea (OH). We investigated the microstates of sleep EEG in 100 OSA patients. Then correlation analysis was carried out between microstate parameters and EEG markers of sleep disturbance, such as power spectrum, sample entropy and detrended fluctuation analysis (DFA). OSA_OH patients showed that the microstate C increased presence and the microstate D decreased presence compared to OSA_withoutOH patients and controls. The fifth microstate E appeared during N1-OH, but the probability of other microstates transferring to microstate E was small. According to the correlation analysis, OSA_OH patients in N1-OH showed that the microstate D was positively correlated with delta power, and negatively correlated with beta and alpha power; the transition probability of the microstate B → C and E → C was positively correlated with alpha power. In other sleep stages, the microstate parameters were not correlated with power, sample entropy and FDA. We might interpret that the abnormal transition of brain active areas of OSA patients in N1-OH stage leads to abnormal microstates, which might be related to the change of alpha activity in the cortex.

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Elevated Plasma Levels of Soluble (Pro)Renin Receptor in Patients with Obstructive Sleep Apnea Syndrome in Parallel with the Disease Severity

The Tohoku Journal of Experimental Medicine ◽

10.1620/tjem.238.325 ◽

2016 ◽

Vol 238 (4) ◽

pp. 325-338 ◽

Cited By ~ 14

Author(s):

Tsuguo Nishijima ◽

Kazuki Tajima ◽

Yoshihiro Yamashiro ◽

Keisuke Hosokawa ◽

Akira Suwabe ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Obstructive Sleep Apnea Syndrome ◽

Disease Severity ◽

Plasma Levels ◽

Sleep Apnea Syndrome ◽

Elevated Plasma ◽

Obstructive Sleep ◽

Apnea Syndrome

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Prevalence of Positional Obstructive Sleep Apnea in Patients Undergoing Polysomnography and the Effect of Sleep Stage

Positional Therapy in Obstructive Sleep Apnea ◽

10.1007/978-3-319-09626-1_4 ◽

2014 ◽

pp. 53-64 ◽

Cited By ~ 1

Author(s):

Mahesh Shetty ◽

M. Jeffery Mador

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Sleep Stage ◽

Positional Obstructive Sleep Apnea ◽

Obstructive Sleep

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Obstructive Sleep Apnea and Its Therapy: Clinical and Polysomnographic Manifestations

PEDIATRICS ◽

10.1542/peds.71.5.737 ◽

1983 ◽

Vol 71 (5) ◽

pp. 737-742 ◽

Cited By ~ 5

Author(s):

Yitzchak Frank ◽

Richard E. Kravath ◽

Charles P. Pollak ◽

Elliot D. Weitzman

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Airway Obstruction ◽

Obstructive Sleep Apnea Syndrome ◽

Medical Center ◽

Sleep Apnea Syndrome ◽

Sleep Stages ◽

Sleep Wake Disorders ◽

Obstructive Sleep ◽

Apnea Syndrome

Obstructive sleep apnea syndrome was studied in 32 children, aged 2 to 14 years, in the sleep-wake disorders center at Montefiore Hospital and Medical Center during the years 1977 to 1980. All children under-went all-night polysomnograms; 17 of these children had surgery to relieve airway obstruction and seven had a repeat polysomnographic study 4 to 6 weeks following the surgery. There was a significant improvement in the number of obstructive apneas and in other apnea indices following surgery. There was no significant effect on the durations and the proportions of the various sleep stages, on sleep efficiency, or on the number of awakenings.

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