The Impact of Obstructive Sleep Apnea on Memory Consolidation: A Review

The prevalence of prediabetes and diabetes is substantially higher in PCOS women with obstructive sleep apnea (OSA) compared to PCOS women without OSA1,2,3. Prior studies, however, did not examine the complex interaction between race and OSA on metabolic function in PCOS. We sought to determine if the impact of OSA on glucose and insulin metabolism is affected by race. We studied non-Hispanic white (NHW) (n=53) and African-American (AA) (n=48) women with PCOS. Following an overnight polysomnogram (PSG), PCOS women (NHW without OSA n=40; NHW with OSA n=13; AA without OSA n=36; AA with OSA n=12) had a 2-h 75-g oral glucose tolerance test (OGTT) with blood sampling every 30 minutes for measurement of glucose, insulin, and C-peptide concentrations. OSA severity was measured by the Apnea-Hypopnea Index (AHI). Only women without OSA (AHI < 5) or with moderate-to-severe OSA (AHI > 15) were included in these analyses; women with mild OSA were excluded. Insulin secretion rates (ISR) during the OGTT were derived by deconvolution of C-peptide levels 4. Area under the curve (AUC) response to the glucose challenge was calculated using the trapezoidal method. BMI and age did not differ between races in PCOS women without OSA (BMI [kg/m2]: 36.3±1.2 vs. 37.2±1.1, p=0.58; Age [yr]: 27.7±0.8 vs. 27.2±0.8, p=0.65; for NHW and AA respectively), or in PCOS women with OSA (BMI [kg/m2]: 42.8±1.7 vs. 44.7±2.0, p=0.50; Age [yr]: 31.4±1.6 vs. 28.6±1.6, p=0.18; for NHW and AA respectively). OSA severity was similar in NHW and AA PCOS women without OSA (AHI: 1.5±0.2 vs 2.1±0.2, p=0.076), and PCOS women with OSA (AHI: 32.0±4.9 vs. 28.3±4.4, p=0.26). Higher glucose responses during the OGTT were observed in NHW PCOS women with OSA compared to both NHW (AUC: 18,965±648 vs. 15,797±371, p=0.0004) and AA (AUC: 18,965±648 vs. 15,801±497, p=0.0005) PCOS women without OSA. Glucose responses did not differ significantly between AA PCOS women with OSA and AA PCOS women without OSA (AUC: 17,104±965 vs. 15,801±497, p=0.15). Similarly, ISR was higher in NHW PCOS women with OSA compared to both NHW (AUC: 5,648±488 vs. 3,907±231, p=0.0006) and AA (AUC: 5,648±488 vs. 3,981±235, p=0.0011) PCOS women without OSA. ISR did not differ significantly between AA PCOS women with OSA and AA PCOS women without OSA (AUC: 4,827±461 vs. 3,981±235, p=0.09). CONCLUSIONS: OSA has a greater impact on glucose and ISR during an oral glucose challenge in NHW compared to AA women with PCOS. Future studies would benefit from including race when evaluating metabolic outcomes in women with PCOS.

Unrecognised obstructive sleep apnoea (OSA) has been associated with adverse cardiorespiratory perioperative outcomes. However, with changing anaesthetic and perioperative management, there is ongoing uncertainty about the importance of OSA as a risk factor for post-operative complications. A cohort study involving subjects undergoing elective surgery was conducted. OSA was diagnosed with a limited channel sleep monitor. In subjects undergoing routine perioperative care, complications were identified based on the assessment of the attending clinical team. The primary outcome was a composite end-point of cardiorespiratory outcomes comprising myocardial infarction, atrial fibrillation, other arrhythmias, bradycardia, need for inotropic support, unplanned intensive care unit admission, pneumonia or respiratory failure. Four hundred seventy-two subjects were recruited, with 356 being included in the analyses; 281 (79%) had OSA and 66 (19%) had severe OSA. Subjects with OSA did not have a significantly higher incidence of complications (5.7%) compared to those without (2.7%, adjusted relative risk 1.89 (0.23-15.67)). Additionally, complications were not increased in those with severe OSA. Unrecognised OSA was not associated with an increase in clinically evident cardiorespiratory complications in this cohort. The lower complication rates compared with earlier studies suggest that increased use of less invasive surgical techniques, improved pain management and increased awareness of OSA have had an impact in reducing postoperative complications in this group. Further research is needed to clarify the impact of severe OSA on post-operative outcomes in different surgical cohorts with varying risk profiles in order to develop optimal perioperative pathways.

Obstructive sleep apnea (OSA) is very common in patients with Type 2 diabetes (T2D). Over the last two decades there has been increasing interest in the impact of OSA on glucose metabolism and the impact of OSA in patients with T2D, which mostly focused on the impact of OSA on glycemic measures. However, more recently the impact of OSA on diabetes-related vascular risk factors and outcomes in patients with T2D gained interest. In this article I will briefly review of the epidemiology and impact of OSA in patients with T2D with particular focus on the impact of OSA on diabetes-related outcomes such as hyperglycemia, cardiovascular disease risk factors and vascular complications.

INTRODUCTION: Snoring is a common cause of marital disharmony and social embarrassment. Obstructive sleep apnoea (OSA) have further impact on Quality of Life (QoL). AIMS: First, to compare the impact of snoring and OSA on QoL; second, to assess the impact of laser palatoplasty (LAUP) on QoL in snorers. METHODS: We conducted a prospective cohort comparison of 191 snorers (mean age 46 years; 132 men, 59 women), 57 patients with OSA (mean age 47 years; 49 men, 8 women), and 105 patients, at a mean of 12 months (range, 4-24 months) after LAUP (mean age 45 years; 82 men, 23 women). All completed the Nottingham Health Profile (NHP) and the results were compared with established NHP population norms. RESULTS: The results are shown in Table 1. CONCLUSIONS: This is the largest QoL study of snorers to date and shows that both snoring and OSA have clear impacts on all six NHP domains. The magnitude of the impact in snoring approaches that for OSA for most parameters. The impact of OSA on the sleep domain in men is significantly higher than that of snoring. Energy and emotional reaction domains are significantly improved by LAUP in both sexes, to levels approaching those in the normal population. Also pain, sleep, social isolation and mobility in habitual snorers was helped by surgery. The NHP generic QoL health status measure is a useful tool for the assessment of sleep disorders.

Obstructive sleep apnoea is recognised as a common but under-diagnosed health issue. Currently, there is very little published data relating to the burden and impact of obstructive sleep apnoea among indigenous populations. The purpose of this review was to investigate the prevalence, impact, risk factors and treatment of obstructive sleep apnoea in indigenous populations in high-income countries. An integrative review was conducted on 25 English language studies and reports that investigated obstructive sleep apnoea among indigenous populations in high-income countries. Studies that did not focus on indigenous populations in the results or discussion were excluded. Eligible studies were identified by searching PubMed, Web of Science and Google Scholar databases and reference lists of eligible studies. Publication dates range from 1998 to 2012. Synthesis of studies indicates the prevalence of obstructive sleep apnoea is higher and severity is greater in indigenous populations compared with non-indigenous populations. Comparable risk factors for obstructive sleep apnoea were identified in indigenous and non-indigenous populations, with only three studies identifying ethnicity as an independent risk factor. Indigenous populations in high-income countries are subject to an overall greater prevalence of obstructive sleep apnoea that is also more severe. A higher prevalence of obesity, alcohol and tobacco use and comorbid medical conditions associated with low socioeconomic status rather than indigenous status per se appears to explain this disparity.

Impact of Obstructive Sleep Apnea on Clinical Outcomes Following Left Ventricular Assist Device Implantation

To investigate the prevalence and impact of obstructive sleep apnea (OSA) and obesity in lateral skull base cerebrospinal fluid leak repair (LSBR) of various etiologies. Retrospective case review at a tertiary skull base center was conducted of consecutive adults undergoing LSBR via transmastoid, middle cranial fossa, or combined approach between 2013-2018. The following data were collected: demographics, comorbidities, radiology and intraoperative findings, and surgical outcomes including complications and need for revision surgery or shunt placement. Patients with incomplete data or leaks following skull base surgery, trauma or chronic ear disease were excluded. Ninety-four patients (67.4% female, mean age 53.5 ± 12.9 years) underwent repair for spontaneous (sCSFL, 44%) and other etiology (nsCSFL) leaks. nsCSFL served as a comparison group consisting of leaks status-post lateral skull base surgery, temporal bone fractures, and chronic ear disease. Class III obesity (P = .02), OSA (P = .03), and imaging findings of empty sella (OR = 3.32, P = .02), and skull base thinning including contralateral tegmen thinning (31%, OR = 4.3, P = .02), arachnoid granulations (26%, OR = 4.35, P = .02), and superior canal dehiscence (15.8%, OR = 8.57, P = .04) were more common in sCSFL. Four patients (4.2%) required surgical revision for recurrence, and another four (4.2%) resolved with shunting. Evidence of elevated intracranial hypertension was present in nine patients with sCSF leaks and was predictive of need for revision or shunt procedures (P < .01). Obesity, OSA, and imaging consistent with elevated intracranial pressures were more common among patients with sCSFL. Elevated intracranial pressure predicted outcomes following multilayer repair of spontaneous CSF leaks LEVEL OF EVIDENCE: 4 Laryngoscope, 130:2234-2240, 2020.

Untreated obstructive sleep apnea (OSA) increases healthcare utilization and is associated with reduced work performance and occupational injuries. The economic burden related to untreated OSA is substantial, accounting for billions of dollars per year. Furthermore, therapy of OSA is an extremely cost-efficient use of healthcare resources, comparing highly favorably with other commonly funded medical therapies. Governments, transportation agencies, industry, and insurance companies need to be better informed concerning the economic impact of untreated OSA and the benefits of therapy.

Impact of Obstructive Sleep Apnea on Optic Nerve Function in Patients With Craniosynostosis and Recurrent Intracranial Hypertension

Obstructive sleep apnoea is a common sleep disorder, and adult congenital heart disease (CHD) is also a significant burden on the population. Early diagnosis and treatment are important for improving quality of life and reducing the risk of health complications. The limited research on obstructive sleep apnoea and adult CHD highlights the need for further investigation into the relationship between these two conditions and the mechanisms underlying this relationship. We used NIS 2019 database to identify adult CHD admissions aged 18-44 years and assess the impact of obstructive sleep apnoea on all-cause mortality, dysrhythmia, and stroke. A propensity-matched cohort of individuals with and without obstructive sleep apnoea was obtained, and the outcomes were assessed using multivariable analysis and compared in terms of resource utilisation. Of the 41,950 young adult CHD admissions, 6.3% (n = 2630) had obstructive sleep apnoea. The obstructive sleep apnoea+ (n = 2590) and obstructive sleep apnoea- (n = 2590) cohorts were comparable in terms of median age (35 years) and were predominantly male (63.1% versus 62.5%). The obstructive sleep apnoea+ cohort had a higher frequency of risk factors like chronic obstructive pulmonary disease, hypothyroidism, and prior venous thromboembolism than the obstructive sleep apnoea cohort. We found significant association of obstructive sleep apnoea with dysrhythmia (adjusted odds ratio 2.99, 95% confidence interval 2.13-4.19, p < 0.001), but no significant impact on the risk of all-cause mortality or stroke. The obstructive sleep apnoea+ cohort also had higher transfers to short-term facilities, prolonged stays, and higher charges (p < 0.001). Our study provides important insights into relationship between obstructive sleep apnoea and adult CHD and highlights the need for further investigation into the impact of obstructive sleep apnoea on individuals with adult CHD.

Objective To determine the impact of obstructive sleep apnea(OSA) on C-peptide,the major clinical indicator of islet function in patients with type 2 diabetes. Methods Polysomnography was performed and C-peptide was measured in 60 patients with type 2 diabetes. Four groups were separated according to apnea-hyponea index (AHI):20 patients in group without OSA (AHI ＜5 ),21 patients in mild OSA group (5 ≤ AHI ＜ 15 ), 12 patients in moderate OSA (15 ≤ AHI ＜ 30 )group, 7 patients in severe OSA group ( AHI ≥30). Results Severity of OSA was associated with C-peptide, after adjusting age, body mass index( BMI ), waist circumference, fasting plasma glucose, fasting insulin, years of diabetes and total sleep time. Compared with patients without OSA, the adjusted mean C-peptide decreased 0.13 nmol/L( F = 3.78,P =0.032) in mild OSA group,0. 18 nmol/L ( F = 3.16, P = 0. 048 ) in moderate OSA group, and 0.25 nmoL/L ( F = 5.32, P = 0.001 ) in severe OSA group. Conclusion In patients with type 2 diabetes, severity of OSA is associated with poorer islet function. Key words: Obstructive sleep apnea; C-peptide; Type 2 diabetes mellitus; Fasting plasma glucose

Impact of Obstructive Sleep Apnoea on Heart Failure with Preserved Ejection Fraction

REM sleep and sleep apnea are associated with language function in Down syndrome children: An analysis of a community sample

IntroductionWe explore the impact of obstructive sleep apnea (OSA) and positive airway pressure (PAP) therapy on novel coronavirus (COVID-19) infection rate and severity.MethodsRetrospective analysis was performed utilizing a database of patients evaluated by Kaiser Permanente Southern California sleep medicine between 2015–2020 (includes sleep study, daily PAP, and electronic health record data.) Adult patients were analyzed if: on March 1, 2020 patient was alive, had ≥1 month health-plan enrollment, and had sleep diagnostic or PAP data. PAP adherence was calculated between March 1, 2020 to COVID-19 confirmation, death, disenrollment or study end date (July 31, 2020), whichever came earlier. COVID-19 outcomes were evaluated based on OSA status and PAP adherence: patients with PAP <2 hours/night were considered “untreated”; ≥2 hours/night were “treated”; 2–3.9 hours/night were “moderately-treated”; ≥4 hours/night were “well-treated”. Apnea hypopnea index (AHI) defined OSA severity. Multiple logistic regression evaluated the association of various demographic/clinical factors.ResultsOf 81,932 patients (39.8% female, age 54.0±14.9 years) analyzed, 1493 (1.8%) had COVID-19 with 224 (0.3%) hospitalizations and 61 (0.07%) resulting in intensive care or death. Increased severity of “Untreated” OSA was associated with higher COVID-19 rate and lower when “treated” [No OSA 1.7%; Mild 2%; Moderate 2%; Severe 2.4%; OSA unknown severity 2%; Treated 1.4%; p<0.0001]. Better PAP adherence was associated with reduced infection rate [“untreated” 2.1%; “moderately-treated” 1.7%, “well-treated” 1.3%, No OSA 1.7%; p=<0.0001]. Multivariable analysis confirmed increased infection rate with OSA versus no OSA [OR 0.82(0.70,0.96)] and the benefit of good PAP adherence versus “untreated” [“moderately-treated” OR 0.82 (0.65, 1.03); “well-treated” OR (0.69 (0.59, 0.80)]. Increased infection rate was also associated with obesity, higher Charlson Comorbidity score, Black and Hispanic ethnicities, and Medicaid enrollment; increasing age was associated with reduced infection rate. Separate multivariable analysis showed dose-response association of OSA severity on infection rate [Mild OR 1.21 (1.01,1.44 95%CI); Moderate-Severe OR 1.27 (1.07,1.51) versus no OSA]. Neither OSA presence nor PAP adherence significantly impacted rate of hospitalization nor intensive care or death.ConclusionSignificant associations emerged with OSA increasing and PAP therapy reducing COVID-19 infection rate. Findings support continued PAP use during the pandemic.Support (if any)AASM Foundation SRA: 205-SR-19

There is compelling evidence that obstructive sleep apnoea (OSA) can affect metabolic syndrome (MetS) and cardiovascular risk, but the intermediate mechanisms through which it occurs have not been well defined. We explored the impact of OSA in morbidly obese patients with MetS on adipokines, pro-inflammatory markers, endothelial dysfunction, and atherosclerosis markers. We included 52 morbidly obese patients in an observational study matched for age, gender and central obesity in 3 groups (OSA-MetS, Non-OSA-MetS, and Non OSA-non-MetS). Anthropometrical, blood pressure, and fasting blood measurements were obtained the morning after an overnight polysomnography. VEGF, soluble CD40 ligand (sCD40L), TNF-α, IL-6, leptin, adiponectin, and chemerin were determined in serum by ELISA. OSA was defined as apnea/ hypopnea index ≥ 15 and MetS by NCEP-ATP III. Cases and control subjects did not differ in age, BMI, waist circumference, and gender (43 ± 10 years, 46 ± 5 kg/m(2), 128 ± 10 cm, 71% females). The cases had severe OSA with 47 (32-66) events/h, time spent < 90% SpO2 7% (5%-31%). All groups presented similar serum cytokines, adipokines, VEGF, and sCD40L levels. In a morbidly obese population with established MetS, the presence of OSA did not determine any differences in the studied mediators when matched by central obesity. Morbidly obese NonOSA-NonMetS had a similar inflammatory, adipokine VEGF, and sCD40L profile as those with established MetS, with or without OSA. Obesity itself could overwhelm the effect of sleep apnea and MetS in the studied biomarkers. Salord N; Gasa M; Mayos M; Fortuna-Gutierrez AM; Montserrat JM; Sánchez-de-la-Torre M; Barceló A; Barbé F; Vilarrasa N; Monasterio C. Impact of OSA on biological markers in morbid obesity and metabolic syndrome.