Effect Of Sleep-related Breathing Disorders Research Articles

The Bilateral Effects of Sleep-Related Breathing Disorders and Opioid Agonist Use: A Vicious Cycle in Methadone Maintenance Clinics

The artical abstract is not available.

The role of inflammation mechanisms in the development of predisposition to thrombosis and thromboembolism in patients with chronic obstructive pulmonary disease and concurrent obstructive sleep apnea

The objective: to study the effect of sleep-related breathing disorders on the activation of blood coagulation reactions associated with systemic inflammation in patients with chronic obstructive pulmonary disease and concurrent obstructive sleep apnea.Subjects and methods. An open prospective comparative study analyzed thrombogenic risk factors, markers of inflammation and insulin resistance in 65 patients with chronic obstructive pulmonary disease and concurrent obstructive sleep apnea, 26 of them received non-invasive ventilation as a part of their therapy (main group).Results. The blood levels of homocysteine and prothrombin fragments 1+2 are closely associated with the duration of nocturnal hypoxemia, concentrations of C-reactive protein, C-peptide, and endothelial vascular growth factor and can be managed with CPAP therapy.The authors state that they have no conflict of interests.

Obstructive Sleep Apnea Syndrome (OSAS) and Cardiovascular System.

There is increasing evidence of a relationship between Obstructive Sleep Apnea (OSA) and cardiovascular diseases. The strong association between OSA and arterial hypertension, in particular in patients with resistant hypertension and/or a non-dipping profile, has been extensively reported. The relationship between OSA and high blood pressure (BP) has been found independent from a number of confounders, but several factors may affect this relationship, including age and sex. It is thus important to better assess pathophysiologic and clinical interactions between OSA and arterial hypertension, also aimed at optimizing treatment approaches in OSA and hypertensive patients with co-morbidities. Among possible mechanisms, cardiovascular autonomic control alterations, altered mechanics of ventilation, inflammation, endothelial dysfunction, and renin-angiotensin-aldosterone system should be considered with particular attention. Additionally, available studies also support the occurrence of a bidirectional association between OSA and cardiovascular alterations, in particular heart failure, stroke and cardiac arrhythmias, emphasizing that greater attention is needed to both identify and treat sleep apneas in patients with cardiovascular diseases. However, a number of aspects of such a relationship are still to be clarified, in particular with regard to gender differences, effect of sleep-related breathing disorders in childhood, and influence of OSA treatment on cardiovascular risk, and they may represent important targets for future studies.

Association of Migraine and Sleep-Related Breathing Disorder: A Population-Based Cohort Study.

In this nationwide population-based cohort study, we aimed to evaluate the effects of sleep-related breathing disorders (SBD) on migraine development.Patients ages 20 years or more and diagnosed with SBD between 2000 and 2009 were evaluated as the SBD cohort (n = 3411), and compared with comparison cohort (n = 13,644). The adjusted hazard ratio (aHR) for developing migraine was calculated in both cohorts by multivariate Cox proportional hazards model.The cumulative incidence of migraine was significantly higher in the SBD cohort than in the comparison cohort. In the SBD cohort, the overall aHR for developing migraine was 2.43 (95% confidence interval [CI] = 1.72–3.44). The risk of developing migraine was higher in men (aHR 2.71) than in women (aHR 2.29) with SBD. When stratifying by age, we observed increased incidence of migraine in patients ages 20 to 44 years and 45 to 64 years, with a higher aHR of 2.51 (95% CI = 1.47–4.30) and 2.68 (95% CI = 1.63–4.43), respectively. The risk of developing migraine in the patients with SBD with or without comorbidity exhibited nonsignificant differences. After stratifying by the use of hypnotics, the aHR for developing migraine was 2.39 in the patients with hypnotics use and 3.58 in the patients without hypnotics use.Our findings indicate increased risk of developing migraine in adults, but not elderly ones, with SBD.

What We Don't Know about Sleep-Related Breathing Disorders in the Elderly

IN THIS ISSUE OF SLEEP, SFORZA, ROCHE, AND COLLEAGUES 1 PRESENT CROSS-SECTIONAL DATA EXAMINING THE ASSOCIATION BETWEEN COGNITIVE function and sleep-related breathing disorders (SRBD) in 827 healthy elderly subjects. An extensive assessment including clinical interview, neurological examination, 12-lead ECG, ECG Holter, and magnetic resonance imaging excluded those with myocardial infarction, previously diagnosed sleep disorders, stroke, dementia, and other cardiac and neurological disorders from the cohort at study entry. Two years after enrollment, 827 (58.5% women, mean age 68 years) of the original cohort had one night of nocturnal unattended at home polygraphy, self-assessed cognitive difficulties in everyday life, depression, anxiety, and daytime sleepiness, and an extensive neuropsychological battery of primarily memory and executive function testing. Noteworthy findings were: (1) 53.8% prevalence of SRBD, defined as apnea + hypopnea index (AHI) > 15; (2) lack of day time sleepiness in the entire group with no significant difference in daytime sleepiness between those with and without SRBD; (3) little hypoxemia in those with SRBD, with no difference in minutes SaO 2 30) demonstrating the lowest scores, but no significant differences in other cognitive function tests; and (6) in multivariate models no significant or strong relationships between cognitive function and severity of SRBD. 1 This study is unique and important, largely because the find ings regarding the relationship between SRBD and cognitive function in healthy older adults were negative on almost every front, with the exception of a consistent deficit in episodic memory. The sample size, strength of the study design, methods, and analysis support the internal consistency and generalizability of the findings. The neuropsychological cognitive function battery was comprehensive, and the measures the investigators used are standard for detecting memory and executive function deficits. Inclusion of another measure of attention, such as the psychomotor vigilance task, may have increased sensitivity to decrements in attention. The approach to data analysis was thoughtful, with targeted bivariate and multivariate analyses to detect differences, if they existed. So here is what we know: in a large population-based sample of healthy 68-year-olds, a comprehensive measure of cognitive function showed that those with SRBD had the same cognitive function (except for a deficit in delayed recall) as those without SRBD. 1 Yet, much remains unknown about SRBD in the elderly. The biggest unknown is the long-term effect of SRBD on cognitive, everyday function, and other common comorbidities such as heart disease in older adults. It is possible that these healthy older adults without cardiac and neurological disease have recent onset SRBD and are thereby without consequent cognitive impairment of significance. We also do not know the earlier severity of SRBD in this sample, further complicating definitive conclusions about short- and long-term effects of SRBD in the elderly. Moreover, if this sample of healthy older adults has had SRBD most of their adult lives, what has protected them from

Poster 378: The Effect of Sleep-Related Breathing Disorders on Functional Outcome in Stroke Patients

Objective: To assess whether the presence of a sleep-related breathing disorder (SRBD) is associated with a poorer functional outcome for patients after an acute stroke. Design: A retrospective chart review. Setting: Acute inpatient stroke rehabilitation unit in a large academic institution. Participants: A convenience sample of 71 stroke patients who received a continuous, nocturnal pulse oximetry study with recording on room air within 1 week of admission to the acute stroke rehabilitation unit.

Sleep-related breathing disorders and risk of stroke.

Stroke and sleep-related breathing disorders are both common and are associated with significant morbidity and mortality. Several recent large epidemiological studies have shown a strong association between these 2 disorders independent of known risk factors for stroke. This article will outline the scientific basis for this relationship and suggest sleep-related breathing disorders as modifiable risk factors for stroke. Several studies have shown a characteristic circadian rhythmicity in stroke. We have discussed the influence of normal sleep states as well as the effect of sleep-related breathing disorders on cerebral hemodynamics. The hemodynamic, metabolic, and hematologic changes during sleep-related breathing disorders in the form of decreased cerebral perfusion and increased coagulability are possible pathogenetic mechanisms for stroke. There are accumulating lines of evidence that sleep apnea disorder may indeed cause diurnal hypertension. However, the increased risk of stroke in patients with sleep-related breathing disorders appears to be independent of coexisting hypertension; the presence of hypertension would increase the risk even further. Furthermore, several studies have documented high prevalence of sleep apnea disorders in patients with transient ischemic attacks and stroke. Sleep-related breathing disorder appears to contribute as a risk factor for stroke through hemodynamic and hematologic changes. Because of the high prevalence of sleep apnea disorder in this population, patients with transient ischemic attacks and stroke should undergo evaluation for these disorders.

Manifestations and consequences of obstructive sleep apnoea

Over the last two decades the diagnostic tools used in sleep medicine have developed enormously, making it possible to study the interaction of sleep-related breathing disorders (SRBD) with cardiovascular function and the autonomic nervous system, as well as the effects of SRBD on a variety of physiological processes during wakefulness. Different modes of nasal ventilation are now available, allowing all forms of SRBD to be treated. If early diagnosis and treatment are provided, the acute and long-term sequelae of SRBD can be prevented. In addition to the care and treatment of patients with severe obstructive sleep apnoea syndrome (OSAS), future patient management will need to focus on patients with milder forms of obstructive sleep apnoea (OSA). In particular, the consequences of SRBD on cardiac arrhythmias, arterial hypertension and hypersomnolence are discussed, considering epidemiological, clinical, diagnostic and therapeutic aspects. Some economical issues arising from SRBD are also discussed, and the authors conclude that a Europewide programme for early detection, treatment and prevention of SRBD is required. This could make a large contribution to the reduction of cardiovascular morbidity and mortality and also reduce the incidence of "human error catastrophes" due to hypersomnolence.

Traffic Accidents in Commercial Long-Haul Truck Drivers: The Influence of Sleep-Disordered Breathing and Obesity

This study assesses a possible independent effect of sleep-related breathing disorders on traffic accidents in long-haul commercial truck drivers. The study design included integrated analysis of recordings of sleep-related breathing disorders, self-reported automotive and company-recorded automotive accidents. A cross-sectional population of 90 commercial long-haul truck drivers 20-64 years of age was studied. Main outcome measures included presence or absence, as well as severity, of sleep-disordered breathing and frequency of automotive accidents. Truck drivers identified with sleep-disordered breathing had a two-fold higher accident rate per mile than drivers without sleep-disordered breathing. Accident frequency was not dependent on the severity of the sleep-related breathing disorder. Obese drivers with a body mass > or = 30 kg/m2 also presented a two-fold higher accident rate than nonobese drivers. We conclude that a complaint of excessive daytime sleepiness is related to a significantly higher automotive accident rate in long-haul commercial truck drivers. Sleep-disordered breathing with hypoxemia and obesity are risk factors for automotive accidents.