High Prevalence Of Obstructive Sleep Apnea Research Articles

#1384 Obstructive sleep apnea and fluid management in the hemodialysis: are clinicians putting existing scientific evidence into practice?

Abstract Background and Aims Obstructive Sleep Apnea (OSA) prevalence was found to be higher in an intermittent hemodialysis (iHD) population of the French-speaking Switzerland than in the general population of the same geographical area. The high prevalence of OSA in iHD patients was linked to fluid overload. Interdialytic fluid management targeting a low dry weight showed to reduce OSA's severity, offering a novel therapeutic option in this population. The aims of this study were: 1) to assess the prevalence of confirmed OSA in an end-stage renal disease (ESRD) population undergoing iHD in the Italian-speaking area of Switzerland; 2) to assess the awareness of the treating nephrologists about the OSA's diagnosis of their patients; and 3) to evaluate whether nephrologists integrate the current knowledge in their fluid management strategy of iHD patients with OSA. Method We performed a multicenter, cross-sectional study between July 2022 and July 2023, screening all patients attending the four iHD units of the Ente Ospedaliero Cantonale (EOC), the public hospital network of Canton Ticino (Switzerland), and including those with confirmed OSA. For these patients, we collected anthropometric parameters, iHD protocol characteristics and fluid status from electronic patient dossiers. Fluid overload was measured by multifrequency bioelectrical impedance (Body Composition Monitor®, BCM®; Fresenius Medical Care). Nephrologists of the four iHD units were asked to identify patients with known OSA diagnosis, without consulting the medical dossiers, and were interviewed about their specific iHD strategy in patients with OSA. We compared the fluid management of patients identified as “OSA positive” and those with OSA diagnosis, but misclassified as “OSA negative” by the treating nephrologist. Results Out of 193 patients treated by iHD in the four HD units, 45 patients had a confirmed diagnosis of OSA and were included in this study. Mean age was 76.0 ± 7.5 y, 82.2% were men, mean BMI was 29.1 ± 4.5 kg/m2. They were treated 3 times per week, in mean for 3.76 ± 0.37 hours; 22 were treated by hemodialysis and 23 by hemodiafiltration. The 23% prevalence of diagnosed OSA observed in the study population was significantly lower than the 56% prevalence found in the French Switzerland iHD cohort (p < 0.001). Out of the 45 patients with diagnosed OSA, only 27 (60.0%) were correctly identified by the treating nephrologist. We found no difference in the dry weight target defined by the treating nephrologist between the patients correctly identified as “OSA positive” and those misclassified as “OSA negative”, both being close to the dry weight calculated with BCM® (mean difference 0.7 ± 2.3 vs 0.3 ± 1.4 kg; p = 0.564). The pre-dialysis fluid overload of the whole population was 2.4 ± 1.7 kg, being higher in the “OSA positive” group (2.9 ± 2.0 kg) than in the “OSA negative” group (1.8 ± 0.7 kg; p = 0.0172). However, we found no difference in post-dialysis achievement of dry weight between the groups (residual overweight 0.2 ± 1.0 and 0.1 ± 0.7 kg respectively; p = 0.672). In the interviews, only half of the nephrologists (4/8) were aware of the correlation between fluid overload and OSA, and two of them reported to integrate this knowledge in their fluid management strategy, even if not systematically. Conclusion Nephrologists' attention to sleep apnea in iHD patients seems to be low, despite its high prevalence in this population and scientific evidence supporting that targeting fluid overload is an effective option to improve OSA severity. However, nephrologists tried to achieve the dry weight very strictly in all patients, independently of OSA. More intensive training of nephrologists to the clinical and diagnostic peculiarities of OSA in patients with ESKD is required, in order to improve OSA diagnosis and targeted therapeutic care.

Exploring the Multifaceted Landscape of Pediatric Obstructive Sleep Apnea: Insights into Prevalence, Severity, and Coexisting Conditions.

Pediatric obstructive sleep apnea (OSA) is a multifaceted disorder marked by recurrent upper airway obstruction during sleep, often coexisting with various medical conditions. This study, aimed to comprehensively analyze the Multifaceted Landscape of Pediatric Insights into Prevalence, Severity, and Coexisting Conditions. With a sample of 1928 participants, our study sought to determine the prevalence, severity, and associations between OSA and diverse conditions. Conducted retrospectively from February 2019 to April 2023, the study included pediatric patients. Data were collected through electronic health records, involving clinical assessments, medical histories, and diagnostic tests to establish OSA and coexisting condition diagnoses. Relationships between sleep parameters, apnea types, and severity indices were evaluated. High OSA prevalence was evident across age groups, with severity peaking between 3 to 12 years. Among the participants, coexisting conditions included allergic rhinitis (59.6%), tonsillar hypertrophy (49.7%), adenoid hypertrophy (28.4%), and obesity (15.3%). Analysis revealed intriguing relationships between different sleep parameters and apnea types. Notable associations were observed between Obstructive Apnea (OA) and Central Apnea (CA), and Mixed Apnea (MA) displayed associations with both OA and CA. Hypopnea correlated directly with the Apnea-Hypopnea Index (AHI), reflecting its role in OSA severity. This study provides a comprehensive understanding of the intricate dynamics between pediatric OSA and coexisting conditions. The prevalence of OSA and its coexistence with various conditions underscore the need for comprehensive evaluation and management strategies. By revealing associations between different sleep parameters and apnea types, the study emphasizes the complexity of OSA diagnosis and management. These findings hold the potential to enhance clinical approaches, ultimately leading to improved care and outcomes for affected children.

Association of self-reported and objective sleep disturbance with the spectrum of gastroesophageal reflux disease.

The relationship between obstructive sleep apnea (OSA) and gastroesophageal reflux disease (GERD) is complex. We aimed to determine the association of self-reported and objective sleep parameters with diverse manifestations of the GERD spectrum. We prospectively recruited 561 individuals who underwent an electrocardiogram-based cardiopulmonary coupling for OSA screening during a health check-up. All participants received the Reflux Disease Questionnaire and an upper endoscopy to determine the presence of troublesome reflux symptoms and erosive esophagitis (EE). Sleep quality was evaluated by the Pittsburgh Sleep Quality Index and sleep dysfunction was defined as a Pittsburgh Sleep Quality Index score > 5. OSA was defined as a cardiopulmonary coupling-derived apnea-hypopnea index exceeding 15 events/h. Comparisons were made between participants on the GERD spectrum with respect to their various self-reported and objective sleep parameters. Among the 277 patients with GERD (49.4%), 198 (35.3%) had EE. Patients with GERD had higher PSQI scores (6.99 ± 3.97 vs 6.07 ± 3.73, P = .005) and a higher prevalence of sleep dysfunction (60.6% vs 49.6%, P = .009). Patients with EE had a higher prevalence of OSA (42.9% vs 33.9%, P = .034). Along the GERD spectrum, symptomatic patients with EE had the highest PSQI scores and prevalence of sleep dysfunction (70.7%), while asymptomatic patients with EE had the highest prevalence of OSA (44%). Our findings indicate a high prevalence of sleep dysfunction among individuals with GERD. Furthermore, patients on the GERD spectrum are prone to experiencing a range of self-reported and objective sleep disturbances. Hu K-Y, Tseng P-H, Hsu W-C, etal. Association of self-reported and objective sleep disturbance with the spectrum of gastroesophageal reflux disease. J Clin Sleep Med. 2024;20(6):911-920.

Association of tau burden with sleep disordered breathing in adults with Down syndrome

AbstractBackgroundAdults with Down syndrome (DS) overproduce the amyloid precursor protein and nearly all evidence clinical symptoms of Alzheimer’s Disease (AD) dementia in later life. Sleep disordered breathing, and specifically, obstructive sleep apnea (OSA), is common in adults with DS. OSA has been associated with risk of AD in adults without DS, and sleep disturbances may have a bidirectional relationship with AD pathology. We hypothesized that greater tau burden is associated with subsequent sleep disordered breathing in a time‐lagged design.MethodsEighty young adults with DS (37±8 yrs, 49% women, 94% cognitively‐stable/6% MCI‐DS) from the ABC‐DS study underwent tau PET ([18F]‐AV1451, Braak stage SUVRs) and were assessed 4±0.7 years after PET using WatchPAT home sleep testing. Sleep variables included oxygen desaturation index (ODI) and apnea‐hypopnea index (AHI). General linear models assessed tau burden on later sleep impairments. Models were run in the whole group and the cognitively‐stable group alone, with and without age adjustment. Analyses were run using overall sleep measures and those in REM and non‐REM (NREM) sleep separately.ResultsIn unadjusted models, greater tau in early, middle, and late Braak stages were associated with a higher ODI, while greater tau in middle Braak stages was associated with a higher AHI. In the cognitively‐stable group alone, greater tau in early and middle, but not late, Braak stages were associated with a higher ODI, while greater tau in middle Braak stages was associated with a higher AHI. Adjusting for age, greater tau in late Braak stages was associated with ODI in the whole group and the cognitively‐stable group alone. Associations for overall sleep measures were driven by NREM measures (Table 1).ConclusionIn adults with DS with a high prevalence of OSA, tau burden was associated with subsequent intermittent nocturnal hypoxemia as measured by the ODI during NREM sleep. These findings align with those in adults without DS, linking AD pathology, disturbed sleep, witnessed apneas, and nocturnal hypoxemia. Both longitudinal and randomized studies are required to clarify cause‐effect relationships, including the presence of mediating and/or moderating variables such as reduction in sleep depth or continuity.

Strengthening oropharyngeal muscles as an approach to treat post-stroke obstructive sleep apnea: A feasibility randomised controlled trial.

This study aimed to determine the feasibility of a randomised controlled trial (RCT) evaluating oropharyngeal exercise (OPE) intervention as an alternative therapy for obstructive sleep apnea (OSA) in patients with stroke or transient ischaemic attack (TIA). Despite the high prevalence of OSA in this population, the standard therapy, continuous positive airway pressure (CPAP), is often poorly tolerated. Thirty stroke/TIA patients with OSA unable to tolerate CPAP were randomly assigned to an oropharyngeal exercise or sham exercise protocol. They performed exercises for 6 weeks, 5 days per week, 30 minutes twice per day. Feasibility was ascertained by the proportion of enrolled patients who completed more than 80% of the OPE regimen. Isometric tongue pressures, apnea-hypopnea index (AHI), oxygen desaturation index (ODI), daytime sleepiness, and quality of life (QOL) outcomes were collected at baseline, post-training (6-week follow-up), and retention (10-week follow-up) to document preliminary efficacy. Adherence to study exercises was excellent, with 83% of participants completing more than 80% of the exercises. The isometric tongue pressures were observed to improve in the oropharyngeal exercise group (compared with the sham group), along with a decrease in OSA severity (measured by the AHI and ODI), reduced daytime sleepiness, and enhanced quality of life outcomes following the exercise programme. Only the effects on posterior isometric tongue pressure and daytime sleepiness remained significantly different between groups at the retention session. In conclusion, an RCT evaluating the efficacy of oropharyngeal exercises on post-stroke/TIA OSA is feasible and our preliminary results suggest a clinically meaningful effect.

Obstructive sleep apnea in chronic kidney disease patients undergoing hemodialysis. Prevalence, severity, and treatment. A narrative review

Background: Chronic kidney disease (CKD), also known as chronic renal insufficiency (CRI), can be defined by a glomerular filtration rate (GFR) less than 60mL/min/1.73m^2 associated with an albumin-to-creatinine ratio greater than 30mg of albumin per 1g of creatinine. CKD is a significant factor leading to a decline in the quality of life, increased morbidity, and a substantial reduction in life expectancy. Currently, it is estimated that there are 3.9 million patients worldwide on renal replacement therapy for CKD. Recent data indicates that in the United States of America (USA), more than 500,000 people suffer from renal failure or insufficiency. In Brazil, epidemiological data is incomplete and outdated. In 2016, there were 122,825 patients in Brazil on renal replacement therapy. Objectives: This literature review aims to assess the prevalence, severity, and therapeutic recommendations for obstructive sleep apnea (OSA) in patients with CKD undergoing hemodialysis. Methods: A literature review was conducted using PubMed, Web of Science, and SciELO databases with keywords including "Obstructive Sleep Apnea", "Chronic kidney disease", "End-stage renal disease", "sleep disorders", "hemodialysis", "CPAP", "Continuous positive airway pressure", and "Physiotherapy." Only studies published in the last twenty years and in the English language were included. Results: Despite scientific evidence demonstrating a high prevalence of OSA in CKD patients undergoing hemodialysis, there are still a lack of studies examining the effects of Continuous positive airway pressure (CPAP) therapy on the clinical outcomes of these patients. In the scientific literature, only three randomized clinical trials were found that investigated the impact of CPAP therapy on improving kidney function. Consequently, there is a critical need for clinical studies to assess the effects of CPAP therapy in CKD patients undergoing hemodialysis. It is also essential to highlight the role of physiotherapy in managing sleep disorders and aiding in the adaptation and monitoring of patients undergoing CPAP therapy. Conclusion: This literature review concluded that more randomized controlled studies are necessary to better define the optimal therapy for OSA in CKD patients, with the goal of preventing a decline in GFR progression, reducing morbidity and mortality, and enhancing overall quality of life.

O038 Obstructive Sleep Apnoea Prevalence and Severity in a Specialist Heart Failure with Preserved Ejection Fraction (HFpEF) Clinic

Abstract Heart Failure with Preserved Ejection Fraction (HFpEF) is a debilitating, incurable form of HF associated with a normal left ventricular ejection fraction and elevated ventricular filling pressures. While Obstructive Sleep Apnoea (OSA) is common in HFpEF and OSA treatment may be associated with improved outcomes, the causal role of OSA in the pathophysiology of HFpEF remains unclear. Accordingly, accurate diagnosis and tracking of OSA in HFpEF patients is emerging as a potentially important approach for impacting prognosis. This study sought to identify the prevalence and severity of OSA in consecutive patients referred to a recently established tertiary hospital HFpEF clinic. All patients were confirmed to have HFpEF using standard clinical approaches and completed the Epworth Sleepiness Scale (ESS) to screen for sleep-disordered breathing and a level 2 polysomnogram to confirm OSA presence and severity. To date 28 patients have been assessed for OSA (9M/27F; Age 67±2y; BMI 35.0±1.6kg/m2; BNP 214±64ng/L). All 28 patients (100%) were diagnosed with OSA (AHI≥5 events/h), while 16 (57%) had moderate-severe OSA (AHI≥15 events/h). Average ESS was 7±1, with only 6 patients (21%) identified at risk for sleep-disordered breathing (ESS>9). These preliminary data confirm a very high prevalence of OSA in HFpEF patients when assessed via polysomnography. Furthermore, these patients appear asymptomatic in terms of sleepiness, as measured by the ESS. The nature of the association between OSA and HFpEF and the potential benefit of OSA treatment warrant study. Given that the ESS did not effectively identify OSA risk in HFpEF, alternative screening tools warrant consideration.

Obstructive sleep apnea in patients with type 2 diabetes mellitus in Egyptian population

BackgroundSleep disordered breathing (SDB) is a widespread disorder with a wide range of harmful outcomes including obstructive sleep apnea (OSA), central sleep apnea (CSA), or sleep-related hypoventilation.PurposeThe aim of the present study was to screen for the occurrence of sleep apnea syndrome in patients with type 2 diabetes mellitus (DM) and to evaluate the relation between the presence of sleep apnea and the level of glycemic control.MethodsThis was a prospective clinical study that enrolled 59 patients who were previously diagnosed as type 2 DM. Sleep study level IV was done using overnight recording of oxygen saturation and pulse.ResultsAmong the studied patients, 42 were females and 17 were males, Their mean age was 59.76 ± 11.13 years. Obstructive sleep apnea was diagnosed in 46 patients (78%). Thirty three (86.8%) patients among those with uncontrolled glycemic level were diagnosed as OSA, whereas 13(61.9%) patients with controlled glycemic level were diagnosed as OSA showing statistically significant difference, p = 0.047. There was no correlation between either HbA1c, age, Mallampati score, or BMI and ODI but there was a correlation between STOP-BANG questionnaire and ODI (P = 0.036). The variables that were significantly related to presence of OSA, were comorbidities, ESS, Mallampati score, STOP-BANG, and sleep symptoms (nocturia and snoring) P value (0.029), (0.031), (0.022), (0.005), (0.049), and (0.012), respectively.ConclusionPatients with type 2 diabetes showed a significant high prevalence of OSA. With significant higher prevalence among patients with uncontrolled DM versus controlled DM.

Association between Obstructive Sleep Apnea and Heart Failure in Adults-A Systematic Review.

Heart failure (HF) patients commonly experience obstructive sleep apnea (OSA), which may worsen their condition. We reviewed a diverse range of studies to investigate the prevalence of OSA in HF patients, the effects of positive airway pressure (PAP) treatment, and the potential impact of sodium-glucose cotransporter-2 inhibitors (SGLT2i) and sacubitril/valsartan on OSA outcomes. We analyzed case-control, observational studies, and randomized controlled trials. Prevalence rates, PAP treatment, and HF pharmacotherapy were assessed. Numerous studies revealed a high prevalence of OSA in HF patients, particularly with preserved ejection fraction. PAP treatment consistently improved an apnea-hypopnea index, left ventricular ejection fraction, oxygen saturation, and overall quality of life. Emerging evidence suggests that SGLT2i and sacubitril/valsartan might influence OSA outcomes through weight loss, improved metabolic profiles, and potential direct effects on upper airway muscles. The complex interplay between OSA and HF necessitates a multifaceted approach. PAP treatment has shown promising results in improving OSA symptoms and HF parameters. Additionally, recent investigations into the effects of HF pharmacotherapy on OSA suggest their potential as adjunctive therapy. This review provides insights for clinicians and researchers, highlighting the importance of addressing OSA and HF in patient management strategies.

Premature mortality with gout and hyperuricemia may be reduced by early resolution of comorbid obstructive sleep apnea

Hyperuricemia is known to be a necessary and causal condition for gout, but much more prevalent than gout. Medicine has standardized treatments for gout, but has no such determination for asymptomatic hyperuricemia. Nevertheless, people with hyperuricemia, gouty or not, too often continue to be at risk for shortened lifespans from life-threatening comorbidities, all of which are known to be consequences of obstructive sleep apnea (OSA), which is shown herein to cause most hyperuricemia. This review also presents the wide variety of OSA consequences, many of which are irreversible and life-threatening, as the rationale for treating all hyperuricemia (gouty and asymptomatic) by diagnostic testing and effective treatment for OSA as soon as hyperuricemia is detected. It advocates frequent ultrasonic screening for aggregated urate crystals. Multiple epidemiological studies have found OSA to be significantly more prevalent in those people with gout diagnosed with OSA than it is in those never diagnosed with it. A clinical study shows an even higher prevalence of OSA in people with gout. The pathophysiology of hypoxia from OSA explains how it would lead to both the overproduction and the underexcretion of uric acid, leading to hyperuricemia and the precipitation of monosodium urate crystals which cause a gout flare. Resolving OSA has been shown to prevent or even reverse life-threatening diseases that are recognized comorbidities of hyperuricemia and gout, and can prevent further gout flares. In order to extend the length and quality of life of people with gout or hyperuricemia, when either first manifests a patient sleep study is recommended, followed by effective OSA treatment as warranted.

Prevalence, associated risk factors, and respiratory event distribution of obstructive sleep apnea in children with Down syndrome.

Children with Down Syndrome (DS) have a high prevalence of obstructive sleep apnea (OSA). We aimed to assess OSA prevalence in a single center cohort of children with DS, identify associated risk factors of obstructive respiratory events, and examine the influence of different sleep stages and body positions on respiratory events distribution. Single center retrospective study that included children with DS who underwent overnight polysomnogram (PSG). OSA severity was categorized by obstructive apnea-hypopnea index (OAHI) as mild (1.5-4.9 events/h), moderate (5-9.9 events/h), and severe (≥ 10 events/h). A logistic regression analysis was used to examine the association between OSA-related risk factors in normal and abnormal OAHI category and in REM and Non-REM predominant AHI groups. PSG data were available for 192 children with a median age of 5years (IQR 7). OSA prevalence was 82.3% (27.1% mild, 19.8% moderate, and 35.4% severe). A logistic regression model identified BMI and being an African American as significant predictors for OAHI severity. In children with OSA, the median OAHI was 7.6 and obstructive respiratory events were more common in REM sleep and in thesupine position. The median REM OAHI was 20 events/h (IQR: 24.4), whereas the median Non-REM OAHI was 5.2 events/h (IQR: 12.6 p < 0.0001). Similarly, supine OAHI was 11.6 (IQR: 19.3) and off supine OAHI was 6.6 (IQR: 11.6, p = 0.0004). Age was a significant predictor (p = 0.012) for Non-REM predominant OSA which was present in 15.2% of children with OSA. Children with DS have a high prevalence of OSA. Higher BMI and being an African American were significant associated risk factors for higher OAHI. Obstructive respiratory events in children with DS occur predominantly in REM sleep and in thesupine position. Non-REM predominant distribution of respiratory events was noted in older children with DS.

Health disparities in the detection and prevalence of pediatric obstructive sleep apnea

IntroductionPediatric Obstructive Sleep Apnea (OSA) is associated with negative health outcomes, behavior problems, and poor academic performance when left untreated. Prior research has shown that children from racial and ethnic minority backgrounds and those living in lower socioeconomic status (SES) homes or neighborhoods have higher prevalence of OSA but lower likelihood of receiving evidence-based care for OSA. Disparities in pediatric OSA detection (e.g., timely assessment and diagnosis) likely contribute to this observed inequity in receiving treatment. A polysomnogram (PSG) is the gold standard for diagnosing OSA but completing PSG can be challenging. Study aims were to examine racial, ethnic, and SES differences in (1) OSA prevalence and severity and (2) OSA detection, specifically PSG completion rates, timing since referral, and age of diagnosis.MethodsChildren (aged 1–18, N = 1,860, 56% male) were referred for PSG during a 6-month period. Participants' racial/ethnic background were as follows: 64.8% White non-Hispanic, 23.5% Black non-Hispanic, 9.4% White Hispanic, and 2.4% other. Children predominantly had Medicaid insurance (64.5%). SES was measured by insurance type and neighborhood SES using the Distressed Communities Index (DCI) for each participant's zip code (Economic Innovations Group; https://eig.org/dc). Covariates included child age and sex, BMI, premature birth status, and smoke exposure in the home.ResultsWe replicated previous research by showing that children from minority racial/ethnic backgrounds and lower SES backgrounds had higher prevalence rates of OSA and worse disease severity. Across racial, ethnic, and socioeconomic backgrounds, only 31.6% of the children referred successfully completed PSG. Insurance coverage (Medicaid or private vs. self-pay), was an important factor in predicting earlier timing and better completion rates of PSG, which is essential for successful diagnosis and treatment of pediatric OSA.

Factors associated with the diagnosis and treatment of obstructive sleep apnoea in chronic heart failure: a mixed methods study

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): This study was co-funded by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care East Midlands (CLAHRC EM), now recommissioned as NIHR Applied Research Collaboration East Midlands (ARC EM) and Leicestershire Partnership NHS Trust - Raising Health Charitable Funds Award and supported by the NIHR Leicester Biomedical Research Centre. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. Background Heart Failure (HF) is associated with a considerable burden of disability that includes frequent hospitalisation and high risk of mortality. Despite advances in HF treatment, many patients continue to experience symptoms and will die from progressive HF, often exacerbated by the presence of co-morbidities, such as obstructive sleep apnea (OSA). Despite the high prevalence of OSA in chronic HF and the association with the development and progression of chronic HF, OSA remains largely under diagnosed and under treated. Purpose To explore factors associated with the diagnosis and treatment of OSA in CHF. Methods A convergent parallel mixed methods research design was utilised. Quantitative methods included a systematic review and meta-analysis, diagnostic validation study and a survey study, whilst semi-structured interviews and reflexive thematic analysis was utilised for the qualitative component. Data collection and data analysis were conducted simultaneously with the integration of the findings in the discussion. Results The systematic review and meta-analysis showed that the STOP-Bang screening questionnaire had a high sensitivity to detect OSA in the sleep clinic and surgical populations but lacked adequate specificity. The diagnostic validation study indicated a high sensitivity of the STOP-Bang questionnaire, but due to differences in prevalence, risk of selection bias and spectrum effect, validation in a sleep clinic population is unlikely to reflect the true performance of the STOP-Bang questionnaire in a stable CHF population. The survey study demonstrated a knowledge deficit in the diagnosis and treatment of OSA, and variable practice among HF clinicians in the UK. Findings from the qualitative component identified several key barriers and enablers across the OSA diagnostic pathway from both patients’ and clinicians’ accounts. Conclusion Due to a lack of typical OSA symptoms, there is currently no real evidence of cardiovascular hospitalisation and mortality benefit for OSA treatment in CHF. This contributed to a paucity of guidance on the management of OSA in CHF clinical guidelines. Due to a lack of typical OSA symptoms, screening questionnaires that rely on patient symptoms may be less effective. Although clinicians felt that OSA was an important clinical condition, findings demonstrated a disconnect between the stated level of clinical importance and clinicians’ actual level of knowledge. The current absence of evidence to support the treatment of OSA in CHF and paucity of CHF guidelines to inform the management of OSA in CHF, are likely to contribute to clinicians not prioritising the recognition and treatment of OSA in CHF.

Screening for Obstructive Sleep Apnea in truck drivers

Professional drivers show a higher prevalence of obstructive sleep apnea (OSA) compared with the general population. OSA has been widely associated with an increased risk of traffic accidents. This article aims to investigate the presence of risk factors for OSA, its prevalence and the value of screening tools in a truck drivers' cohort. Descriptive and analytical prospective study. Demographic, anthropometric, Epworth Sleepiness Scale, STOP-Bang and Berlin Questionnaire were used to select subjects with suspicion of OSA. Polysomnography (PSG) was performed in individuals with positive screening. Mean age was 44.6±7 years, mean body mass index was 28.7±4 kg/m². Of the 281 truck drivers screened, 88 were positive for potential OSA. Of these, 63 completed PSG study and the diagnosis was confirmed in 85.7% (prevalence of 19.2%). The following variables showed a positive correlation with the apnea-hypopnea index: neck circumference and STOP-Bang. The combination of a predominantly male population, obesity, age distribution and lifestyle could account for the high prevalence of OSA in this specific population. Questionnaires proved to be a valuable screening tool. Screening, treatment, and management of OSA should be a priority as a public safety policy.

Pediatric Sleep Respiratory Disorders: A Narrative Review of Epidemiology and Risk Factors

Sleep is a fundamental biological necessity, the lack of which has severe repercussions on the mental and physical well-being in individuals of all ages. The phrase “sleep-disordered breathing (SDB)” indicates a wide array of conditions characterized by snoring and/or respiratory distress due to increased upper airway resistance and pharyngeal collapsibility; these range from primary snoring to obstructive sleep apnea (OSA) and occur in all age groups. In the general pediatric population, the prevalence of OSA varies between 2% and 5%, but in some particular clinical conditions, it can be much higher. While adenotonsillar hypertrophy (“classic phenotype”) is the main cause of OSA in preschool age (3–5 years), obesity (“adult phenotype”) is the most common cause in adolescence. There is also a “congenital–structural” phenotype that is characterized by a high prevalence of OSA, appearing from the earliest ages of life, supported by morpho-structural abnormalities or craniofacial changes and associated with genetic syndromes such as Pierre Robin syndrome, Prader-Willi, achondroplasia, and Down syndrome. Neuromuscular disorders and lysosomal storage disorders are also frequently accompanied by a high prevalence of OSA in all life ages. Early recognition and proper treatment are crucial to avoid major neuro-cognitive, cardiovascular, and metabolic morbidities.

The Belun sleep platform to diagnose obstructive sleep apnea in patients with hypertension and high cardiovascular risk.

Current hypertension guidelines recommend that at-risk individuals be screened for obstructive sleep apnea (OSA). The Belun Ring is a wearable OSA diagnostic device worn on the palmar side of the proximal phalanx of the index finger. We recruited 129 participants (age: 60 ± 8 years, male sex: 88%, BMI: 27 ± 4 kg/m2) with hypertension and high cardiovascular risk for a simultaneous polysomnography and Belun Ring monitoring for one night. Epworth Sleepiness Scale score more than 10 was detected in 27 (21.0%) participants. In the 127 participants who completed the study, the apnea-hypopnea index (AHI) derived from polysomnography was 18.1 (interquartile range: 33.0) events/h and that derived from the Belun Ring was 19.5 (interquartile range: 23.3) events/h [intraclass correlation coefficient: 0.882, 95% confidence interval (95% CI): 0.837-0.916]. A Bland-Altman plot showed the difference between the Belun Ring and polysomnography AHIs to be -1.3 ± 10.4 events/h. Area under the receiver operating characteristic for the Belun Ring AHI was 0.961 (95% CI: 0.932-0.990, P < 0.001). When the Belun Ring AHI of at least 15 events/h was used to diagnose OSA, the sensitivity, specificity, positive predictive value, and negative predictive value were 95.7, 77.6, 85.3, and 93.8%, respectively. The overall accuracy was 87.4%. The Cohen's kappa agreement was 0.74 ± 0.09 (P < 0.001). Similar results were obtained when the oxygen desaturation index was used to diagnose OSA. A high prevalence of OSA was detected in patients with hypertension and high cardiovascular risk. The Belun Ring is a reliable device for OSA diagnosis similar to polysomnography.Graphical abstract: http://links.lww.com/HJH/C180.

Relationship between obstructive sleep apnea and coronary artery stenosis, myocardial injury and cardiac structure and function in coronary heart disease patients

Objective: To further investigate the relationship between sleep apnea and coronary heart disease. Obstructive sleep apnea (OSA) is associated with various cardiovascular diseases including coronary heart disease. Moderate to severe OSA patients are prone to more severe coronary stenosis. We combined the serological indicators, echocardiography and coronary angiography all together to further investigate the relationship between sleep apnea and coronary heart disease. Methods: A total of 110 coronary heart disease patients who underwent coronary angiography and overnight polysomnography during hospitalization were enrolled, including 97 males and 13 females aged 27-85 years. Data of baseline characteristics, biochemical measurements, echocardiography, coronary angiography and polysomnography were collected. The differences in cardiovascular indicators of different degrees of OSA were compared by t-test and nonparametric test. Logistic regression was used to analyze the risk factors for OSA and coronary stenosis. Results: The median age of the enrolled 110 patients was 56 years. Totally, 88.2% patients were male and 84.5% suffered from OSA. Patients with moderate to severe OSA had a greater degree of heart rate variation during sleep, a wider proximal ascending aorta, and were more prone to abnormal right heart structure, however, no significant difference was found in myocardial injury. Patients with more severe coronary stenosis were more likely to have OSA, and they often had higher apnea-hypopnea index (AHI) and more central sleep apnea. Hypertension was independently associated with coronary stenosis and moderate to severe OSA after adjustment (OR=3.88, P=0.035; OR=2.95, P=0.046). Conclusions: Patients with more severe coronary stenosis had higher prevalence of OSA and more central sleep apnea affairs. Coronary heart disease patients with moderate to severe sleep apnea were more likely to develop aortic widening and abnormal right heart structure. Hypertension was an independent risk factor for severe coronary stenosis and moderate to severe OSA, respectively.

Prevalence of obstructive sleep apnea in patients with chronic kidney disease: a hospital-based study.

Chronic kidney disease (CKD) is has been rising over the past few years, and obstructive sleep apnea (OSA) is a prevalent comorbidity in this population. To determine the prevalence of OSA in patients with chronic kidney disease stages I-V and end-stage renal disease (ESRD). Patients with CKD of varying grades and ESRD routinely visiting outpatient nephrology clinic or admitted in department of nephrology were included in the study. Stages I-III were categorized as early stages of CKD and stages IV-V and ESRD as late stages of CKD. Patients were categorized into a high risk group based on STOP-BANG and Berlin questionnaires. Patients who were high risk were subjected to in-hospital overnight level III polysomnography. Student's independent t-test and analysis of variance (ANOVA) were employed for the comparison of continuous variables. Chi-square test and Fisher's exact test, as appropriate, were used for the comparison of categorical variables. Of 111 patients, 46 (41%) were found to have OSA. Of these patients, 15 (33%) had mild OSA (AHI 5-14/h), 13 (28%) had moderate OSA (15-29/h), and 18 (39%) had severe OSA (AHI ≥ 30/h). Overall, 31% of patients in the early stage of CKD and 45% in the late stage were found to have OSA. This study demonstrated a high prevalence of OSA in patients withCKD when compared to the general population affecting both genders equally. The risk of OSAwas higher in the advanced stages of CKD compared to the early stages, and dialysis had no effect on prevalence. Since OSA increases the cardiovascular morbidity in CKD the leading cause of death in these patients, early diagnosis and treatment of OSAmay have promise to affect the mortality.

P059 Respiratory control stability in posttraumatic stress disorder

Abstract Rationale A recent meta-analysis indicated that 75.7% of individuals with posttraumatic stress disorder (PTSD) also suffer from obstructive sleep apnoea (OSA). The reason for the high prevalence of OSA in PTSD is currently unknown. This study investigated whether respiratory control stability (which is known to contribute to OSA in the general population) varies with PTSD symptoms. Methods First year University students were recruited and completed an online questionnaire battery including: Life Events Checklist (LEC), PTSD checklist for DSM-5 (PCL-5), Shortness of Breath Questionnaire (SOBQ) and Berlin Sleep Questionnaire. 1/3 of participants timed their maximum breath hold (performed at functional residual capacity) at home on 3 occasions using a stopwatch as per Messieno et al (2018). Results 313 complete survey responses were obtained. The mean age of participants was 19.9 years and 214 respondents were women. 19 participants were at high risk of OSA based (Berlin Questionnaire) and 80 had probable PTSD (LEC items 1-16 “happened to me” or “witnessed it” plus PCL-5&amp;gt;33). In the whole sample, there was a significant relationship between PTSD symptoms and Shortness of Breath (Pearson p&amp;lt;0.001, r2=0.2). There was no relationship between PTSD symptoms and at-home measured maximum breath-hold duration (n=107, p=0.44, r2=0.006). Conclusions In an unselected University student population, posttraumatic stress disorder symptoms are associated with self-reported shortness of breath during everyday activities. However, there was no evidence of a relationship between a surrogate of respiratory control stability (maximum breath-hold duration) and PTSD symptoms.

Abstract 15100: Relationship Between Obstructive Sleep Apnea and Acute Coronary Syndrome: A Cross-Sectional Study

Introduction: Obstructive sleep apnea (OSA) is a common and underestimated chronic condition recognized as a risk factor for cardiovascular diseases. OSA and acute coronary syndrome (ACS) have been reported in several cases. This study aims to assess the prevalence of the OSA among patients with ACS. Hypothesis: We hypothesize that there is a correlation between OSA and ACS. Methods: This study is a cross-sectional, descriptive study that included 110 patients with ACS at the Cairo University Hospitals in Egypt between December 2018 and July 2019. We included patients diagnosed with ACS over the age of 40. We excluded patients who had disturbed consciousness levels, were intubated/mechanically ventilated, were on psychiatric medications, or used drugs. Furthermore, we excluded individuals with CKD or liver disease. We collected patients’ demographic characteristics, and chronic medical conditions, and performed a sleep assessment. Every patient had a detailed workup for ACS. We assessed OSA based on the STOP-BANG score. The significance of baseline and clinical characteristics, laboratory and imaging findings, and the severity of ACS and its outcome were studied. Results: The mean age of the patients was 58.2±9.6. The majority of patients were male (74.5%). 70.9% of the patients had metabolic syndrome. The mean body mass index was 28.6±4.8; the majority of patients presented with STEMI (60.9%), while only 26.4% and 12.7% presented with NSTEMI and unstable angina respectively. The prevalence of OSA among ACS patients was 63.6%, and of them, 55.7% presented with STEMI, while only 32.9% and 11.4% presented with NSTEMI and unstable angina respectively. Also, the study revealed a statistically significant relationship between OSA and NSTEMI patients (OR: 2.77 [95% CI 1.02-7.55], p=0.041), while there was no statistically significant relationship between OSA and unstable angina patients (OR: 0.73 [95% CI 0.2-2.3], p=0.579) and between OSA and STEMI patients (OR: 0.54 [95% CI 0.2-1.2], p=0.14). Conclusion: To the best of our knowledge, this is the first study to study the prevalence of OSA in ACS patients in the region of Africa. The study indicated a high prevalence of OSA among ACS patients, with a more significant correlation between OSA and NSTEMI patients.