High Risk For Obstructive Sleep Apnea Research Articles

Impact of a Simulated Workday of Sit-stand Desk Use on Sleep Among Adults Screened as High Risk for Sleep Apnea

Exercise improves sleep and reduces apnea severity in adults with obstructive sleep apnea (OSA). However, whether reducing sedentary behavior impacts sleep and apnea severity is unknown. PURPOSE: To examine whether reducing prolonged sitting during a simulated workday by use of a sit-stand desk leads to changes in sleep compared to a sedentary workday in a sample of adults at high risk for OSA. METHODS: Eight inactive adults (5 males, 53.8±8.5 yr, body mass index: 29.8±5.5 kg/m2) who were classified as ‘high risk’ for OSA based upon the STOP-BANG screening algorithm participated in a randomized crossover trial consisting of two simulated 8-h workdays: (1) continuous sitting (SIT); and (2) alternating periods of sitting and standing every 30 min (SIT-STAND). Sleep and apnea were assessed on the night following each simulated workday by wrist-worn actigraphy and a portable OSA testing device, respectively. Actigraphic measures of total sleep time (TST) and wake after sleep onset (WASO) served as the primary sleep variables, while the apnea-hypopnea index (AHI) assessed OSA severity from the OSA testing device by a blinded assessor. Natural logarithm transformation of AHI was performed due to non-normality. Effect sizes (Hedges’ g) and Pearson correlations evaluated differences in sleep following each condition and associations between changes in sleep measures, respectively. RESULTS: In the full sample, trivial improvements in WASO (g=0.16) and TST (g=0.03) were observed following SIT-STAND compared to SIT. In contrast, a small increase in AHI (i.e., worsening of OSA) was observed following SIT-STAND compared to SIT (g=0.31). The change in AHI was associated with the change in actigraphic WASO (r=.63, P=.09). Four of the 8 adults had clinically significant OSA (i.e., mean AHI≥10 across conditions). Among those with clinically significant OSA, large increases in WASO and AHI were seen following SIT-STAND relative to SIT (g=1.16 and 0.89, respectively). In those without significant OSA, small- to moderate-sized reductions in WASO and AHI were observed following SIT-STAND compared to SIT (g=0.68 and 0.30, respectively). CONCLUSION: Following sedentary behavior reduction during a simulated workday, changes in sleep and apnea seemed to differ based upon the presence of clinically significant OSA.

Sleepy driving and risk of obstructive sleep apnea among truck drivers in Saudi Arabia

Objective: Truck drivers represent a group at a particularly higher risk of motor vehicle accidents (MVAs). Sleepy driving and obstructive sleep apnea (OSA) among truck drivers are major risk factors for MVAs. No study has assessed the prevalence of sleepy driving and risk of OSA among truck drivers in Saudi Arabia. Therefore, this study aimed to assess sleepy driving and risk of OSA among these truck drivers.Methods: This study included 338 male truck drivers working in Saudi Arabia. A validated questionnaire regarding sleepy driving and OSA was used. The questionnaire included sociodemographic assessment, the Epworth Sleepiness Scale (ESS), the Berlin Questionnaire (BQ), and driving-related items.Results: The drivers had a mean age of 42.9 ± 9.7 years. The majority (94.7%) drove more than 5 h a day. A history of MVAs during the last 6 months was reported by 6.5%. Approximately 95% of the participants reported that they had accidentally fallen asleep at least once while driving over the past 6 months, and 49.7% stated that this had happened more than 5 times during the last 6 months. Based on the BQ score, a high risk of OSA was detected in 29% of the drivers. “Not getting good-quality sleep” (odds ratio [OR] = 2.89; 95% confidence interval [CI], 1.08–7.75; P = .014) and driving experience from 6 to 10 years (OR = 3.37; 95% CI, 1.28–8.91; P = .034) were the only independent predictors of MVAs in the past 6 months.Conclusions: Sleepy driving and a high risk of OSA was prevalent among the study population of male truck drivers in Saudi Arabia. Not getting good-quality sleep and driving experience from 6 to 10 years contributes to the accident risk among these truck drivers.

Sleep Complaints and Sleep Quality in Spinal Cord Injury: A Web-Based Survey.

The purpose of this study was to determine sleep quality and presence of sleep disorders in participants with spinal cord injury (SCI). A web-based survey, available online from February 2011 to July 2013, using validated sleep questionnaires, advertised via the internet and locally through SCI consumer organizations in the United States, Australia, New Zealand, and Canada, was designed to evaluate sleep in adults with self-reported SCI. Demographic characteristics and medical history were obtained from participant self-report. In our study population, 70% of the 304 participants were male with a mean age of 45 ± 13 years. The mean duration of injury was 16 ± 12 years. Cervical injuries were reported by 49% and thoracic injuries noted in 40% of participants. Increased sleep apnea risk was noted in 31% of participants, with 66% reporting snoring. Insomnia symptoms were reported by 54% of the respondents. Almost 40% of participants ranked their sleep quality as "fairly bad" to "very bad" in the previous month, 29% reported "often" or "almost always" waking up because of pain, and 22% had difficulty falling asleep because of leg cramps. In the past year, 27% of the respondents reported daily uncomfortable leg sensations and 28% found these leg symptoms to be "moderately to extremely distressing." This study increases the awareness that insomnia, sleep apnea, and poor sleep quality are common in individuals with chronic SCI; often coexisting. There is a need for increased screening for sleep problems by healthcare providers taking care of individuals living with SCI.

The prevalence of high risk obstructive sleep apnoea among patients with type 2 diabetes in Jordan

ObjectiveTo estimate the prevalence of Obstructive Sleep Apnea (OSA) among patients with type 2 Diabetes Mellitus (T2DM) in Jordan, and to explore the association between sleep apnea and clinical and demographic variables. MethodA cross-sectional study was carried out from the 1st of November 2011 to the 1st of February 2012 on 1143 patients with T2DM (aged 30–90 years) at the National Center for Diabetes, Endocrinology, and Genetics (NCDEG). The center is considered to be the only referral center in the country and accordingly, the patients represent the population in different parts of the country. All participants completed the Arabic version of the Berlin Questionnaire and were categorized as either low or high-risk patients for OSA. ResultsA total of 1143 patients with T2DM were included in this study. There were 587 (51.4%) males and 556 (48.6%) females. The findings showed that 554 (48.5%) patients were at high risk for OSA and 589 (51.5%) were low risk for OSA. Logistic regression analysis revealed that age, smoking, and neck circumference were significantly correlated with high risk for OSA. The clinical and demographic variables were also collected for analysis. ConclusionsThe study found that high risk for OSA was highly prevalent among Jordanian patients with T2DM and that age, smoking and neck circumference were significantly correlated with OSA. Health care providers should be made aware of the high prevalence of sleep problems affecting patients with diabetes and should consider the appropriate screening and treatment for these patients, therefore improving their quality of life.

Estimating obstructive sleep apnea in Cyprus: a randomised, stratified epidemiological study using STOP-Bang sleep apnea questionnaire

IntroductionSeveral epidemiological studies have demonstrated that Obstructive Sleep Apnea (OSA) is a highly prevalent disorder in the general population and increases over time all over the world. The high prevalence is in part due to increasing rates of obesity. However, estimates of OSA prevalence in Southern Europe are generally lacking. AimThe aim of our study was to predict the risk of OSA in the general population of Cyprus, the southeast part of Europe, by using a dedicated questionnaire like STOP-Bang. Subjects and methodWe screened 5736 sample housing units for eligible adults and a total population of 4118 eligible responders completed the STOP-Bang questionnaire. Participants were all adults, age 18 + residing in Cyprus. The sample was stratified according to the last demographic report (2016) by district, rural or urban area, gender and age and the estimated sample size needed was 2000. Our survey was conducted by Computer Aided Telephone Interviewing (CATI) method. The question about Neck Circumference was removed from the final evaluation due to the uncertainty of most of the participants and the risk of bias. ResultsFrom a total of 4118 participants (2252 males – 54.7%, 1862 females – 45.3%), with 46.6% over 50 years old, 2641 (64.1%) were at low risk for OSA (0–2 positive answers), 1200 (29.1%) at intermediate risk (3–4 positive answers) and 277 (6.7%) at high risk (≥5 positive answers). In sum, 29.9% responded positively for snoring, 39.3% for feeling tired or sleepy during the day, 12.3% for observed apnea during sleep, and 24.6% for having or being treated for hypertension. Class II and III obesity with Body Mass Index (BMI) > 35 kgr/m2 was observed in 192 subjects (4.7%). In the subpopulation of obese participants (BMI>30 kg/m2), intermediate to high risk of OSA was present in 45%, whereas in obesity class II and III the percentage reached almost 90%. ConclusionsOur survey yielded that the prevalence of intermediate to high risk for OSA was 50% in males and 18% in females, in the general population of Cyprus. These findings were similar to previously reported high OSA prevalence worldwide, considering the fact that a single questionnaire is only a screening tool and cannot alone diagnose sleep apnea.

IMPACTO DE LA CALIDAD DEL SUEÑO Y SOMNOLENCIA DIURNA EN PACIENTES CON DIABETES MELLITUS E HIPERTENSIÓN ARTERIAL

Objetivo: Evaluar la calidad del sueño nocturno y la somnolencia diurna en pacientes con diagnóstico de diabetes mellitus e hipertensión arterial. Métodos: Se realizó un estudio transversal, prospectivo, en pacientes mayores de 18 años con diagnóstico de diabetes Mellitus e hipertensión Arterial, según la ADA 2016 y ESH/ESC, que asisten a la consulta de medicina interna del Hospital “Dr. Miguel Pérez Carreño” en el periodo comprendido de enero a julio del 2017. Resultados: Se evaluó 263, con predominio femenino con 63,1 %; con un rango de edad de 19-92 años, una media de 61 años ± 13. Se aplicó el cuestionario de Berlín para estimar el riesgo de SAOS, evidenciando 56,27 % bajo riesgo y 43,7 % alto riesgo; los pacientes con sobrepeso tenían un 27 % y los obesos un 21,7 % con alto riesgo. Se observó mala calidad de sueño en el 79,8% de los pacientes hipertensos y 95,5 % en pacientes diabéticos. La somnolencia diurna en hipertensos fue de 47,2 %, y en diabéticos el 45,4 %. Se presentó Alto riesgo de SAOS en hipertensos 47,9 %, en diabéticos 40,9 %. Se determinó que no hubo relación entre HTA y DM con mala calidad de sueño (p = 0,186), somnolencia diurna (0,627) y SAOS (p = 0,208). Conclusiones: La mala calidad de sueño estuvo presente en la mayoría de la población y la presencia de somnolencia diurna fue menor. Hubo alto riesgo de SAOS en relación con el índice de masa corporal y el hábito alcohólico.

Association of Risk of Obstructive Sleep Apnea With Thyroid Eye Disease: Compressive Optic Neuropathy.

To evaluate the association of risk of obstructive sleep apnea (OSA) and thyroid eye disease-compressive optic neuropathy (TED-CON). The authors performed a retrospective observational study. All TED patients evaluated by the principal investigator over the past 5 years were screened with the snoring tired observed pressure (STOP)-Bang questionnaire to assess their risk for OSA. Patients were grouped into 2 age-matched cohorts based on the presence (TED-CON) or absence of CON. The groups were then compared using chi-square analysis for binary variables and Student t test for continuous variables. Three hundred twenty-six patients were identified to have TED. Of those, 109 were enrolled in the study. The prevalence of high risk of OSA was significantly higher in the TED-CON (59.2%) when compared with the noncompressive TED group (32.8%; p = 0.006). Obstructive sleep apnea and TED have each been independently associated with elevated serologic and tissue inflammatory mediators. The systemic inflammation associated with OSA has been implicated in the pathogenesis of disease states aggravated by untreated OSA. Effective treatment of OSA decreases the levels of circulating inflammatory mediators. Currently, smoking is the only known modifiable risk factor in TED. There is evidence to implicate the pathologic elevation of inflammatory cytokines in the mechanism of smoking on TED. This preliminary investigation reveals a significantly greater prevalence of OSA risk factors among patients with TED-CON, suggesting that this may be another modifiable risk factor associated with TED. Based on screening with the STOP-Bang questionnaire, there is a higher percentage of patients at high risk of OSA with TED with CON than with TED without CON.

Clinical Characteristics of Obstructive Sleep Apnea in Psychiatric Disease.

Patients with serious psychiatric diseases (major depressive disorder (MDD), bipolar disorder (BD), and schizophrenia and psychotic disorder) often complain about sleepiness during the day, fatigue, low energy, concentration problems, and insomnia; unfortunately, many of these symptoms are also frequent in patients with Obstructive Sleep Apnea (OSA). However, existing data about the clinical appearance of OSA in Psychiatric Disease are generally missing. The aim of our study was a detailed and focused evaluation of OSA in Psychiatric Disease, in terms of symptoms, comorbidities, clinical characteristics, daytime respiratory function, and overnight polysomnography data. We examined 110 patients (56 males and 54 females) with stable Psychiatric Disease (Group A: 66 with MDD, Group B: 34 with BD, and Group C: 10 with schizophrenia). At baseline, each patient answered the STOP–Bang Questionnaire, Epworth Sleepiness Scale (ESS), Fatigue Severity Scale (FSS), and Hospital Anxiety and Depression Scale (HADS) and underwent clinical examination, oximetry, spirometry, and overnight polysomnography. Body Mass Index (BMI), neck, waist, and hip circumferences, and arterial blood pressure values were also measured. The mean age of the whole population was 55.1 ± 10.6 years. The three groups had no statistically significant difference in age, BMI, hip circumference, and systolic and diastolic arterial blood pressure. Class II and III obesity with BMI > 35 kg/m2 was observed in 36 subjects (32.14%). A moderate main effect of psychiatric disease was observed in neck (p = 0.044, η2 = 0.064) and waist circumference (p = 0.021, η2 = 0.078), with the depression group showing the lowest values, and in pulmonary function (Forced Vital Capacity (FVC, %), p = 0.013, η2 = 0.084), with the psychotic group showing the lowest values. Intermediate to high risk of OSA was present in 87.37% of participants, according to the STOP–Bang Questionnaire (≥3 positive answers), and 70.87% responded positively for feeling tired or sleepy during the day. An Apnea–Hypopnea Index (AHI) ≥ 15 events per hour of sleep was recorded in 72.48% of our patients. AHI was associated positively with male sex, schizophrenia, neck, and waist circumferences, STOP–Bang and ESS scores, and negatively with respiratory function. A large main effect of psychiatric medications was observed in waist circumference (p = 0.046, η2 = 0.151), FVC (%) (p = 0.027, η2 = 0.165), and in time spend with SaO2 < 90% (p = 0.006, η2 = 0.211). Our study yielded that patients with Psychiatric Disease are at risk of OSA, especially men suffering from schizophrenia and psychotic disorders that complain about sleepiness and have central obesity and disturbed respiratory function. Screening for OSA is mandatory in this medical population, as psychiatric patients have significantly poorer physical health than the general population and the coexistence of the two diseases can further negatively impact several health outcomes.

Predictive value of STOP-Bang questionnaire combined with Epworth sleepiness scale for OSA

Objective:To explore the predictive value of STOP-Bang questionnaire(SBQ) combined with Epworth sleepiness scale(ESS) for OSA. Method: Both SBQ and ESS were conducted to assess 356 potential OSA patients. ROC curve was drawn in comparison with the gold standard of PSG. The values were obtained after the sensitivity, specificity, positive predictive values and negative predictive values were calculated. Result:When combined, the sensitivity(89.31%), specificity(78.95%), positive predictive value(97.26%), negative predictive value(46.88%) and the area under ROC curve(AUC=0.821) were higher. Conclusion:SBQ and ESS have certain predictive value in OSA screening. When combined, the accuracy of prediction OSA can be improved, which can help medical staff to identify patients with high risk of OSA early.

012 Incidence and Characteristics of Men at High Risk for Sleep Apnea in a High Volume Andrology Clinic

Approximately 30% of American men are at risk for obstructive sleep apnea (OSA), the diagnosis of which is confirmed by polysomnography (PSG) testing. The incidence of men presenting to men’s health clinics who are at risk for OSA is poorly understood. Here we determine the risk of OSA among men and evaluate the outcomes of those referred for PSG testing. Men presenting to a single andrology clinic between July 2017 and May 2018 were evaluated for risk of OSA using the validated STOP-BANG sleep apnea survey. STOP-BANG results were stratified by those at low/intermediate and high risk for OSA. Patient specific characteristics were recorded, including comorbidities and testosterone therapy (TTh) use. Distribution of variables was assessed with the Ryan-Joiner normality test. Student’s t-Test and Chi-Squared analysis were used to assess continuous and categorical variables, respectively, and R and ggplot2 were used to calculate odds ratios and confidence intervals. Secondary analysis was performed to determine the PSG referral outcome and patient reported outcome of the referral process using an anonymous Survey Monkey survey.

Abstract P281: Psychosocial Factors Are Strongly Associated With Sleep Disturbances and Evening Chronotype Among Diverse Women: Evidence From the AHA Go Red for Women Strategically Focused Research Network

Background: Psychosocial factors have been linked to increased CVD risk through biological and behavioral mechanisms, possibly including short and/or long sleep duration. However, relations between specific aspects of sleep, chronotype, and psychosocial factors have not been fully characterized, particularly among women, who are more prone to poor sleep and psychosocial distress. Hypothesis: Depression, low social support, and caregiver responsibilities and strain will be associated with poor sleep patterns and having an evening chronotype among free-living ethnically diverse women. Methods: Women ages 20-76 y participating in the AHA Go Red for Women SFRN were included (N=506, 61% racial/ethnic minority, mean age = 37 ±16y). Assessments included: 1) sleep duration and quality, [Pittsburgh Sleep Quality Index (PSQI)]; 2) presence of insomnia, [Insomnia Severity Index (ISI)]; 3) obstructive sleep apnea (OSA) [Berlin Questionnaire], and 4) chronotype [Morningness-Eveningness Questionnaire]. Depression was assessed using the Beck Depression Inventory-II, low social support using the ENRICHD Social Support Instrument, and caregiver strain using the Caregiver Strain Index. Logistic regression models were used to evaluate cross-sectional associations between psychosocial factors and sleep, adjusted for age, race, ethnicity, education, and insurance. Results: Nearly 1 in 5 participants had depressive symptoms, 27% had low social support, 21% were caregivers, and 29% of caregivers experienced high strain. Half of women had short sleep duration (&lt;7h/night), 39% had poor quality sleep (PSQI score &gt;5), and 38% had some level of insomnia (ISI score ≥8). After adjusting for confounders, women who were depressed had ~3-fold higher odds of short sleep (&lt;7h/night), 2-fold higher odds of poor sleep quality and having a high OSA risk (95%CI=1.69-4.61, 1.42-3.70, and 1.34-4.24, respectively), and 4-fold higher odds of insomnia (95%CI=2.42-6.59). Women with depressive symptoms were more likely to have an evening vs morning or intermediate chronotype (OR: 2.62, 95%CI=1.41-4.89). Low social support was associated with insomnia (OR: 1.79, 95%CI=1.18-2.71) and evening chronotype (OR: 2.38, 95%CI=1.35-4.19). Being a primary caregiver was associated with sleeping &lt;7h/night (OR: 1.73, 95%CI=1.09-2.77) and high risk for OSA (OR: 2.46, 95%CI=1.43-4.22). There was no association between depression and long sleep (&gt;8 h/night). Conclusions: In this diverse sample of women, sleep problems were highly prevalent and associated with psychosocial risk factors for CVD including depression, low social support, and caregiving. Low social support and depression were also associated with evening chronotype. These findings suggest that sleep may be a potential mechanism linking psychosocial factors to CVD risk but associations may be bidirectional and warrant confirmation prospectively.

Implementation of an Obstructive Sleep Apnea Protocol in the Postanesthesia Care Unit for Patients Undergoing Spinal Fusion Surgery

The purpose of this project was to implement and evaluate the effectiveness of a postanesthesia care unit (PACU) obstructive sleep apnea (OSA) protocol in patients undergoing spinal fusion surgery. The structure of this project was a preimplementation and postimplementation design. A convenience sample of 63 patients admitted to the PACU after spinal fusion surgery, with diagnosed or high-risk OSA, was included in protocol implementation. The prevalence of diagnosed and high-risk OSA at the project implementation site totaled 74% in the spinal fusion population. The incidence of oxygen desaturations was 41% in the preimplementation group and 35% in the postimplementation group. The PACU to intensive care unit transfers were 10% in the preimplementation group and 3% in the postimplementation group. Protocols for surgical patients with OSA require further examination but may function as a guide for postoperative nursing care.

Implementation of an obstructive sleep apnea screening tool with hypertensive patients in the primary care clinic.

Patients with severe obstructive sleep apnea (OSA) have an almost 4-fold higher odds of resistant hypertension than those with less severe OSA. Obstructive sleep apnea screening practices in primary care are deficient. Additional study is needed regarding the value of OSA screening in hypertensive adults who present to the primary care clinic. This was a convenience sample of adults with hypertension from a rural primary care clinic in Iowa. Staff identified patients who met the inclusion criteria for the project. The STOP-Bang Questionnaire was used to screen the patients for OSA. Providers subsequently used discretion as to ordering polysomnography (PSG). Thirty-two patients were screened over a 3-month time period. All of the men included in the study scored either high or intermediate risk for OSA. Forty percent of the study participants scored high risk for OSA, with 33% of those participants referred for PSG. At project conclusion, three participants had undergone PSG testing, and all were diagnosed with sleep apnea. To ensure timely diagnosis and treatment of OSA, primary care providers should consider screening all hypertensive adults for OSA. With compulsory screening and subsequent identification and treatment of patients with OSA, nurse practitioner providers can pave the way in reducing mortality and morbidity associated with OSA, as well as resistant hypertension.

Riesgo de apnea obstructiva del sueño y nivel de actividad física y su asociación con riesgo cardiovascular elevado en adultos chilenos

Introduction: Obstructive sleep apnea (OSA) is associated with high cardiovascular morbidity and mortality. Subjects and methods: 3,657 subjects between 30 and 74 years-old (x: 50.1 ± 12.1 SD) from 2010 Chilean National Health Survey were selected. Risk of OSA was estimated using a clinical prediction rule (CPR) based on the variables of the STOP-Bang Questionnaire. According to their score they were classified as LOW (< 3), MEDIUM (3-4) and HIGH (? 5) risk of OSA. Their physical activity level (PAL) was classified into 3 levels: Low, Moderate and High, according to the self-reported results with the GPAQ questionnaire. To study the association between the risk of OSA and PAL with High / Very High CVR (? 10%, Framingham) we constructed a logistic regression model adjusted for sex, age, BMI, type 2 diabetes, high blood pressure, high total cholesterol, low HDL cholesterol, high triglycerides, educational level, smoking and self-reported sleep hours. Results: 3,098 subjects were classified as OSA risk: LOW 1.683 (54.3%), MEDIUM 1.116 (36%) and HIGH 299 (9.7%). The PAL was evaluated in 3,570 subjects and classified as: Low 1,093 (30.6%), Moderate 705 (19.7%), and High 1,772 (49.6%). The CVR was determined in 3,613 subjects, and 711 (19.7%) classified as High/Very High risk. The regression model shows: MEDIUM risk an OR = 1.75 (1.05 - 2.90, p = 0.03), HIGH risk an OR = 3.86 (1.85-8.06, p < 0.001). For the PAL Low an OR = 1.14 (0.75-1.74, p = 0.525), PAL Moderate an OR = 1.18 (0.73-1.92, p = 0.501). Conclusion: The MEDIUM and HIGH risk of OSA, but not the self-reported PAL, constitute an independent risk factor for high cardiovascular risk.

High risk of obstructive sleep apnea, insomnia, and daytime sleepiness among commercial motor vehicle drivers.

We investigated the prevalence of sleep problems, such as obstructive sleep apnea (OSA), insomnia, and daytime sleepiness in commercial motor vehicle (CMV) drivers compared with that in the general population. This is a cross-sectional study comparing sleep habits and sleep problems in 110 truck drivers with 1001 matched controls from the general population. The assessment was based on self-administered questionnaires that included the Berlin questionnaire, the insomnia severity index, and the Epworth sleepiness scale (ESS). Multivariate regression analysis was performed to determine whether CMV drivers were independently associated with these sleep problems compared with controls. The prevalence of a high risk of OSA and insomnia was 35.5% and 15.2%, respectively, in CMV drivers, which was significantly higher than in controls with a prevalence of 12.2% and 4.1%, respectively (P < 0.001 for both). Although CMV drivers showed higher ESS scores than controls, the prevalence of daytime sleepiness did not differ between the two groups (19.1% vs. 16.8%, P = 0.54). After adjusting for covariates, CMV drivers had 3.68 times higher odds (95% CI 2.29-5.84) of OSA and 2.97 times higher odds (95% CI, 1.46-6.06) of insomnia compared with controls. However, the degree of daytime sleepiness was not independently associated with CMV drivers. The prevalence of OSA and insomnia in CMV drivers was higher than that in the general population. Daytime sleepiness was associated with increased BMI, depression, OSA, and short sleep duration, regardless of CMV driving as an occupational factor.

Floppy eyelid syndrome in stickler syndrome

PurposeTo report the possible connection between Stickler syndrome and floppy eyelid syndrome. ObservationsA 36-year-old man with genetically confirmed Stickler syndrome presented with prominent bilateral eyelid laxity consistent with floppy eyelid syndrome. He had a high-arched palate and reported years of apneic episodes during sleep consistent with obstructive sleep apnea (OSA). Conclusions and importanceTo our knowledge, there have been no prior reported cases of floppy eyelid syndrome in Stickler syndrome patients. However, many patients with Stickler syndrome have palate abnormalities, which are associated with a higher risk of OSA. Given the known association between floppy eyelid syndrome and OSA, this case highlights the potential role for the ophthalmologist in identifying these patients and referring them for a sleep study if floppy eyelid syndrome is identified.

Poor Outcomes Among Patients With Chronic Obstructive Pulmonary Disease With Higher Risk for Undiagnosed Obstructive Sleep Apnea in the LOTT Cohort.

Evaluate consequences of intermediate to high risk of undiagnosed obstructive sleep apnea (OSA) among individuals with chronic obstructive pulmonary disease (COPD). Using data from the Long Term Oxygen Treatment Trial (LOTT), we assessed OSA risk at study entry among patients with COPD. We compared outcomes among those at intermediate to high risk (modified STOP-BANG score ≥ 3) relative to low risk (score < 3) for OSA. We compared risk of mortality or first hospitalization with proportional hazard models, and incidence of COPD exacerbations using negative binomial regression. We adjusted analyses for demographics, body mass index, and comorbidities. Last, we compared St. George Respiratory Questionnaire and Quality of Well-Being Scale results between OSA risk groups. Of the 222 participants studied, 164 (74%) were at intermediate to high risk for OSA based on the modified STOP-BANG score. Relative to the 58 low-risk individuals, the adjusted hazard ratio of mortality or first hospitalization was 1.61 (95% confidence interval 1.01-2.58) for those at intermediate to high risk of OSA. Risk for OSA was also associated with increased frequency of COPD exacerbations (adjusted incidence rate ratio: 1.78, 95% confidence interval 1.10-2.89). Respiratory symptoms by St. George Respiratory Questionnaire were 5.5 points greater (P = .05), and Quality of Well-Being Scale scores were .05 points lower (P < .01) among those at intermediate to high risk for OSA, indicating more severe respiratory symptoms and lower quality of life. Among individuals with COPD, greater risk for undiagnosed OSA is associated with poor outcomes. Increased recognition and management of OSA in this group could improve outcomes.

Risk of Obstructive Sleep Apnea and Echocardiographic Parameters.

BackgroundObstructive sleep apnea (OSA) is a chronic progressive disorder with high mortality and morbidity rate, associated with cardiovascular diseases (CVD), especially heart failure (HF). The pathophysiological changes related to OSA can directly affect the diastolic function of the left ventricle.ObjectivesTo assess the association of the risk of OSA, evaluated by the Berlin Questionnaire (BQ), and echocardiographic (ECHO) parameters related to diastolic dysfunction in individuals without HF assisted in primary care.MethodsA cross-sectional study that included 354 individuals (51% women) aged 45 years or older. All individuals selected were submitted to an evaluation that included the following procedures: consultation, filling out the BQ, clinical examination, laboratory examination and transthoracic Doppler echocardiography (TDE). Continuous data are presented as medians and interquartile intervals, and categoric variables in absolute and relative frequencies. The variables associated with risk of OSA and at the 0.05 level integrated the gamma regression models with a log link function. A value of p < 0.05 was considered an indicator of statistical significance. Exclusion criteria were presence of HF, to fill out the BQ and patients with hypertension and obesity not classified as high risk for OSA by other criteria. All individuals were evaluated on a single day with the following procedures: medical appointment, BQ, laboratory tests and ECHO.ResultsOf the 354 individuals assessed, 63% were classified as having high risk for OSA. The patients with high risk for OSA present significantly abnormal diastolic function parameters. High risk for OSA confirmed positive and statistically significant association, after adjustments, with indicators of diastolic function, such as indexed left atrium volume LAV-i (p = 0.02); E’/A’ (p < 0.01), A (p = 0.02), E/A (p < 0.01).ConclusionOur data show that patients at high risk for OSA present worsened diastolic function parameters measured by TDE.

Snoring during Bronchoscopy with Moderate Sedation Is a Predictor of Obstructive Sleep Apnea.

BackgroundSnoring is the cardinal symptom of obstructive sleep apnea (OSA). Snoring and upper airway obstruction associated with major oxygen desaturation may occur in populations undergoing flexible bronchoscopy.MethodsTo evaluate the prevalence of patients at a high risk of having OSA among patients undergoing bronchoscopy with sedation and to investigate whether snoring during the procedure predicts patients who are at risk of OSA, we prospectively enrolled 517 consecutive patients who underwent the procedure with moderate sedation. Patients exhibiting audible snoring for any duration during the procedure were considered snorers. The STOP-Bang (Snoring, Tiredness, Observed apnea, high blood Pressure-Body mass index, Age, Neck circumference and Gender) questionnaire was used to identify patients at high (score ≥3 out of 8) or low risk (score <3) of OSA.ResultsOf the 517 patients, 165 (31.9%) snored during bronchoscopy under sedation. The prevalence of a STOP-Bang score ≥3 was 61.9% (320/517), whereas 200 of the 352 nonsnorers (56.8%) and 120 of the 165 snorers (72.7%) had a STOP-Bang score ≥3 (p=0.001). In multivariable analysis, snoring during bronchoscopy was significantly associated with a STOP-Bang score ≥3 after adjustment for the presence of diabetes mellitus, chronic obstructive pulmonary disease, chronic kidney disease, and stroke (adjusted odds ratio, 1.91; 95% confidence interval, 1.26–2.89; p=0.002).ConclusionTwo-thirds of patients undergoing bronchoscopy with moderate sedation were at risk of OSA based on the screening questionnaire. Snoring during bronchoscopy was highly predictive of patients at high risk of OSA.

Prevalence and Risk of Obstructive Sleep Apnea and Arterial Hypertension in the Adult Population in Poland: An Observational Subset of the International Prospective Urban Rural Epidemiology (PURE) Study.

Obstructive sleep apnea (OSA) is a common breathing disorder affecting millions of people worldwide. The disorder is connected with serious consequences including hypertension, myocardial infarction, arrhythmias, coronary disease, cardiac insufficiency, stroke, transient ischemic attack, and cognitive decline. Epidemiological data assessing the prevalence of OSA in different countries vary in methodology, size, and characteristics of population chosen and thus are hardly comparable. There are very few reports on the prevalence of OSA and on the diagnostic accuracy of sleep questionnaires available in Poland. In this report we present the analysis of the prevalence of, and risk factors for OSA in the Polish adult population consisting of 613 community-based subjects (227 men and 386 women). The study was based on the STOP-BANG questionnaire, a validated Screening Tool for OSA in primary care. It is a part of Polish subset of the Prospective Urban Rural Epidemiology (PURE) study, an ongoing population cohort study of individuals from urban and rural communities from 21 countries. We took into account age, gender, body mass index (BMI), and antihypertensive treatment. The findings are that over one half of the Polish population investigated had a moderate to high risk of OSA (66.5% of men and 60.1% of women). After the adjustments for age, gender, and BMI we noticed a dose-response relationship between arterial blood pressure behavior and OSA. The association was significant among women, but not men. Based on previous studies we can assume that one half of this high risk group would be further diagnosed for OSA. This study, the first large scale screening for OSA in Poland, shows a substantial, much higher than previously appreciated, prevalence of risk for OSA in the population at large.