Impact Of Obstructive Sleep Apnea Research Articles

Differential impact of obstructive sleep apnea on hippocampal structure in late middle‐aged and older women and men

AbstractBackgroundRecent studies have suggested that obstructive sleep apnea (OSA) could be a modifiable risk factor for dementia. Consequently, efforts have been made to better understand the role of OSA on brain structure integrity, but results between studies are inconsistent. Discrepancies could be partly due to moderating factors (e.g., sex) or complex physiological mechanisms (e.g., oedema) that blur the association between OSA and brain structure. Here, we investigated the association between OSA severity and hippocampal grey matter volume in women and men. We also performed free‐water fraction analyses to understand how oedema could impact hippocampal volumes.MethodSeventy‐three men (age: 65.47±7.22 years; apnea‐hypopnea index [AHI]: 15.52±16.14 events/h; 31 with mild cognitive impairments [MCI]) and 47 women (age: 71.11 ± 6.65; AHI: 11.56 ± 9.92; 22 with MCI) underwent an overnight polysomnography, a neuropsychological evaluation and a magnetic resonance imaging session. Using the hippocampal subfield module in Freesurfer 7.1, total bilateral hippocampal volumes were extracted and normalised to the total intracranial volume. Diffusion data was preprocessed using TractoFlow‐ABS, and Freewater‐Flow and the Sherbrooke Connectivity Imaging Lab scripts were used to extract bilateral hippocampal free‐water fraction. Controlling for age and cognitive status, sex‐stratified linear regressions were performed between (i) the bilateral hippocampal volume or (ii) Free‐water‐corrected bilateral hippocampal volume and log‐transformed AHI.ResultIn women, we observed a positive association between the AHI and bilateral hippocampal volumes (r=0.414; p=0.005), where more severe OSA was associated with higher volumes. This association was not observed in men (p=0.427). When using the free‐water corrected volumes, this association was no longer significant in women (p=0.481), suggesting that the increased hippocampal volume could be due to OSA‐related cytotoxic (intracellular) oedema.ConclusionIn this cohort, while men’s hippocampal volume was unaffected by OSA, women with OSA presented hippocampal hypertrophy likely due to intracellular oedema. Cytotoxic oedema is a known precursor to vasogenic (extracellular) oedema and cell death, suggesting that women might be more vulnerable to the cerebral consequences of OSA than men. Since women have a higher lifetime risk of developing Alzheimer's disease, future studies on OSA should pay a particular attention to women.

The manisfestation of vestibular evoked myogenic potentials in patients with obstructive sleep apnea

Obstructive sleep apnea（OSA） is a syndrome characterized by repeated apneas and hypopneas, periodic intermittent hypoxemia accompanied by repeated drops in intrathoracic pressure（due to blockage of the airway during inhalation） and fragmentation of sleep. It can cause intermittent hypoxia and hypercapnia, and has adverse effects on many systems of human body, including the cardiovascular system, endocrine system, and the neuropsychiatric system, etc. The impact of OSA on vestibular function has also attracted the attention of researchers, and vestibular evoked myogenic potentials（VEMPs） are used to evaluate function of the otolithic apparatus and its conduction pathways in patients with OSA. The changes of VEMPs in OSA patients and the value of VEMPs in clinical work were summarized in this review.

Impact of obstructive sleep apnea complicated with type 2 diabetes on long-term cardiovascular risks and all-cause mortality in elderly patients

BackgroundThe prognostic significance of obstructive sleep apnea (OSA) in elderly patients with type 2 diabetes is unclear. The aim of this study was to determine the risk of cardiovascular disease (CVD) and mortality in elderly patients with OSA complicated with type 2 diabetes compared to patients with OSA without type 2 diabetes.MethodsFrom January 2015 to October 2017, 1113 eligible elderly patients with OSA, no history of cardiovascular, ≥60 years of age, and complete follow-up records were enrolled in this consecutive multicentre prospective cohort study. All patients had completed polysomnography (PSG) examinations. An apnoea-hypopnoea index of ≥5 events per hour recorded by polysomnography was defined as the diagnostic criterion for OSA. We collected baseline demographics, clinical characteristics, sleep parameters and follow-up outcomes. The primary aim of this study was to identify the risk of incident major adverse cardiovascular events (MACE). Secondary outcomes were all-cause mortality, components of MACE and a composite of all events. Kaplan-Meier survival analysis and Cox proportional hazards models were used to evaluate whether type 2 diabetes was associated with incident events.ResultsA total of 266 (23.9%) patients had OSA complicated with type 2 diabetes. MACE occurred in 97 patients during the median 42-month follow-up. Kaplan-Meier survival curves indicated a significant relationship between type 2 diabetes and MACE (log-rank P = 0.003). Multivariable Cox regression analysis showed that type 2 diabetes increased the risk of MACE (HR = 1.64, 95% CI:1.08–2.47, P = 0.019), hospitalisation for unstable angina (HR = 2.11, 95% CI:1.23–3.64, P = 0.007) and a composite of all events in elderly patients with OSA (HR = 1.70, 95% CI:1.17–2.49, P = 0.007). However, there were no significant differences in the incidence of cardiovascular death, all-cause mortality, MI and hospitalisation for heart failure between patients with and without diabetes (P > 0.05). The subgroup analysis demonstrated that females (AHR = 2.46, 95% CI:1.17–5.19, P = 0.018), ≥ 70 years (AHR = 1.95, 95% CI:1.08–3.52, P = 0.027), overweight and obese (AHR = 2.04, 95% CI:1.29–3.33, P = 0.002) with mild OSA (AHR = 2.42, 95% CI: 1.03–5.71, P = 0.044) were at a higher risk for MACE by diabetes.ConclusionOSA and type 2 diabetes are interrelated and synergistic with MACE, hospitalisation for unstable angina and a composite of all events development. Overweight and obese females, ≥ 70 years with mild OSA combined with type 2 diabetes presented a significantly high MACE risk.

Impact of obstructive sleep apnea on clinical outcomes in patients hospitalized with COVID-19.

PurposeData from large patient registry studies suggested an increased incidence and increased mortality in coronavirus disease-2019 (COVID-19) in patients with a history of obstructive sleep apnea (OSA). This study aimed to compare the prevalence of OSA in patients with and without COVID-19 among patients admitted to the same hospital in the same time period. In addition, the impact of OSA on clinical outcomes of COVID-19 infection was investigated.MethodsObservational cohort study. Clinical data were collected retrospectively from the complete medical records for each patient individually from March 1st 2020 to May 16th 2020.ResultsA total of 723 patients were diagnosed with COVID-19 and 1161 with non-COVID-19 disease. The prevalence of OSA did not differ between these groups (n = 49; 6.8% versus n = 66; 5.7%; p = 0.230). In patients with COVID-19, mortality was increased in the group of 49 patients with OSA (n = 17; 34.7%) compared to 674 COVID-19 patients without OSA (n = 143; 21.2%; p = 0.028). This increased risk of mortality in COVID-19 patients with OSA (OR = 2.590; 95%CI 1.218–5.507) was independent from Body Mass Index (BMI), male gender, age, diabetes, cardiovascular disease, and obstructive lung disease. Presence of OSA in COVID-19 disease was further associated with an increased length of hospital stay (12.6 ± 15.7 days versus 9.6 ± 9.9 days; p = 0.049).ConclusionThe prevalence of OSA did not differ between patients with or without COVID-19, but mortality and hospital length of stay were increased in patients with OSA and comorbid COVID-19. Hence, OSA should be included in COVID-19 risk factor analyses, Clinicians should be aware of the association and the mechanism should be further explored.

OBSTRUCTIVE SLEEP APNEA RISK IS ASSOCIATED WITH LOWER HEALTH-RELATED QUALITY OF LIFE IN WOMEN WITH POLYCYSTIC OVARY SYNDROME

Obstructive sleep apnea (OSA) disproportionally affects women with polycystic ovary syndrome, with more than a third of patients impacted. Health-related quality of life (HRQoL) is an important metric of chronic disease, and women with PCOS have repeatedly been shown to experience lower HRQoL compared to the general population. A preliminary study revealed a relationship between an increased oxygen desaturation index on sleep studies and decreased HRQoL in women with PCOS, however the impact of OSA on HRQoL in this population remains poorly understood.

Impact of obstructive sleep apnea on the long-term cardiovascular outcomes in patients with acute coronary syndrome

Objective: To investigate the impact of obstructive sleep apnea (OSA) on long-term cardiovascular outcomes in patients with acute coronary syndrome (ACS). Methods: This is a single-center, prospective cohort study. Between June 2015 to January 2020, consecutive ACS patients hospitalized at Beijing Anzhen Hospital, Capital Medical University were enrolled. All patients underwent portable sleep breathing monitoring, and they were then divided into moderate/severe OSA group (apnea-hypopnea index (AHI)≥15 events/hour) and no/mild OSA group (AHI<15 events/hour). The primary endpoint was major adverse cardiac and cerebrovascular event (MACCE), defined as a composite of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, ischemia-driven revascularization and hospital admission for unstable angina or heart failure. MACCE were compared yearly by the log-rank test. Multivariable Cox regression analyses were performed to determine the independent predictors of MACCE. Results: A total of 1 927 patients with ACS were enrolled, including 1 629 males (84.5%), aged (56.4±10.5) years. Moderate/severe OSA was present in 1 014 (52.6%) patients. Compared with no/mild OSA group, moderate/severe OSA group exhibited a higher body mass index (P<0.05). Hypertension, prior PCI were more prevalent in moderate/severe OSA group (both P<0.05). The difference of ACS category between the two groups was statistically significant (P=0.021). The rate of patients who underwent PCI and the number of stents were higher in the moderate/severe OSA group. During a 5-year follow-up (median 2.9 years (IQR 1.5-3.6 years)), the cumulative incidence of MACCE was significantly higher in the moderate/severe OSA group than in the no/mild OSA group (34.0% vs. 24.0%, HR=1.346, 95%CI 1.100-1.646, log-rank P=0.004). The cumulative incidence of MACCE remained statistically higher at 4 and 5 year in the moderate/severe OSA group as compared to the no/mild OSA group (33.3% vs. 22.9%, HR=1.397, 95%CI 1.141-1.710, log-rank P=0.001; 34.0% vs. 24.0%, HR=1.341, 95%CI 1.096-1.640, log-rank P=0.004, respectively). Multivariate analysis showed that moderate/severe OSA (HR=1.312, 95%CI 1.054-1.631, P=0.015) was an independent predictor of long-term MACCE in ACS patients. Conclusions: Moderate/severe OSA is observed in more than 52% ACS patients. Moderate/severe OSA is an independent predictor of long-term MACCE.

Sleep‐Disordered Breathing and Cardiovascular Disease in Children and Adolescents

Obstructive sleep apnea (OSA) is a known risk factor for cardiovascular disease in adults. It is associated with incident systemic hypertension, arrhythmia, stroke, coronary artery disease, and heart failure. OSA is common in children and adolescents, but there has been less focus on OSA as a primary risk factor for cardiovascular disease in children and adolescents. This scientific statement summarizes what is known regarding the impact of sleep‐disordered breathing and, in particular, OSA on the cardiovascular health of children and adolescents. This statement highlights what is known regarding the impact of OSA on the risk for hypertension, arrhythmia, abnormal ventricular morphology, impaired ventricular contractility, and elevated right heart pressure among children and adolescents. This scientific statement also summarizes current best practices for the diagnosis and evaluation of cardiovascular disease–related complications of OSA in children and adolescents with sleep apnea and highlights potential future research in the area of sleep‐disordered breathing and cardiovascular health during childhood and adolescence.

The impact of obstructive sleep apnea on endothelial function during weight loss in an obese pediatric population

BackgroundChildhood obesity is an increasing problem with substantial comorbidities such as obstructive sleep apnea (OSA) and increased cardiovascular morbidity. Endothelial dysfunction is an underlying mechanism related to both obesity and OSA. Research questionTo investigate the effect of weight loss on endothelial function and OSA in obese children and to determine whether a change in endothelial function can be linked to an improvement in OSA. MethodsObese children between 8 and 18 years of age were recruited while entering a 12-month inpatient weight loss program. Patients were followed at 3 study visits: baseline, after 10 months of weight loss, and 6 months after ending the program (18 months). Anthropometry and endothelial function (EndoPAT) were determined at all study visits. At baseline, sleep screening with a portable device (ApneaLink) was performed. This was repeated after 10 months if OSA was diagnosed at baseline. ResultsAt baseline, 130 children were included, of which 87 had OSA (67%). Seventy-two patients attended the follow-up visit at 10 months, and 28 patients attended the follow-up visit at 18 months. The BMI z-score decreased after 10 months (from 2.7 (1.4–3.4) to 1.7 (0.5–2.7); p < 0.001) and remained stable at 18 months. Endothelial function improved significantly after weight loss, evidenced by a shorter time to peak response (TPR) and higher reactive hyperemia index (p = 0.02 and p < 0.001), and remained improved after 18 months (p < 0.001 and p = 0.007). After 10 months of weight loss, 10 patients had residual OSA. These patients had a higher TPR at 10 months (225 (75–285)s) than those without OSA (135 (45–225)s) and patients with a normalized sleep study (105 (45–285)s; p = 0.02). Linear mixed models showed that more severe OSA was associated with a worse TPR at baseline and less improvement after weight loss. ConclusionWeight loss improves endothelial function in an obese pediatric population. However, even after weight loss, endothelial function improved less in the presence of OSA.

Association Between Obstructive Sleep Apnea and Reduced Mortality in Critically Ill Patients: A Propensity Score-Based Analysis.

BackgroundThe impact of obstructive sleep apnea (OSA) on the prognosis of intensive care unit (ICU) patients remains controversial. Thus, this study aimed to determine the association between OSA status and outcomes in ICU patients.MethodsWe conducted a retrospective cohort study composed of 38,177 critically ill patients from the Medical Information Mart for Intensive Care III (MIMIC-III) database. Propensity score matching was used to evaluate the association between OSA and mortality in ICU adults.ResultsA total of 38,177 critically ill patients were included in this study. Among them, 1428 (3.71%) patients had OSA. Before matching, patients with OSA had a significantly lower 28-day mortality (relative risk (RR), 0.47; 95% confidence interval (CI), 0.38–0.58), 90-day mortality (RR, 0.50; 95% CI, 0.43–0.60), ICU mortality (RR, 0.41; 95% CI, 0.31–0.54), and in-hospital mortality (RR, 0.46; 95% CI, 0.36–0.57). After adjusting with propensity-score matching, the findings of reduced risk of mortality remained unchanged. The RR of 28-day mortality, 90-day mortality, ICU mortality, in-hospital mortality was 0.57 (95% CI, 0.34–0.57), 0.53 (95% CI, 0.40–0.70), 0.54 (95% CI, 0.37–0.79), and 0.55 (95% CI, 0.39–0.77), respectively.ConclusionThis study indicated that ICU patients with OSA had a significantly lower risk of mortality compared with those without OSA.

Impact of obstructive sleep apnea on new-set atrial fibrillation after septal myectomy in patients with hypertrophic obstructive cardiomyopathy.

BackgroundObstructive sleep apnea (OSA) is associated with a higher prevalence of postoperative atrial fibrillation in patients who underwent cardiac surgery. However, whether OSA is a risk factor for postoperative atrial fibrillation after septal myectomy remains unclear. We hypothesized that OSA was associated with postoperative atrial fibrillation after septal myectomy.MethodsA total of 99 patients with hypertrophic obstructive cardiomyopathy who underwent septal myectomy were included in our manuscript. Polysomnography was performed in all patients, and the heart rhythm was continuously monitored during the perioperative period.ResultsIn the present study, 25 (25.3%) patients developed postoperative atrial fibrillation after septal myectomy. The prevalence of postoperative atrial fibrillation was significantly higher in patients with OSA and increased with the worsening severity of OSA. Notably, the apnea-hypoxia index was significantly higher in patients with postoperative atrial fibrillation among the different OSA groups. In receiver operating characteristic analysis, the area under the curve for the apnea-hypopnea index was 0.785 (95% CI: 0.684–0.887, P<0.001); an apnea-hypopnea index of 10.4 was the optimal cutoff point to predict postoperative atrial fibrillation. In the multivariable analysis, apnea-hypopnea index ≥10.4 (odds ratio: 6.29, 95% CI: 2.18–18.14, P=0.001), moderate-to-severe OSA (odds ratio: 4.88, 95% CI: 1.42–16.86, P=0.01), and left atrium diameter (odds ratio: 1.12, 95% CI: 1.03–1.22, P=0.01) were independent risk factors associated with postoperative atrial fibrillation after adjusting for relevant variables. However, the association between the diagnosis of OSA and postoperative atrial fibrillation was no longer statistically significant.ConclusionsThe severity of OSA reflected by the apnea-hypopnea index in patients with obstructive hypertrophic cardiomyopathy who underwent surgery is an independent risk factor for postoperative atrial fibrillation, which is associated with adverse clinical outcomes.

Obstructive Sleep Apnea Increases the Risk of Perioperative Myocardial Infarction Following Off-Pump Coronary Artery Bypass Grafting.

Background and Aims: The impact of obstructive sleep apnea (OSA) on perioperative myocardial infarction (PMI) following coronary artery bypass grafting (CABG) remains unclear. Off-pump CABG (OPCABG) has become a common practice for CABG in China. The present study investigated mainly the correlation between OSA and PMI following OPCABG.Methods: In this prospective observational single-center study, consecutive eligible patients listed for elective OPCABG underwent cardiorespiratory polygraphy before surgery between January 2019 and June 2020. OSA was defined as an apnea-hypopnea index (AHI) ≥15 events/h. The primary end point was perioperative myocardial infarction (PMI) following OPCABG (type 5 MI).Results: Patients with OSA accounted for 42.2% (62/147) of the cohort. Twenty-four patients (16.3%) met the protocol criteria for PMI: 17 (27.4%) in the OSA group and 7 (8.2%) in the non-OSA group (P = 0.002). Multivariate logistic regression analysis revealed that AHI (OR = 1.115, 95% CI 1.066 to 1.166, P < 0.001), high-sensitivity c-reactive protein (hs-CRP) (OR = 1.080, 95% CI 1.025 to 1.138, P = 0.004), and SYNTAX score (OR = 1.098, 95% CI 1.056 to 1.141, P < 0.001) were associated with PMI incidence. Furthermore, ROC analysis revealed that the AHI (AUC = 0.766, 95% CI 0.689 to 0.832, P < 0.001) and SYNTAX score (AUC = 0.789, 95% CI 0.715 to 0.852, P < 0.001) had predictive value for PMI. In addition, multiple linear regression analysis showed that the AHI was an independent influencing factor of hs-CRP (B = 0.176, 95% CI 0.090 to 0.263, P < 0.001) and the SYNTAX score (B = 0.553, 95% CI 0.397 to 0.709, P < 0.001).Conclusions: OSA was independently associated with a higher incidence of PMI following OPCABG, and the formation of severe coronary atherosclerotic lesions aggravated by an enhanced inflammatory response might be the potential mechanism. The efficacy of CPAP treatment for improving prognosis after CABG remains to be further investigated.

Impact of obstructive sleep apnea on neuromuscular transmission- a descriptive study

ABSTRACT Objective: Obstructive sleep apnea (OSA) is a sleep disorder accompanied by intermittent hypoxia. Neuromuscular transmission (NT) is known to be disturbed under chronic hypoxia. In this descriptive study, it has been aimed to test NT under intermittent hypoxia in OSA. Methods: Thirty-nine newly diagnosed OSA patients without any comorbidities or conditions that alter NT were included in the study. Jitter analysis was performed using a concentric needle electrode. Results: The mean jitter value of 39 OSA patients was 25.9 ± 3.7 μs. When compared to the mean reference jitter values, patients in the present study had significantly higher jitter (p < 0.001). Seven (17.9%) patients met the electrophysiological criteria for NT failure. Conclusion: The authors propose that intermittent hypoxia can be the trigger for NT failure in OSA. The interaction between increased oxidative stress and disturbed mitochondrial functions may also contribute.

Impact of Obstructive Sleep Apnea on Gestational Diabetes Mellitus

IntroductionObstructive sleep apnea (OSA) increases the risk of type 2 diabetes, and hyperinsulinemia. Pregnancy increases the risk of OSA; however, the relationship between OSA and gestational diabetes mellitus (GDM) is unclear. We aimed (1) to evaluate OSA prevalence in GDM patients; (2) to assess the association between OSA and GDM; and (3) to determine the relationships between sleep parameters with insulin resistance (IR). MethodsA total of 177 consecutive women (89 with GDM, 88 controls) in the third trimester of pregnancy underwent a hospital polysomnography. OSA was defined when the apnea-hypopnea index (AHI) was ≥5h−1. ResultsPatients with GDM had higher pregestational body mass index (BMI) and neck circumference than controls, but no differences in snoring or OSA-symptoms, or AHI (3.2±6.0 vs. 1.9±2.7h−1, p=.069). OSA prevalence was not significantly different in both groups. We did not identify OSA as a GDM risk factor in the crude analysis 1.65 (95%CI: 0.73–3.77; p=.232). Multiple regression showed that total sleep time (TST), TST spent with oxygen saturation<90% (T90), and maximum duration of respiratory events as independent factors related with homeostasis model assessment of IR, while T90 was the only independent determinant of quantitative insulin sensitivity check index. ConclusionOSA prevalence during the third trimester of pregnancy was not significantly different in patients with GDM than without GDM, and no associations between OSA and GDM determinants were found. We identified T90 and obstructive respiratory events length positive-related to IR, while TST showed an inverse relationship with IR in pregnant women.

Impact of obstructive sleep apnea on immune function

阻塞性睡眠呼吸暂停特征性的慢性间歇性低氧和睡眠片段化可导致巨噬细胞、树突状细胞、自然杀伤细胞、固有类淋巴细胞、T细胞及B细胞数目和表型改变，影响免疫功能，参与OSA相关心血管疾病、胰岛素抵抗及肿瘤等并发症的发生发展。.

680 Impact of Obstructive Sleep Apnea and Positive Airway Pressure Therapy on COVID-19 Outcomes

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

551 Outcomes of Sickle Cell Crisis in Relation to Pediatric Obstructive Sleep Apnea in the United States: A US Population cohort study

Abstract Introduction This study aimed to quantify the impact of obstructive sleep apnea (OSA) on the mortality, morbidity, and resources utilization among children admitted with Sickle cell crisis (SCC) Methods This is a retrospective analysis using the 2016 and 2017 National Inpatient Sample Database. The Inclusion Criteria was a principal Diagnosis of SSC and age &amp;lt;18 years. OSA, as a Secondary Diagnosis, was identified using the appropriate ICD-10 CM codes. The Primary Outcomes were Inpatient Mortality, and secondary outcomes were: In-Hospital Length of Stay(LOS), Total hospitalization Cost, Blood transfusion (BT) requirement, and a requirement for Invasive mechanical ventilation (IMV). We used Multivariate Linear/ logistic regression to adjust for confounders including age and sex. Results Out of 36,484 children with SSC included in the study, 1450 children had OSA (SCC+OSA). SSC-OSA and SSC+OSA groups did not differ in gender, household income, and hospital characteristics, but did so in age (11.3 vs 12.4; p &amp;lt;0.001). OSA was most common in the age group of 13–18 (54%) and lowest in 0–4 (2.4%). Compared to SSC-OSA, the SCC+OSA cohort had significantly higher odds of mortality (adjusted OR= 11.9, [95% Confidence Interval: 1.02- 138.8],p=0.04). Additionally, SSC+OSA cohort was associated with increased odds of IMV (aOR=5.24 [CI: 1.84 – 14.8], p=0.002), longer LOS (adjusted mean difference (aMD)=0.67 [CI-0.32 – 1.02], p=&amp;lt;0.001), and higher hospitalization Cost (aMD=2818.76 [CI-1680- 4157], p=&amp;lt;0.001). No difference in BT (aOR=0.94 [CI: 0.68 – 1.29], p=0.71) was noted. Conclusion This study demonstrates that the presence of OSA is associated with detrimental outcomes in SSC with higher in-hospital mortality, higher morbidity (Invasive mechanical ventilation rate), and higher resource utilization (LOS, total hospitalization cost). More attention to the screening, early diagnosis, and appropriate treatment of OSA is imperative to improve health outcomes in children with sickle cell disease. Support (if any):

Impact of obstructive sleep apnoea and intermittent hypoxia on blood rheology: a translational study.

Haemorheological alterations are reported in obstructive sleep apnoea (OSA) and reversed with continuous positive airway pressure (CPAP), observations potentially explained by intermittent hypoxia (IH)-induced oxidative stress. Our objective was to investigate whether IH causes haemorheological alterations via oxidative stress. Wistar rats were exposed to normoxia (n=7) or IH (n=8) for 14 days. 23 moderate-to-severe OSA patients were assessed at three time-points: baseline, after randomisation to either 2 weeks of nocturnal oxygen (n=13) or no treatment (n=10) and after 1 month of CPAP treatment (n=17). Furthermore, an OSA-free control group (n=13) was assessed at baseline and after time-matched follow-up. We measured haemorheological parameters (haematocrit, blood viscosity, plasma viscosity (rats only), erythrocyte aggregation and deformability (humans only)) and redox balance (superoxide dismutase (SOD), glutathione peroxidase, protein oxidation (advanced oxidation protein products (AOPPs)) and lipid peroxidation (malondialdehyde)). We also tested the haemorheological sensitivity of erythrocytes to reactive oxygen species (ROS) in our human participants using the oxidant t-butyl hydroperoxide (TBHP). In rats, IH increased blood viscosity by increasing haematocrit without altering the haemorheological properties of erythrocytes. IH also reduced SOD activity and increased AOPPs. In humans, baseline haemorheological properties were similar between patients and control participants, and properties were unaltered following oxygen and CPAP, except erythrocyte deformability was reduced following oxygen therapy. Redox balance was comparable between patients and control participants. At baseline, TBHP induced a greater reduction of erythrocyte deformability in patients while CPAP reduced TBHP-induced increase in aggregation strength. IH and OSA per se do not cause haemorheological alterations despite the presence of oxidative stress or higher sensitivity to ROS, respectively.

The impact of obstructive sleep apnea on bronchiolitis severity in children with Down syndrome

ObjectivesAcute bronchiolitis commonly causes respiratory failure in children ≤2 years, and is particularly severe in those with Down syndrome (DS). Obstructive sleep apnea (OSA), common in DS, is also associated with respiratory complications. However, it is unknown whether OSA is associated with worse outcomes in children with and without DS, hospitalized with bronchiolitis. We hypothesized that in children with bronchiolitis, OSA is associated with worse outcomes in those with DS, independent of DS-related comorbidities. MethodsHospital discharge records of children with bronchiolitis aged ≤2 years were obtained for 1997–2012 from the Kid's Inpatient Database. The primary outcome was invasive mechanical ventilation (IMV), and secondary outcomes were non-invasive mechanical ventilation (NIMV), length of hospital stay, and inflation-adjusted cost of hospitalization (IACH). Multivariable regression was conducted to ascertain the associations between OSA and primary and secondary outcomes accounting for DS-associated comorbidities. ResultsThere were 928,961 hospitalizations for bronchiolitis. The DS group with bronchiolitis (n = 8697) was more likely to have OSA [241 (2.77%) vs 1293 (0.14%), p < 0.001] compared to the non-DS group (n = 920,264). Multivariable logistic regression showed that OSA was associated with IMV (adjusted odds ratio [OR], 3.32 [95% CI 2.54–4.35], p < 0.0001) in all children with bronchiolitis; and in those with DS, it was associated with IMV (adjusted OR, 2.34 [95% CI 1.38–3.97], p = 0.002), NIMV (adjusted OR, 8.21 [95% CI 4.48–15.04], p < 0.0001) and IACH (adjusted β, 0.18 [95% CI 0.02–0.34], p = 0.031). ConclusionsOSA is independently associated with assisted ventilation in all children hospitalized with bronchiolitis, regardless of DS-associated comorbidities in those with DS. The severity of bronchiolitis in children with DS may be driven by the high prevalence of OSA.

Impact of obstructive sleep apnea on cardiometabolic health in a random sample of older adults in rural South Africa: building the case for the treatment of sleep disorders in underresourced settings.

The association between obstructive sleep apnea (OSA) and increased cardiometabolic risk (CMR) has been well documented in higher-income countries. However, OSA and its association with CMR have not yet been investigated, based on objective measures, in southern Africa. We measured polysomnography-derived sleep characteristics, OSA prevalence, and its association with cardiometabolic diseases in a rural, low-income, African-ancestry sample of older adult participants in South Africa. Seventy-five participants completed the study. Body mass index, hypertension, diabetes, dyslipidemia, and HIV status were determined. A continuous CMR score was calculated using waist circumference, random glucose, high-density-lipoprotein cholesterol, triglycerides, and mean arterial blood pressure. Sleep architecture, arousal index, and apnea-hypopnea index for detection of the OSA (apnea-hypopnea index ≥ 15 events/h) were assessed by home-based polysomnography. Associations between CMR score and age, sex, socioeconomic status, apnea-hypopnea index, and total sleep time were investigated by multivariable analysis. In our sample (53 women, age 66.1 ± 10.7 years, 12 HIV+), 60.7% of participants were overweight/obese, 61.3% were hypertensive, and 29.3% had undiagnosed OSA. Being older (P = .02) and having a higher body mass index (P = .02) and higher waist circumference (P < .01) were associated with OSA. Apnea-hypopnea index severity (β = 0.011; P = .01) and being a woman (β = 0.369; P = .01) were independently associated with a higher CMR score in socioeconomic status- and age-adjusted analyses. In this South African community with older adults with obesity and hypertension, OSA prevalence is alarming and associated with CMR. We show the feasibility of detecting OSA in a rural setting using polysomnography. Our results highlight the necessity for actively promoting health education and systematic screening and treatment of OSA in this population to prevent future cardiovascular morbidity, especially among women.

Outcomes of patients hospitalized for acute pulmonary embolism by obstructive sleep apnea status.

Pulmonary embolism (PE) is a major cause of cardiovascular morbidity and mortality. Obstructive sleep apnea (OSA) is increasingly recognized in the aging population, especially with the rising obesity epidemic. The impact of OSA on inpatient mortality in PE is not well understood. We used the Nationwide Inpatient Sample databases from 2005 to 2016 to identify 755,532 acute PE patients (age≥18 years). Among these, 61,050 (8.1%) were OSA+. Temporal trends in length of stay, inpatient mortality, and its association with OSA in PE patients were analyzed. The proportion of PE patients who were OSA+ increased from 2005 to 2016. OSA+ PE patients were younger and predominantly men. Despite a higher prevalence of traditional risk factors for inpatient mortality in OSA+ patients, OSA was associated with a lower risk of mortality in PE patients (odds ratio, 95% confidence interval; p: unadjusted 0.56, 0.53–0.58; p < 0.0001 and adjusted 0.55, 0.52–0.58; p < 0.0001). Overall mortality and length of stay in PE patients decreased over time. Relative to OSA– patients, there was a slight increase in mortality among OSA+ PE patients over time, although the length of stay remained unchanged between the two groups. In conclusion, OSA+ PE patients had a lower inpatient mortality compared to OSA– patients despite a higher prevalence of traditional mortality risk factors. Secondary pulmonary hypertension related to OSA with preconditioning of the right ventricle to elevated afterload may potentially explain the protective effect of OSA on mortality in PE. However, mechanistic studies need to further elucidate the links behind this association.