Obstructive Sleep Apnea Index Research Articles

Karolinska Sleepiness Scale is not Associated with Obstructive Sleep Apnea Severity Indices in Male Taxi Drivers

Objective: In the current study, we aimed to evaluate the diagnostic utility of the Karolinska Sleepiness Scale (KSS) for obstructive sleep apnea (OSA) in taxi drivers. Methods: Forty male professional taxi drivers who participated in a driving simulator experiment in the sleep laboratory were included in the current study. All participants were asked to fill out the KSS before and after a 50-minute driving simulator task in the morning after overnight polysomnography (PSG) in the hospital. OSA was defined as an apnea-hypopnea-index (AHI) 15 events/hour on the PSG. Excessive daytime sleepiness (EDS) was defined as KSS score of at least 6. Results: In all, only 3 cases fulfilled the criteria for EDS before the driving whereas 13 cases were sleepy after the task was completed (p <0.001). No significant association was found between KSS scores after the task and the PSG variables including total sleep time, time spent in delta sleep and REM sleep as well as OSA severity indices AHI and Oxygen Desaturation Index (ODI). The agreement between OSA and sleepiness on the KSS was calculated as 0.21 (p=0.07) indicating a very weak association. The KSS has a sensitivity of 24.1%, a specificity of 45.5%, a positive predictive value of 53.9%, a negative predictive value of 30.0%, an accuracy of 46.6% for the OSA diagnosis. The area under the curve was 0.57 (95% CI 0.39 – 0.74) for the AHI and 0.56 (95% CI 0.39 – 0.73) for the ODI, confirming a very poor performance of the KSS scores to predict AHI and ODI. Conclusion: The KSS is not associated with the severity of the OSA indices in male taxi drivers. Objective measurements of EDS are warranted for a more precise evaluation of fitness to drive in professional drivers.

0904 Exaggerated hypoxia burden of sleep apnea in patients with hyperacute lateral medullary infarction

Abstract Introduction Acute lateral medullary infarction (LMI) can sometimes appear with respiratory failure in the acute stage. Polysomnographic investigations have shown a specific association between LMI and sleep apnea syndrome. The aim of our study was to investigate this association in hyperacute stage of LMI. Methods We investigated 8 patients who underwent polysomnography (PSG) for sleep apnea during hyperacute stage of LMI and compared the data to 8 healthy control subjects matched according to age, sex, body-mass index (BMI), and apnea-hypopnea index (AHI). The PSG was performed within an average of 1.5 days after the onset of neurological symptoms. PSG recordings in the hyperacute phase of LMI were analyzed. Results Six patients were males (75%) and two were females (25%). The average age of the patients was 51.9 ± 14.5 years and the average BMI was 27.2 ± 3.5. According to the AHI results of patients with LMI in the hyperacute phase, there were 2 (25%) cases of mild obstructive sleep apnea (OSA), 2 (25%) cased of moderate OSA, and 4 (50%) cases of severe OSA. The central sleep apnea index was higher in the patient group (4.3 ± 5.4/hr) than the control group 0.6 ± 0.4/hr) and was statistically significant (p=0.035). On the other hand, sleep parameters (obstructive sleep apnea index, respiratory arousal index, mean saturation) related to obstructive sleep apnea were poor in the control group. Conclusion Our study showed that sleep apnea syndrome, particularly CSA, is common in the hyperacute phase of LMI compared to control group. Early recognition of this problem and appropriate intervention may minimize the adverse effects on the respiratory system and improve the prognosis. Further and follow-up studies are needed to clarify the clinical significance and appropriate treatment options in these patients. Support (if any)

0440 Peripheral arterial tonometry–based measures of obstructive sleep apnea in Black, Mexican American and non-Hispanic White adults

Abstract Introduction Racial/ethnic differences may exist in sleep quality and disorders, but there are limited data directly comparing objective measures of obstructive sleep apnea (OSA) among Black, Mexican American (MA) and non-Hispanic White (NHW) populations. Methods To date, the ongoing Health & Aging Brain among Latino Elders (HABLE)-Dormir study has enrolled 761 participants using a community-based participatory research approach. Here we describe OSA indices assessed by in-home assessments using WatchPAT, a Peripheral Arterial Tonometry (PAT)-based home sleep testing system that is validated for the diagnosis of OSA. Results Participants had a mean age of 65.6+/-8.2 (50-90) years, comprised of 64% women; 34% MA, 24% Black and 42% NHW adults. Over half (52.0%) of the participants had moderate or more severe OSA as defined by the respiratory event index (REI based on 3% desaturations) of >=15/hour, 73.1% with REM-OSA (REM-REI >=15/hour) and 40.6% with NREM-OSA (NREM-REI >=15/hour). The median of the average snoring volume through the night was 41 (40-61) dB. The median percentage of sleep time spent with oxygen saturation below 90% (SpO2< 90%) was 1.0%. After adjustment for age, sex, Body Mass Index, cognitive status, and history of hypertension, diabetes, stroke and heart attack, Black and MA participants were 71% and 55% more likely to have REM-OSA compared to NHW participants (p=0.04), but had similar prevalence of NREM-OSA (p=0.80) and overall OSA (p=0.32). The adjusted mean percentage of sleep time spent with over 40dB snoring volume was higher among Black (22.7%, p=0.03) and MA adults (21.2%, p=0.11) than NHW adults (18.5%). The adjusted mean prevalence of nocturnal hypoxemia (SpO2< 90% time >= 1%) was similar among Black (48.2%), MA (51.7%) and NHW (50.0%) adults; p=0.83. Conclusion In this middle-to-older-aged population, PAT-based measures of OSA indicate a higher prevalence in minoritized adults of REM-specific sleep apnea, a phenotype associated with increased rates of hypertension and mortality. Home-based measures that do not distinguish between REM and NREM respiratory events may underestimate sleep apnea in these groups. Support (if any) This research was supported by National Institutes of Health grant R01AG066137.

Development and validation of a metabolite index for obstructive sleep apnea across race/ethnicities

Obstructive sleep apnea (OSA) is a common disorder characterized by recurrent episodes of upper airway obstruction during sleep resulting in oxygen desaturation and sleep fragmentation, and associated with increased risk of adverse health outcomes. Metabolites are being increasingly used for biomarker discovery and evaluation of disease processes and progression. Studying metabolomic associations with OSA in a diverse community-based cohort may provide insights into the pathophysiology of OSA. We aimed to develop and replicate a metabolite index for OSA and identify individual metabolites associated with OSA. We studied 219 metabolites and their associations with the apnea hypopnea index (AHI) and with moderate-severe OSA (AHI ≥ 15) in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) (n = 3507) using two methods: (1) association analysis of individual metabolites, and (2) least absolute shrinkage and selection operator (LASSO) regression to identify a subset of metabolites jointly associated with OSA, which was used to develop a metabolite index for OSA. Results were validated in the Multi-Ethnic Study of Atherosclerosis (MESA) (n = 475). When assessing the associations with individual metabolites, we identified seven metabolites significantly positively associated with OSA in HCHS/SOL (FDR p < 0.05), of which four associations—glutamate, oleoyl-linoleoyl-glycerol (18:1/18:2), linoleoyl-linoleoyl-glycerol (18:2/18:2) and phenylalanine, were replicated in MESA (one sided-p < 0.05). The OSA metabolite index, composed of 14 metabolites, was associated with a 50% increased risk for moderate-severe OSA (OR = 1.50 [95% CI 1.21–1.85] per 1 SD of OSA metabolite index, p < 0.001) in HCHS/SOL and 55% increased risk (OR = 1.55 [95% CI 1.10–2.20] per 1 SD of OSA metabolite index, p = 0.013) in MESA, both adjusted for demographics, lifestyle, and comorbidities. Similar albeit less significant associations were observed for AHI. Replication of the metabolite index in an independent multi-ethnic dataset demonstrates the robustness of metabolomic-based OSA index to population heterogeneity. Replicated metabolite associations may provide insights into OSA-related molecular and metabolic mechanisms.

Impact of Exercise Training on Obstructive Sleep Apnea: A Systematic Review and Meta-analysis of Randomized Trials

ABSTRACT Background Randomized controlled trials have highlighted the importance of exercise training on the severity of obstructive sleep apnea (OSA). The primary objective of this meta-analysis was to analyze the data from these studies on the severity of OSA indices as measured by formal polysomnography. The secondary objective was to evaluate the effect of exercise on oxygen desaturation index, body mass index and several metabolic parameters associated with OSA. Methods Two independent reviewers and an experienced librarian searched MEDLINE, EMBASE, COCHRANE, and Scopus and SPORTDiscus databases from January 1, 2000, to October 21, 2021 to identify randomized controlled trials that evaluated the impact of exercise training on OSA severity. Pre-exercise and postexercise training data on the primary and secondary objectives were extracted. Results A total of 11 randomized controlled trials (533 study participants) were identified based on the inclusion criteria. The mean pre-exercise and postexercise reduction in apnea hypopnea index was −6.94 event per hour (95% confidence interval [CI]: −10.74 to −3.13, I2 = 84%). The mean changes in oxygen desaturation index and body mass index were −5.32 events per hour (95% CI: −9.65 to −0.99, I2 = 73%) and −1.21 kg·m−2 (95% CI: −1.80 to −0.62, I2 = 49%) respectively. Conclusion In adult patients with OSA, exercise training was associated with statistically significant reduction in OSA severity.

Effects of Obstructive Sleep Apnea and Gender on Glomerular Filtration Rate in Hypertensive Population

Objective To explore the associations of obstructive sleep apnea(OSA) and gender with estimated glomerular filtration rate(eGFR) in hypertensive populations.Methods From February 2005 to August 2010,2064 hypertensive patients who were treated in the Department of Hypertension Center underwent overnight polysomnographic monitoring.According to the apnea-hypopnea index(AHI),they were assigned into an hypertension combined with OSA group and a hypertension group.The clinical characteristics and sleep monitoring indicators were compared between different genders and between the two groups.Multivariate Logistic regression was employed to analyze the influencing factors of eGFR.Results Among the 2064 hypertensive patients,there were 1537 males(including 1221 patients with OSA) and 527 females(including 350 patients with OSA).The males had higher prevalence of OSA(χ2=36.631,P<0.001) and diastolic blood pressure(Z=-7.776,P<0.001) and lower eGFR(Z=-3.010,P=0.003) than the females.The males had higher AHI(Z=-8.727,P<0.001),apnea index(Z=-9.252,P<0.001),hypopnea index(HI)(Z=-4.868,P<0.001) than the females,and the lowest oxygen saturation(t=-3.325,P=0.001) was significantly lower in males than in females.The hypertension combined with OSA group showed lower eGFR than the hypertension group(Z=-27.434,P<0.001;Z=-18.762,P<0.001).HI was negatively correlated with eGFR in the male population(r=-0.006,P=0.017),and AHI and HI were negatively correlated eGFR in females(r=-0.108,P=0.013;r=-0.094,P=0.032).After adjustment,Logistic regression showed that OSA and oxygen desaturation index 4 were the risk factors for the reduction of eGFR in hypertensive patients in males and females,respectively(OR=1.383,95%CI=1.010-1.905,P=0.045;OR=1.013,95%CI=1.002-1.024,P=0.021).Conclusion OSA lowers the eGFR of hypertensive patients,and OSA and oxygen desaturation index are the risk factors for the decrease in eGFR in male and female hypertensive patients,respectively.

0537 Symptom Improvement Reported with Some PAP Use in Non-adherent Pediatric Patients with OSA

Abstract Introduction Positive airway pressure (PAP) is commonly used in children to treat obstructive sleep apnea (OSA) when surgery is not an option or is ineffective1-3, but adherence is often poor. Observational studies suggest utilization of PAP improves symptoms, signs, and polysomnogram indices of OSA in at least 85% of children4-9. The Agency for Healthcare Research and Quality released the report “Continuous Positive Airway Pressure Treatment for Obstructive Sleep Apnea”10. Conclusions of this report determined that the published evidence reviewed does not support that PAP affects long term outcomes. No pediatric studies were included in this report. Objectives of this study were to determine if pediatric patients with OSA who are non-adherent to PAP therapy report an improvement in symptoms with some use of PAP. Methods A retrospective chart review was performed on patients with OSA on PAP seen in the pediatric sleep clinic. Patients were considered adherent to PAP if usage was longer than 4 hours/night for 70% of nights or more. Follow up visits occurred around 3 months, 6 months, 1 year, and 18 months-2 years. Adherence data and reported improvement in symptoms were documented at each visit, and demographical information was obtained. Results 235 patients were included in the analysis (63.9% male, 32.3% female, 3.8% missing), with a mean age (SD) at PAP initiation of 12 years (4.5). The sample was predominately Caucasian (51.5%) or African American (38.3%), 85.9% were non-Hispanic, and 53.2% obese. The mean (SD) apnea-hypopnea index was 24.7(27.6)/hr. At first visit post-initiation, of the 138 patients that had adherence data available, 80.4% reported improvement in symptoms with PAP use. Of these patients, 55.86% were non-adherent but reported symptom improvement with some use of PAP. Visit 4 data was available for 74 patients. At visit 4, 91.9% reported improvement in symptoms. Of these, 48.53% were considered non-adherent but reported symptom improvement with some use of PAP. Conclusion Historically, PAP adherence in children has been relatively poor11. Utilizing PAP therapy to treat OSA may result in an improvement in symptoms when used in patients who are considered non-adherent to therapy. Support (If Any)

Berlin and Epworth Surveys to Predict Obstructive Sleep Apnea for Adults on Biomimetic Oral Appliance Therapy: A Nonrandomized Clinical Trial.

Background Two questionnaires (Berlin Questionnaire (BQ) and Epworth Sleepiness Scale (ESS)) are the widely used screening instruments for subjects suffering from sleep disorders. Obstructive sleep apnea (OSA) is the most common form of sleep-disordered breathing. The biomimetic oral appliance therapy (BOAT) offers an alternative nonsurgical method, which can improve symptoms and indices of OSA on objective sleep testing. Aim To describe testing the ability of BQ and EES for prediction of BOAT outcomes during OSA. Methods Seventeen adults (9 males, 8 females; age, mean (SD): 45.76 (10.31), BMI mean (SD): 33.5(13.43)) who underwent an overnight sleep study were diagnosed by a sleep specialist physician. The BQ and EES were recorded before and after BOAT treatment. Subjects with mild-to-moderate OSA had 2 months of follow-up visits and underwent a final overnight sleep study to measure apnea-hypopnea index (AHI). The subjects were asked to wear the appliance for 10–12 hours/day and at night. Findings were analyzed statistically using paired t-tests. Result As per sleep test results, pre-BOAT AHI measures versus post-BOAT AHI measures showed significant improvement. Comparing the BQ before versus after treatment showed that at the pretreatment stage, 66.0% of patients had high-risk score, whereas 34% had low-risk score. After treatment, 66.0% of patient had low-risk scores, whereas 34% had high-risk scores. As for the ESS, treatment resulted in significant reduction of total score from 10.43 ± 6.32 to 5.00 ± 5.20 (P < 0.01, paired t-test). Finally, there was a mild negative correlation between AHI and each of the BQ and ESS scores that was not statistically significant (r = −0.420, N = 26, P > 0.05, and r = −0.41, N = 26, P > 0.05, respectively). Conclusion The BOAT device may provide a useful form of therapy to improve OSA-related PSG parameters such as AHI. Both BQ and ESS were predictive to improvements detected by the sleep study during BOAT device use.

Variations in Polysomnographic Indices of Obstructive Sleep Apnea following Lingual Tonsil Hypertrophy Excision: Is the Difference Significant?

Background and Objectives: Obstructive sleep apnea (OSA) is a sleep-related respiratory disorder that affects between 5% and 20% of the population. In obstructive sleep apnea, lingual tonsillar hypertrophy (LTH) has been suggested as a contributing factor to airway blockage. Objectives: The aim of this work is to demonstrate the polysomnographic indices and their values in OSA patients with LTH before and after the surgical intervention. Materials and Methods: The study was conducted on eighteen patients endoscopically diagnosed as having LTH, with the main complaints being snoring, sleep apnea, and/or sleep disturbance. Clinical examination, grading of LTH, body mass index (BMI), endoscopic assessment using Muller’s maneuver, and sleep endoscopy were recorded for all patients. The Epworth Sleepiness Scale (ESS) and overnight sleep polysomnography (PSG) were conducted before and after the surgical removal of LTH. All data were submitted for statistical analysis. Results: The mean ± SD of the AHI decreased from 33.89 ± 26.8 to 20.9 ± 19.14 postoperatively, and this decrease was of insignificant statistical value. The average SpO2 (%) mean ± SD was 91.14 ± 5.96, while the mean ± SD of the desaturation index was 34.64 ± 34.2. Following surgery, these indices changed to 96.5 ± 1.47 and 9.36 ± 7.58, respectively. The mean ± SD of the ESS was changed after the surgery, from 17.27 ± 6.48 to 7.16 ± 3.56. The mean ± SD of sleep efficacy was 71.2 ± 16.8 and the snoring index mean ± SD was 277.6 ± 192.37, and both improved postoperatively, to become 88.17 ± 9.1 and 62.167 ± 40.01, respectively. Conclusions: The AHI after lingual tonsillectomy showed no statistically significant change. The changes in the average SpO2 (%), desaturation index, sleep efficiency, snoring index, and Epworth Sleepiness Scale following the surgery were statistically significant.

Investigation of Snoring and Obstructive Sleep Apnea Using Portable Polysomnography in Patients with Temporomandibular Disorder.

ObjectiveTo investigate snoring and obstructive sleep apnea (OSA) in patients with temporomandibular disorder (TMD) using portable polysomnography and identify sex-based differences in clinical features and sleep-related resultsMethodsSeventy consecutive patients (44 female; mean age, 46.6918.18 years) with myofascial pain-associated TMD, diagnosed based on the criteria for TMD Axis I, were enrolled. Sleep quality and quantity were measured using portable polysomnography. Clinical characteristics were investigated using well-structured standardized reports on clinical signs and symptoms, questionnaires, and clinical examination by TMD specialists.ResultsAmong 70 TMD patients, 50.0% had OSA and 15.7% had snoring, with no sex-based differences. The mean Mallampati scores for OSA prediction (2.69±1.12 vs. 1.70±0.82, p<0.001), mean body mass index (BMI) (24.94±1.78 vs. 22.02±2.24, p<0.001), and ratio of overweight patients (57.7 vs. 11.4%) with BMI ≥25 were significantly higher in males than in females (all p<0.001). Conversely, the mixed sleep apnea index was significantly higher in females than in males (0.81±0.80 vs. 0.44±0.54, p=0.022). Female sex was associated with the absence of snoring (OR=0.146, p=0.022). Based on the area under curve (AUC) value for snoring prediction, Mallampati score was the strongest predictor (AUC>0.932, p<0.001), followed by BMI, overweight, and obstructive sleep apnea index (AUC>0.8, all p<0.001).ConclusionsOur results support the necessity of investigating sex-based differences when examining sleep problems, including snoring and OSA, in TMD patients. Mallampati scoring could be a useful tool for physical examination prior to polysomnography. Sleep and biopsychosocial factors are important for the diagnosis and treatment of TMD.

Influence of diet and sport on the risk of sleep apnea in patients with metabolic syndrome associated with hypothyroidism - a 4-year survey.

Apnea is a common problem observed among obese individuals, affecting the quality of sleep and increasing cardiovascular risk and mortality. The current study monitored the risk of obstructive sleep apnea (OSA) following diet therapy and sports-associated diet therapy in patients with metabolic syndrome (MS) and hypothyroidism. The subjects included in the study were divided into 3 groups: control group (CG) (n=36), diet therapy group (DG) (including patients following a personalized diet therapy program) (n=76), and diet therapy and sports group (DSG) (which considered patients doing sports in addition to following a personalized diet therapy program) (n=80). The evaluation methods included body analysis (body mass index, fat mass, and visceral fat), paraclinical analysis (homeostasis model assessment of insulin resistance), assessment of difficulty in breathing, stress monitoring, hypothyroidism, and risk of OSA. The OSA index was assessed using the Berlin Questionnaire of Sleep Apnea and Epworth Sleepiness Scale. The correlation between OSA with body mass index (BMI), homeostasis model assessment of insulin resistance (HOMA-IR) index, fat mass, and visceral fat showed a statistically significant positive ratio (p<0.05; F=3.871). The obtained results indicated that diet therapy and physical activity reduced the OSA risk by 78.72%.

The Rise of IGFBP4 in People with Obstructive Sleep Apnea and Multilevel Sleep Surgery Recovers Its Basal Levels.

IGFBP4 is the smallest member of the insulin-like growth factor binding protein family (IGFBP). It is a hepatic protein that plays a role in modulating the activity and bioavailability of IGF-I. The expression of IGFBP4 was found to increase under conditions of hypoxia. Obstructive sleep apnea (OSA) is a common disorder, characterized by cyclic episodes of intermittent hypoxia and fragmented sleep. Our aim was to quantify levels of circulating IGFBP1, IGFBP2, IGFBP3, IGFBP4, and IGFBP7 in fasting plasma samples of 69 Kuwaiti participants and explore its correlation with indices of OSA. The quantification was performed using multiplexing assay. The study involved 28 controls and 41 patients with OSA. Levels of circulating IGFBP4 were significantly higher in people with OSA (289.74 ± 23.30 ng/ml) compared to the control group (217.60 ± 21.74 ng/ml, p = 0.028). The increase in IGFBP4 correlated significantly and positively with AHI (r = .574, p = .01) and AI (r = .794, p = .001) in people with moderate and severe OSA. There was a significant decline in circulating IGFBP4 after 3 months of surgery (225.89 ± 18.16 ng/ml, p = 0.012). This was accompanied by a prominent improvement in OSA (AHI 8.97 ± 2.37 events/h, p = 0.001). In this study, our data showed a significant increase in circulating IGFBP4 in people with OSA. We also report a significant positive correlation between IGFBP4 and indices of OSA at baseline, which suggests IGFBP4 as a potential diagnostic biomarker for OSA. There was a significant improvement in OSA after 3 months of surgical intervention, which concurred with a significant decline in IGFBP4 levels. Altogether, the detected change suggests a potential link between IGFBP4 and OSA or an OSA-related factor, whereby OSA might play a role in triggering the induction of IGFBP4 expression.

Cardiovascular risk and mortality prediction in patients suspected of sleep apnea: a model based on an artificial intelligence system

Objective. Cardiovascular disease (CVD) is one of the leading causes of death worldwide. There are many CVD risk estimators but very few take into account sleep features. Moreover, they are rarely tested on patients investigated for obstructive sleep apnea (OSA). However, numerous studies have demonstrated that OSA index or sleep features are associated with CVD and mortality. The aim of this study is to propose a new simple CVD and mortality risk estimator for use in routine sleep testing. Approach. Data from a large multicenter cohort of CVD-free patients investigated for OSA were linked to the French Health System to identify new-onset CVD. Clinical features were collected and sleep features were extracted from sleep recordings. A machine-learning model based on trees, AdaBoost, was applied to estimate the CVD and mortality risk score. Main results. After a median [inter-quartile range] follow-up of 6.0 [3.5–8.5] years, 685 of 5234 patients had received a diagnosis of CVD or had died. Following a selection of features, from the original 30 features, 9 were selected, including five clinical and four sleep oximetry features. The final model included age, gender, hypertension, diabetes, systolic blood pressure, oxygen saturation and pulse rate variability (PRV) features. An area under the receiver operating characteristic curve (AUC) of 0.78 was reached. Significance. AdaBoost, an interpretable machine-learning model, was applied to predict 6 year CVD and mortality in patients investigated for clinical suspicion of OSA. A mixed set of simple clinical features, nocturnal hypoxemia and PRV features derived from single channel pulse oximetry were used.

Identifying Obstructive Sleep Apnea Subtypes and Its Correlation With Mood States

Objective: It has been difficult to establish specific subtypes of obstructive sleep apnea (OSA) due to the heterogeneous nature of the disor- der. Previous studies have attempted to exact clinical subgroups or phenotypes of the disorder. However, the psychiatric impact of OSA has been often overlooked, and thus, this study used cluster analysis to examine subgroups of OSA incorporating mood states.Methods: This study is comprised of 346 adult OSA patients (apnea-hypopnea index, AHI≥5) who underwent polysomnography at Nowon Eulji Medical Center from January 2003 to November 2012. Their data also included validated self-report questionnaires that evaluate daytime sleepi- ness, sleep quality, morningness-eveningness, and mood states: Epworth Sleepiness Scale, Korean version of the Pittsburgh Sleep Quality In- dex (PSQI-K), Horne and Östberg Questionnaire, and Korean edition of Profile of Mood States (K-POMS), respectively. A K-means cluster analy- sis was performed to determine the optimal number of clusters and characteristics.Results: We identified three clusters: cluster 1, moderately symptomatic OSA with the least disturbed mood (n=166); cluster 2, severely symptomatic OSA not so disturbed mood (n=90); cluster 3, moderately symptomatic with highest disturbed mood (n=90). Cluster 1 had the lowest AHI and the lowest K-POMS total scores. Cluster 2, despite having the most severe OSA parameters, did not show mood disturbances. Cluster 3 had the highest K-POMS total scores and PSQI-K scores.Conclusion: Certain individuals with OSA are more likely to suffer from disturbed mood states without serious OSA indices. Psychiat- ric manifestations should also be considered when determining the severity of the disorder.

Utility of the type 3 portable monitor for the diagnosis of sleep disordered breathing in patients with stable heart failure

Objective: To evaluate the utility of a type 3 portable monitor (PM) at home for the diagnosis of sleep disordered breathing (SDB) in patients with stable congestive heart failure (CHF). Methods: Seventy-six consecutive patients with CHF (61 males, 15 females, mean±standard deviation age (57.0±16.9) years) were enrolled from the sleep center of Peking university People's Hospital during January 2016 to January 2019, and underwent overnight, unattended home sleep apnea testing (HSAT) with a portable monitor followed by an overnight simultaneous polysomnogram (PSG) with in-laboratory portable monitor (in-lab PM) recording within one week. The consistency of apnea hypopnea index (AHI), obstructive sleep apnea index (OAI), central sleep apnea index (CAI) between HSAT and PSG as well as the in-lab PM and PSG were analyzed by Bland-Altman plot; the sensitivity and specificity of PM for the diagnosis of SDB in patients with CHF were evaluated. Results: The number of patients included in the final analysis were 65 in HSAT, 63 in in-lab PM and 65 in PSG. AHI [M(Q1,Q3)] was 26.1 (10.9,40.1) events/h by HSAT, 27.9 (11.3,43.2) events/h by in-lab PM, both were not different from AHI 29.0 (10.2,45.0) events/h by PSG (P>0.05). The AHI, OAI and CAI assessed by HSAT correlated significantly with those by PSG (r=0.892, 0.903, 0.831, P<0.05). Bland-Altman analysis of AHI, OAI, CAI by PSG versus HSAT showed a mean difference of 3.1 events/h, 0.8 events/h, 1.2 events/h; limits of consistency were -15.2 to 21.4 events/h, -9.7 to 11.3 events/h, -10.9 to 13.2 events/h, respectively. Based on a threshold of AHI ≥5 events/h, HSAT had 94.6% sensitivity, 75% specificity, compared to PSG. For detecting Cheyne-Stokes respiration (CSR), a sensitivity of 96.4%,a specificity of 97.2% were achieved, compared to PSG. Conclusion: Type 3 PM can be used to diagnose SDB in patients with CHF.

Association of Obstructive Sleep Apnea Indicators with Heart Failure

Background: Obstructive sleep apnea (OSA) occurs when the airway is repeatedly blocked during sleep, resulting in frequent brief awakenings throughout the night. OSA has been found to increase the risk of many cardiovascular diseases, especially heart failure (HF). HF with reduced, preserved, and borderline ejection fraction (HFrEF, HFpEF, and HFbEF) are three subtypes common in OSA patients. The aim of this study is to further explore the relationship between OSA and HF and the influence of specific OSA measures.&#x0D; Methods: Electronic medical data was collected from health histories, echocardiograms, and polysomnography studies. Observations were sorted into three categories based on left ventricular ejection fraction: HFpEF (n=334), HFrEF (n=77), and HFbEF (n=37). Multinomial logistic regression was then conducted to determine the relative risk of HFpEF and HFrEF from each variable as compared to the baseline HFbEF.&#x0D; Results: Pacemaker presence, previous stroke, BMI, and a measure of left ventricular dysfunction (LVD), called relative wall thickness, all raised the risk of HFpEF compared to HFbEF, while another LVD measure, left ventricular end-systolic dimension, reduced it. These factors also increased risk for HFrEF, except for previous stroke and pacemaker presence, which were not significant. Relevant OSA metrices included average blood oxygen saturation and three measures of sleep apnea severity, named central apnea index, hypopnea index per hour, and the Epworth Sleepiness Scale (ESS). These all decreased relative HFpEF risk, other than ESS, which raised it.&#x0D; Conclusions: As was expected, several standard HF predictors increased the risk of both types of HF. Surprisingly, few OSA indices had the same effect. This suggests that targeting specific OSA markers may not be effective in treating patients with any of these HF types. Future work could involve the influence of OSA and its indices on mortality, or the responses of these indicators to treatment, both topics with limited previous findings.

Putative associations between inflammatory biomarkers, obesity, and obstructive sleep apnea.

BACKGROUND:Previous studies have reported increased levels of inflammatory mediators in patients with obstructive sleep apnea (OSA), but their relation with the severity of OSA is controversial.OBJECTIVE:To address potential relationships between OSA-related inflammatory markers, namely, C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and fibrinogen, with different oxygenation parameters and with BMI.METHODS:All eligible patients with suspected OSA newly referred to the Sleep Medicine Research Center at King Abdulaziz University Hospital, Jeddah, were evaluated demographically and anthropometrically, and underwent overnight polysomnography. Fasting morning blood samples were collected to measure serum levels of CRP, fibrinogen, TNF-α, and IL-6. Potential correlations between these inflammatory mediators and severity measures of OSA and body mass index (BMI) were explored.RESULTS:Sixty-four patients completed the study (40 with OSA and 24 without OSA). Significantly increased levels of CRP, fibrinogen, IL-6, and TNF-α emerged in patients with OSA compared to non-OSA. Significant associations between log CRP and log fibrinogen levels emerged with increasing BMI. However, there was no significant association between any of the inflammatory markers and the severity of OSA based on the apnea/hypopnea index or oxyhemoglobin saturation-derived parameters.CONCLUSIONS:OSA patients exhibit increased levels of inflammatory mediators that do not appear to be associated with polysomnographic measures, but exhibit positive correlation with the degree of adiposity.

Associations of OSA and Nocturnal Hypoxemia with Strength and Body Composition in Community Dwelling Middle Aged and Older Men.

PurposeReduced hand grip strength (HGS) is associated with poorer health in chronic conditions, yet there has been little research examining the association with hand grip strength and obstructive sleep apnea (OSA). Further, these studies have not examined, nor adjusted, for muscle mass. The aim of this study was to determine associations between OSA indices, HGS, muscle mass, and fat mass.Participants and MethodsA total of 613 participants (age range 41–88, BMI 28.6 ± 4.3) from the population-based Men Androgen Inflammation Lifestyle Environment and Stress Study underwent in-home overnight polysomnography, assessment of dominant and non-dominant HGS, and dual x-ray absorptiometry to determine whole body muscle mass and fat mass. Linear models determined cross-sectional associations of polysomnographic-derived OSA indices with hand grip strength, muscle mass, and fat mass, whilst adjusting for lifestyle information (income, smoking status, diet, self-reported physical activity), blood sample derived testosterone and systemic inflammation (C-reactive protein), cardiometabolic health (cardiovascular disease, hypertension, type 2 diabetes), and depression.ResultsIn adjusted models, reduced dominant HGS was associated with lower oxygen nadir (unstandardised β [B] = 0.19, 95% confidence interval [CI] 0.08 to 0.29), greater time spent below 90% oxygen saturation (B = −0.08, 95% CI −0.14 to −0.02), and increased apnea duration (B = −0.3, 95% CI −0.23 to −0.02). By contrast, there were no associations between HGS and both AHI and REM AHI. Fat mass was consistently associated with worsening OSA indices, whereas muscle mass demonstrated no associations with any OSA index.ConclusionOur findings suggest impairments in HGS may be related to fat infiltration of muscle, hypoxemia-induced reductions in peripheral neural innervation, or even endothelial dysfunction, which is a common outcome of hypoxemia. Longitudinal data are needed to further examine these hypotheses and establish if reduced grip strength in patients with OSA is associated with long-term adverse health outcomes.

Impact of obstructive sleep apnea on left ventricular mass index in men with coronary artery disease.

Left ventricular hypertrophy (LVH) is associated with augmented risk for mortality in patients with coronary artery disease (CAD). These patients often have obstructive sleep apnea (OSA). We aimed to evaluate the relationship between OSA and the left ventricular mass index (LVMI) in men with CAD. Consecutive patients with CAD were recruited and underwent overnight portable monitoring for the assessment of OSA. LVMI was ascertained using high-resolution echocardiography. Univariate and multivariate regression analyses were conducted to explore the associations between the OSA parameters and the LVMI levels. Of the 1,053 examined male patients with CAD, 425 (40.4%) had moderate-to-severe OSA (respiratory event index ≥ 15 events/h). The prevalence of LVH (LVMI > 125 g/m²) was 36.0% (n = 379). The mean LVMI values increased with increasing OSA severity (P < .001). Patients with respiratory event index ≥ 30 events/h had 2.30 (95% confidence interval 1.50-3.54, P < .001) times increased risk of LVH than those without OSA (respiratory event index < 5 events/h) independent of confounders. The minimum oxygen saturation levels were the strongest factor correlated with LVMI (β = -0.299, P = .004) of several OSA indices. Patients with minimum oxygen saturation < 70% had an adjusted odds ratio of 3.62 (95% confidence interval 1.81-7.25, P < .001) for LVH development compared with those with minimum oxygen saturation ≥ 90%. OSA severity was associated with a higher likelihood of LVH in men with CAD, which is partially related to severe nocturnal intermittent hypoxemia. Aggressive effort at managing OSA among patients with CAD may further reduce the cardiovascular risk.

Effects of Intraoperative Ketamine on Post-Operative Recovery in Obstructive Sleep Apnea Patients: A Case-Control Study.

ObjectiveTo evaluate the post-operative outcomes of patients with obstructive sleep apnea (OSA) given intraoperative ketamine.Design: case-control studyA total of 574 patients (287 received ketamine and 287 were matched controls) diagnosed with OSA and body mass index (BMI) > 30 who received general anesthesia were included in this study. Patients given intraoperative ketamine were matched (1:1) with those who did not receive ketamine for age, gender, BMI, ethnicity, anesthesia time, intraoperative fentanyl dose, ketamine dose, and surgery type. A sub-analysis was performed based on the dose of ketamine administered and also on the surgery type. Measured outcomes include post-operative pain scores, post-operative opioid requirements, respiratory status, oxygen use, and duration post-operatively.ResultsIntraoperative ketamine use did not decrease pain scores or post-operative opioid use when compared with the control (no intraoperative ketamine) group. Patients who received high-dose ketamine had significantly higher post-operative pain scores (p=0.048) while in the post-anesthesia care unit (PACU) and required supplemental oxygen for a longer period of time (p = 0.030), pain scores were not significant for patients who underwent orthopedic/spine procedures (p = 0.074), and high-dose ketamine group patients who underwent orthopedic/spine surgery required significantly more opioids in the PACU (p = 0.031). Among patients who received low-dose ketamine, those who underwent head, ear, nose, and throat surgery required significantly more opioids in PACU (p = 0.022).ConclusionsLow-dose intraoperative ketamine did not decrease pain scores or post-operative opioid use significantly and did not improve standard respiratory recovery parameters for OSA patients after surgery. Neither low- nor high-dose ketamine demonstrated the anticipated benefits of low pain scores and reduced post-operative opioid use. These outcomes will differ depending on the surgery type and dose of ketamine used.