Mild Sleep Apnea-hypopnea Syndrome Research Articles

Association between adherence to the mediterranean diet, physical activity, and sleep apnea-hypopnea syndrome (SAHS) in a middle-aged population with cardiovascular risk: Insights from the ILERVAS cohort

IntroductionSleep Apnea-Hypopnea Syndrome (SAHS) is a common sleep disorder influenced by factors like age, gender, and obesity. The Mediterranean Diet (MedDiet) and physical activity have shown health benefits in lung diseases, but their effects on SAHS remain underexplored. MethodsIn a cross-sectional analysis of 678 middle-aged individuals with low-to-moderate cardiovascular risk from the ILERVAS cohort, we assessed adherence to the MedDiet and physical activity levels using validated tools. Sleep parameters, SAHS severity, and excessive daytime sleepiness were evaluated through non-attended cardiorespiratory polygraphy and the Epworth Sleepiness Scale. Multinomial logistic regression models were employed to assess the relationship between MedDiet adherence, physical activity, and SAHS severity. ResultsThe prevalence of severe, moderate, and mild SAHS was 15.5%, 23.2% and 36.1%, respectively. We found no significant associations between adherence to the MedDiet, physical activity levels, and the presence or severity of SAHS. However, we noted a significant interaction between MedDiet and physical activity with minimum SpO2 values (p = 0.049). Notably, consuming more than one serving of red meat per day was independently associated with a higher risk of moderate SAHS [OR = 2.65 (1.29–5.44), p = 0.008]. ConclusionIndividually, MedDiet adherence and physical activity did not show independent correlations with SAHS. However, when considered together, a minimal but significant effect on minimum SpO2 was observed. Additionally, red meat consumption was associated with a moderate risk of SAHS. Further research is necessary to comprehend the intricate connections between lifestyle factors and sleep-breathing disorders, with a focus on personalized approaches for high-risk populations.

Xerostomia in patients with sleep apnea-hypopnea syndrome: A prospective case-control study.

BackgroundTo describe the characteristics of xerostomia (dry mouth) in the population with sleep apnea-hypopnea syndrome (SAHS) and contrast its prevalence versus that found in healthy subjects, and to compare the frequency of xerostomia in SAHS patients with and without continuous positive airway pressure (CPAP) treatment. Material and MethodsA prospective comparative study was made between adults recently diagnosed with SAHS in a public hospital (n=60) and healthy individuals (n=54). The presence of xerostomia was assessed on waking up and during the day, using a frequency scale from 0 (“never”) to 3 (“always”). ResultsThe prevalence of xerostomia on waking up in the SAHS group was 45%, versus 20.4% among the controls. During the rest of the day the prevalence of the symptom decreased in both the SAHS group (21.7%) and among the controls (9.3%). Multiple binary logistic regression analysis found body mass index (BMI) to be correlated to the association SAHS-xerostomia on waking up (p=0.007). Patients with moderate SAHS had a greater frequency of xerostomia than those with mild SAHS (p=0.022). The frequency of xerostomia on waking up was significantly greater in patients using CPAP than in those without such treatment (57.1% versus 16.7%, respectively) (p=0.008). ConclusionsThe frequency of xerostomia was greater in patients with SAHS, particularly on waking up and in those receiving CPAP. The symptom was more prevalent in individuals with moderate to severe SAHS than in those with mild SAHS, and was significantly influenced by BMI. Key words:Sleep apnea, xerostomia, dry mouth, CPAP, side effects, body mass index, obesity.

Usefulness of Spectral Analysis of Respiratory Rate Variability to Help in Pediatric Sleep Apnea-Hypopnea Syndrome Diagnosis.

The sleep apnea-hypopnea syndrome (SAHS) is a chronic respiratory disorder of high prevalence among children (up to 4%). Nocturnal polysomnography (PSG) is the gold standard method to diagnose SAHS, which is a complex, expensive, and time-consuming test. Consequently, alternative simplified methods are demanded. We propose the analysis of the respiratory rate variability (RRV) signal, directly obtained from the airflow (AF) signals. The aim of our study is to evaluate the usefulness of the spectral information obtained from RRV in the diagnosis of pediatric SAHS. A database composed of 946 AF and blood oxygen saturation (SpO2) recordings from children between 0 and 13 years old was used. Our database was divided into four severity groups according to the apnea-hipopnea index (AHI): no-SAHS (AHI <; 1 events/h), mild (1 events/h ≤ AHI <; 5 events/h), moderate (5 events/h ≤ AHI <; 10 events/h), and severe SAHS (AHI ≥ 10 events/h). RRV and 3% oxygen desaturation index (ODI3) were obtained from AF and SpO2 recordings, respectively. A spectral band of interest was determined (0.09-0.20 Hz.) and a total of 12 spectral features were extracted. Nine of these features showed statistically significant differences (p-value <; 0.05) among the four severity groups. The spectral features from RRV along with ODI3 were used as inputs to binary logistic regression (LR) classifiers. The diagnostic performance of LR models were evaluated for the AHI cut-off points of 1, 5, and 10 e/h, achieving 66.5%, 84.0%, and 88.5% accuracy, respectively. These results outperformed those obtained by single ODI3. The joint use of the spectral information from RRV and ODI3 achieved a high diagnostic capability in the most severely-affected children, thus showing their complementarity. These results suggest that the information contained in RRV spectrum together with ODI3 is useful to help identify moderate-to-severe SAHS.

Association between Sleep Apnea Hypopnea Syndrome and the Risk of Atrial Fibrillation: A Meta-Analysis of Cohort Study.

Numerous reports have been done to seek the relationship between sleep apnea hypopnea syndrome (SAHS) and the risk of atrial fibrillation (AF). However, definite conclusion has not yet been fully established. We examined whether SAHS increases AF incidence in common population and summarized all existing studies in a meta-analysis. We summarized the current studies by searching related database for potential papers of the association between SAHS and the risk of AF. Studies that reported original data or relative risks (RRs) with 95% confidence intervals (CIs) for the associations were included. Sensitivity analyses were performed by omitting each study iteratively and publication bias was detected by Begg's tests. Eight eligible studies met the inclusion criteria. Fixed effects meta-analysis showed that SAHS increased AF risk in the common population (RR = 1.70, 95% CI: 1.53–1.89, P = 0.002, I2 = 69.2%). There was a significant association between mild SAHS and the risk of AF (RR = 1.52, 95% CI: 1.28–1.79, P = 0.01, I2 = 78.4%), moderate SAHS (RR = 1.88, 95% CI: 1.55–2.27, P = 0.017, I2 = 75.6%), and severe SAHS (RR = 2.16, 95% CI: 1.78–2.62, P < 0.001, I2 = 91.0%). The results suggest that sleep apnea hypopnea syndrome could increase the risk of AF, and the higher the severity of SAHS, the higher risk of atrial fibrillation.

Value of actigraphy and oximetry for diagnosing sleep apnea-hypopnea syndrome

To explore the value of actigraphy and oximetry for diagnosing sleep apnea-hypopnea syndrome (SAHS). Suspected SAHS subjects were enrolled from sleep center of Peking University People's Hospital between December 2013 and September 2014. Light-out and light-on were simultaneously recorded for polysomnography (PSG), actigraphy and oximetry. Actigraphy was used to correct total sleep time (TST) for oximetry. Oxygen desaturation index (ODI4), namely the times of pulse oxygen saturation (SpO2) drop≥4% per hour, was detected by oximetry. ODIA was used instead of ODI4 with TST corrected by actigraphy. Receiver operating characteristic (ROC) curve was used for evaluating the value of ODI4 and ODIA for diagnosing SAHS and cut-off value was calculated. Paired t-test or signed rank t-test was used for data acquired using actigraphy or oximetry compared with data acquired by PSG. Sensitivity and specificity were calculated using fourfold table. Disease severity of SAHS was classified by apnea-hypopnea index (AHI) detected by PSG. If AHI<5/h, SAHS was not considered. 5-<15/h was classified as mild, 15-<30/h was classified as moderate and AHI≥30/h was classified as severe. Among 213 SAHS subjects, 38 of them were normal, 34 of them were mild, 51 were moderate and 90 were severe. Compared with PSG, actigraphy can correctly estimate TST in non-SAHS (P=0.408) and mild SAHS groups (P=0.949); while in moderate and severe SAHS groups, TSTs detected by actigraphy were shorter than TSTs acquired by PSG ((405±51) vs (419±40) min and (399 ± 62) vs (422 ± 60) min) (both P<0.05). Area under ROC curve (AUC) of ODI4 for diagnosing SAHS was 0.956 using a cut-off value of 5; the AUC of ODIA for diagnosing SAHS was 0.951 with a cut-off value of 5 as well. The sensitivity of ODI4 for mild, moderate and severe SAHS was 80.6%, 66.7% and 58.9% respectively, all with a specificity of 100%. After adjusting TST with actigraphy, the sensitivity of ODIA for mild, moderate and severe SAHS was 84.0%, 73.8 % and 68.9%, with specificity of 94.7%, 100% and 99.2% respectively. Actigraphy can correctly estimate TST in non-SAHS and mild SAHS groups. ODI4 can be used for diagnosing SAHS. After correcting TST by actigraphy, the sensitivity of ODIA is higher.

Severe sleep apnea–hypopnea syndrome is related to left ventricle dysfunction and hypertrophy in acromegalic patients

ObjectiveTo assess whether sleep apnea-hypopnea syndrome (SAHS) is a risk factor for development of acromegalic cardiomyopathy. MethodsA descriptive, cross-sectional study of 32 patients with acromegaly (15 categorized as non-controlled-NCA and 17 as controlled-CA) compared to 20 matched controls (by sex, age, and BMI) referred to the pulmonology department for suspected SAHS. Polysomnography, echocardiography (M-mode, 2-dimensional, and Doppler), and 12-lead electrocardiography were performed in all participants. Development of cardiac morbidity (ischemia heart disease or heart failure) was evaluated after 7 years. ResultsSAHS was diagnosed in 81.3% of patients with acromegaly and 85% of controls. Mild SAHS was more common in CA than in NCA patients (31.3% vs. 0%, p=0.048). There was a trend to greater prevalence of left ventricular diastolic dysfunction (LVDD) in acromegalic patients as compared to controls (58.1% vs. 30%, p=0.05). Presence of severe SAHS in patients with acromegaly was related to greater risk of LVDD (90.9% vs. 40%, p=0.008; OR 2.3 [1.3–4.0]), LV hypertrophy (55.6% vs. 10.5%, p=0.02; OR 5.3 [1.3–22.2]), and cardiac events (87.5% vs. 35.6%; p=0.01; OR 7.53 [1.07–53.24]). ConclusionSAHS is highly prevalent in patients with acromegaly. Only in these patients was severe SAHS associated to hypertrophy, LV diastolic dysfunction, and cardiac events.

LABA in patients with stage I COPD and mild sleep apnea syndrome: a pilot study

Abstract Patients suffering from both sleep apnea-hypopnea syndrome (SAHS) and chronic obstructive pulmonary disease (COPD) have a more severe form of sleep apnea. Knowing all pathophysiological aspects that mutually interact in sleep disorders and COPD, we aimed to investigate if the introduction of long-acting β2 agonists (LABA) during the night could improve overnight oxygenation and the ability to perform daily activities in stage I COPD patients with mild SAHS. We conducted a prospective study of 22 patients with stage I COPD and SAHS confirmed by overnight polygraph screening, without nocturnal CPAP treatment. During twelve weeks, all patients used LABA (salmeterol 50 mcg) with a metered dose inhaler before bedtime. The levels of apnea hypopnea index, oxygen saturation, heart rate, and Epworth daytime sleepiness scale (ESS) were recorded before and after the treatment. There was a significant improvement of lowest and average overnight oxygenation compared to baseline (mean difference 2.1±0.42, p&lt;0.0001; 1.7±0.3, p&lt;0.0001, respectively). In addition, patients reported reduction in daytime sleepiness according to ESS (mean difference 1.23±0.51; p=0.03). Fewer patients exhibited tachycardia when on salmeterol (68 vs. 41%; p=0.01). Use of inhaled salmeterol improves overnight oxygenation in patients with stage I COPD and SAHS. Future prospective studies are warranted to confirm this potentially beneficial effect of long-acting β2 agonists.

The Serbian version of the Epworth Sleepiness Scale

The Epworth Sleepiness Scale (ESS) is extensively used for evaluating daytime sleepiness in patients with sleep apnea-hypopnea syndrome (SAHS). The aim of this study was to translate and validate the ESS in the Serbian language. The Serbian version of the ESS (ESSs) was administered to 112 patients with symptoms of sleep disorder breathing referred to Sleep Center of the Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia and 111 healthy controls. Test-retest reliability was tested in 19 healthy subjects. Patients referred to the Sleep center had significantly higher ESS scores compared to controls (9 vs. 4, p < 0.001). The difference was also present for each item separately, excluding item 5. The ESSs scores were significantly higher in patients with severe (median, 13.5; interquartile range (IQR), 10.3-17.8) compared to moderate (median, 9; IQR, 7.3-9.5; p = 0.005) and mild SAHS (median, 8; IQR, 5.5-9.7; p < 0.001). Item analysis demonstrated good internal consistency of the scale (Cronbach's alpha 0.88 in patients and 0.72 in healthy controls). Test-retest Spearman's correlation coefficient was 0.68 (p = 0.001). The Serbian version of the ESS demonstrated good internal consistency and test-retest reliability. The ESSs could be used for both clinical practice and research in Serbian population.

Microscopical evaluation of extracellular matrix and its relation to the palatopharyngeal muscle in obstructive sleep apnea

Obstructive sleep apnea hypopnea syndrome (SAHS) is a complex disease of the upper respiratory airways. SAHS physiopathology is multifactorial in which airway compliance is a very important component. To evaluate the tissue changes in the palatopharyngeal muscle by morphometric, histochemical, immunohistochemical, and stereological quantification, with special attention to extracellular matrix associated with this muscle at the structural and ultrastructural levels. Thirty patients with SAHS were divided into groups of 10 according to disease severity: mild, moderate, and severe SAHS. In addition, the control group consisted of 10 patients. Fragments of palatopharyngeal muscle removed from patients with SAHS and tonsillectomies from patients in the control group were histopathologically submitted to light microscopy and transmission electron microscopy. Histopathological evaluations by light and transmission electron microscopes showed differences in analyzed groups, such as reduction of the muscle fiber diameter in patients with SAHS, taking disease severity into consideration. In contrast, stereological analysis showed a gradual increase of the collagen and elastic system fibers relative frequencies, proportionally to SAHS seriousness. MMP-2 and MMP-9 immunostaining also showed an increased reaction in the muscle fiber cytoplasm and endomisium during SAHS progression. The ultrastructural analysis showed that palatopharyngeal muscle fibers presented cytoplasmic residual corpuscles, a sign of early cell aging. In conclusion, the increase of tissue compliance in individuals with SAHS can be, in addition to other factors, consequence of diminished contractile activity of the muscle fibers, which exhibited clear signs of early senescence. Moreover, extracellular matrix components changes may contribute to muscle myopathy during SAHS progression.

Uso secuencial de la pulsioximetría nocturna y la poligrafía respiratoria (AutoSet®) para el diagnóstico del síndrome de apneas-hipopneas durante el sueño en pacientes con alta sospecha clínica

To construct an algorithm for the diagnosis of sleep apnea/hypopnea syndrome (SAHS) based on the optimized sequential use of nocturnal pulse oximetry and respiratory polygraphy (AutoSet, AS) in patients suspected of SAHS. Simultaneous performance of pulse oximetry and AS in 145 patients highly suspected of SAHS (at least two of the following signs or symptoms: chronic snoring, observations of repeated apneic events, and abnormal daytime drowsiness). SAHS was diagnosed when the apnea/hypopnea index (AHI) was greater than or equal to 10, based on AS findings. The diagnostic algorithm was obtained by calculating the prevalence of SAHS, calculating the best diagnostic cutoff point for a desaturation index greater than or equal to 4% (ID4%) based on the AHI; analyzing the positive predictive value (PPV) and negative predictive value (NPV) for the cutoff and the correlation and agreement between ID4% and the AHI depending on the presence and severity of SAHS. The overall prevalence of SAHS was 83.4%. The best cutoff point was obtained using ID4% greater than or equal to 10 (sensitivity 82%; specificity 83%). The PPV and NPV for the prevalence calculated were 0.95 and 0.29, respectively. The correlation between ID4% and AHI was 0.84; overall agreement was 0.93. For patients who did not have SAHS, the PPV was 0.49, and the NPV was 0.35; both gradually increased in cases of mild, moderate and severe SAHS (to 0.90 and 0.95, respectively, for severe SAHS). Using these data we created a diagnostic algorithm according to which an ID4% greater than or equal to 30 for nocturnal pulse oximetry (sensitivity 72%, specificity 100%) would indicate that AS testing would be unnecessary. An ID4% less than 30, on the other hand, would lead to further testing (AS, or polysomnography in the event of a negative AS), based on the high prevalence of SAHS in our series. The sequential use of nocturnal pulse oximetry and AS allows substantial savings of polysomnographic testing in groups at high risk of SAHS.