Mild Sleep Apnea Research Articles

Prevalence and Characteristics of Sleep Apnea in Intensive Care Unit Survivors After SARS-CoV-2 Pneumonia.

Sleep apnea (SA) was reported as possibly exacerbating symptoms of COVID-19, a disease induced by SARS-CoV-2 virus. The same comorbidities are common with both pathologies. This study aimed to estimate the prevalence, characteristics of SA and variation in AHI three months after severe COVID-19 requiring intensive care unit (ICU) admission. A prospective cohort of patients admitted to ICU for severe COVID-19 underwent an overnight home polygraphy 3 months after onset of symptoms, as part of a comprehensive follow-up program (pulmonary function tests, 6-minute walk tests and chest CT-scan). Patients with an apnea hypopnea index (AHI) ≥5 were considered as having SA. We performed a comparative descriptive analysis of 2 subgroups according to the existence, severity of SA and indication for effective SA treatment: patients with absent or mild SA (AHI <15) vs patients with moderate to severe SA (AHI ≥15). Among 68 patients included, 62 (91%) had known comorbidities (34 hypertension, 21 obesity, 20 dyslipidemia, 16 type 2 diabetes). It has been observed a preexisting SA for 13 patients (19.1%). At 3 months, 62 patients (91%) had SA with 85.5% of obstructive events. Twenty-four patients had no or a mild SA (AHI <15) and 44 had moderate to severe SA (AHI ≥15). Ischemic heart disease exclusively affected the moderate to severe SA group. Except for thoracic CT-scan which revealed less honeycomb lesions, COVID-19 symptoms were more severe in the group with moderate to severe SA, requiring a longer curarization, more prone position sessions and more frequent tracheotomy. SA involved 91% of patients in our population at 3 months of severe COVID-19 and was mainly obstructive type. Although SA might be a risk factor as well as consequences of ICU care in severe COVID-19 infection, our results underline the importance of sleep explorations after an ICU stay for this disease.

Study of Polysomnography in Patients of Metabolic Syndrome

Objectives: Obstructive sleep apnoea (OSA) is a condition wherein collapse of the upper airway during sleep results in decreased or complete cessation of airflow. The association of OSA with increased cardiovascular morbidity, mortality, and various cardiovascular risk factors is known for a long time. Metabolic syndrome a cluster of metabolic abnormalities, with insulin resistance as the central pathophysiological feature is ‘Syndrome X’ and in association with OSA is ‘Syndrome Z’. The aims of this study were as follows: (1) To study the incidence of OSA in patients with metabolic syndrome, (2) to study and correlate the severity of OSA with metabolic syndrome. Material and Methods: This is a hospital-based observational study conducted in Department of Respiratory Medicine IGGMC, Nagpur. Results: In the present study of ‘polysomnography in patients of metabolic syndrome’; 50 cases of metabolic syndrome were evaluated. 20 (55.55%) subjects were in the age group of 40–50 years. 22 (44%) subjects had moderate excessive daytime sleepiness, followed by higher normal daytime sleepiness in 14 (28%) based on Epworth sleepiness scale. Of the 50 subjects of Metabolic Syndrome, 14 (28%) had Apnoea Hypopnea Index (AHI) &lt;5 and 36 (72%) had AHI 5 or more, of which 42% had mild sleep apnoea, 22% moderate sleep apnoea and 8% severe sleep apnoea. Conclusion: Prevalence of Syndrome Z was found to be high in patients of metabolic syndrome .

Sleep apnea predicts cardiovascular death in patients with Marfan syndrome: a cohort study

BackgroundSurgical replacement of the aortic root is the only intervention that can prevent aortic dissection and cardiovascular death in Marfan syndrome (MFS). However, in some individuals, MFS also causes sleep apnea. If sleep apnea predicts cardiovascular death, a new target for predictive, preventive, and personalized medicine (PPPM) may emerge for those individuals with MFS who have sleep apnea.MethodsThis is an investigator-initiated study with long-term follow-up data of 105 individuals with MFS. All individuals were screened for sleep apnea regardless of symptoms. Cardiovascular death served as a primary endpoint, and aortic events as a secondary outcome.ResultsSleep apnea with an apnea–hypopnea index (AHI) > 5/h was observed in 21.0% (22/105) with mild sleep apnea in 13% (14/105) and moderate to severe sleep apnea in 7.6% (8/105). After a median follow-up of 7.76 years (interquartile range: 6.84, 8.41), 10% (10/105) had died, with cardiovascular cause of death in 80% (8/10). After adjusting for age and body mass index (BMI), the AHI score emerged as an independent risk factor for cardiovascular death (hazard ratio 1.712, 95% confidence interval [1.061–2.761], p = 0.0276). The secondary outcome of aortic events occurred in 33% (35/105). There was no effect of the AHI score on aortic events after adjusting for age and BMI (hazard ratio 0.965, 95% confidence interval [0.617–1.509]), possibly due to a high number of patients with prior aortic surgery.InterpretationSleep apnea is emerging as an independent predictor of cardiovascular death in MFS. It seems mandatory to screen all individuals with MFS for sleep apnea and to include these individuals, with both MFS and sleep apnea, in further studies to evaluate the impact of preventive measures with regard to cardiovascular death.

The impact of sleep disordered breathing on cardiac troponin in acutely decompensated heart failure

PurposeSleep disordered breathing in decompensated heart failure has physiological consequences (e.g., intermittent hypoxemia) that may predispose to subclinical myocardial injury, yet a temporal relationship between sleep apnea and troponin elevation has not been established.MethodsWe assessed the feasibility of performing respiratory polygraphy and measuring overnight high-sensitivity cardiac troponin T change in adults admitted to the hospital with acutely decompensated heart failure. Repeat sleep apnea tests (SATs) were performed to determine response to optimal medical heart failure therapy. Multivariable logistic regression was used to identify associations between absolute overnight troponin change and sleep apnea characteristics.ResultsAmong the 19 subjects with acutely decompensated heart failure, 92% of SATs demonstrated sleep disordered breathing (apnea–hypopnea index [AHI] > 5 events/h). For those with repeat SATs, AHI increased in 67% despite medical management of heart failure. Overnight troponin increase was associated with moderate to severe sleep apnea (vs. no to mild sleep apnea, odds ratio (OR = 18.4 [1.51–224.18]), central apnea index (OR = 1.11 [1.01–1.22]), and predominantly central sleep apnea (vs. obstructive, OR = 22.9 [1.29–406.32]).ConclusionsSleep apnea severity and a central apnea pattern may be associated with myocardial injury. Respiratory polygraphy with serial biomarker assessment is feasible in this population, and combining this approach with interventions (e.g., positive airway pressure) may help establish if a link exists between sleep apnea and subclinical myocardial injury.

0737 Factors Influencing Arousal Thresholds

Abstract Introduction Obstructive Sleep Apnoea (OSA) is the most common sleep-related breathing disorder with an estimated prevalence of approximately 15-30 percent in males and 10-15 percent in females. A low respiratory arousal threshold (ArTH) is one of several traits involved in OSA pathogenesis. This has been shown to be reliably predicted using an Arousal Score which is calculated using the patients overall Apnoea-Hypopnoea Index (AHI), nadir SpO2 and Hypopnoea:Apnoea ratio where a score of 2 or more predicts a low arousal threshold, and a score of 1 indicates a high arousal threshold. Our objective was to describe factors associated with high arousal thresholds in patients with OSA as determined by the Arousal Score in a metropolitan population. Methods 208 unselected, consecutive, adult, overnight polysomnography with prospectively calculated arousal scores were assessed from 2019 – 2020. Demographic and anthropometric data including Age, Sex, BMI, Epworth Sleepiness Score (ESS), AHI, SpO2 nadir, Hypopnoea:Apnoea ratio and arousal index was recorded. The arousal score was calculated by assigning one point for meeting each of the following requirements: AHI &amp;lt;30; SpO2 nadir &amp;gt; 82.8%; Hypopnoea:Apnoea ratio &amp;gt; 58.3, with a score &amp;lt;2 considered low. Spearmann correlation was performed to determine the factors associated with the Arousal Score. Results 208 patients were included in the study. 35.6% of patients had mild sleep apnoea, 23.1% moderate sleep apnoea, 22.6% severe sleep apnoea with 18.8% of patients with no sleep apnoea. Mean arousal score was 2.47 (Std Dev 0.839). Spearman correlation indicated that disease severity, BMI (rs -.374, p-value &amp;lt; 0.01) and STOP-BANG (r2 -0.419, p-value &amp;lt; 0.01) had a statistically significant relationship with Arousal Score. That is, a higher AHI, BMI and STOP-BANG was associated with a low arousal score. Moreover, Gender and Epworth Sleepiness Score exhibited an insignificant association with arousal score. We found increasing severity of disease was associated with lower arousal score and therefore a higher arousal threshold Conclusion Our study demonstrates that worsening sleep apnoea severity, higher BMI and higher STOP-BANG are associated with a lower arousal score and therefore higher arousal threshold. Gender and ESS do not appear to be significantly associated. Support (If Any)

0764 Evaluation of cloud-connected home sensors of apnea-hypopnea index versus polysomnography and home sleep test during upper airway stimulation home titration

Abstract Introduction A growing number of cloud-connected sensors can longitudinally record apnea hypopnea index (AHI) at home. The Ectosense NightOwl is an FDA-approved peripheral arterial tomography device; the Withings Sleep Analyzer mat is an under-mattress sensor with AHI data for retrospective research use (CE marked, not FDA approved). We used these sensors to monitor patients with upper airway stimulation (UAS) therapy during therapy acclimatization and post-titration follow-up and compared sensor AHI to polysomnography (PSG) and home sleep test (HST) AHIs. Methods Enrolled patients underwent UAS implantation as part of regular clinical care and were required to have a smartphone. The Ectosense and Withings sensors were distributed at UAS device activation. Patients were asked to use NightOwl weekly, and Withings provided nightly AHI. Sleep studies (PSG &amp; HST) occurred at 3 and 6-mo post implant. Ectosense &amp; Withings AHI were averaged and correlated against the nearest 3- and 6-month sleep study AHIs. Results Patients were 67% male, aged 57 ± 10 years. Smartphone platforms were 59% Apple iOS, 24% Google Android, and 17% Unknown. As of October 2021, 45 patients have had near-simultaneous Withings and PSG/HST AHI, 35 have had near-simultaneous NightOwl and PSG/HST AHI. The Withings AHI was fairly linear against PSG/HST AHI, adjusted R2 = 0.47, p &amp;lt; 0.0001, (y=10 + 0.82x). Withings AHI &amp;lt; 15 (n=18) had a 90% positive predictive value for a PSG/HST AHI less than 15 (n=20). Ectosense data was less linear and more scattered, adjusted R2 = 0.15, p=0.01, (y=14 + 0.47x). Ectosense AHI &amp;lt; 15 (n=12) had an 80% positive predictive value of a PSG/HST AHI less than 15 (n=15). Conclusion Home-based sensors provide longitudinal SDB data in a home setting and may adequately classify patients with mild sleep apnea, and may have utility for home-based management of UAS patients in the post-implantation period. Support (If Any) Inspire Medical Systems

0802 Central Sleep Apnea as a Result of Cerebral Cavernous Malformation Hemorrhage in the Pediatric Population

Abstract Introduction Cerebral Cavernous malformations (CCMs) consist of a collection of capillaries in the central nervous system (CNS) that are enlarged and irregular in structure. Patients with CCMs are at increased risk of hemorrhage into the brain or spinal cord, resulting in seizures, focal neurologic deficits, hydrocephalus, and death. Given the importance of the brainstem and central chemoreceptors in regulating respiratory function, rupture of CCMs can also lead to dysregulation of breathing. We present a series of 3 pediatric patients who have a diagnosis of central sleep apnea (CSA) due to rupture of CCMs managed with home ventilators with significant differences in clinical presentation from mild CSA to night time respiratory support for severe CSA and chronic respiratory failure requiring continuous mechanical ventilation. Report of Cases: Subject 1 is a 13 yo M with a history of ruptured posterior fossa arteriovenous malformation (AVM) complicated by post-hemorrhagic hydrocephalus, right hemiparesis and severe central apnea requiring nighttime mechanical ventilation via tracheostomy. Subject 2 is a 19 yo M with a history of mid-pontine cavernoma with multiple episodes of hemorrhage failing surgical resection resulting in right hemiparesis, severe central apnea and hypoventilation requiring continuous mechanical ventilator support via tracheostomy. Subject 3 is a 6 yo F with a history of thoracic cavernous hemangioma resulting in spinal cord injury and mild central sleep apnea requiring mask ventilation via home ventilator during sleep. All of these patients experienced loss of respiratory drive as a result of complications from brainstem or spinal cord lesions with varying degrees of ventilator support requirement and clinical presentation. Conclusion Due to the propensity for CNS bleeds among patients with CCM they are at increased risk of respiratory compromise. Home ventilator support can be used effectively to treat central apneas and chronic respiratory failure but this is a moving paradigm as subsequent bleeds worsen respiratory compromise. Support (If Any) Support (if any):

0830 A Pediatric Case of Myoclonic Seizures Precipitating Central Sleep Apnea And Sequences of Periodic Breathing During Sleep

Abstract Introduction Myoclonic seizures are known to be influenced by the sleep-wake cycle. Although myoclonic seizures have been shown to alter sleep architecture, little is known about their influence on sleep-disordered breathing. Report of Cases: A 7-year-old male with a history of generalized epilepsy of unknown etiology with absence as well as myoclonic seizures, poor impulse control, and fine motor delay was referred for restless sleep and frequent nocturnal awakenings. A routine electroencephalography (EEG) performed 33 months prior to presentation, at an outside institution, reportedly showed 3.0 Hz generalized frontally dominant spike and wave discharges lasting less than two seconds. Video EEG (vEEG) revealed diffuse bilateral poly-spike and slow wave discharges, predominantly during sleep, and myoclonic seizures with abrupt whole-body jerks. Polysomnography, at this time, was characterized by mild central sleep apnea (AHI: 3.7; OAHI: 0.0; CAI: 2.8; REM AHI: 14.4). His lamotrigine dosing was increased to from 1.8 mg/kg/day to 3.6 mg/kg/day, at presentation, with seizure control for three months but he developed a recurrence of myoclonic seizures in the setting of sleep deprivation. A repeat vEEG was similar to previous findings and his lamotrigine was increased further and clobazam was added. Due to worsening behaviors, clobazam was discontinued and a weaning plan for lamotrigine was formulated. Repeat polysomnography demonstrated worsening central sleep apnea (AHI: 18.3, OAHI: 2.3), without hypoventilation, characterized by sequences of periodic breathing that occurred in conjunction with myoclonic seizures. The majority of seizure-induced periodic breathing episodes were observed during a one-hour period of NREM sleep near the end of the study. Stereotyped epileptiform activity occurred in conjunction with a resumption of hyperventilatory respirations following apneic events. The increased respiratory drive, however, did not appear to be clinically epileptic in nature as the epileptiform activity either preceded or trailed the respirations. A variable REM and then NREM predominance of central events on successive polysomnograms further suggests that his central events are not intrinsic but that they are precipitated by epileptiform activity. Zonisamide, an anticonvulsant with carbonic anhydrase inhibitory properties was initiated and is being titrated to therapeutic goal. Conclusion This case illustrates an unusual presentation of myoclonic seizure-induced periodic breathing during sleep. Support (If Any) Cincinnati Children’s Research Foundation.

A meta-analysis of diagnostic test performance of peripheral arterial tonometry studies.

The objective of this meta-analysis was to analyze agreement in apnea-hypopnea index (AHI) determination between peripheral arterial tonometry (PAT) and polysomnography (PSG) studies. Mean AHI bias and standard deviation extracted from Bland-Altman plots reported in studies were pooled in a meta-analysis, which was then used to calculate percentage errors of limit agreement in AHI determination by PAT using PSG AHI as the reference. Individual participant data (where reported in studies) were used to compute Cohen's kappa to assess agreement between PSG and PAT on sleep apnea severity and for computing the sensitivity and specificity of PAT at different AHI thresholds using PSG AHI as the reference. From 17 studies and 1,318 participants (all underwent simultaneous PSG and use of the WatchPAT device), a pooled mean AHI bias of 0.30 (standard error [SE], 0.74) and a WatchPAT AHI percentage error of 230% was calculated. The meta-analysis of Cohen's kappa for agreement between PSG and WatchPAT studies for classifying patients with no sleep apnea, mild, moderate, or severe sleep apnea severity was 0.45 (SE, 0.06), 0.29 (SE, 0.05), 0.25 (SE, 0.07), and 0.64 (SE, 0.05), respectively. At AHI thresholds of 5, 15 and 30 events/h, WatchPAT studies showed pooled sensitivities and specificities of 94.11% and 43.47%, 92.21% and 72.39%, and 74.11% and 87.10%, respectively. Likelihood ratios were not significant at any AHI threshold. The results of this meta-analysis suggest clinically significant discordance between WatchPAT and PSG measurements of AHI, significant sleep apnea severity misclassification by PAT studies, and poor diagnostic test performance. Iftikhar IH, Finch CE, Shah AS, Augunstein CA, Ioachimescu OC. A meta-analysis of diagnostic test performance of peripheral arterial tonometry studies. J Clin Sleep Med. 2022;18(4):1093-1102.

Abstract 14397: Severity of Sleep Apnea in Patients Receiving Catheter Ablation of Atrial Fibrillation: A Comparison of Home Sleep Apnea Test and Polysomnography

Introduction: Sleep apnea is highly prevalent in patients referred for catheter ablation (CA) of atrial fibrillation (AF). A watch-type peripheral arterial tonometry (WP) as a home sleep apnea test demonstrates a high degree correlation of the apnea-hypopnea index (AHI) with Polysomnography (PSG), but the evidence of the accuracy in patients with AF is not adequate. Methods: This was a single-center, retrospective, observational study. The data were derived from screening tests using WP for sleep apnea, which was routinely performed in patients scheduled to receive CA of AF in our institution. After excluding patients already diagnosed with sleep apnea, we enrolled 464 consecutive patients (age 65±11 years, 76.5% male, and 54.9% of non-paroxysmal AF) who underwent both WP and PSG. PSG was performed after the CA during hospitalization. We compared the AHI using WP with that using PSG in patients receiving CA of AF. The severity of the sleep apnea was stratified as follows: normal (AHI&lt;5), mild (5≤AHI&lt;15), moderate (15≤AHI&lt;30), and severe (30≤AHI). Results: The AHI using WP (WP-AHI) was 25.9±12.7, and that using PSG was 31.4±18.9. There was a moderate correlation between the WP-AHI and AHI (r=0.48). According to the WP-AHI, the number of patients with normal, mild, moderate, and severe sleep apnea were 4 (0.9%), 85 (18.3%), 236 (50.9%), and 139 (30.0%), respectively. According to the AHI, there were 20 (4.3%), 70 (15.1%), 162 (34.9%), and 212 (45.7%) patients with normal, mild, moderate, and severe sleep apnea, respectively. In 85 patients with mild sleep apnea evaluated by WP, 38 (44.7%) and 15 (17.7%) patients were classified as moderate and severe using PSG. In 236 patients with moderate sleep apnea evaluated by WP, 100 (42.4%) were classified as severe using PSG. Conclusions: The AHI using WP was smaller than that using PSG. Further, a certain proportion of patients with mild or moderate sleep apnea using WP were diagnosed with severe sleep apnea evaluated by PSG.

Assessment of thrombocytopenia, sleep apnea, and cardiac involvement in GNE myopathy patients.

We previously identified UDP-N-acetylglucosamine 2-epimerase (GNE) myopathy patients with sleep apnea and a past history of thrombocytopenia, but without disease-specific cardiac involvement. This study aimed to clarify the occurrence, severity, and serial changes of these complications. Thirty-three genetically confirmed GNE myopathy patients who participated in a 5-y longitudinal observational history study underwent platelet count and platelet-associated immunoglobulin G (PA-IgG) measurements, a sleep study, and electrocardiography (ECG), Holter ECG, and echocardiogram examinations. Among the 33 patients, three had low platelet counts and 17 out of 26 were PA-IgG positive. No patient exhibited bleeding tendencies, and 3 out of 28 had low platelet counts. Muscle weakness was more pronounced, and summed MMT and grip power significantly lower, in PA-IgG-positive patients than in PA-IgG-negative patients. Of 19 patients, 7, 4, and 3 who underwent a sleep study had mild, moderate, and severe sleep apnea, respectively, and three started continuous positive airway pressure (CPAP). The respiratory disturbance index was not significantly correlated with physical evaluation items or forced vital capacity. All patients underwent ECG, 32 underwent cardiac ultrasound, and 25 underwent Holter ECG. No disease-specific cardiac involvement was noted, no serial changes during the follow-up period were observed for ECG and echocardiography, and none of the patients required therapy for cardiac abnormalities. PA-IgG is a potential disease biomarker in GNE myopathy patients, although its significance needs to be clarified. While none of the patients in this study experienced cardiomyopathy or arrythmia due to myopathy, sleep apnea was identified as a frequent complication.

Night-to-night variability of sleep apnea detected by cyclic variation of heart rate during long-term continuous ECG monitoring.

BackgroundSleep apnea is common in patients with cardiovascular disease and is a factor that worsens prognosis. Holter 24‐h ECG screening for sleep apnea is beneficial in the care of these patients, but due to high night‐to‐night variability of sleep apnea, it can lead to misdiagnosis and misclassification of disease severity.MethodsTo investigate the long‐term dynamic behavior of sleep apnea, seven‐day ECGs recorded with a patch ECG recorder in 120 patients were analyzed for the cyclic variation of heart rate (CVHR) during sleep periods as determined by a built‐in three‐axis accelerometer.ResultsThe frequency of CVHR (Fcv) showed considerable night‐to‐night variability (coefficient of variance, 66 ± 35%), which was consistent with the night‐to‐night variability in apnea‐hypopnea index and oxygen desaturation index reported in earlier studies. In patients with presumed moderate‐to‐severe sleep apnea (Fcv > 15 cph at least one night), it was missed on 62% of nights, and on at least one night in 88% of patients. The CV of Fcv was negatively correlated with the average of Fcv, suggesting that patients with mild sleep apnea show greater night‐to‐night variability and would benefit from long‐term assessment. The average Fcv was higher in the supine position, but the night‐to‐night variability was not explained by the night‐to‐night variability of time spent in the supine position.ConclusionsCVHR analysis of long‐term ambulatory ECG recordings is useful for improving the reliability of screening for sleep apnea without placing an extra burden on patients with cardiovascular disease and their care.

Impact of lifestyle modifications on snoring and mild sleep apnoea patients.

Behavioural modification through increasing nutritional awareness, along with customised dietary changes and education about physical inactivity, for obese snorers and mildly sleep apnoeic patients would help improve their quality of life. A one-year prospective interventional study enrolled snorers and/or mild obstructive sleep apnoea sufferers, with 36 patients each in the test group and control group. Nutritional information and tailor-made diet charts were given to the 36 test subjects. The severity of snoring and daytime sleepiness after 6 and 12 months was compared using the Epworth Sleepiness Scale and Thornton Snoring Scale as measures of quality of life. Subjective scores on both scales showed highly significant improvement (p ≤ 0.001) in the test group. No significant improvement was seen in the control group. Awareness of basic nutrition and customised diet plans help to achieve behavioural modification in the long term, resulting in a better quality of life.

English

BACKGROUND Hypertension or elevated blood pressure is a serious medical condition, obstructive sleep apnoea (OSA) is an important identifiable cause of hypertension. Early identification and treatment of sleep disordered breathing contributes to prevention of hypertension, and treatment of OSA may improve blood pressure control as well. This observational study was done to demonstrate the association of sleepdisordered breathing with patients who have systemic hypertension. METHODS Total 94 patients were included in this study. Out of ninety-four patients, eleven patients had mild sleep apnoea, nine patients had moderate sleep apnoea, and twelve had severe sleep apnoea. RESULTS In mild OSA there were four patients with blood pressure &lt; 120 / 80 mmHg while seven patients with blood pressure of 121 - 140 / 81 - 90 and there were four patients with blood pressure 141 / 91. In moderate OSA there were 9, 3, 6 and 1 patients in the group of blood pressure &lt; 120 / 80, 121 - 140 / 81 - 90, &gt; 140 - 160 / 91 - 100 and &gt; 160 / 100 mmHg respectively. In severe obstructive sleep apnoea there were 5, 7, 6 and 2 patients in the group of blood pressure &lt; 120 / 80, 121 - 140 / 81 - 90, 141 - 160 / 91 - 100 and &gt; 160 / 100 mmHg respectively. The severity of hypertension is strongly associated with apnoea-hypopnea index (AHI). CONCLUSIONS This study shows a statistically significant association of hypertension with obstructive sleep apnoea and increased severity of hypertension associated with the increased severity of obstructive sleep apnoea hypopnea syndrome (OSAHS). KEY WORDS Hypertension, polysomnography, apnoea / hypopnea index (AHI), Epworth sleepiness scale (ESS), Body Mass Index (BMI), obstructive sleep apnoea (OSA), obstructive sleep apnoea / hypopnea syndrome (OSAHS)

Efficacy and Effectiveness of the ProSomnus® [IA] Sleep Device for the Treatment of Obstructive Sleep Apnea: EFFECTS Study.

ObjectivesTo evaluate the effectiveness of a new mandibular advancement device (MAD) (Prosomnus® [IA] Sleep Device, Prosomnus Sleep Technologies, Pleasanton CA) fitted with a compliance tracker as a first-line treatment in a population of patients with mild to severe obstructive sleep apnea (OSA).MethodsTreatment effectiveness was measured using pre and post-treatment home sleep testing (HST) and validated sleep and quality of life questionnaires. Mean disease alleviation (MDA) was calculated to compare the treatment effectiveness of MAD to historical continuous positive airway pressure (CPAP) effectiveness data.ResultsMAD was found to be an effective first-line treatment for patients with mild, moderate, and severe sleep apnea with excellent compliance rates, similar to or better than CPAP, and an equal or better MDA of 56.7% compared to literature values of 50% for CPAP.ConclusionsMAD should be considered an effective first-line treatment for patients with mild and moderate sleep apnea and for severe sleep apnea for patients who prefer, refuse, or are not candidates for CPAP.

Clinical characteristics of periodic limb movements during sleep categorized by continuous positive airway pressure titration polysomnography in patients with obstructive sleep apnea.

The presence of periodic limb movements during sleep (PLMS) varies among patients with obstructive sleep apnea (OSA) undergoing treatment with continuous positive airway pressure (CPAP). The factors associated with this variation are unknown. PLMS were defined as a periodic leg movements index of > 15/h. Patients withOSA and PLMS were categorized into four groups depending on diagnostic and CPAP titration polysomnography (PSG). A multinomial logistic regression analysis was performed using a non-PLMS group as the reference category. This study included 861 patients withOSA who underwent a full-night CPAP titration PSG. The proportions of the subjects with PLMS on both PSGs (persistent PLMS), those with CPAP-emergent PLMS, and those with CPAP-resolved PLMS were 12.9%, 9.2%, and 3.9%, respectively. Compared with the non-PLMS group, the persistent group was more likely to be of older age and male sex and has a higher body mass index and restless legs syndrome (RLS). Patients in the CPAP-emergent group were also older and more likely to have RLS as well as moresevere apnea. Patients in the CPAP-resolved group were more likely to be women,of older age, have a higher body mass index, but less severe apnea. PLMS elicited by CPAP are more likely to occur in older patients with moresevere sleep apnea and comorbid RLS, whereas OSA patients in which PLMS resolve after CPAP are more likely to be women and have milder sleep apnea. Persistent PLMS share clinical characteristics with PLMS in general population.

342 CBT-I Has Sustained Effects on Insomnia Versus Heart-Failure Self-Management Education among Adults with Chronic Heart Failure

Abstract Introduction Insomnia is common among adults with chronic heart failure (HF), often not explained by sleep apnea (SA), and associated with daytime symptoms and poor daytime function. The purpose of this randomized controlled trial was to evaluate the sustained effects of cognitive behavioral therapy for insomnia (CBT-I) on insomnia severity and sleep characteristics over 6 months among adults with stable chronic HF. Methods We included adults with HF who had at least mild insomnia [Insomnia Severity Index (ISI) &amp;gt; 8] and no more than mild SA or SA treated with continuous positive airway pressure. We randomized in groups to 8 weeks of group CBT-I (Healthy Sleep: HS) [4 group sessions + calls on alternate weeks] or attention control (Healthy Hearts: HH) [HF self-management education + brief sleep hygiene] in the same format. We administered the ISI, the Pittsburgh Sleep Quality Index (PSQI), the Dysfunctional Beliefs &amp; Attitudes about Sleep Scale (DBAS), and the Sleep Disturbance Questionnaire (SDQ) at baseline (T0), 2 weeks after treatment ended (T1) and at 6 months (T2). Statistical analysis included descriptive statistics and mixed effects models with random intercepts and slopes. Results The sample include 175 participants (HS: N = 91; 62 + 13 years; 58% Male; 15% Black; 68% NY Heart Class II-III) (HH: N = 84; 64 + 12.5 years; 56% Male; 17% Black; 70% NY Heart Class II-III). There was no significant difference at baseline in demographic characteristics or the mean ISI [HS: 15.3 (4.5); HH: 14.4 (4.5)], but a greater percentage in the HS group had clinical/moderate-severe insomnia (ISI &amp;gt; 15) (HS: 60.4% vs. HH: 47%). The CBT-I intervention (HS) was associated with significant improvement in insomnia severity (ISI: p = .001), sleep quality (PSQI: p = .002), and sleep-related cognitions (DBAS: p = .0006; SDQ: p = .0138), and a modest effect on self-reported sleep duration (46 vs. 20 mins, p = .054), but no effect on sleep efficiency. At 6 months, 12.9% of the HS group, compared with 24.9% of the HH group had clinical insomnia. Conclusion CBT-I has sustained effects on insomnia, sleep-quality, and sleep-related cognitions in people with HF. Support (if any) R01NR01691 (NSR, PI)

Longer and Deeper Desaturations Are Associated With the Worsening of Mild Sleep Apnea: The Sleep Heart Health Study.

Study ObjectivesObesity, older age, and male sex are recognized risk factors for sleep apnea. However, it is unclear whether the severity of hypoxic burden, an essential feature of sleep apnea, is associated with the risk of sleep apnea worsening. Thus, we investigated our hypothesis that the worsening of sleep apnea is expedited in individuals with more severe desaturations.MethodsThe blood oxygen saturation (SpO2) signals of 805 Sleep Heart Health Study participants with mild sleep apnea [5 ≤ oxygen desaturation index (ODI) < 15] were analyzed at baseline and after a mean follow-up time of 5.2 years. Linear regression analysis, adjusted for relevant covariates, was utilized to study the association between baseline SpO2-derived parameters and change in sleep apnea severity, determined by a change in ODI. SpO2-derived parameters, consisting of ODI, desaturation severity (DesSev), desaturation duration (DesDur), average desaturation area (avg. DesArea), and average desaturation duration (avg. DesDur), were standardized to enable comparisons between the parameters.ResultsIn the group consisting of both men and women, avg. DesDur (β = 1.594, p = 0.001), avg. DesArea (β = 1.316, p = 0.004), DesDur (β = 0.998, p = 0.028), and DesSev (β = 0.928, p = 0.040) were significantly associated with sleep apnea worsening, whereas ODI was not (β = −0.029, p = 0.950). In sex-stratified analysis, avg. DesDur (β = 1.987, p = 0.003), avg. DesArea (β = 1.502, p = 0.024), and DesDur (β = 1.374, p = 0.033) were significantly associated with sleep apnea worsening in men.ConclusionLonger and deeper desaturations are more likely to expose a patient to the worsening of sleep apnea. This information could be useful in the planning of follow-up monitoring or lifestyle counseling in the early stage of the disease.

Daytime Neuromuscular Electrical Therapy of Tongue Muscles in Improving Snoring in Individuals with Primary Snoring and Mild Obstructive Sleep Apnea.

Study Objectives: Evaluating daytime neuromuscular electrical training (NMES) of tongue muscles in individuals with Primary Snoring and Mild Obstructive Sleep Apnea (OSA). Methods: A multicenter prospective study was undertaken in patients with primary snoring and mild sleep apnea where daytime NMES (eXciteOSA® Signifier Medical Technologies Ltd., London W6 0LG, UK) was used for 20 min once daily for 6 weeks. Change in percentage time spent snoring was analyzed using a two-night sleep study before and after therapy. Participants and their bed partners completed sleep quality questionnaires: Epworth Sleepiness Scale (ESS) and Pittsburgh Sleep Quality Index (PSQI), and the bed partners reported on the nighttime snoring using a Visual Analogue Scale (VAS). Results: Of 125 patients recruited, 115 patients completed the trial. Ninety percent of the study population had some reduction in objective snoring with the mean reduction in the study population of 41% (p < 0.001). Bed partner-reported snoring reduced significantly by 39% (p < 0.001). ESS and total PSQI scores reduced significantly (p < 0.001) as well as bed partner PSQI (p = 0.017). No serious adverse events were reported. Conclusions: Daytime NMES (eXciteOSA®) is demonstrated to be effective at reducing objective and subjective snoring. It is associated with effective improvement in patient and bed partner sleep quality and patient daytime somnolence. Both objective and subjective measures demonstrated a consistent improvement. Daytime NMES was well tolerated and had minimal transient side effects.

A 3D-printed microfluidic platform for simulating the effects of CPAP on the nasal epithelium

Obstructive sleep apnea (OSA) is a chronic disorder that involves a decrease or complete cessation of airflow during sleep. It occurs when the muscles supporting the soft tissues in the throat relax during sleep, causing narrowing or closure of the upper airway. Sleep apnea is a serious medical condition with an increased risk of cardiovascular complications and impaired quality of life. Continuous positive airway pressure (CPAP) is the most effective treatment for moderate to severe cases of OSA and is effective in mild sleep apnea. However, CPAP therapy is associated with the development of several nasal side effects and is inconvenient for the user, leading to low compliance rates. The effects of CPAP treatment on the upper respiratory system, as well as the pathogenesis of side effects, are incompletely understood and not adequately researched. To better understand the effects of CPAP treatment on the upper respiratory system, we developed an in vitro 3D-printed microfluidic platform. A nasal epithelial cell line, RPMI 2650, was then exposed to certain conditions to mimic the in vivo environment. To create these conditions, the microfluidic device was utilized to expose nasal epithelial cells grown and differentiated at the air–liquid interface. The airflow was similar to what is experienced with CPAP, with pressure ranging between 0 and 20 cm of H2O. Cells exposed to pressure showed decreased barrier integrity, change in cellular shape, and increased cell death (lactate dehydrogenase release into media) compared to unstressed cells. Stressed cells also showed increased secretions of inflammatory markers IL-6 and IL-8 and had increased production of ATP. Our results suggest that stress induced by airflow leads to structural, metabolic, and inflammatory changes in the nasal epithelium, which may be responsible for developing nasal side-effects following CPAP treatment.