Mixed Apnea Research Articles

Neonatal obstructive sleep apneas in a mouse model of Down syndrome.

Down syndrome (DS) is a genetic disease caused by a third copy of chromosome 21, leading to various physical features, developmental and cognitive delays, and intellectual disability. Obstructive sleep apnea (OSA) is highly prevalent in children with DS, with severity reported to be inversely related to age and culminating in neonates. OSA causes intermittent hypoxia and hypercapnia, which may have detrimental effects on health and development. Consequently, there are concerns about the impact of OSA on neurodevelopmental disorders associated with DS, particularly in neonates. Dp(16)1Yey mice, a genetically engineered model of DS, exhibit cognitive impairments and characteristics typically associated with OSA, including craniofacial hypoplasia and reduced upper airway volume in adulthood. To investigate the contribution of respiratory-related disorders to DS pathophysiology, we examined the cardio-respiratory phenotype of Dp(16)1Yey mice at birth, with special attention to OSA, using a pneumotachograph and a facemask combined with a laser abdominal profilometer to distinguish obstructive, central, and mixed apneas. Dp(16)1Yey mouse pups exhibited lower weight and heart rates compared to their wild-type counterparts. Baseline breathing variables and responses to hypercapnia were similar between the two groups. Obstructive apneas were observed in both Dp(16)1Yey and wild-type mice, but the total time spent in obstructive apneas was longer in Dp(16)1Yey mice, due to their longer mean duration. These findings highlight the relevance of the Dp(16)1Yey model for studying OSA in DS during the neonatal period and for investigating the contribution of early respiratory disorders to DS pathology.NEW & NOTEWORTHY Severe obstructive sleep apnea is prevalent in neonates with Down syndrome, but neonatal breathing disorders remain unexplored in mouse models. Using the Dp(16)1Yey model, we observed prolonged obstructive apneas and lower heart rates at birth in mutant pups compared to wild-type littermates. This preclinical model provides a novel platform to study neonatal obstructive sleep apnea in Down syndrome and its contribution to neurodevelopmental disorders associated with Down syndrome.

The differences between the subtypes of obstructive sleep apnea among different provinces in Turkey: a multicenter study

PurposeOur aim in this study is to investigate the significance and implications of different clinical subtypes of patients with obstructive sleep apnea syndrome (OSAS) in three different sleep centers from varied provinces.MethodsBetween January 2023 and November 2024, 330 patients from three sleep centers (Adana, Gaziantep, and Istanbul) were retrospectively examined for age, gender, body mass index (BMI), polysomnography parameters, sleep stages, arousals, oxygen parameters, heart rates, apnea-hypopnea indexes (AHI) and snoring.ResultsOSAS patients of Gaziantep were fat and severe OSAS patients who slept lightly but efficiently at lower oxygen levels with longer durations. They fell into Rapid Eye Movement (REM) sleep quickly. The number of hypopneas is high. OSAS patients of Adana sleep deeply, frequently wake after sleep onset, and snore less. The number of obstructive apnea is high. OSAS patients of Istanbul sleep efficiently but snore a lot. REM oxygen saturation, oxygen desaturation index (ODI) levels, and the average heart rate were high in Istanbul. The number of central and mixed apneas is high.ConclusionsSleep patterns and oxygen measurements varied among clinical subtypes of patients with OSAS, as well as among provinces. Understanding regional or subtype-specific OSAS could alter practice because treatment can be planned according to the severity of OSAS.

Effect of Study-Duration and Time of Day on Multichannel Sleep Study Findings in Former Preterm Infants.

Determine the appropriate duration for multichannel sleep studies in former preterm infants with cardio-respiratory events beyond term equivalent age. A sleep study of 10 h will provide equivalent information compared to a 20-h study to detect significant cardio-respiratory abnormalities in this population. Single-center retrospective study of 50 infants with 20-h sleep study. Studies were evaluated for periodic breathing, obstructive, central, mixed apnea, desaturations, and bradycardia. Each study was partitioned into two 10-h epochs, compared to one another and the 20-h study. Differences were detected at the level of individual sleep studies when each epoch was compared to each other and a total 20-h study. 10-h study missed 17-31% of breathing abnormalities detected over 20 h adjusted for study time. Group analysis showed no statistical difference in the number and duration of events between epochs. A 20-h sleep study improves the detection of breathing abnormalities missed with a 10-h study.

The Impact of Tonsillectomy on Sleep Apnea and Quality of Life in Children and Adults

Tonsillectomy, performed with or without adenoidectomy, involves the complete removal of the tonsils and has long been a cornerstone in the management of obstructive sleep apnea (OSA) and related sleep-disordered breathing conditions. Sleep apnea is classified into obstructive, central, or mixed types, with mixed apnea combining obstructive and central features, often linked to severe OSA. Sleep apnea is associated with various risk factors and leads to significant consequences, including cardiovascular morbidity, neurobehavioral deficits, increased healthcare utilization, and reduced quality of life. A primary contributing factor, particularly in pediatric OSA, is the proliferation of the adenoids and tonsils, resulting in upper airway obstruction during sleep. Adenotonsillectomy is an established first-line treatment for pediatric OSA, effectively improving apnea indices and quality of life, though residual central sleep apnea may persist in some cases. In adults, tonsillectomy reduces apnea severity; however, its effectiveness is influenced by factors such as body mass index. The impact of tonsillectomy on the quality of life of adults with sleep apnea remains underexplored. This review aims to assess the impact of tonsillectomy on various types of sleep apnea in both children and adults, while identifying gaps in current research and future directions. Further studies are needed to investigate the long-term outcomes of surgical interventions and the role of obesity in determining surgical success, to optimize diagnostic, therapeutic, and management strategies for sleep apnea across diverse populations.

P034 Noxturnal cRIP: An alternative to AASM recommended flow sensors in analysis of respiratory events in polysomnography

Abstract Introduction AASM recommends the use of nasal pressure (NP), oronasal thermal flow (Th), and respiratory inductance plethysmography (RIP) for detecting and characterising respiratory events (RE) in polysomnography. A previous comparative study assessed utility of Noxturnal RIP flow (cRIPflow) as an alternative to Th for identification of RE in polysomnography. This demonstrated that cRIPflow was comparable with AASM recommendation for Th and NP (TH-NP) and indicated higher accuracy than Th in RE identification. We further investigate utility of cRIPflow between varying groups of apnoea hypopnoea index (AHI) severity. Method Respiratory scoring was performed by an experienced scorer on 10 diagnostic studies under AASM standards. Scoring was repeated using three different measurements for each study: cRIPflow only, Th only and Th-NP. AHI, central apnoea index (CAI), obstructive apnoea index (OAI), mixed apnoea index (MAI) and hypopnoea index (HI) were calculated. Data was catagorised into Group1 (AHI <30/hr) and Group2 (AHI >30/hr). Wilcoxon matched pairs test was utilised for comparison between flow measurements. Results Statistical difference found in Group1 (n=6) HI comparing cRIPflow vsTh (cRIPflow 6.08/hr+/-5.87SD, Th 4.57/hr+/-4.27SD, p=0.0312). No other statistical differences in RE identified when comparing cRIPflow vsTh, cRIPflow vs Th-NP and Th vs Th-NP within Group1 (n=6) and Group2 (n=4). Discussion This data suggests cRIPflow may be more sensitive in HI identification in lower severity AHI populations. Analysis with larger sample size would provide more insight. cRIPflow is comparative with AASM recommended flow sensors across varying AHI severity populations, suggesting an alternative method for detecting and characterising RE in polysomnography.

A PhD completed. Issues related to indication, surgery, and outcome of maxillomandibular advancement in obstructive sleep apnea

Obstructive sleep apnea is a common sleep-related breathing disorder. Although maxillomandibular advancement is widely recognized for its proven effectiveness, there are still uncertainties surrounding this procedure. This research therefore focused on the indication, surgical techniques, and outcomes of maxillomandibular advancement in patients with obstructive sleep apnea. A systematic review and meta-analysis showed that maxillomandibular advancement is more effective than multilevel surgery for the treatment of obstructive sleep apnea. Both maxillomandibular advancement and hypoglossal nerve stimulation were identified as effective and safe treatment methods for obstructive sleep apnea. Various retrospective studies also indicated that patients with hypopnea-dominant obstructive sleep apnea are better candidates for maxillomandibular advancement, in contrast to patients with cardiovascular diseases or a higher central apnea index. Furthermore, it was demonstrated that maxillomandibular advancement is effective in patients with a high percentage of central and mixed apneas, despite the potential surgical inaccuracies of maxillomandibular advancement, highlighting the broad applicability of this treatment method.

Study on cerebral oxygen saturation in children with sleep-disordered breathing.

To explore the association between the severity of sleep-disordered breathing, different types of respiratory events, peripheral oxygen saturation (SpO2), age and sleep stage on cerebral oxygen saturation (rSO2) in children. We enrolled children aged 4-14 years who were treated for snoring or mouth breathing at the Sleep Center of Beijing Children's Hospital, from February 2022 to July 2022. All children completed polysomnography, and SpO2, rSO2, and heart rate (HR) were recorded synchronously. A total of 70 children were included, including 16 (22.9%) with primary snoring, 38 (54.3%) with mild obstructive sleep apnea (OSA), and 16 (22.9%) with moderate-to-severe OSA. There were no significant differences in the mean rSO2 or minimum rSO2 among the primary snoring, mild OSA, and moderate-to-severe OSA groups (all p > 0.05). A total of 1119 respiratory events were included in the analysis. Regardless of the type of respiratory event, rSO2 and HR changes occur prior to fluctuations in SpO2. A mixed-effects model showed that ΔrSO2 was positively correlated with ΔSpO2, duration of respiratory event, mixed and obstructive apnea, central apnea, while negatively correlated with age and rapid eye movement (REM) sleep stage (all p < 0.05). Larger rSO2 fluctuations were impacted by a greater ΔSpO2, longer duration of respiratory events, younger age, apnea-related respiratory events and non-REM sleep stage. Thus, sleep disordered breathing in younger children warrants more attention. More research is needed to determine whether REM sleep has special protective effects on rSO2.

Detection of Sleep Apnea Using Wearable AI: Systematic Review and Meta-Analysis.

Early detection of sleep apnea, the health condition where airflow either ceases or decreases episodically during sleep, is crucial to initiate timely interventions and avoid complications. Wearable artificial intelligence (AI), the integration of AI algorithms into wearable devices to collect and analyze data to offer various functionalities and insights, can efficiently detect sleep apnea due to its convenience, accessibility, affordability, objectivity, and real-time monitoring capabilities, thereby addressing the limitations of traditional approaches such as polysomnography. The objective of this systematic review was to examine the effectiveness of wearable AI in detecting sleep apnea, its type, and its severity. Our search was conducted in 6 electronic databases. This review included English research articles evaluating wearable AI's performance in identifying sleep apnea, distinguishing its type, and gauging its severity. Two researchers independently conducted study selection, extracted data, and assessed the risk of bias using an adapted Quality Assessment of Studies of Diagnostic Accuracy-Revised tool. We used both narrative and statistical techniques for evidence synthesis. Among 615 studies, 38 (6.2%) met the eligibility criteria for this review. The pooled mean accuracy, sensitivity, and specificity of wearable AI in detecting apnea events in respiration (apnea and nonapnea events) were 0.893, 0.793, and 0.947, respectively. The pooled mean accuracy of wearable AI in differentiating types of apnea events in respiration (normal, obstructive sleep apnea, central sleep apnea, mixed apnea, and hypopnea) was 0.815. The pooled mean accuracy, sensitivity, and specificity of wearable AI in detecting sleep apnea were 0.869, 0.938, and 0.752, respectively. The pooled mean accuracy of wearable AI in identifying the severity level of sleep apnea (normal, mild, moderate, and severe) and estimating the severity score (Apnea-Hypopnea Index) was 0.651 and 0.877, respectively. Subgroup analyses found different moderators of wearable AI performance for different outcomes, such as the type of algorithm, type of data, type of sleep apnea, and placement of wearable devices. Wearable AI shows potential in identifying and classifying sleep apnea, but its current performance is suboptimal for routine clinical use. We recommend concurrent use with traditional assessments until improved evidence supports its reliability. Certified commercial wearables are needed for effectively detecting sleep apnea, predicting its occurrence, and delivering proactive interventions. Researchers should conduct further studies on detecting central sleep apnea, prioritize deep learning algorithms, incorporate self-reported and nonwearable data, evaluate performance across different device placements, and provide detailed findings for effective meta-analyses.

Construction and evaluation of a predictive model for the types of sleep respiratory events in patients with OSA based on hypoxic parameters.

To explore the differences and associations of hypoxic parameters among distinct types of respiratory events in patients with obstructive sleep apnea (OSA) and to construct prediction models for the types of respiratory events based on hypoxic parameters. A retrospective analysis was conducted on a cohort of 67 patients with polysomnography (PSG). All overnight recorded respiratory events with pulse oxygen saturation (SpO2) desaturation were categorized into four categories: hypopnea (Hyp, 3409 events), obstructive apnea (OA, 5561 events), central apnea (CA, 1110 events) and mixed apnea (MA, 1372 events). All event recordings were exported separately from the PSG software as comma-separated variable (.csv) files, which were imported into custom-built MATLAB software for analysis. Based on 13 hypoxic parameters, artificial neural network (ANN) and binary logistic regression (BLR) were separately used for construction of Hyp, OA, CA and MA models. Receiver operating characteristic (ROC) curves were employed to compare the various predictive indicators of the two models for different respiratory event types, respectively. Both ANN and BLR models suggested that 13 hypoxic parameters significantly influenced the classification of respiratory event types; The area under the ROC curves of the ANN models surpassed those of traditional BLR models respiratory event types. The ANN models constructed based on the 13 hypoxic parameters exhibited superior predictive capabilities for distinct types of respiratory events, providing a feasible new tool for automatic identification of respiratory event types using sleep SpO2.

Phrenic nerve stimulation for central sleep apnea: a single institution experience

PurposePhrenic nerve stimulation (PNS) was approved by the Food and Drug Administration (FDA) to treat moderate to severe central sleep apnea. We report here, results of a retrospective study regarding our institutional outcomes at one year. In this study we evaluated the change in the apnea hypopnea index, epworth sleepiness score, and functional outcomes of sleep score at one year post implant.MethodsThis is a retrospective analysis of patients ≥ 18 years of age who had PNS implanted for moderate to severe CSA at the Ohio State University Wexner Medical Center apnea between Feb 1, 2018 to July 1, 2021. Sleep disordered breathing parameters and objective sleepiness as measured by the Epworth Sleepiness Scale (ESS) scores, and Functional Outcomes of Sleep Questionnaire (FOSQ) scores were assessed at baseline and one-year post-implant.ResultsTwenty-two patients were implanted with PNS at OSU between February 1, 2018 and May, 31, 2022. The AHI showed a statistically significant decrease from a median of 40 events/hour at baseline to 18 at follow-up (p-value = 0.003). The CAI decreased from 16 events/hour to 2 events/hour (p-value of 0.001). The obstructive apnea index, mixed apnea index, and hypopnea index did not significantly change. The ESS scores had a statistically significant improvement from a median score of 12 to 9 (p-value = 0.028). While the FOSQ showed a trend to improvement from 15.0 to 17.8, it was not statistically significant (p-value of 0.086).ConclusionOur study found that PNS therapy for moderate to severe CSA improves overall AHI and CAI. Objective sleepiness as measured by the ESS also improved at one-year post implant.

0517 Integrating Body Sensor into a Wearable Platform to Enhance the Identification of Central and Mixed Apneas

0517 Integrating Body Sensor into a Wearable Platform to Enhance the Identification of Central and Mixed Apneas

Exploring the Multifaceted Landscape of Pediatric Obstructive Sleep Apnea: Insights into Prevalence, Severity, and Coexisting Conditions.

Pediatric obstructive sleep apnea (OSA) is a multifaceted disorder marked by recurrent upper airway obstruction during sleep, often coexisting with various medical conditions. This study, aimed to comprehensively analyze the Multifaceted Landscape of Pediatric Insights into Prevalence, Severity, and Coexisting Conditions. With a sample of 1928 participants, our study sought to determine the prevalence, severity, and associations between OSA and diverse conditions. Conducted retrospectively from February 2019 to April 2023, the study included pediatric patients. Data were collected through electronic health records, involving clinical assessments, medical histories, and diagnostic tests to establish OSA and coexisting condition diagnoses. Relationships between sleep parameters, apnea types, and severity indices were evaluated. High OSA prevalence was evident across age groups, with severity peaking between 3 to 12 years. Among the participants, coexisting conditions included allergic rhinitis (59.6%), tonsillar hypertrophy (49.7%), adenoid hypertrophy (28.4%), and obesity (15.3%). Analysis revealed intriguing relationships between different sleep parameters and apnea types. Notable associations were observed between Obstructive Apnea (OA) and Central Apnea (CA), and Mixed Apnea (MA) displayed associations with both OA and CA. Hypopnea correlated directly with the Apnea-Hypopnea Index (AHI), reflecting its role in OSA severity. This study provides a comprehensive understanding of the intricate dynamics between pediatric OSA and coexisting conditions. The prevalence of OSA and its coexistence with various conditions underscore the need for comprehensive evaluation and management strategies. By revealing associations between different sleep parameters and apnea types, the study emphasizes the complexity of OSA diagnosis and management. These findings hold the potential to enhance clinical approaches, ultimately leading to improved care and outcomes for affected children.

The Prevalence of Sentinel Central Events (SCent) During Drug-Induced Sleep Endoscopy.

The Prevalence of Sentinel Central Events (SCent) During Drug-Induced Sleep Endoscopy.

Central and mixed apneas in children with obstructive sleep apnea: effect of adenotonsillectomy

PurposeInvestigate the effect of adenotonsillectomy on mixed apnea index (MAI) and central apnea index (CAI) in children with moderate-to-severe obstructive sleep apnea syndrome (OSAS).MethodsObservational retrospective analysis of polysomnographic data in children diagnosed with moderate-to-severe OSAS and without comorbidity, submitted to adenotonsillectomy.ResultsData were available for 80 children, 55 boys and 25 girls, with a median age of 3.6 years (2.1–5.9). Before surgery AHI was 14.1 (11.0–18.4) per hour, with a median preoperative OAI of 7.1 (4.1–10.6), MAI of 1.2 (0.6–1.6) and CAI of 1.0 (0.4–2.0). Adenotonsillectomy caused significant improvements in MAI, from 1.2 (0.6–1.6) to 0.5 (0.1–0.8) (p < 0.001) and CAI from 1.0 (0.4–2.0) to 0.5 (0.1–0.9) (p < 0.001). This represents a normalization of MAI in 91.7% and CAI in 75.6% of children that had an abnormal value prior surgery.ConclusionNon obstructive apneas are common in children with OSAS. Adenotonsillectomy caused significant decrease not only in OAI, but also in MAI and CAI in children with moderate-to-severe OSAS.

Comparative effects of moderate-intensity interval training on sleep quality and functional capacity in atrial fibrillation patients with two types of sleep apnea

IntroductionThis study aimed to examine the effects of moderate-intensity interval training (MIIT) on the quality of sleep and functional capacity in atrial fibrillation (AF) patients with different presentations of sleep apnoea after coronary artery bypass graft (CABG) surgery.Methods18 participants with AF and sleep apnoea aged 45–65 years were assigned into two groups: AF with obstructive sleep apnoea group (group A, n1 = 9) and AF with mixed sleep apnoea group (group B, n2 = 9). Both groups received MIIT for ten weeks (3 sessions / week) and medical treatment (i.e., Continuous Positive Airway Pressure and drug therapy). Exclusion criteria were unstable cardiac comorbidities and neurological/musculoskeletal limitations to exercise intervention. Outcome measures included sleep parameters collected from the actigraphy, overall sleep quality rating domain of the Pittsburgh Sleep Quality Index (PSQI), and six-minute walk distance (6-MWD).ResultsSignificant changes were present in the means of all outcomes in group A (p &lt; 0.05) and two outcomes (i.e., cut points &amp; 6-MWD) in group B compared to baseline (p &lt; 0.05). Also, there were significant differences in the absolute mean changes from baseline (∆) between the two groups, in favour of group A, in sleep latency (p &lt; 0.001), total sleep duration (p = 0.026), sleep efficiency (p &lt; 0.001), overall sleep quality rating item of the PSQI (p = 0.001), and 6-MWD (p = 0.008).ConclusionsMIIT can be a supplementary therapeutic intervention that could contribute to greater positive changes in sleep quality and functional capacity in AF patients with obstructive sleep apnoea rather than in AF patients with mixed sleep apnoea post-CABG. MIIT could enhance the functional capacity independent of improving sleep quality in patients with AF and mixed sleep apnoea post-CABG.

Prediction models for respiratory event types in OSA patients based on hypoxic parameters

Objective: To analyze the hypoxic parameters in patients with obstructive sleep apnea (OSA), to explore the difference and association between different types of respiratory events and to construct predictive models for respiratory event types. Methods: Fifty patients [including 41 males and 9 females with age 18-74(45.72±13.39) years ] with OSA diagnosed by polysomnography (PSG) were selected for retrospective analysis, and all respiratory events with pulse oximetry (SpO2) desaturation in the recorded overnight data were divided into hypopnea group (Hyp, 3 316), obstructive apnea group (OA, 5 552), central apnea group (CA, 1 088) and mixed apnea group (MA, 1 369) according to the type of events, and all event records were exported separately from the PSG software as comma-separated variable (.csv) files, which were imported and analyzed using the in-house built Matlab software. A total of 13 hypoxic parameter differences were compared among the four groups, including minimum oxygen saturation of events (e-minSpO2), the depth of desaturation (ΔSpO2), the duration of desaturation and resaturation (DSpO2), the duration of desaturation (d.DSpO2), duration of resaturation (r.DSpO2), duration of SpO2<90% (T90), duration of SpO2<90% during desaturation (d.T90), duration of SpO2<90% during resaturation (r.T90), area under the curve of SpO2<90% (ST90), area under the curve of SpO2<90% during desaturation (d.ST90), area under the curve of SpO2<90% during resaturation (r.ST90), oxygen desaturation rate (ODR) and oxygen resaturation rate (ORR). Hyp model (H), OA model (O), CA model (C) and MA model (M) were constructed respectively; group differences for the different hypoxia parameters were assessed using single factor analysis and Kruskal-Wallis H test. For different categories of respiratory events, binary logistic regression was used to identify the variables included in the regression model. Receiver operating characteristic (ROC) curves were generated to assess and compare the sensitivity, specificity, positive predictive value and negative predictive value of the four models, thereby gauging the predictive precision of each model. Results: ΔSpO2, ODR, ORR, T90, d.T90, r.T90, ST90, d.ST90 and r.ST90 for each type of respiratory events showed MA>OA>CA>Hyp, and e-minSpO2 showed MA<OA<CA<Hyp. Logistic regression showed that e-minSpO2, ΔSpO2, d.DSpO2, r.DSpO2, ODR, ORR, d.T90, r.T90, d.ST90 and r.ST90 were independent predictors for Hyp, ΔSpO2, d.DSpO2, r.DSpO2, ORR, d.T90, r.T90, d.ST90 and r.ST90 were independent predictors for OA, ΔSpO2, d.DSpO2, r. DSpO2, ODR, ORR, r.T90, d.ST90 and r.ST90 were independent predictors for CA, while e-minSpO2, ΔSpO2, d.DSpO2, r.T90, d.ST90 and r.ST90 were independent predictors for MA. The area under the ROC curve (AUC) of the H, O, C, and M models were 0.875, 0.751, 0.755, and 0.749, respectively, and all models had high specificity (0.865, 0.722, 1.000, and 0.993, respectively) and negative predictive values (0.871, 0.692, 0.904, and 0.881, respectively). Conclusions: Four predictive models for respiratory event types can be constructed based on hypoxic parameters, providing a feasible novel tool for applying nocturnal SpO2 to automatically identify respiratory event types.

Hypoglossal Stimulation: Indication, Surgical Technique and Clinical Results

Hypoglossal stimulation is a safe and effective treatment option for patients with obstructive sleep apnea and unsuccessful PAP therapy. A number of criteria must be met for the indication: proof of failed PAP therapy and ineffectiveness of the other therapy alternatives, AHI of 15-65/h (a relevant number of central and/or mixed apneas should be excluded) and BMI up to max. 35kg/m2. In the case of the respiratory-synchronous and bilateral stimulation system, a complete concentric collapse at the velum level should currently be ruled out in DISE. In the future, stimulation of the branch of the ansa cervicalis innervating the sternothyroid muscle and the ramus internus of the superior laryngeal nerve could open up additional treatment options.

Ventricular assist devices and sleep-disordered breathing-A mechanical heart stimulating a sleepy brain.

Sleep-disordered breathing, including obstructive sleep apnea (OSA) and central sleep apnea (CSA), is common in severe heart failure (HF) patients. There is limited data on the effect of left ventricular assist devices (LVAD) on sleep apnea. We performed a retrospective review of 350 durable LVAD patients and found 5 with a history of pre- and post-LVAD sleep studies. All five patients had OSA, and three had concomitant CSA. We observed reduced apnea-hypopnea index following LVAD placement. This was due to a near abolishment of CSA in three mixed sleep apnea patients-as seen by a central apnea index improvement from an average of 25.9 ± 13.1 to 1.4 ± 2.5 events per hour (p = 0.063). LVAD placement was associated with an increase in thermodilution cardiac output from 2.7 ± 0.6 to 4.1 ± 1.1 L/min (p = 0.014). These findings support chemoreception physiology seen in patients with poor circulation and the effect of restoring this circulation with LVAD support.

Catathrenia in severe obstructive sleep apnea: A novel entity never described before

Catathrenia in severe obstructive sleep apnea: A novel entity never described before

Prevalence of Sleep-Disordered Breathing in Prader-Willi Syndrome.

Sleep-disordered breathing (SDB) is common in patients with Prader-Willi Syndrome (PWS). However, the prevalence of SDB varies widely between studies. Early identification of SDB and factors contributing to its incidence is essential, particularly when considering growth hormone (GH) therapy. The aims of the study were to describe the prevalence and phenotypes of sleep-disordered breathing (SDB) in patients with Prader-Willi syndrome (PWS) and to determine the effects of age, gender, symptoms, GH therapy and body mass index on SDB severity. This study was a retrospective chart review of all patients with genetically confirmed Prader-Willi syndrome who underwent diagnostic overnight polysomnography (PSG) in the sleep laboratory at Sidra Medicine. Clinical and PSG data of enrolled patients were collected. We identified 20 patients (nine males, eleven females) with PWS who had overnight sleep polysomnography (PSG) at a median age (IQR) of 5.83 (2.7-12) years. The median apnea-hypopnea index (AHI) was 8.55 (IQR 5.8-16.9) events/hour. The median REM-AHI was 27.8 (IQR 15-50.6) events/hour. The median obstructive apnea-hypopnea index (OAHI) was 7.29 (IQR 1.8-13.5) events/hour. The median central apnea-hypopnea index (CAHI) was 1.77 (IQR 0.6-4.1) events/hour. Nineteen patients (95%) demonstrated SDB by polysomnography (PSG) based on AHI ≥1.5 events/hour. Nine patients (45%) were diagnosed with obstructive sleep apnea (OSA). Three patients (15%) were diagnosed with central sleep apnea (CSA). Seven patients (35%) were diagnosed with mixed sleep apnea. No correlations were observed between AHI and age, gender, BMI, symptoms, or GH therapy. However, REM-AHI was significantly correlated with BMI (P=0.031). This study shows a high prevalence of SDB among our patients with PWS. Obstructive sleep apnea was the predominant phenotype. BMI was the only predictor for high REM-AHI. Further studies of large cohorts are warranted to define SDB in PWS and design the appropriate treatment.