Obstructive Sleep Apnea In Men Research Articles

The association between sedentary behavior and obstructive sleep apnea: a cross-sectional study from the NHANES (2007–2008 to 2015–2020)

BackgroundSedentary behavior (SB) may contribute to obesity and lower extremity fluid retention, which may favor the development of obstructive sleep apnea (OSA). However, linking sedentary behavior to OSA is unclear. The purpose of this study was to determine if there is an association between SB and OSA.MethodsThree typical questions in the NHANES questionnaire(①The frequency of feeling excessively sleepy per month. ②The frequency of gasping, snorting or stopping breathing per week. ③The frequency of snoring per week.) have been used for the assessment of OSA. A physical activity questionnaire(On a typical day, the amount of time you spend sitting or reclining.) was used to assess SB. This secondary analysis included National Health and Nutrition Examination Survey (NHANES) participants (unweighted = 20,115). Weighted sample and multiple logistic regression complex sample analysis techniques were used in this study.ResultsAfter adjustment for confounders, participants with SB(> 8 h/d) had a higher risk of OSA compared to SB(< 4 h/d). Stratified analysis by gender showed that there was no significant association of SB and OSA in men. However, in women, with SB(< 4 h/d) as the reference, participants with(≥ 4 h/d) had an increased risk of OSA. By age-stratified analysis, the association of SB with OSA was stronger among older participants.ConclusionAnalysis in this study showed a positive association between SB and OSA, more pronounced in women and participants older than 60 years old.

Rethinking the distribution of sleep services: discrepancy of obstructive sleep apnoea in rural compared with metropolitan men in Australia - a large national survey.

Geographical location is increasingly recognised as a contributor to health inequity, with barriers including travel distances and a shortage of healthcare services. Individuals living in rural areas are known to have increased illness and comorbidities. Obstructive sleep apnoea (OSA) is one such illness. OSA is a condition where a person repeatedly pauses breathing while asleep due to their airways becoming wholly or partially blocked, and it is associated with various chronic diseases. Exploration into the effects of these barriers on OSA is limited. This study explores the proportion of diagnosed and undiagnosed OSA in men living in rural compared to metropolitan areas. This was a cross-sectional, secondary analysis of the Australian Ten to Men dataset. The present study looked at men aged over 18 years diagnosed with OSA in their lifetime from wave 2 (n=10 513) and wave 3 (n=7262) of the dataset. Wave 2 data were collected between November 2015 and May 2016, and wave 3 between July 2020 and February 2021. In wave 2, a higher proportion of rural men were diagnosed with OSA than metropolitan men (OR, 1.47, 95%CI 1.22-1.78, p<0.001), but not regional men. In addition, a significantly higher proportion of men in rural areas were at risk for OSA than metropolitan men (37.7% v 32.6%, p<0.0001). However, men living rurally were older, had higher BMI and lower socioeconomic status. Location was no longer a significant predictor of OSA after controlling for age, BMI and socioeconomic status. In wave 3, rate of diagnosis of OSA during the lifetime was no longer significantly associated with location (p=0.057) or being diagnosed with OSA in the previous 12 months (p=0.062). This study highlights the need to ensure adequate services in rural areas, given the higher proportion of men diagnosed with, or at risk of, OSA in rural areas. OSA is also associated with an increase risk of comorbidities such as heart disease, hypertension and diabetes, which are diseases also seen more prevalently in rural men. Rethinking the distribution of healthcare services will go some way to addressing this problem.

Hypogonadism in men with obstructive sleep apnea and its related risk factors

Background Sleep-related breathing disorders, including obstructive sleep apnea (OSA), have been linked to altered hypothalamic–pituitary–gonadal axis. Hypoxia, sleep fragmentation. and decreased deep sleep time in patients with OSA affect the hypothalamic–pituitary–gonadal axis, including serum luteinizing hormone (LH) and testosterone levels. Purpose To study serum levels of LH and testosterone in men with OSA and to investigate the possible risk factors that could affect their levels. Patients and methods This was a prospective cohort case–control study. The case group included 16 adult patients diagnosed with OSA confirmed by polysomnography. The control group included 16 matched healthy participants. Both groups were subjected to history taking, clinical examination, and investigations, including the Epworth sleepiness scale, BMI, neck circumference measurement, and serum levels of LH and testosterone. Results Patients with OSA had significantly higher mean levels of serum LH compared with healthy controls (P=0.031). The mean serum level of testosterone was lower in the OSA group compared with the matched controls; however, this difference was statistically insignificant (P=0.192). Among the studied risk factors for altered hormonal levels in patients with OSA, there was a significant positive correlation between desaturation index and serum LH levels (P=0.046) and a significant negative correlation between Epworth sleepiness scale and serum testosterone levels (P=0.025). Conclusion Our findings suggest that OSA in men is associated with a dysfunction in the hypothalamic–pituitary–gonadal axis, represented as high levels of serum LH. Although serum levels of testosterone were lower in patients with OSA, the study was underpowered to show a statistically significant difference.

PS-C32-5: GENDER DIFFERENCE IN HYPERTENSIVE PATIENTS ASSOCIATED WITH PROBABLE OSA

Objectives: Obstructive Sleep Apnea (OSA) has high association with hypertension and cardiovascular disease. OSA has been widely proven to be more common in men than women possibly due to pathophysiological difference and clinical presentations. However, there are limited studies on assessing the gender difference in correlation between OSA and hypertensive patients. This study aimed to examine the determinants of probable OSA according to gender among hypertensive patients in primary care clinics. Design and Methods: A cross-sectional study was carried out using systematic random sampling method in hypertensive patients who attended two government primary care clinics in Sarawak, Malaysia. A validated STOP-Bang questionnaire was used in this study and socio-demographic data was captured with questionnaire. Probable OSA was defined as STOP BANG score of 3 and above. SPSS version 23 was used to do the analysis and multivariate logistic regressions were used to determine the determinants of probable OSA according to gender. Results: 440 hypertensive patients were enrolled into this study, 60.7% of them were female. There was a higher proportion of male patients (92.5%) found to have probable OSA as compared to female patients (30%) (p &lt; 0.001). Looking into criteria of STOP BANG, between female and male patients, there were significant differences in daytime symptoms (p = 0.020) and BMI categories (p = 0.001). As for demographic data, the determinant of probable OSA in men were low income (&lt;RM3,000) (AOR = 4.320, P = 0.022, 95% confidence interval [CI] 1.23,15.15), longer duration of hypertension (AOR = 1.269, P = 0.029, 95% CI 1.03,1.57) and being married (AOR = 5.612, P = 0.021, 95% CI 1.30,24.22). For female, the determinant of probable OSA were neck circumference (AOR = 1.613, P = 0.002, 95% CI 1.19,2.81) and Chinese ethnicity (AOR = 11.711, P = 0.013, 95% CI 1.67,81.95). Conclusion: In conclusion, this study reported that among hypertensive patients, OSA is more prevalent in men than women, and criteria of STOP BANG and clinical characteristics are significantly different between gender. Primary care clinicians should be aware of these difference and screen for probable OSA accordingly for further early intervention.

Risk stratification by sex and menopausal status in the multivariable apnea prediction index.

To determine the sensitivity of the Multivariable Apnea Prediction (MAP) index for obstructive sleep apnea (OSA) in pre- and post-menopausal women with the goal of developing a tailored scoring classification approach. Data from two studies (N = 386); the diabetes sleep treatment trial (N = 236) and EMPOWER (N = 150) were used to assess the sensitivity and specificity of the MAP index by comparing men (n = 129) to women (n = 257), and premenopausal (n = 100) to post-menopausal women (n = 136). We evaluated participants at two cut points, apnea-hypopnea index (AHI) values of ≥ 5 and ≥ 10, using 0.5 as a predicted probability cut point to establish baseline sensitivity and specificity. Contingency tables and receiver operating characteristic (ROC) analysis were conducted to evaluate the accuracy of the MAP index in predicting OSA in men versus women, and in pre-versus post-menopausal women. To select optimal predicted probabilities for classification by sex and menopausal status, Youden's J statistic was generated from ROC coordinates. The MAP index was more sensitive to women in the AHI ≥ 5 group (76%) compared to AHI ≥ 10 group (30%). Among post-menopausal women with AHI ≥ 5, sensitivity was similar to men (98%), but less than men when AHI ≥ 10 (32%). Suggested probability cut points for women with an AHI ≥ 10 are 0.24 overall; 0.15 for premenopausal, and 0.38 for postmenopausal women. Because women's risk for OSA (AHI ≥ 10) was underestimated by the MAP index, we suggest the use of tailored cut points based on sex and menopausal status or assessing for OSA risk with an AHI of ≥ 5.

Obstructive Sleep Apnea in Men With Idiopathic Intracranial Hypertension: A Prospective Case-Control Study.

Idiopathic intracranial hypertension (IIH) is uncommon in men. Previous studies reported on high frequency of obstructive sleep apnea (OSA) in men with IIH, but the pathophysiology of this association remains unclear. One possible culprit for increased intracranial pressure in patients with OSA is hypercapnia. The purpose of this study was to compare the rate of hypercapnia during polysomnography (PSG) study in men with and without IIH and to report on the rate and severity of OSA in men with IIH compared with control subjects of similar age and body mass index (BMI). Prospective case-control study of male patients diagnosed with IIH underwent PSG with continuous oxygen and carbon dioxide monitoring overnight. Healthy control subjects with similar age and BMI also underwent PSG. The incidence of OSA diagnosis, rate of hypercapnia and hypoxia, and apnea hypopnea index (AHI) were compared between 2 groups. Eleven subjects with IIH and 10 controls underwent PSG. Both groups were similar regarding age and BMI on the Mann-Whitney U test ( P = 0.072 for age, P = 0.251 for BMI). Subjects for whom carbon dioxide data were not available for more than 50% of total sleep time were excluded from hypercapnia analysis. The mean age was 41.9 years, and the mean BMI was 33.8 kg/m 2 in subjects and controls. OSA was diagnosed in 9 of 11 men with IIH and 4 of 10 controls. There was no statistically significant difference in the rate of hypercapnia and hypoxia between 2 groups for whom the data were available. All patients with BMI over 30 kg/m 2 (7 of 7) and 50% (2 of 4) controls with BMI over 30 kg/m 2 were diagnosed with OSA compared with 50% (2 of 4) of cases and 33% (2 of 6) of controls with BMI less than 30 kg/m 2 . BMI was a significant predictor of total AHI ( P = 0.042) and OSA severity ( P = 0.023), but IIH diagnosis was not ( P > 0.05). There was no difference in hypercapnia rate between men with IIH and controls; thus, hypercapnia is an unlikely causative factor in pathophysiology of IIH. OSA on PSG was almost 2 times as prevalent in patients with IIH compared with controls; however, BMI was the strongest predictor of OSA diagnosis, and most patients (9 of 11) with BMI over 30 kg/m 2 had OSA on PSG. In men with BMI less than 30, the rate of OSA on PSG study was higher in men with IIH. Based on these data, we recommend that all men with the diagnosis of IIH should undergo PSG study.

Morbidities Worsening Index to Sleep in the Older Adults During COVID-19: Potential Moderators.

Older adults were considered a vulnerable group for the COVID-19 infection and its consequences, including problems with sleep.AimTo evaluate the prevalence of sleep disorders in older adults, to describe their sleep patterns, as well as to analyse if there were any changes in comparison with the period pre-pandemic.Materials and MethodsOnline survey used for data collection received answers from 914 elderly age range 65–90 years, from April to August 2020. Results: 71% of the sample reported a pre-existent sleep disorder, and some of them worsened during the pandemic, especially Insomnia in women and Obstructive Sleep Apnea in men. No difference in sleep duration before and during the pandemic was found, although there was a worsening of some aspects related to sleep, such as sleep quality, sleep efficiency, awakening quality, sleep latency and nocturnal awakenings, especially in the female gender. Educational level influenced sleep latency, indicating higher sleep latency among those with primary education when compared with the ones with Ph.D.ConclusionThe pandemic had influenced sleep patterns among the elderly, as well as worsening of pre-existent sleep disorders. Female gender and low educational level were considered risk factors for sleep alterations, and high educational level, on its turn, appeared to be a protective factor.

0710 Validation of the Predictive Utility of the Multivariable Apnea Index for Obstructive Sleep Apnea in Women

Abstract Introduction The Multivariable Apnea Prediction (MAP) index is a commonly used screening tool for obstructive sleep apnea (OSA). Previous analyses have demonstrated higher sensitivity of the MAP in predicting OSA in men versus women and in post-menopausal versus pre-menopausal women with type 2 diabetes (T2DM) and an apnea-hypopnea index (AHI) ≥10. The purpose of this secondary analysis was to validate previous findings by comparing women with and without T2DM across all categories of OSA severity including mild (AHI ≥5). Methods The sample (N=386) was comprised of participants from the Diabetes Sleep Treatment Trial who were recruited because of risk for OSA with T2DM (n=279), and the EMPOWER study which examined triggers for lapses or relapse after intentional weight loss in overweight but otherwise healthy participants (n=115). AHI was assessed by in-home sleep study, ApneaLink Plus®. Descriptive statistics and binomial logistic regression and receiver operating characteristic analyses were conducted to evaluate classification of OSA diagnosis, defined as AHI ≥5 or ≥10, by MAP between sexes and by menopause status. Results Participants were middle aged (mean 54.09 years + 10.63), obese (mean BMI of 34.79 + 6.52 kg/m2), primarily female (67%), and white (64%). Compared to men, women were younger (52.99 years + 10.15 vs. 56.26 years + 11.25, p=0.004) and had a lower AHI (9.10 + 18.94 vs. 17.25 + 18.94, p&amp;lt;0.001). No significant differences, except for age, were noted between pre- and post-menopausal women. Sensitivity of MAP on OSA diagnosis was higher for men than women (AHI ≥5: 94.7% vs. 76%; AHI ≥10: 84.2% vs 29.6%). Sensitivity of MAP on OSA diagnosis was lower for pre-menopausal than post-menopausal women using AHI ≥5 (74.0% vs. 98.8%) and AHI ≥10 (19.0% vs. 32.1%). Conclusion This validation study corroborates previous findings that the MAP index was better at identifying OSA in men than women, and in post- versus pre-menopausal women using AHI values across all categories of OSA severity. Improved screening methods are needed to detect women at high risk for OSA. Support (If Any) This study was funded by the National Institutes of Health (R01-DK090628, R01-HL107370).

Insulin Resistance, Hyperglycemia, and Risk of Developing Obstructive Sleep Apnea in Men and Women in the United States.

Rationale: Recent prospective studies suggest diabetes as a risk factor for the development of obstructive sleep apnea (OSA). However, the extent to which diabetes-related traits, such as hyperglycemia and insulin resistance, are related to OSA risk remains uncertain. Objectives: To examine the risk of developing OSA according to baseline concentrations of fasting insulin and hemoglobin A1c (HbA1c). Methods: Participants from four prospective U.S. cohorts were included: NHS (Nurses' Health Study; 2002-2012), NHSII (Nurses' Health Study II; 1995-2013), HPFS (Health Professionals Follow-up Study; 1996-2012), and MESA (Multi-Ethnic Study of Atherosclerosis; 2000-2012). OSA was assessed by self-reported clinical diagnosis in NHS/NHSII/HPFS and at-home polysomnography in MESA (defined as Apnea-Hypopnea Index ⩾30). Results: Of 9,283 participants with fasting insulin data, 790 (8.5%) developed OSA over 10 to 18 years of follow-up. After adjusting for sociodemographic, lifestyle, and comorbidity factors, the odds ratio for incident OSA comparing the extreme quintiles of fasting insulin was 3.59 (95% confidence interval, 2.67-4.82; P-trend < 0.0001). Of 6,342 participants with HbA1c data, 715 (11.3%) developed OSA. The comparable odds ratio for HbA1c was 2.21 (95% confidence interval, 1.69-2.89; P-trend < 0.0001). Additional adjustment for body mass index and waist circumference attenuated the associations for fasting insulin (P-trend = 0.005) and HbA1c (P-trend = 0.03). In the fully adjusted model simultaneously including both biomarkers, only fasting insulin but not HbA1c was associated with OSA risk. Conclusions: Independent of obesity, insulin resistance may play a more important role than hyperglycemia in the pathogenesis of OSA. Given the limitation of using self-reported diagnosis to exclude baseline prevalent OSA cases, additional studies are needed to further establish the temporal relationship and assess whether improving insulin resistance may reduce OSA risk.

Prevalence and Severity of Obstructive Sleep Apnea in Men with Polycythemia on Testosterone Therapy

ABSTRACT Introduction Polycythemia is independently associated with both testosterone therapy (TTH) and obstructive sleep apnea (OSA). Objective The purpose of this study was to evaluate the prevalence and severity of OSA in men who experience polycythemia while on TTH. Methods Study population included men who had polycythemia [hematocrit (HCT) &amp;gt;50%] while on TTH for TD, with total and free T levels within the normal range. Men completed screening questionnaires for OSA and daytime sleepiness, respectively: STOP-BANG (SB, range 0-8) and the Epworth Sleepiness Scale (ESS, range 0-24). Men whose scores demonstrated intermediate to high risk of OSA proceeded to a diagnostic sleep study which recorded the following parameters: apnea hypoxia index (AHI, normal &amp;lt;5 events/h), total duration SpO2 saturation &amp;lt;88% and SpO2 nadir. Descriptive statistics are presented. Results 73 men had a mean age of 60±11.5 years. Mean HCT pre-TTH and on TTH were 45±3% and 52±1.5%, respectively, for a mean increase of 6.6±3.6%. Mean on-treatment total T level 686±285 ng/dL. Median STOP-BANG score was 4 (IQR 3-5), median ESS score was 5 (IQR 3-9). 63% of patients screened positive for OSA on questionnaires. 81% of sleep studies confirmed OSA; mean AHI of the group was 15.4±13.2 events/hour (range 1.6-54.6 events/hour). 36% of men had AHI≥15 events/hour and 14% ≥30 AHI events/hour. Mean SpO2 nadir was 83±5% (range 69%-93%). 67% of men with OSA had an oxygen nadir in the 80s, 19% in the 70s and 3% in the 60s. Total duration of hypoxia (SpO2 ≤88%) was 32±50 minutes (range 0.1-202 minutes), 46% of men having hypoxia &amp;lt;10 minutes, 8% 10-20 minutes, 19% 70-150 minutes. Conclusions Men on TTH who are eugonadal that experience polycythemia have high rates of OSA. 80% of the patients undergoing sleep study had OSA. These data suggest that men with polycythemia on TTH should be screened for OSA. Disclosure No

Epidemiology of obstructive sleep apnea in older patients with stable cardiovascular disease and chronic kidney disease

Abstract Funding Acknowledgements Type of funding sources: None. Obstructive sleep apnea (OSA) is diagnosed late, especially in older people. The presence of chronic hypoxia and glomerular hypertension decrease renal function in patients with OSAS, which causes the progression of chronic kidney disease (CKD) [3]. The aim of the study was to investigate epidemiological aspects of OSA in older patients with stable cardiovascular disease and chronic kidney disease. Materials and methods 80 older patients with stable cardiovascular disease (43 males, mean age was 67.6 ± 6.1 years) were studied. CKD was diagnosed and classified according to the KDIGO guidelines (2012). OSA was observed according to Clinical Guidelines for Obstructive Sleep Apnea and Insomnia (U.S., 2020). Berlin Questionnaire and Epworth Sleepiness Scale, cardiorespiratory monitoring for screening and diagnosis of OSA were used. Follow-up period was 12 months. Results Chronic kidney disease was observed in 48 (60%) patients. There were no patients with stages 1 and 2 of CKD, stage 3a was detected in 35 (43.8%), 3b - in 10 (12.5%), stage 4 - in 3 (3.8%) patients. Significant daytime sleepiness was observed in every fourth elderly and senile patient with CKD (12; 25%). A high risk of OSA was observed in the majority of patients with CKD - 34 (70.8%). OSA was first diagnosed in 31 (64.5%) patients with CKD. Moreover, the frequency did not depend on gender (p = 0.39) and age (p = 0.48). There were no differences between elderly (60-74 years old) and senile patients (75-89 years old) in the prevalence of OSAS (p&amp;gt; 0.05).More than half had an average degree of OSA (19; 61.3%). Mild and severe degrees were observed with the same frequency in 6 (19.4%) older patients with CKD. Severity of OSA in men and women did not differ (p&amp;gt; 0.05). The average level of oxygen saturation was higher in men: 93.4 (92.4; 94.15) and 92.3 (91.7; 93.1)%, respectively, p = 0.02. There were no differences in the frequency of OSA detection depending on the stage of CKD (p&amp;gt; 0.05). Only 2 (6.5%) patients with OSA and CKD was consulted a somnologist after 12 months of observation Conclusion A high prevalence of OSA was observed in most older patients with stable cardiovascular disease and CKD (34; 70.8%), significant daytime sleepiness was observed in every fourth patient. OSA was first diagnosed in 31 (64.5%) patients with CKD, despite the high risk and clinical symptoms. The severity of OSAS did not depend on gender, age, and the presence of CKD in older patients with stable cardiovascular disease . Subsequently only 2 (6.5%) patients in a sleep consulted, which reflects a low level of overall patient health awareness and availability of quality somnological aid.

Does Nasal Obstruction Induce Obstructive Sleep Apnea in Healthy Women?

PurposeObstructive sleep apnea (OSA) is less prevalent among women and is associated with different symptoms and consequences to OSA in men. The reasons for these differences are unknown and difficult to tease apart in clinical populations. If OSA could be temporarily induced in healthy men and women, the causes of some of these differences could be investigated. Nasal blocking has been used to induce OSA in healthy men but its effect in women has not been reported.Patients and MethodsA total of 14 healthy individuals (10 women) underwent in-laboratory diagnostic sleep studies on two occasions separated by a week. On one occasion, the nasal passages were blocked, whereas on the other occasion, participants slept naturally. In both conditions, a full-face mask was used to monitor respiratory events. Participants’ self-reported sleepiness, mood and performance on a motor learning task were assessed in the evening and morning of both sleep studies. Furthermore, endothelial function and self-reported sleep quality were assessed in the morning following each study.ResultsNasal blockage induced OSA in healthy young (age=22±3 years) and slim (BMI=22.2±3.2 kg/m2) women (control AHI=2.0±2.6, blocked AHI=33.1±36.7 events/hr, p=0.02). One night of OSA was associated with poorer self-reported sleep quality (p<0.001) and increased self-reported snoring (p<0.04), choking and gasping during sleep (p<0.001) but was not associated with alterations in mood, neurocognitive or endothelial function on the following morning.ConclusionNasal blockage induces OSA in healthy, young, and normal weight women. However, whether the induced OSA is representative of naturally occurring OSA and the technique useful for future studies is unclear.

Prevalence of obstructive sleep apnea in patients with type 2 diabetes: A systematic review and meta-analysis

Obstructive sleep apnea (OSA) is highly prevalent among patients with diabetes, intensifying the complications of the disease. Various studies in Iran have reported different prevalence rates. This systematic review and meta-analysis was performed to determine OSA prevalence in patients with type 2 diabetes in Iran. In this study, we evaluated five articles published in Persian and English. The articles were searched using the keywords of obstructive sleep apnea, sleep disordered breathing, sleep apnea, OSA, diabetes mellitus and Iran and all possible combinations of these terms in national databases of Scientific Information Database (SID) and Magiran and international databases of Google Scholar, Web of Science, PubMed and Scopus with no time limit. Data were analyzed using the meta-analysis and random effects model. In addition, the heterogeneity between studies was assessed using I2 statistic, and data analysis was performed in Stata version 11. In this study, five articles with a total sample size of 2360 were evaluated. According to the results, the prevalence of OSA in diabetic patients was reported to be 54.50% (95% Confidence Interval [CI]: 39.90–69.09). In addition, the results were indicative of a lower prevalence of OSA in men (63.26%; 95% CI: 43.26–83.26), compared to women (66.22%; 95% CI: 57.60–74.84). According to the results of the study, there was a high OSA prevalence in patients with type 2 diabetes. Therefore, it is crucial to recognize diabetic patients at risk of OSA to decrease the adverse effects of this condition.

Association of time of obesity onset with comorbidities in treatment-seeking men and women with severe obesity.

SummaryObjectivesEarly obesity onset is a risk factor for specific comorbidities in adulthood, but whether this relationship is present in men and women with severe obesity is unknown. This study aimed to examine whether obesity onset in childhood or adolescence, as compared with adulthood, is associated with higher odds of comorbidities in men and women with severe obesity.MethodsA cross‐sectional study of treatment‐seeking men and women with severe obesity attending a tertiary care centre in Norway, from 2006 to 2017, was performed.ResultsA total of 4,583 participants (69.13% women) were included. Almost all men (99.69%) and women (99.18%) suffered from ≥1 comorbidities. Compared with women, men were older (mean [SD]) (45.54 [12.14] vs. 42.56 [12.00] years, p < 0.001) and had higher body mass index (44.06 [6.16] vs. 43.39 [5.80] kg m−2, p < 0.001). The most prevalent comorbidities were non‐alcoholic fatty liver disease, dyslipidaemia and hypertension among men and dyslipidaemia, non‐alcoholic fatty liver disease and joint pain among women. After current age and body mass index were adjusted, childhood onset of obesity (0–11 years), compared with adult onset (>20 years), was associated with lower odds (OR [95% CI]) of obstructive sleep apnoea (OSA) in men (0.69 [0.53, 0.91], p < 0.01) and higher odds of OSA (1.49 [1.16, 1.91], p < 0.01) in women, and the interaction was significant (p < 0.01). Childhood onset of obesity was also associated with higher odds of coronary heart disease in men (1.82 [1.15, 2.89], p = 0.01) and type 2 diabetes in women (1.25 [1.01, 1.54], p = 0.04).ConclusionChildhood onset of obesity was associated with higher odds of coronary heart disease in men and OSA and type 2 diabetes in women, but with lower odds of OSA in men.

The effect of acute morphine on obstructive sleep apnoea: a randomised double-blind placebo-controlled crossover trial

ObjectiveAnaesthesiology guidelines suggest that opioids worsen obstructive sleep apnoea (OSA) despite no randomised controlled trial evidence. We therefore conducted a randomised controlled trial to evaluate the effects of a common...

Determinants of Slow-Wave Activity in Overweight and Obese Adults: Roles of Sex, Obstructive Sleep Apnea and Testosterone Levels.

Background: Slow-wave activity (SWA) in non-rapid eye movement (NREM) sleep, obtained by spectral analysis of the electroencephalogram, is a marker of the depth or intensity of NREM sleep. Higher levels of SWA are associated with lower arousability during NREM sleep and protect against sleep fragmentation. Multiple studies have documented that SWA levels are higher in lean women, compared to age-matched lean men, but whether these differences persist in obese subjects is unclear. Obstructive sleep apnea (OSA), a condition associated with obesity, is more prevalent in men than in women. Sex differences in SWA could therefore be one of the factors predisposing men to OSA. Furthermore, we hypothesized that higher levels of testosterone may be associated with lower levels of SWA.Objective: The aim of the current study was to identify sex differences in the determinants of SWA in young and middle-aged overweight and obese adults.Methods: We enrolled 101 overweight and obese but otherwise healthy participants from the community (44 men, 57 women) in this cross-sectional study. Participants underwent an overnight in-laboratory polysomnogram. The recordings were submitted to sleep staging and spectral analysis. Sex differences and the potential contribution of testosterone levels were evaluated after adjusting for age, body mass index and race/ethnicity.Results: OSA was present in 66% of men and in 44% of women. After adjustment for differences in age, race/ethnicity and BMI, the odds ratio for OSA in men vs. women was 3.17 (95% CI 1.14–9.43, p = 0.027). There was a graded inverse relationship between the apnea-hypopnea index (AHI) and SWA in men (β = −0.21, p = 0.018) but not in women (β = 0.10, p = 0.207). In a multivariate regression model, higher testosterone levels were independently associated with lower SWA in men after controlling for age, race/ethnicity and apnea-hypopnea index (β = −0.56, p = 0.025).Conclusion: Increasing severity of OSA was associated with significant decrease in sleep intensity in men but not in women. Higher testosterone levels were associated with lower sleep intensity in men. Men with higher testosterone levels may therefore have lower arousal thresholds and higher ventilatory instability in NREM sleep, and be at greater risk of OSA.

Impact of testosterone replacement therapy on thromboembolism, heart disease and obstructive sleep apnoea in men.

To assess the association of testosterone replacement therapy (TRT) with thromboembolism, cardiovascular disease (stroke, coronary artery disease and heart failure) and obstructive sleep apnoea (OSA). A cohort of 3 422 male US military service members, retirees and their dependents, aged 40-64 years, was identified, who were prescribed TRT between 2006 and 2010 for low testosterone levels. The men in this cohort were matched on a 1:1 basis for age and comorbidities to men without a prescription for TRT. Event-free survival and rates of thromboembolism, cardiovascular events and OSA were compared between men using TRT and the control group, with a median follow-up of 17 months. There was no difference in event-free survival with regard to thromboembolism (P = 0.239). Relative to controls, men using TRT had improved cardiovascular event-free survival (P = 0.004), mainly as a result of lower incidence of coronary artery disease (P = 0.008). The risk of OSA was higher in TRT users (2-year risk 16.5% [95% confidence interval 15.1-18.1] in the TRT group vs 12.7% [11.4-14.1] in the control group. This study adds to growing evidence that the cardiovascular risk associated with TRT may be lower than once feared. The elevated risk of OSA in men using TRT is noteworthy.

Association between obstructive sleep apnea and comorbidities with periodontal disease in adults.

Background:Several studies have reported an association between periodontal disease and obstructive sleep apnea (OSA). However, heterogeneity of results suggests that there is insufficient evidence to support this association.Aims:The objective of this study was to identify the association between periodontal disease and OSA in adults with different comorbidities.Settings and Design:One hundred and ninety-nine individuals (107 women and 92 men) underwent polysomnography with a mean age of 49.9 years were recruited.Materials and Methods:The presence of OSA, comorbidities, and periodontal disease was evaluated in each individual. Student's t-tests or Chi-square and ANOVA tests were used to determine the differences between groups.Results:The prevalence of periodontal disease was 62.3% and 34.1% for gingivitis. The results showed no statistically significant association between all groups of patients with OSA and non-OSA patients for gingivitis (P = 0.27) and for periodontitis (P = 0.312). However, statistically significant association was shown between periodontitis and mild OSA compared with the periodontitis and non-OSA referent (P = 0.041; odds ratio: 1.37 and 95% confidence interval 1.11–2.68). The analysis between OSA and comorbidities showed a statistically significant difference for patients with OSA and hypertension (P < 0.001) and for patients with OSA and hypertensive cardiomyopathy (P < 0.001) compared with healthy individuals. Periodontitis was more likely in men with severe OSA and with any of two comorbidities such as hypertension or hypertensive cardiomyopathy. Women with hypertension or hypertensive cardiomyopathy were more likely to have mild OSA, and these associations were statistically significant (P < 0.05).Conclusions:This study identified association between periodontitis and mild OSA and this association was more frequent in women with hypertension or hypertensive cardiomyopathy. Periodontitis was associated with severe OSA in men who showed any of two comorbidities such as hypertension or hypertensive cardiomyopathy.

Associations of Undiagnosed Obstructive Sleep Apnea and Excessive Daytime Sleepiness With Depression: An Australian Population Study.

To determine whether undiagnosed obstructive sleep apnea (OSA) and/or excessive daytime sleepiness are associated with symptomatic depression in Australian men. Participants were randomly selected, urban community dwelling men aged 40 to 88 years without a prior diagnosis of OSA. Clinically significant depressive symptoms were assessed using the Beck Depression Inventory-1A or Centre for Epidemiological Studies Depression Scale (2007-2010). A random sample of men (n = 788) undertook full at-home unattended polysomnography (Embletta X100, Broomfield, Colorado, United States) and completed the Epworth Sleepiness Scale questionnaire (2010-2012). Undiagnosed severe obstructive sleep apnea (apnea-hypopnea index ≥ 30 events/h) was associated with depressive symptoms (adjusted odds ratio = 1.98; 95% confidence interval [CI] 1.05-3.73; P = .036). However, a significant interaction was observed between obstructive sleep apnea and excessive daytime sleepiness (P = .03) such that individuals with OSA and excessive daytime sleepiness (Epworth Sleepiness Scale score of 10 or higher) exhibited the strongest associations with depression (mild-moderate apnea: adjusted odd ratio = 3.86; 95% CI 1.87-7.95; severe apnea: adjusted odd ratio = 4.82; 95% CI 1.42-16.35) when compared to individuals without apnea. Depressive symptoms in men were associated with undiagnosed OSA in the community. It is important that clinicians and primary care practitioners consider screening for depression in men with severe OSA and for OSA in men with depression. Screening for depression should also be considered in men with excessive daytime sleepiness regardless of OSA severity.

A Review on Obstructive Sleep Apnoea in Men

Sleep apnoea occurs by the blockage of airway/airline when throat muscles relax and soft tissue near the throat collapses during sleep, so due to collapsing of soft tissue the chest muscles and diaphragm work tougher as the pressure generated to open the blocked air route, breathing/inhalation typically continues with a loud-gasp and body-jerk. It supply the poor flow of oxygen in to vital organs in the body, and produce heart rhythm irregularities. Sleep apnoea is the most common sleep issue, common in general population which affect 40-45% of all men on a regular basis. Sleep apnoea may be strongly connected with obesity and hypertension in men, affecting an individual quality of life.