Prevalence Of Sleep Apnea Syndrome Research Articles

Assessing sleep-related breathing disorders among newly diagnosed rheumatoid and psoriatic arthritis patients: a cross-sectional study.

This cross-sectional study aimed to determine the prevalence and risk factors for sleep-related breathing disorders (SRBD) in newly diagnosed, untreated rheumatoid arthritis (RA) and psoriatic arthritis (PsA) patients, and to develop a screening algorithm for early detection. We evaluated newly diagnosed RA or PsA patients using the Epworth Sleepiness Scale (ESS) questionnaire, cardiorespiratory polygraphy (RPG), and clinical and laboratory assessments. Sleep apnea syndrome (SAS) was diagnosed based on pathological RPG findings excessive daytime sleepiness, defined as ESS score above 10. The study included 39 patients (22 RA, 17 PsA) and 23 controls. In RPG, SRBD was identified in 38.5% of arthritis patients compared to 39.1% of controls (p = 1.00), with male gender (p = .004) and age (p < .001) identified as risk factors. Excessive daytime sleepiness was noted in 36.4% of RA patients, 17.6% of PsA patients, and 21.7% of controls. Of the 24 patients diagnosed with SRBD, 41.6% met the criteria for SAS. SAS prevalence was 31.8% among RA patients, 0% in PsA patients, and 13% in controls. A significant association was observed between excessive daytime sleepiness and SRBD (p = .036). Our findings reveal a high prevalence of SRBD in newly diagnosed, untreated RA and PsA patients in ESS and RPG, with excessive daytime sleepiness being a reliable predictor of SRBD. Patients with RA exhibited a higher predisposition to SAS. We therefore suggest incorporating ESS and RPG as screening tools in RA or PsA for early detection and management of SRBD.

Sleep disordered breathing assessment in patient with slowly progressive neuromuscular disease

BackgroundSleep-disordered breathing (SDB) is common in patients with neuromuscular diseases (NMD). Focusing on hypercapnia may lead to the neglect of other SDB such as obstructive and/or central sleep apnea syndrome (SAS). Our objectives were to assess the risk of inappropriate SDB management according to different screening strategies and to evaluate the prevalence and determinants of isolated and overlapping sleep apnea in patients with slowly progressive NMD. MethodsThis monocentric, cross-sectional, retrospective study analyzed medical records of adult NMD patients referred to a sleep department. Diagnostic strategies, including respiratory polygraphy (RP), nocturnal transcutaneous capnography (tcCO2), and blood gases (BG), were assessed for their performance in diagnosing SDB. Demographics and pulmonary function test results were compared between patients with or without SDB to identify predictors. ResultsAmong the 149 patients who underwent a full diagnostic panel (RP + tcCO2 + BG), 109 were diagnosed with SDB. Of these, 33% had isolated SAS, and central apneas were predominant. Using single diagnostic strategies would lead to inappropriate SDB management in two thirds of patients. A combination of 2 diagnostic tools resulted respectively in 21.1, 22.9 and 42.2 % of inappropriate SDB management for RP + tcCO2, RP + BG and tcCO2 + BG. ConclusionThe significant prevalence of sleep apnea syndrome in patients with slowly progressive NMD highlights the need for increased awareness among clinicians. Improved diagnostics involve a systematic approach addressing both sleep apnea and diurnal and nocturnal alveolar hypoventilation to avoid inappropriate management and limit the consequences of SDB.

Super-multifactorial survey YHAB revealed high prevalence of sleep apnoea syndrome in unaware older adults and potential combinatorial factors for its initial screening.

Study Objectives: Aging is a risk factor for sleep apnoea syndrome (SAS), which is associated with lower quality of life and sudden mortality. However, SAS is often overlooked in older adults without suspicions. Therefore, this study aimed to evaluate SAS incidence and 48 other general factors in older adults. Methods: This cross-sectional study included all non-caregiver-certified, healthy individuals (N = 32) who survived during the long-term cohort study and agreed to participate in apnoea-hypopnoea index (AHI) measurement (aged 83–95 years). AHI and 48 other general factors were evaluated, and simple linear regression analysis was used to identify potential AHI-related factors. Stepwise evaluation was further performed using multiple linear regression analyses. Results: Although no individuals were previously diagnosed with SAS, 30 (93.75%) participants had some degree of SAS (AHI > 5/h), and 22 (68.75%) had severe or moderate SAS (AHI > 15/h). Compared with typical single risk factors represented by body mass index, combining daily steps and other factors improved the fit to the multiple linear regression. Combining daily steps and body mass index improved the fit for males and combining daily steps and red blood cell count improved the fit for females. Conclusion: SAS was highly prevalent in unaware healthy Japanese older adults; combinations of daily steps and body mass index, and daily steps and red blood cell count may predict AHI in such individuals without the need for a specific AHI test.

Sleep, short-term memory, and mood states of volunteers with increasing altitude.

PurposeThis study sought to identify the changes and potential association between sleep characteristics and short-term memory, and mood states among volunteers at different altitudes and times.MethodA total of 26 healthy volunteers were recruited from the PLA General Hospital, and we conducted a longitudinal prospective survey for over 1 year from November 2019 to April 2021. First, we collected demographic data, sleep parameters by overnight polysomnography (PSG), short-term memory by digit span test, and mood states by completing a questionnaire with a brief profile of mood states among participants in the plain (53 m). Then, we continuously followed them up to collect data in the 3rd month at an altitude of 1,650 m (on the 3rd month of the 1-year survey period), the 3rd month at an altitude of 4,000 m (on the 6th month of the 1-year survey period), and the 9th month at an altitude of 4,000 m (on the 12th month of the 1-year survey period). Multiple linear regression analysis was used to construct models between sleep parameters and short-term memory, and mood states.ResultsThe prevalence of sleep apnea syndrome (SAS) significantly increased with rising elevation (P < 0.01). The apnea-hypopnea index (AHI), the mean apnea time (MAT), the longest apnea time (LAT), and the duration of time with SaO2 < 90% (TSA90) were increased (P < 0.05), and the mean pulse oxygen saturation (MSpO2), the lowest pulse oxygen saturation (LSpO2), and heart rate were significantly decreased with increasing altitude (P < 0.05). Digit span scores were decreased with increasing altitude (P < 0.001). A negative mood was more severe and a positive mood increasingly faded with rising elevation (P < 0.001). Additionally, linear correlation analysis showed that higher AHI, LAT, and MAT were strongly associated with a greater decline in short-term memory (in the 3rd and 9th month at an altitude of 4,000 m, respectively: rs = −0.897, −0.901; rs = −0.691, −0.749; rs = −0.732, −0.794, P < 0.001), and also were strongly associated with more severe negative mood (in the 3rd month at altitudes of 1,650 m and 4,000 m, respectively: rs = 0.655, 0.715, 0.724; rs = 0.771, 0.638, 0.737, P < 0.000625). Multiple linear regression pointed out that AHI was a significant predictor of negative mood among people at different altitudes (in the 3rd month at an altitude of 1,650 m: TMD = 33.161 + 6.495*AHI; in the 3rd month at an altitude of 4,000 m: TMD = 74.247 + 1.589*AHI, P < 0.05).ConclusionSAS developed easily in high altitudes, most often in CSA (central sleep apnea, CSA). The sleep, short-term memory, and negative mood were significantly more damaged with elevation in volunteers. Sleep parameters were closely associated with short-term memory and mood states in volunteers at high altitudes; the higher the sleep parameters (AHI, LAT, and MAT) scores, the more significant the mood disorders and the more obvious impairment of short-term memory. AHI was a critical predictor of the negative mood of volunteers at different altitudes. This study provides evidence that could help with the prevention and control of sleep disorder, cognitive disorder, and negative mood among populations with high altitudes.

INTERMITTENT HEART BLOCK IN OSA

INTERMITTENT HEART BLOCK IN OSA

Impact of sleep-disordered breathing on the management of children with Chiari malformation type I.

Children with Chiari malformation type I (CM-I) have an increased risk of sleep apnea. The aim of the study was to describe the management of CM-I patients in relation to symptoms, magnetic resonance imaging (MRI) findings and sleep apnea syndrome (SAS). We performed a retrospective analysis of clinical charts of all 57 CM-I patients seen between September 2013 and April 2017. A total of 45 patients had isolated CM-I or associated co-morbidity (CM-Iia), 5 had craniosynostosis (CM-Ics), and 7 a polymalformative syndrome (CM-Ipm). The prevalence of SAS, defined as an apnea-hypopnea index >1 event/h, was high in CM-I ranging from 50% to 80% according to the CM-I group. The prevalence of central sleep apnea (CSA) was low, with 5 (9%) patients having CSA and only 3 patients with CM-Iia having isolated CSA. A total of 17 patients (30%) had foramen magnum decompression (FMD). Neither positive symptoms of CM-I nor MRI findings alone, nor both combined were good indicators for FMD. No correlation was observed between the cerebellar tonsil descent and SAS in CM-I. But all 5 patients with CSA had a FMD. The combination of MRI findings and/or symptoms of CM-I together with moderate-to-severe SAS best discriminated patients who needed a FMD. Our findings highlight the importance of a combined evaluation of symptoms, MRI and polygraphy results in the management of CM-I patients.

Sleep apnea and atrial fibrillation: the spell of Groundhog Day.

Sleep apnea and atrial fibrillation: the spell of Groundhog Day.

Sleep Apnea Syndrome: Prevalence and Comorbidity with Other Non-communicable Diseases and HIV Infection, among Hospitalized Patients in Yaoundé, Cameroon.

Background Sleep apnea syndrome (SAS), a growing public health threat, is an emerging condition in sub-Saharan Africa (SSA). Related SSA studies have so far used an incomplete definition. This study is aimed at assessing SAS using an American Academy of Sleep Medicine (AASM) complete definition and at exploring its relationship with comorbidities, among patients hospitalized in a Cameroonian tertiary hospital. Methods This cross-sectional study was conducted in cardiology, endocrinology, and neurology departments of the Yaoundé Central Hospital. Patients aged 21 and above were consecutively invited, and some of them were randomly selected to undergo a full night record using a portable sleep monitoring device, to diagnose sleep-disordered breathing (SDB). SAS was defined as an apnea − hypopnea index (AHI) ≥ 5/h, associated with either excessive daytime sleepiness or at least 3 compatible symptoms. Moderate to severe SAS (MS-SAS) stood for an AHI ≥ 15/h. We used chi-square or Fisher tests to compare SAS and non-SAS groups. Findings. One hundred and eleven patients presented a valid sleep monitoring report. Their mean age ± standard deviation (range) was 58 ± 12.5 (28–87) years, and 53.2% were female. The prevalence (95% confident interval (CI)) of SAS was 55.0 (45.7, 64.2)% and the one of MS-SAS 34.2 (25.4, 43.1)%. The obstructive pattern (90.2% of SAS and 86.8% of MS-SAS) was predominant. The prevalence of SAS among specific comorbidities ranged from 52.2% to 75.0%. Compared to SAS free patients, more SAS patients presented with hypertension (75.4% vs. 48.0%, p = 0.005%), history of stroke (36.7% vs. 32.0%, p = 0.756), cardiac failure (23.0% vs. 12.0%, p = 0.213), and combined cardiovascular comorbidity (80.3% vs. 52.0%, p = 0.003). Similar results were observed for MS-SAS. Metabolic and neuropsychiatric comorbidities did not differ between SAS and SAS-free patients. Conclusion The SAS diagnosed using modified AASM definition showed high prevalence among patients hospitalized for acute medical conditions, as it was found with SDB. Unlike HIV infection, metabolic and brain conditions, cardiovascular comorbidities (hypertension and cardiac failure) were significantly more prevalent in SAS patients.

A Case of Central Sleep Apnea Developing During CPAP Therapy Which Was Improved After Treatment of Atrial Fibrillation

In recent years, the prevalence of sleep apnea syndrome (SAS) has increased, alongside that of metabolic syndrome.

Sleep apnea syndrome in patients with long-term pacing

Cardiovascular diseases leading to pacemaker implantations are suspected of being associated with a high rate of undiagnosed sleep apnea syndrome (SAS). The aim of this study was to determine the prevalence of SAS in patients with permanent pacemakers. Cross sectional study in patients presenting to Pacemaker control, between March and October 2018. All underwent Epworth Sleepiness Scale assessment and polysomnography with the pacemaker programmed to right ventricular DDI pacing mode (lower pacing rate, 50 pulses per minute). SAS was defined as an apnea-hypopnea index ≥ 5 h. Fifty-four consecutive patients (mean age, 68 ± 11 years) not known to have sleep apnea were included; 44 patients were paced for high-degree atrioventricular block (83%), and 10 for sinus node disease (37%). Mean Epworth Sleepiness Scale was in the normal range (8 ± 4), although 13 patients (25%) had an abnormal score > 11/h. Thirty-three patients (61%) had SAS; of these, 14 (26%) had a severe SAS (apnea-hypopnea index > 30/h). In paced patients, there is an excessively high prevalence of undiagnosed SAS. Whether treating SAS would have changed the need for pacing is unknown.

Central sleep apnea syndrome prevalence is high early after an acute coronary syndrome without heart failure or left ventricular dysfunction

Although the prevalence of obstructive sleep apnea (OSA) syndrome is high in patients with acute coronary syndrome (ACS), little is known about central sleep apnea (CSA) prevalence in these patients, especially if they have no left ventricular dysfunction. Furthermore, central apnea could be promoted by ticagrelor, a relatively new drug. To investigate the prevalence of central sleep apnea in patients without left ventricular dysfunction after an ACS. All consecutive patients within 100 days after an ACS were included if they had left ventricular ejection fraction (LVEF) > 45%, no history of heart failure, systolic arterial pulmonary artery inferior to 45 mm Hg, no known history of sleep apnea, and if they were not receiving a sedative drug. After inclusion, patients underwent an overnight sleep study with a Nox T3 portable sleep monitor. Between May 1, 2018 and April 10, 2019, we included 50 consecutive patients 43 ± 24 days after an ACS (age 56.1 ± 10.5, male 54%, mean body mass index 28.6 ± 4.9, mean LVEF: 55.5 ± 4.9%). All of them were receiving a dual antiplatelet therapy: aspirin 100%, ticagrelor 85%, clopidogrel 10%, prasugrel 5%. 23 patients (46%) had a clinically significant (moderate to severe) apnea hypopnea index (AHI) > 15/h: CSA: 24%, OSA: 22%. Among them 13 (26%) had a severe sleep breathing disorder(AHI >30): CSA 16% OSA: 10%. The only favoring factor to have an AHI > 30 was timing for the sleep diagnostic test: 29 ± 24 days in patients with AHI > 30 versus 49 ± 22 days in the other patients, P = 0.01. The role of ticagrelor could not be assessed because nearly all of the patients received it. As expected, OSA is frequent in coronary artery disease patients (early after ACS in this study). High prevalence of CSA was less expected. Our results suggest that, before looking for another (neurological) cause, confirmation of CSA should be done at least 2 months after the ACS.

Sleep disorders in aging polio survivors: A systematic review.

Sleep disturbances, especially sleep disordered breathing and sleep movement disorders, seem to be highly prevalent among aging polio survivors. They could contribute to late functional deterioration, fatigue, poor quality of life and negative health outcomes, thereby increasing cardiovascular risk. This review focused on current knowledge of the prevalence of sleep disorders in polio survivors, their features, predictive factors and management. Articles were searched in PubMed and the Cochrane Library up to March 2018. Articles needed to 1) be written in English; 2) include only participants with previous poliomyelitis or post-polio syndrome diagnosis; and 3) involve any form of sleep disorders. Articles about isolated fatigue or non-specific sleep complaints as well as non-polio specific articles (neuromuscular disorders) were not included in the qualitative analysis. Among 166 studies identified, 41 were included in this review. The prevalence of sleep apnea syndrome, nocturnal alveolar hypoventilation and restless legs syndrome seemed higher than in the general population (from 7.3% to 65%, 15% to 20% and 28% to 63%, respectively). This review highlights the lack of randomised studies assessing sleep disorder management in this specific population. Because of the small number of eligible publications, none was excluded for methodological limitations, and only a qualitative analysis was provided. Follow-up of polio survivors should include systematic screening for sleep disorders because they are associated with adverse consequences. Sleep disorder evaluation and management should improve the long-term survival and quality of life of polio survivors. Methodologically robust clinical trials are needed, but the decreasing prevalence and large clinical spectrum of the disease may complicate the creation of comparable groups.

Sectoral Differences in the Association of Optic Nerve Head Blood Flow and Glaucomatous Visual Field Defect Severity and Progression.

To investigate sectoral differences in the relationship between optic nerve head tissue blood flow, anatomically corresponding visual field defect severity, and future progression. This retrospective longitudinal medical chart review comprised 508 eyes of 319 open-angle glaucoma patients (mean deviation: -9.2 ± 7.0 dB), followed for an average of 4.7 ± 1.1 years; an average 11.7 ± 3.7 visual field tests were performed. Average total deviation (TD) was calculated in the superior, central, and inferior sectors of the Humphrey 24-2 program. The optic nerve head was divided to obtain inferior, temporal, and superior tissue-area mean blur rate (MT), derived from laser speckle flowgraphy. At baseline, the correlation between MT and TD was compared in anatomically corresponding sectors. We performed a multivariate analysis to determine the contribution of baseline MT to corresponding TD slope and to determine background factors influencing superior to temporal MT. We used a linear-mixed effect model for the statistical analysis. At baseline, the highest β coefficients were found between MT-superior and TD-inferior, MT-temporal and TD-central, and between MT-inferior and TD-superior, in that order (β = 0.38, β = 0.27, β = 0.26, respectively). MT-superior and MT-temporal independently contributed to corresponding TD slope (P < 0.05). Male sex, high body mass index, and the prevalence of sleep apnea syndrome were contributing factors to lower superior to temporal MT (P < 0.05). Review of medical history, measurements of systemic variables, and laser speckle flowgraphy parameters might help clinicians to predict visual field defect severity and progression.

Importance of cardiac implantable electronic devices in the diagnosis of sleep apnea syndrome

Abstract Introduction Sleep apnea syndrome (SAS) is a common respiratory disorder that is particularly prevalent in patients with cardiovascular disease. Diagnosis is based on polysomnography. In patients with cardiac implantable electronic devices (CIEDs), the prevalence of SAS may reach 60%. The aim of this study was to assess the value of CIEDs in screening for SAS. Methods This prospective study included patients with CIEDs with an algorithm for sleep apnea. The frequency response function was activated and simplified polysomnography was performed. The device’s data were collected on the day of the polygraph. Results The sample included 29 patients, with a mean age of 76.1 years, 71.4% male. The prevalence of SAS was 77%. For SAS, the agreement between polysomnography and the device was kappa = 0.54 (p = 0.001, 95% CI 0.28-0.81) (moderate agreement); for moderate to severe SAS, the agreement was kappa = 0.73 (p Conclusion SAS is highly prevalent in patients with CIEDs. The values obtained through these devices have a strong positive correlation with the apnea-hypopnea index, which makes them a good tool for the screening of severe SAS.

1619-P: Risk Factors for Sleep Apnea Syndrome in Nonobese Type 2 Diabetics

Diabetics often have vascular diseases and other comorbidities. Sleep apnea syndrome (SAS) is a disorder characterized by repeated episodes of apnea and hypopnea during nocturnal sleep. Risk factors for SAS include obesity, male gender, and advanced age. It was reported that type 2 diabetes patients (T2DM) without obesity often have SAS. Among the 1,367 ambulant T2DM who were being treated at our institution, 245 (165 men, 80 women) with a BMI &amp;lt;25kg/m2 and who agreed to undergo a portable sleep polygraph test, were evaluated to identify risk factors for SAS, focusing on micro- and macroangiopathy and stable comorbidities. The rates of retinopathy, nephropathy, carotid artery stenosis, coronary artery disease, and peripheral arterial disease were 32.2%, 45.1%, 19.3%, 39.6%, and 15.2%, respectively. The rates of intracranial lesions, respiratory diseases, cardiovascular diseases, cancer, thyroid diseases, and mental illness were 25.7%, 9.4%, 42.4%, 19.2%, 8.6%, and 4.1%, respectively. The apnea-hypopnea index (AHI) was 11.3±9.7 (mean±standard deviation) (12.1±9.9 in men, 9.8±9.1 in women). The prevalence of SAS (AHI≥15) was 25.5% in men and 18.8% in women. Carotid artery stenosis and intracranial lesions were more common among patients with SAS than among those without SAS (p&amp;lt;0.05 each), while no such association was found for microangiopathy. Multivariate analysis adjusting for BMI, male gender, and age identified BMI (odds ratio, 1.23; 95% confidence interval, 1.04-1.47; p&amp;lt;0.05) and intracranial lesions (2.93; 1.51-5.71; p&amp;lt;0.005) as independent risk factors for SAS. The intracranial lesions identified were stable and diverse, ranging from infarction and hemorrhage to benign brain tumor and contusion. The association of intracranial lesions with hypoxia may be related to the respiratory centers, although the underlying mechanism is unknown. T2DM with stable intracranial lesions even without obesity, should be carefully monitored for nocturnal hypoxia, particularly during emergency hospitalization. Disclosure S. Kawasaki: None. H. Misawa: None. T. Kondo: None. Y. Kondo: None. Y. Terauchi: Advisory Panel; Self; AstraZeneca, Daiichi Sankyo Company, Limited, Eli Lilly and Company, Merck Sharp &amp; Dohme Corp., Mitsubishi Tanabe Pharma Corporation, Novo Nordisk A/S, Sanofi. Research Support; Self; Daiichi Sankyo Company, Limited, Eli Lilly and Company, Merck Sharp &amp; Dohme Corp., Novartis Pharmaceuticals Corporation, Novo Nordisk A/S, Ono Pharmaceutical Co., Ltd., Sanofi, Shionogi &amp; Co., Ltd., Sumitomo Dainippon Pharma Co., Ltd. Speaker's Bureau; Self; Astellas Pharma Inc., AstraZeneca, Bayer Yakuhin, Ltd., Daiichi Sankyo Company, Limited, Eli Lilly and Company, Merck Sharp &amp; Dohme Corp., Mitsubishi Tanabe Pharma Corporation, Novartis Pharmaceuticals Corporation, Novo Nordisk A/S, Ono Pharmaceutical Co., Ltd., Sanofi, Sanwa Kagaku Kenkyusho, Shionogi &amp; Co., Ltd., Sumitomo Dainippon Pharma Co., Ltd.

Autonomic Dysfunction Increases Cardiovascular Risk in the Presence of Sleep Apnea

The high prevalence of sleep apnea syndrome (SAS) and its direct relationship with an augmented risk of cardiovascular disease (CVD) have raised SAS as a primary public health problem. For this reason, extensive research aiming to understand the interaction between both conditions has been conducted. The advances in non-invasive autonomic nervous system (ANS) monitoring through heart rate variability (HRV) analysis have revealed an increased sympathetic dominance in subjects suffering from SAS when compared with controls. Similarly, HRV analysis of subjects with CVD suggests altered autonomic activity. In this work, we investigated the altered autonomic control in subjects suffering from SAS and CVD simultaneously when compared with SAS patients, as well as the possibility that ANS assessment may be useful for the early stage identification of cardiovascular risk in subjects with SAS. The analysis was performed over 199 subjects from two independent datasets during night-time, and the effects of the physiological response following an apneic episode, sleep stages, and respiration on HRV were taken into account. Results, as measured by HRV, suggest a decreased sympathetic dominance in those subjects suffering from both conditions, as well as in subjects with SAS that will develop CVDs, which was reflected in a significantly reduced sympathovagal balance (p < 0.05). In this way, ANS monitoring could contribute to improve screening and diagnosis, and eventually aid in the phenotyping of patients, as an altered response might have direct implications on cardiovascular health.

Evaluation of the influence of cardiac resynchronization therapy on sleep apnea syndrome

Many studies have shown a high prevalence of sleep apnea syndrome (SAS), whether obstructive sleep apnea (OSA) or central sleep apnea (CSA) in heart failure patients (HF). Very few data exit about HF patients with cardiac resynchronization therapy (CRT). In this study, we will determine the prevalence of SAS in this population and study the influence of CRT about SAS. A prospective open-label, single-center, non-interventional, cohort-type study was conducted at Reims University Hospital between 1st January and 31st August 2016. All patients implanted with CRT device without known SAS were included. Screening polysomnography was performed before and 6 months after implantation. Primary endpoint was the incidence of SAS and secondary endpoint was the evaluation of the impact of CRT on SAS. During the study period, 31 patients were implanted with a CRT device: 10 were already known having SAS and 5 did not give their consent. At M0, 100% of the 16 included patients were diagnosed having SAS, with 69% severe OSAS. All were treated by CPAP according to guidelines. At 6 months, after 48 h CPAP washout, no independent significant influence of CRT on the Apnea-Hypopnea Index (AHI) was demonstrated (37 ± 19 vs 60 ± 12, P = 0.0625). An improvement in HF parameters was observed (NYHA class (−1, P = 0.0195), QRS width (−26 ms, P = 0.0002) and LVEF (+9.5%, P = 0.0039)). At 6 months, the CRT response rate was high with significant NYHA class and LVEF improvement in 79 and 57% patients respectively. SAS (especially OSA) is frequent in HF patients eligible for CRT and mostly under-diagnosed. The lack of improvement of the AHI by the CRT alone and the existence of a specific treatment of the OSAS improving morbi-mortality, maintaining a very good response rate to the CRT invite to screen this population.

Prevalence and association analysis of obstructive sleep apnea with gender and age differences - Results of SHIP-Trend.

Identification of obstructive sleep apnea and risk factors is important for reduction in symptoms and cardiovascular risk, and for improvement of quality of life. The population-based Study of Health in Pomerania investigated risk factors and clinical diseases in a general population of northeast Germany. Additional polysomnography was applied to measure sleep and respiration with the objective of assessing prevalence and risk factors of obstructive sleep apnea in a German cohort. One-thousand, two-hundred and eight people between 20 and 81 years old (54% men, median age 54 years) underwent overnight polysomnography. The estimated obstructive sleep apnea prevalence was 46% (59% men, 33% women) for an apnea-hypopnea index ≥5%, and 21% (30% men, 13% women) for an apnea-hypopnea index≥ 15. The estimated obstructive sleep apnea syndrome prevalence (apnea-hypopnea index≥5; Epworth Sleepiness Scale >10) was 6%. The prevalence of obstructive sleep apnea continuously increased with age for men and women with, however, later onset for women. Gender, age, body mass index, waist-to-hip ratio, snoring, alcohol consumption (for women only) and self-reported cardiovascular diseases were significantly positively associated with obstructive sleep apnea, whereas daytime sleepiness was not. Diabetes, hypertension and metabolic syndrome were positively associated with severe obstructive sleep apnea. The associations became non-significant after adjustment for body mass. Women exhibited stronger associations than men. The prevalence of obstructive sleep apnea was high, with almost half the population presenting some kind of obstructive sleep apnea. The continuous increase of obstructive sleep apnea with age challenges the current theory that mortality due to obstructive sleep apnea and cardiovascular co-morbidities affect obstructive sleep apnea prevalence at an advanced age. Also, gender differences regarding obstructive sleep apnea and associations are significant for recognizing obstructive sleep apnea mechanisms and therapy responsiveness.

Risk Factors for Sleep Apnea Syndrome in Diabetic Patients with a Focus on Comorbidities

Diabetic patients often have various diseases such as vascular diseases and other comorbidities. Sleep apnea syndrome (SAS) in such patients may lead to acute deterioration due to nocturnal hypoxia. Among the 1,367 ambulant patients with type 2 diabetes (T2DM) who were being treated at our institution, 483 (313 men and 170 women) who agreed to undergo a portable sleep polygraph test were evaluated to identify risk factors for SAS, with a focus on microangiopathy and stable comorbidities. The rates of intracranial lesions, respiratory diseases, cardiovascular diseases, cancer, thyroid diseases, and mental illness were 22%, 9.9%, 39.8%, 16.1%, 7.7%, and 5.8%, respectively. The rates of microangiopathy were as follows: retinopathy (30.6%) and nephropathy (48.5%). The patients had an apnea-hypopnea index (AHI) of 15.4±14.3 (mean±standard deviation) (16.8±14.5 in men and 12.9±13.8 in women). The prevalence of SAS (AHI≥15) was 40.6% (127/313) in men and 29.4% (50/170) in women. Intracranial lesions, cardiovascular diseases, and cancer were more common among patients with SAS than among those without SAS (AHI&amp;lt;15) (p&amp;lt;0.each), while no such association was found for microangiopathy. Multivariate analysis adjusting for known risk factors for SAS (BMI, male gender, and age) identified BMI (odds ratio, 1.25; 95% confidence interval, 1.18-1.33; p&amp;lt;0.0001), male gender (2.11; 1.36-3.34; p&amp;lt;0.001), and intracranial lesions (1.74; 1.07-2.83; p&amp;lt;0.05) as independent risk factors for SAS. The intracranial lesions identified were stable and diverse, ranging from infarction and hemorrhage to benign brain tumor and encephalitis. The association of intracranial lesions with hypoxia may be related to the respiratory centers, although the underlying mechanism is unknown. Given the high prevalence of SAS, T2DM patients with obesity, male gender, and stable intracranial lesions should be carefully monitored for nocturnal hypoxia, particularly during emergency hospitalization. Disclosure S. Kawasaki: None. H. Misawa: None. R. Kaneda: None. T. Kondo: None. Y. Kondo: None. Y. Terauchi: Research Support; Self; MSD K.K.. Speaker's Bureau; Self; MSD K.K.. Advisory Panel; Self; MSD K.K.. Research Support; Self; Ono Pharmaceutical Co., Ltd.. Speaker's Bureau; Self; Ono Pharmaceutical Co., Ltd.. Research Support; Self; Novartis Pharma K.K., Boehringer Ingelheim GmbH. Speaker's Bureau; Self; Boehringer Ingelheim GmbH. Advisory Panel; Self; Boehringer Ingelheim GmbH. Research Support; Self; Mitsubishi Tanabe Pharma Corporation. Speaker's Bureau; Self; Mitsubishi Tanabe Pharma Corporation. Advisory Panel; Self; Mitsubishi Tanabe Pharma Corporation. Research Support; Self; Daiichi Sankyo Company, Limited. Speaker's Bureau; Self; Daiichi Sankyo Company, Limited. Advisory Panel; Self; Daiichi Sankyo Company, Limited. Research Support; Self; Sanwa Kagaku Kenkyusho Co., Ltd.. Speaker's Bureau; Self; Sanwa Kagaku Kenkyusho Co., Ltd.. Research Support; Self; Novo Nordisk Inc.. Speaker's Bureau; Self; Novo Nordisk Inc.. Advisory Panel; Self; Novo Nordisk Inc.. Research Support; Self; Eli Lilly and Company. Speaker's Bureau; Self; Eli Lilly and Company. Advisory Panel; Self; Eli Lilly and Company. Research Support; Self; Sanofi. Speaker's Bureau; Self; Sanofi. Advisory Panel; Self; Sanofi. Research Support; Self; Sumitomo Dainippon Pharma Co., Ltd.. Speaker's Bureau; Self; Sumitomo Dainippon Pharma Co., Ltd.. Research Support; Self; Shionogi &amp; Co., Ltd.. Speaker's Bureau; Self; Shionogi &amp; Co., Ltd., Bayer Yakuhin, Ltd., Astellas Pharma US, Inc., AstraZeneca. Advisory Panel; Self; AstraZeneca, Teijin Pharma Limited.

Poster Number: EI 58 - Relationship between Equol Production Status and Sleep Apnea Syndrome in the Elderly

Introduction: It has been reported that the prevalence of Sleep Apnea Syndrome (SAS) in elderly people (over 65) is more than 20%. Elderly patients with SAS have a predilection to develop hypertension, arrhythmia, angina pectoris, myocardial infarction, diabetes mellitus, and cognitive decline. On the other hand, it is controversial that consumption of soy isoflavones, which are predominantly derived from soybeans, reduces the risk of cardiovascular disease. Recent study reveals, equol, a metabolite of an isoflavone, differs greatly among individuals. Equol is converted from daizein by specific gut bacteria, and is more bioavailable than soy isoflavone. In this study, we sought to confirm whether equol production status is associated with incidence of SAS.