Risk Of OSA Research Articles

Glycemic control and its association with sleep quality and duration among type 2 diabetic patients

BackgroundPoor glycemic control is the current most important tragedy in type 2 diabetic patients. Sleep has a major modulatory effect on endocrine and metabolic function. Sleep disturbance is associated with increased circulating cortisol levels, sympathetic activity, and epinephrine secretion. These physiological conditions are directly or indirectly associated with glucose metabolism in our body cells. In Ethiopia, sleep pattern association with glycemic control level is not studied yet. ObjectivesTo assess glycemic control and its association with sleep quality, sleep duration and napping among patients with type 2 diabetes mellitus in Felege Hiwot Comprehensive Referral and Specialized Hospital Northwest Ethiopia. MethodAn institutional-based cross-sectional study was conducted among 407 type 2 diabetes mellitus patients from July 1, 2020, to April 28, 2021, using a systematic random sampling technique. We drew 5 mL of blood from each patient before breakfast to determine their fasting blood sugar level. The Pittsburg Sleep Quality Index was used to assess patients' sleep quality, and the presence or absence of Obstructive Sleep Apnea was determined using the STOP-BANG questionnaire. Data were analysed using STATA version 14.1.variables with a P-value of <0.05 were considered statistically significant. ResultsGlycemic control was found to be poor in 54.05% of the study participants. Female sex, poor sleep quality, and short and long sleep durations were all significantly associated with impaired glycemic control. Being female increased the odds of poor glycemic control by 2.7 times (AOR = 2.7, 95% CI: 1.23, 6.15) compared to males. T2DM patients who had poor sleep quality had 3.3 times (AOR = 3.3, 95% CI (1.16, 9.37) higher odds of poor glycemic control compared to patients who had good sleep quality. The odds of having poor glycemic control among T2DM patients who were at low risk of OSA and intermediate risk of OSA were decreased by 96% (AOR = 0.03, 95% CI: 0.01, 0.12) and 86% (AOR = 0.14, 95% CI: 0.05, 0.43) compared to T2DM patients who were at high risk of OSA, respectively. T2DM patients who had short sleep duration (<6 hours) were 8.3 times (AOR = 8.3, 95% CI: 2.66–25.85) higher chances of poor glycemic control compared to patients who had average sleep duration. T2DM patients who had long sleep duration (>8 hours) increased the odds of poor glycemic control by 2.6 times (AOR = 2.6, 95% CI (1.12–6.04) compared to those who had average sleep duration. The chances of having poor glycemic control among T2DM patients who did not take the balanced diet recommended by their physician were increased by 3.8 times (AOR = 3.8 95% CI: 1.05–13.77). ConclusionThe prevalence of poor glycemic control in T2DM patients was high. Poor sleep quality, both short and long sleep duration, and an intermediate or low risk of obstructive sleep apnea were statistically associated with poor glycemic control. Hence, good sleep quality and appropriate sleep duration are recommended to maintain glycemic control levels in the normal range.

Prevalence and determinants of post-stroke sleep disorders: a cross-sectional hospital-based study.

Post-stroke sleep disorders (PSSD) are an important part of post-stroke disability. PSSD is neglected as a part of stroke rehabilitation. We aimed to study the prevalence and determinants of PSSD in a hospital based, single center setting. In a cross-sectional study, adult patients (≥ 18years) with stroke (one month to one year after the onset), were enrolled in the study. Demographic, clinical, radiological, and motor and functional disabilities were assessed. Sleep quality was assessed with Pittsburg Sleep Quality Index (PSQI) and STOP BANG questionnaire (for obstructive sleep apnea [OSA]). Patients with poor sleep quality (PSQI > 5) were analyzed for risk factors. A total of 103 patients were recruited in the study period (January 2021 to June 2022). The self-reported prevalence of PSSD was 16% which increased to 72% when thePSQI was administered. High risk of OSA was present in 33%. In bivariate analysis, factors associated with PSQI > 5 were involvement of ≥ 2 lobes, lower body mass index (BMI), worse modified Rankin Scale (mRS), Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A) and Stroke Specific Quality of Life (SSQoL). In multivariate analysis, only depression was associated with PSQI > 5 (OR: 1.3 (1.0; 1.7); p-value = 0.03). PSSD had a prevalence of 72%. In multivariate analysis, the factor associated with PSQI > 5 was worse HAM-D score.

Prevalence, treatment and determinants of obstructive sleep apnoea and its symptoms in a population-based French cohort.

Obstructive sleep apnoea (OSA) is associated with increased morbidity and mortality. Although the disorder has been well studied in selected high-risk populations, few data exist on its prevalence in the general population. We aimed to assess the prevalence and determinants of OSA in France. Data from participants of the French population-based CONSTANCES cohort aged 18-69 years at inclusion and being treated for sleep apnoea or screened for OSA in 2017 using the Berlin Questionnaire were analysed. Weighted analyses were performed to provide recent and representative results in the general population. Among 20 151 participants, the prevalence of treated sleep apnoea was 3.5% (95% CI 3.0-3.9%). The prevalence of untreated subjects with a positive Berlin Questionnaire was 18.1% (95% CI 17.3-19.2%) for a total weighted prevalence of treated sleep apnoea or high risk of OSA of 20.9% (95% CI 20.0-21.9%). Regarding prevalence of OSA symptoms, it was 37.2% (95% CI 36.1-38.3%) for severe snoring and 14.6% (95% CI 13.8-15.5%) for hypersomnolence. In multivariable logistic regression analysis, male sex, age, previous cardiovascular events, smoking, low educational level, low physical activity and depressive symptoms were associated with having either treated sleep apnoea or a positive Berlin Questionnaire. In this large French population-based cohort, one in five participants had a high likelihood of OSA, whereas only 3.5% were treated for the disorder, suggesting major underdiagnosis in the general population. OSA diagnosis should be considered more often in people with risk factors such as depressive symptoms as well as unhealthy behaviours and socioeconomic conditions.

Sleep in multiple sclerosis and neuromyelitis optica spectrum disorder-the SEMN study.

This study aimed to (1) evaluate in patients with multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) the presence of sleep disorders such as hypersomnia, fatigue, risk of apnea, and the presence of restless legs syndrome/Willis-Ekbom disease (RLS/WED); (2) evaluate quality of sleep in patients with MS and NMOSD; and (3) correlate them with clinical and imaging data. The study was cross-sectional and was carried out in the sector of demyelinating diseases of the neurology service of HUGV-UFAM, Manaus, Brazil, from January 2017 to December 2020. Our sample consisted of 60 patients, 41 with MS and 19 with NMOSD. We found that patients with MS and NMOSD have poor sleep quality (65%) and hypersomnia (53% in MS; 47% in NMOSD), but low risk of apnea by STOP-BANG. The frequency of RLS/WE found was 14% in MS, and 5% in NMOSD. No correlation existed between sleep quality, number of relapses, and sleep quality for the Expanded Disability Status Scale (EDSS), i.e., fatigue/illness duration. Patients with MS and NMOSD have poor sleep quality, excessive sleepiness, and are at low risk for OSA, yet the frequency of RLS/WED is like that of the general population. There does not seem to be a significant difference between these sleep disorders in these demyelinating diseases of the CNS.

Machine Learning Identification of Obstructive Sleep Apnea Severity through the Patient Clinical Features: A Retrospective Study.

To evaluate the role of clinical scores assessing the risk of disease severity in patients with clinical suspicion of obstructive sleep apnea syndrome (OSA). The hypothesis was tested by applying artificial intelligence (AI) to demonstrate its effectiveness in distinguishing between mild-moderate OSA and severe OSA risk. A support vector machine model (SVM) was developed from the samples included in the analysis (N = 498), and they were split into 75% for training (N = 373) with the remaining for testing (N = 125). Two diagnostic thresholds were selected for OSA severity: mild to moderate (apnea-hypopnea index (AHI) ≥ 5 events/h and AHI < 30 events/h) and severe (AHI ≥ 30 events/h). The algorithms were trained and tested to predict OSA patient severity. The sensitivity and specificity for the SVM model were 0.93 and 0.80 with an accuracy of 0.86; instead, the logistic regression full mode reported a value of 0.74 and 0.63, respectively, with an accuracy of 0.68. After backward stepwise elimination for features selection, the reduced logistic regression model demonstrated a sensitivity and specificity of 0.79 and 0.56, respectively, and an accuracy of 0.67. Artificial intelligence could be applied to patients with symptoms related to OSA to identify individuals with a severe OSA risk with clinical-based algorithms in the OSA framework.

Sleep disorders and work-related stress with oral hygiene among Indian shift workers.

Construction workers are mostly migrants from isolated villages and are not vigilant about health care measures besides poor language skills. Majority of the population works in shifts across the globe. As a result of poor sleep architecture, excessive sleepiness or insomnia, the construction labourers working in shifts have approximately twice the risk of OSA when compared with those working in the daytime. Likewise, the performance and the productivity of employees in construction sites are impeded by added stress. Therefore, it is of interest to investigate the sleep disorders, work-related stress and its impact on oral hygiene among the construction workers in Chennai. A cross sectional study was conducted among 518 workers in various construction sites at Chennai, South India. The study incorporated BerlinQuestionnaire to evaluate disordered breathing during sleep, the Work Ability Index that contains questions concerning work, working ability and health and the Oral Hygiene Index Simplified (Greene and Vermillion, 1964) that was used for recording the oral hygiene status. Pearson correlation between education and OHI-S was statistically significant (r=-0.108). Multiple linear regression analysis revealed that mean WAI score had a positive significant association with work experience (B=0.059, SE=0.030, p=0.05), habits (B=0.032, SE=0.017, p=0.05) and marital status (B=0.135, SE=0.54, p=0.01). In contrast, education (B=-0.0.052, SE=0.023, p=0.02) and work schedule (B=0.022, SE=0.037, p=0.54) were inversely associated with the mean score. Based on the current findings, it is imperative to restore work ability for those with poor work ability thereby enhancing productivity in the migrant workers. As shift work may be extremely detrimental to poor sleep quality, the employers should arrange shift schedules in accordance with sleep physiology. Additionally, dental awareness and interventions are required to improve oral hygiene among migrant workers.

PS-C33-2: HYPERTENSION, OBSTRUCTIVE SLEEP APNEA AND HYPERALDOSTERONISM: A BIDIRECTIONAL MENDELIAN RANDOMIZATION STUDY

Aim: The aim of this study was to investigate the causal effects between hypertension, obstructive sleep apnea and hyperaldosteronism. Methods and Results: We performed a bidirectional Mendelian randomization (MR) analysis implementing the results from a large-scale genome-wide association study for hypertension by the UK Biobank (N = 462933), obstructive sleep apnea (N = 217955) and hyperaldosteronism and (N = 211463) by the FinnGen to identify genetic instruments. The inverse variance weighted method was the main MR method used. A genetic predisposition to hypertension was significantly increased risk of OSA (OR and 95%CI, 1.49(1.159–1.939) and hyperaldosteronism (OR and 95%CI, 123.863(25.598–599.338). The significance remained consistent in MR sensitivity analyses. Genetically OSA did not show a significant association with the risk of hypertension and hyperaldosteronism, and hyperaldosteronism did not associate with hypertension and OSA. Conclusions: Our study supports that hypertension is a causal risk factor for OSA and hyperaldosteronism. However, the effect of OSA on hypertension and hyperaldosteronism, hyperaldosteronism on hypertension and OSA were not identified in this study.

Obstructive sleep apnea and pulmonary hypertension: the pendulum swings again.

Obstructive sleep apnea and pulmonary hypertension: the pendulum swings again.

Apnea‐associated hypoxemia is linked to greater tau deposition in women with Alzheimer’s disease risk

AbstractBackgroundObstructive sleep apnea (OSA) is characterized by recurrent pharyngeal airway collapse and drops in blood oxygen levels that lead to intermittent hypoxemia. OSA has been associated with Alzheimer’s disease (AD) pathology, including tau. AD is more prevalent in women, and women tend to have higher levels of tau compared to men. OSA is underdiagnosed, particularly in postmenopausal women where OSA risk is similar to men. We conducted a pilot study examining the relationship between OSA and tau using positron emission tomography (PET) in older women at higher risk for AD who participated in the Women Inflammation and Tau Study (WITS).Method10 older women (aged 71±3.3 years) were recruited to WITS, which required elevated genetic risk of AD and a Montreal Cognitive Assessment score suggestive of mild cognitive impairment (range 13‐20). A home sleep test was completed to derive the apnea‐hypopnea index (AHI), nadir and mean oxygen saturation (Osat), and proportion of time in bed (TIB) with oxygen saturation ≤88% (Osat≤88%). Participants also underwent MK‐6240 PET to determine tau deposition. Standardized uptake value ratio (SUVR) was computed in temporal meta‐region of interest (ROI) Braak Stages I, III‐IV, and V‐VI. Spearman correlation was used to analyze the associations between OSA characteristics and tau PET SUVR in the respective ROIs.ResultIn this initial sample from WITS, 40% had mild OSA (AHI≥5/h and AHI&lt;15/h) and 40% had moderate OSA (AHI≥15/h and AHI&lt;30/h). Greater proportion of TIB with Osat≤88% was associated with higher tau SUVR in temporal meta‐ROI (rho=0.69, p=0.03), Braak III‐IV (rho=0.70, p=0.03), and Braak V‐VI (rho=0.69, p=0.03). No significant relationships were observed between AHI and tau PET SUVR in the respective ROIs (all p&gt;0.40).ConclusionIn this small sample of women with elevated AD risk, OSA was evident in the majority. Additionally, we found positive relationships between proportion of TIB with Osat≤88% and tau deposition in temporal and neocortical regions. These findings suggests that OSA‐related intermittent hypoxemia could potentially contribute to the pathogenesis of tau; however, longitudinal studies are needed. Treatment of OSA may be a possible target to reduce or delay the impact of AD.

OSA and Subsequent Risk of Hospitalization With Pneumonia, Respiratory Infection, and Total Infection: The Atherosclerosis Risk in Communities Study

OSA has been linked to microaspiration, systemic inflammation, and suboptimal immune function. Is OSA prospectively associated with risk of hospitalization for pneumonia, respiratory, and total infections? Prospective cohort. Participants in the Atherosclerosis Risk in Communities (ARIC) study (N= 1,586) underwent polysomnography in 1996-1998 and were followed up through 2018 for infection-related hospitalizations. The apnea-hypopnea index (AHI; events/h) was used to categorize participants as having severe OSA (≥ 30), moderate OSA (15-29), mild OSA (5-14), or a normal breathing pattern (< 5). Cox regression was used to calculate hazard ratios (HRs) and 95%CIs. ARIC participants were on average 62.7 (SD= 5.5) years of age, and 52.8%were female. Severe OSA was present in 6.0%, moderate OSA in 12.7%, mild OSA in 30.0%, and normal breathing in 51.3%. A total of 253 hospitalizations with pneumonia occurred over a median 20.4 (max, 22.9) years' follow-up. Participants with severe OSA were at 1.87 times (95%CI, 1.19-2.95) higher risk of hospitalization with pneumonia compared with those with a normal breathing pattern after adjustment for demographics and lifestyle behaviors. Results were attenuated modestly after adjustment for BMI (1.62 [0.99-2.63]), and prevalent asthma and COPD (1.62 [0.99-2.63]). A similar pattern existed for hospitalization with respiratory infection and composite infection (demographic and behavior-adjusted HRs: 1.47 [0.96-2.25] and 1.48 [1.07-2.04], respectively). Severe OSA was associated with increased risk of hospitalizations with pneumonia in this community-based cohort. OSA patients may benefit from more aggressive efforts to prevent pneumonia and other infectious conditions.

O053 Obstructive sleep apnea is a distinct physiological phenotype in individuals with comorbid insomnia and sleep apnea (COMISA)

Abstract Introduction Obstructive sleep apnea (OSA) pathophysiology varies among individuals, though the influence of comorbid insomnia on this pathophysiology is unknown. We examined whether upper airway collapsibility, muscle compensation, loop gain, and the arousal threshold differ between OSA patients with and without comorbid insomnia disorder. Methods We noninvasively determined the four traits using the ventilatory flow pattern captured from standard polysomnography in 34 comorbid insomnia and obstructive sleep apnea (COMISA) and 34 OSA patients without insomnia (OSA-only). Participants had mild-to-severe OSA ( AHI 25.8±2.0 events/h) and were matched according to age (50.2±1.5 years) sex (42M:26F), and body mass index (29.3±0.6 kg/m²). Results COMISA patients had significantly lower respiratory arousal thresholds (128.9 [118.1–137.1] vs. 147.7 [132.3–165.0] %Veupnea, U=261, p&amp;lt;.001), less collapsible upper airways (i.e., higher Vpassive 88.2 [85.5–94.6] vs. 72.9 [64.7–79.2] %Veupnea, U=1081, p&amp;lt;.001) and more stable ventilatory control (i.e., lower loop gain: 0.51 [0.44–0.56] vs. 0.58 [0.49–0.70], U=402, p=.03) relative to OSA-only controls. Muscle compensation did not significantly differ between groups. Discussion OSA patients with comorbid insomnia appear to have OSA driven more by heightened nocturnal arousability than by the contribution of anatomical factors, compared to OSA patients without insomnia. Heightened nocturnal arousability as the driver of apneic events in COMISA suggests the conditioned arousal perpetuating insomnia may also increase risk or severity of OSA. Further research should investigate whether targeting increased arousal propensity (e.g., through CBT-I) provides therapeutic benefit to individuals with COMISA.

P037 Differences in endotypes in people with multiple sclerosis in those with versus without OSA

Abstract Background Obstructive sleep apnoea (OSA) is as common if not more common in people with multiple sclerosis (MS) versus the general population. However, in contrast to the typical OSA risk factors in the general population, MS is far more common in women versus men, many of whom are not obese. Thus, while some people with MS likely get OSA via the same mechanisms as the general population (i.e., anatomical compromise), others may develop OSA due to specific MS-related consequences (e.g., CNS lesions that effect respiratory or upper airway neuromuscular control- i.e. via non-anatomical mechanisms). Accordingly, we investigated if the key OSA endotypes that contribute to OSA differ in people with MS in those with versus without OSA. Methods Nine people with MS with moderate-severe OSA (AHI=41±22events/h) and seven people with MS without moderate-severe OSA (AHI=9±3events/h) completed in-home level 2 sleep studies (n=11 Boston, n=5 Sydney). OSA endotypes were estimated using validated algorithms from the staged sleep study airflow signals and compared between those with versus without moderate-severe OSA. Results Respiratory control instability (loop gain) was significantly higher in people with OSA versus without (0.62±0.2 vs. 0.45±1, p=0.04). Upper airway collapsibility was also higher in OSA participants (Vpassive at the lowest decile= 53±13 vs. 74±6 %eupnea, p&amp;lt;0.01). Other OSA endotypes were not systematically different between groups. Discussion These findings suggest that while some people with MS likely get OSA via primary anatomically driven mechanisms, in others, OSA may be largely driven via non-anatomical mechanisms, potentially related to MS-specific disease consequences.

Consumer-Led Screening for AtrialFibrillation: A Report From the mAFA-II Trial Long-Term Extension Cohort.

There are limited data on mobile health detection of prevalent atrial fibrillation (AF) and its related risk factors over time. This study aimed to report the trends on prevalent AF detection over time and risk factors, with a consumer-led photoplethysmography screening approach. 3,499,461 subjects aged over 18 years, who use smart devices (Huawei Technologies Co.) were enrolled between October 26, 2018, and December 1,2021. Among 2,852,217 subjects for AF screening, 12,244 subjects (0.43%; 83.2% male, mean age 57 ± 15 years) detected AF episodes. When compared with 2018, the risk (adjusted HRs, 95%CI) for monitored prevalent AF increased significantly for subjects when monitoring started in 2020 (adjusted HR: 1.34; 95%CI: 1.27-1.40; P< .001) or in 2021 (adjusted HR: 1.67; 95%CI: 1.59-1.76; P< 0.001). Of the 961,931 subjects who screening for both AF and OSA, 18,032 (1.9%, 97.8% male, mean age 44 ±17 years) were identified as high risk for OSA, which resulted in a 1.5-fold increase (95%CI: 1.30-fold to 1.75-fold) in the prevalent AF. A total of 5,227 (53.3%, 5,227/9,797) subjects were effectively followed up, from which 4,903 (93.8%, 4,903/5,227) subjects were confirmed with the diagnosis of AF, by the mAFA Telecare Team health providers. Photoplethysmography-based smart devices can facilitate screening for AF with >93% confirmation of detected AF episodes even for the low-risk general population, highlighting the increased risk for detecting prevalent AF and the need for modification of OSA that increase AF susceptibility. (Mobile Health [mHealth] Technology for Improved Screening, Patient Involvement and Optimizing Integrated Care in Atrial Fibrillation [mAFA (mAF-App) II study]; ChiCTR-OOC-17014138).

Relationship between sleep disorders and the prognosis of neurological function after stroke.

This study aims to investigate the effects of sleep disorders on the prognosis of neurological function after stroke and other factors affecting the prognosis after stroke. We designed a cohort study. A total of 1,542 patients with their first stroke were hospitalized in the department of neurology of Tianjin Huanhu Hospital from 2015.6.1 to 2016.12.31. We recorded the personal histories of patients. The MMSE (mini-mental state examination), MoCA (Montreal Cognitive Assessment), HAMD (Hamilton Depression Scale), National Institutes of Health Stroke Scale (NIHSS) score, mRS (Modified Rankin Scale), BI (Barthel Index), PSQI (Pittsburgh Sleep Quality Index), ESS (Epworth Sleepiness Scale), Berlin questionnaire, and nocturnal TST (Total sleep time) were assessed before discharge, 3 months, 6 months, and 4 years (2019-2020) after stroke. Low sleep quality (OR 2.019, 95%CI 1.199-3.398, p = 0.008), nocturnal TST (<7 h) (OR 4.060, 95%CI 1.494-11.034, p = 0.006), nocturnal TST (>8 h) (OR 5.928, 95% CI 2.134-16.464, p = 0.001) were risk factors for poor neurological function recovery at 3 months after stroke. Nocturnal TST (<7 h) (OR 13.042, 95%-CI 2.576-66.027, p = 0.002) and nocturnal TST (>8 h) (OR 11.559, 95%-CI 2.108-63.390, p = 0.005) were risk factors for poor neurological function at 6 months after stroke. Nocturnal TST (<7 h) (OR 2.668, 95% CI 1.250-5.698, p = 0.011) and nocturnal TST (>8 h) (OR 2.516, 95% CI 1.080-5.861, p = 0.033) were risk factors for poor neurological function at 4 years after stroke. High risk of OSA (HR 1.582, 95%CI 1.244-2.012, p < 0.001) was a risk factor for all-cause death in patients followed up for 4 years after stroke. Low sleep quality is associated with short-term poor neurological function after stroke. Unusual nocturnal TST (long or short) is associated with short-term or long-term poor neurological function after stroke. A high risk of OSA is associated with a higher risk of all-cause death after stroke.

Respiratory disturbance index as a predictor of atrial fibrillation

Abstract Background Obstructive sleep apnea (OSA) is a risk factor for development of atrial fibrillation (AF). Recent pacemakers have specific algorithms for detecting of OSA based on impedance measurement. Purpose The aim was to determine the burden of AF in patients with high respiratory disturbance index (RDI). It was also intended to determine if the onset of continuous positive airway pressure (CPAP) reduced the AF burden. Methods Retrospective observational study carried out through the analysis of the patient records. It included patients with pacemakers evaluated in an outpatient clinic during the first 8 months of 2018. All had the RDI algorithm. AF burden was assessed according to automatic mode switch (AMS) duration. The percentage of nights with an RDI&amp;gt;20/h was analysed to assess the risk of OSA. Results 108 patients were included (mean age=70.3±9.0 years; 56.5% men). The most prevalent indication for cardiac pacing was atrioventricular node dysfunction (59.3%). The average percentage of nights with an RDI&amp;gt;20/h was 44.2%. The average follow-up (FU) period was 4.1 years. Of all cardiovascular risk factors, diabetes mellitus was the only one associated with a higher incidence of AF at FU (p=0.044). Considering just the patients with an RDI &amp;gt;20/h in more than 20% of nights (RDI20%), male gender was associated with higher rate of major adverse cardiovascular events [(acute myocardial infarction, stroke, acute heart failure and death) (p=0.019)]. Considering patients with AF prior to pacemaker implantation (n=34), 76% of patients had an RDI &amp;gt;20/h in more than 20% of nights (mean of 58.1%). 23 of these patients had long standing persistent AF at the end of FU (vs 17 at the beginnig of FU). Considering patients who developed AF after pacemaker implantation (n=24), 58% of patients had an RDI&amp;gt;20/h in more than 20% of nights (mean of 45.3%). Most patients had paroxismal AF (83%). Patients with prior paroxysmal AF or those who developed AF during FU (n=37) had a higher burden of AF at the end of FU when they had RDI &amp;gt;20/h in more than 50% of nights (mean burden of 24.66% vs 14.69%, p=0.005). There was no statistically significant correlation between the percentage of nights with RDI &amp;gt;20/h and the Apnea Hypopnea Index (AHI) value. Patients who underwent polysomnography (n=30) had a mean AHI of 16/h (which corresponds to moderately severe OSA). 63% of patients who were referred from the pacemaker consultation to pneumology and performed polysomnography started CPAP. CPAP use was not associated with a statistically significant reduction in any endpoints or AF burden. Conclusion A high RDI was associated with onset of de novo AF and higher AF burden in patients with paroxysmal AF. Thus, there is a rationale for early diagnosis and treatment of OSAS to prevent and reduce AF progression. In this study, CPAP was not shown to significantly reduce this endpoint, probably due to reduced polysomnography and CPAP treatment. Funding Acknowledgement Type of funding sources: None.

Identification of novel loci in obstructive sleep apnea in European American and African American children.

To identify genetic susceptibility variants in pediatric obstructive sleep apnea in European American and African American children. A phenotyping algorithm using electronic medical records was developed to recruit cases with OSA and control subjects from the Center for Applied Genomics at Children's Hospital of Philadelphia (CHOP). Genome-wide association studies (GWAS) were performed in pediatric OSA cases and control subjects with European American (EA) and African American (AA) ancestry followed by meta-analysis and sex stratification. The algorithm accrued 1486 subjects (46.3% European American, 53.7% African American). We identified genomic loci at 1p36.22 and 15q26.1 that associated with OSA risk in EA and AA, respectively. We also revealed a shared risk locus at 18p11.32 (rs114124196, p = 1.72 × 10-8) across EA and AA populations. Additionally, association at 1q43 (rs12754698) and 2p25.1 (rs72775219) was identified in the male-only analysis of EA children with OSA, while association at 8q21.11 (rs6472959), 11q24.3 (rs4370952) and 15q21.1 (rs149936782) was detected in the female-only analysis of EA children and association at 18p11.23 (rs9964029) was identified in the female-only analysis of African-American children. Moreover, the 18p11.32 locus was replicated in an EA cohort (rs114124196, p = 8.8 × 10-3). We report the first GWAS for pediatric OSA in European Americans and African Americans. Our results provide novel insights to the genetic underpins of pediatric OSA.

The prevalence of poor sleep quality and its association with the risk of obstructive sleep apnea and restless legs syndrome in diabetic patients treated with cyanoacrylate glue for varicose veins.

This study aimed to assess the prevalence of poor sleep quality and to describe its predictors in diabetic patients having chronic venous insufficiency and varicose veins treated with cyanoacrylate glue. This single-center, prospective cohort study was conducted between March 2018 and March 2021. A total of 103 patients with diabetes mellitus and chronic venous insufficiency (CEAP classification at stages C3-C6) treated with cyanoacrylate glue for varicose veins were recruited. A questionnaire form, Pittsburg Sleep Quality Index, Berlin Questionnaire, and Diagnostic Criteria for Restless Legs Syndrome were used for data collection. A Doppler USG assessment was performed in the first clinical examination. Almost half of the participants had had diabetes mellitus for 10years or more, and 52% had good glucose control. Among the study sample, 61% were poor sleepers, 47% of the participants were RLS positive, and 51% had a high risk of sleep apnea. RLS, HbA1c, and dressing at home had positive associations with poor sleep quality (p < 0.05) on the fifth day after the peripheral embolization. One month after the operation, participants had better sleep quality; however, there were no statistically significant differences between the assessments of RLS and the risk of OSA compared to the fifth day after the operation (p > 0.05). This prospective study showed that restless legs syndrome, a high level of HbA1c, and dressed injection area of the skin are associated with poor sleep quality in patientswith diabetes having chronic venous insufficiency and varicose veins treated with cyanoacrylate glue. Additionally, participants had better sleep quality 1month after the peripheral embolization compared to the fifth day after the operation.

Differential effects of obstructive sleep apnea on the corneal subbasal nerve plexus and retinal nerve fiber layer.

PurposeObstructive sleep apnea (OSA) is an established independent risk factor for peripheral neuropathy. Macro and microvascular changes have been documented in OSA, including high levels of potent vasoconstrictors. In diabetes, vasoconstriction has been identified as an underlying risk factor for corneal neuropathy. This study sought to establish a potential relationship between OSA and corneal nerve morphology and sensitivity, and to determine whether changes in corneal nerves may be reflective of OSA severity.DesignSingle center cross-sectional study.MethodsSixty-seven patients were stratified into two groups: those with OSA and healthy controls. Groups were matched for age, sex, race, smoking, and dry eye status. Outcome measures included serologies, a dilated fundus exam, dry eye testing, anthropometric parameters, corneal sensitivity, subbasal nerve plexus morphology, retinal nerve fiber layer (RNFL) thickness, and the use of questionnaires to assess symptoms of dry eye disease, risk of OSA, and continuous positive airway pressure (CPAP) compliance.ResultsNo significant differences were observed in corneal nerve morphology, sensitivity, or the number of dendritic cells. In the OSA test group, RNFL thinning was noted in the superior and inferior regions of the optic disc and peripapillary region. A greater proportion of participants in the OSA group required a subsequent evaluation for glaucoma than in the control. In those with OSA, an increase in the apnea hypopnea index was associated with an increase in optic nerve cupping.ConclusionsOSA does not exert a robust effect on corneal nerves. OSA is however, associated with thinning of the RNFL. Participants with glaucomatous optic nerve changes and risk factors for OSA should be examined as uncontrolled OSA may exacerbate glaucoma progression.

Predictors of sleep disordered breathing in children with Down syndrome: a systematic review and meta-analysis.

Children with Down syndrome are at increased risk of sleep disordered breathing (SDB). SDB is associated with significant morbidity including neurocognitive impairment, cardiometabolic disease and systemic inflammation. The identification of clinical markers that may predict SDB is critical in facilitating early diagnosis and treatment, and ultimately, preventing morbidity. The objective of this systematic review was to identify predictors of SDB in patients with Down syndrome. A search was conducted using MEDLINE, Embase, the Cochrane Central Register of Controlled Trials and the Cumulative Index to Nursing and Allied Health Literature. A meta-analysis was performed according to the Meta-analyses of Observational Studies in Epidemiology checklist. Our review of the literature identified inconsistent associations between a variety of variables and SDB in children with Down syndrome, although the quality of evidence was poor. Meta-analysis of age and sex identified that children with OSA were older than those without OSA, and there was a similar risk of OSA in males and females, although risk favoured males. Currently, the American Academy of Pediatrics guidelines recommend that children with Down syndrome undergo polysomnography by the age of 4 years. Our review supports the recommendation for routine screening of children with Down syndrome. However, results from our meta-analysis suggest a need for longitudinal screening to diagnose children who may develop SDB as they get older.

Impact of Obstructive Sleep Apnea Diagnosed Using the STOP-Bang Questionnaire Scale on Postoperative Complications Following Major Cardiac Surgery: A Prospective Observational Cohort Study.

PurposeObstructive sleep apnea (OSA) is a common and often undiagnosed condition in patients undergoing major surgeries, including cardiac surgery. This disorder is associated with peri- and postoperative problems. This study measured the association between OSA and peri- and postoperative complications in patients undergoing elective cardiac surgery.MethodsCandidates for elective cardiac surgery were evaluated for OSA by the STOP-Bang questionnaire before the surgery. We evaluated patients before and after the operation regarding the cardiac, respiratory, and neurologic complications. We divided the participants into high-risk (score of 5-8), intermediate-risk (score of 3-4), and low-risk groups (score of 0-2) based on the STOP-Bang questionnaire.ResultsOf the 306 patients who underwent cardiac surgery, 173 (56.5%) were in the high-risk group, 100 (32.7%) were in the intermediate-risk group, and 33 (10.8%) were in the low-risk group for OSA.Patients in the high-risk group were significantly older than the other two groups (p value=0.013), had higher BMI (p<0.001), and suffered more from relevant comorbid conditions, including diabetes mellitus, hypertension, and hyperlipidemia (all p-values significant at < 0.05). However, not significant, patients in the high-risk group suffered more from postoperative complications including cardiac, respiratory, and neurological complications.ConclusionOSA is common in patients undergoing cardiac surgery. Our findings indicate that these patients manifest a higher incidence of postoperative complications compared to those with a lower risk of OSA. Because of the limited use of polysomnography, a simple STOP-Bang questionnaire is beneficial to screen patients for the risk of OSA peri-operatively, and patients diagnosed with OSA can get extra care during and after the surgery.