Risk Of Sleep Apnea Research Articles

Assessment of oropharyngeal respiratory volume and sleep apnoea scores using peripheral arterial tonometry may improve diagnosis and treatment planning of combined dysgnathia therapy approaches.

Increased daytime sleepiness is a frequently reported symptom in patients with pronounced dysgnathia. This study investigated possible correlations using home peripheral arterial tonometry (PAT) and oropharyngeal airway volume determination in patients with dysgnathia and daytime sleepiness. Twenty patients (13 male, median age 27.6 ± 6.8 years) with abnormal sleep history and 10 skeletal neutral configured controls (6 male, median age 29.5 ± 4.2 years) with normal sleep history were examined. Patients and controls were evaluated for apnoea-hypopnoea index (AHI), respiratory disturbance index (RDI), oxygen desaturation index (ODI), snoring volume (dB), total sleep time (TST) and REM-percentage (REM). Airway volumetry was measured via CBCT. Individual user experience for PAT was assessed using the User Experience Questionnaire (UEQ). Patients had significantly higher respiratory scores than controls. AHI increased 4.6-fold (p = .006), RDI 2.5-fold (p = .008) and ODI 6.4-fold (p < .001). Oropharyngeal volumes showed a 30% decrease (p = .003). dB, TST and REM showed no significant differences. AHI (r = -.51; p = .005), ODI (r = -.60; p < .001) and RDI (r = -.45; p = .016) correlated negatively with pharyngeal volume. Wits appraisal correlated negatively with oropharyngeal volume (r = -.47; p = .010) and positively with AHI (r = .41; p = .03) and ODI (r = .49; p = .007). dB and TST (r = -.49; p = .008) and REM and RDI (r = -.43; p = .02) correlated negatively. UEQ-KPI (2.17 ± 0.24) confirmed excellent usability of PAT. Patients with mandibular retrognathia and abnormal sleep history showed significantly higher respiratory indices and smaller oropharyngeal volumes than neutrally configured controls. The dygnathia severity directly influenced the risk of obstructive sleep apnoea.

Retrospective review of acute post-tracheostomy complications and contributing risk factors.

Tracheostomy is performed for various indications ranging from prolonged ventilation to airway obstruction. Many factors may play a role in the incidence of complications in the immediate post-operative period including patient-related factors. Chronic obstructive pulmonary disease and asthma are some of the most common pulmonary pathologies in the United States. The relationship between obstructive pulmonary diseases and acute post-tracheostomy complications has been incompletely studied. A retrospective chart review was designed in order to answer these objectives. Medical records were reviewed for the technique used, complications, and contributing patient factors. Post-operative complications were defined as any tracheostomy-related adverse event occurring within 14 days. The study took place at an academic comprehensive cancer. Inclusion criteria included patients from January 2017 through December 2018 who underwent a tracheostomy. Exclusion criteria included presence of stomaplasty, total laryngectomy, and tracheostomies performed at outside hospitals. Patient factors examined included demographics, comorbidities, and body mass index with the primary outcome measured being the rate of tracheostomy complications. The most common indication for tracheostomy among the 321 patients that met inclusion criteria was airway obstruction or a head and neck cancer surgical procedure. Obstructive sleep apnea was associated with acute complications in bivariate analysis (29.4% complications, p = .003). Chronic obstructive pulmonary disease and asthma were not associated with acute complications in bivariate analysis (11.6% complications, p = .302). Among the secondary outcomes measured, radiation was associated with early complications occurring in post-operative days 0-6 (1.1%, p = .029). Patients with obstructive sleep apnea may have a higher risk of acute post-tracheostomy complications that might be due to the patient population at risk for obstructive sleep apnea. Patients with obstructive pulmonary pathologies such as asthma or chronic obstructive pulmonary disorder did not have an elevated risk of complications which is clinically significant when considering the utility of ventilation and tracheostomy in the management of acute respiratory failure secondary to these conditions.

Multidimensions of sleep health among in-school adolescents in rural and urban areas in southwestern Nigeria

IntroductionPrevious studies have focused on sleep inequities among disadvantaged populations in high-income countries. However, little is known about the differences in sleep health among adolescents in Africa. We aimed to compare the multidimensions of sleep health in adolescents living in rural vs. urban communities in Nigeria. MethodsThis cross-sectional study enrolled adolescents aged 13-19 in six rural and six urban schools in Osun State, Nigeria. We measured the prevalence of poor sleep quality (Pittsburgh Sleep Quality Index score >5), daytime sleepiness (Epworth Sleepiness Scale for Children and Adolescents score >10), and risk of sleep apnea (Teen STOPBANG). We compared the sleep health variables between the rural and urban populations using multivariable logistic regression. ResultsOf the 900 participants (51% rural; 59% female; average age (SD)= 15.1(1.4) years), 79% had short sleep duration (<8.5 hours), 14.9% poor sleep quality, 9.6% excessive daytime sleepiness and 9.8% risk of sleep apnea. Urban adolescents had a higher prevalence of poor sleep quality (p = .004), short sleep duration (p < .001), daytime sleepiness (p = .044), and risk of sleep apnea (p = .006) compared to rural adolescents. The adjusted odds of having poor sleep quality (p = .008) and daytime sleepiness (p = .007) were about 2-fold higher among urban compared to rural adolescents. Later school end time, having single/separated parent(s), absence of parental setting of bedtime were independently associated with poorer sleep health. ConclusionAdolescents in rural communities had better sleep health than adolescents in urban communities. There is a need to develop interventions to improve the sleep quality and overall sleep health of urban-dwelling adolescents.

Risk of obstructive sleep apnea among health workers: results of a screening in a large Italian University Hospital.

Obstructive sleep apnea (OSA) is a common respiratory sleep disorder, related to increased mortality, poor quality of life, and higher risk of work accidents and injuries. Studies on the risk of OSA (rOSA) among health workers (HW) are scant. The aims of this study were to investigate this issue in a large University Hospital and to assess the effectiveness of a screening program. The STOP-BANG questionnaire (SBQ) was sent via e-mail to the 5031 HW employed at the University Hospital of Verona. HW who completed the SBQ were classified at low, moderate, and high rOSA. HW at high rOSA were invited to undergo nocturnal polygraphy. The determinants of rOSA were studied by non-parametric Kruskal-Wallis test, Pearson's chi-squared, and multinomial logistic model. Of 5031 HW, 1564 (31.1%) completed the online questionnaire. Responders with low, moderate, and high rOSA were 72.7%, 13.7%, and 13.6%. Male gender, older age, and higher body mass index (BMI) were significant predictors of high rOSA, as expected. Physicians had the lowest probability of being in the high-risk category. Polygraphy was performed in 64 subjects. The positive predictive value of the self-administered SBQ was 68.8% (95%C.I. 55.9-79.8%) but raised to 96.9% (95%C.I. 89.2-99.6%) when re-administered by medical staff. SBQ showed its effectiveness as a screening tool in detecting undiagnosed OSA in HW. Systematic screening for OSA in work settings could allow early diagnosis and treatment, reducing short- and long-term health effects of OSA.

Screening for sleep apnoea risk in testosterone-treated transgender men.

Obstructive sleep apnoea (OSA) is more prevalent in men. Several studies suggested that higher testosterone levels were associated with a greater risk of OSA. We aimed to determine whether testosterone administration in transgender men would accentuate symptoms of OSA. The study involved 94 adult people undergoing a female-to-male transition with testosterone administration. The participants answered the Berlin Questionnaire (BQ) and a separate question on snoring before starting testosterone treatment and after at least 1 year of being on testosterone treatment. A higher proportion of participants at the follow-up answered positively to the first category of BQ devoted to snoring. A lower proportion of participants at follow-up answered positively to the second category of BQ devoted to tiredness. The percentage of subjects with a high risk of sleep apnoea, according to BQ, and of those who answered the question on snoring positively did not change significantly. An increased number of transgender men who reported snoring in BQ after testosterone administration indicate a higher risk of OSA development.

High risk of obstructive sleep apnoea is associated with higher baseline plasma glial fibrillary acidic protein and predicts decline in levels over time in cognitively unimpaired older adults

AbstractBackgroundFindings from animal studies report links between obstructive sleep apnoea (OSA) models and elevated glial fibrillary acidic protein (GFAP). In humans, elevated plasma GFAP, reflecting reactive astrogliosis, is considered an early event in the Alzheimer’s disease (AD) continuum. The current study investigated whether OSA risk predicts the slope of plasma GFAP in cognitively unimpaired older adults.MethodLinear mixed effect model analyses were conducted on 70 cognitively unimpaired older adult (M = 73.1, SD = 5.2, 57.1% female) participants of the Australian Imaging, Biomarkers and Lifestyle (AIBL) Study of Ageing. Individuals completed the well‐validated STOP‐Bang questionnaire to assess OSA risk (Low; Intermediate; High), and underwent positron emission tomography (PET) to quantify brain Aβ burden. Plasma GFAP was measured using the Simoa® platform over three timepoints (range 30.06 ‐ 99.45 months). The model included, a random intercept, a three‐way interaction between OSA risk, baseline brain Aβ status and time, adjusting for Apolipoprotein E (APOE) ε4 status, sex, baseline age, and baseline body mass index.ResultHigh risk of OSA and high brain Aβ (&gt;25 Centiloids) were independently associated with higher baseline plasma GFAP and forecast a negative longitudinal plasma GFAP trajectory.ConclusionThese novel findings suggest that OSA mechanisms, independent of prior brain Aβ accumulation, may contribute to early reactive astrogliosis in cognitively unimpaired older adults. Additionally, a decline in plasma GFAP was observed during the preclinical period, both in those at high risk of OSA and those at greater risk of AD due to high brain Aβ.

Sleepiness or chronic fatigue, which best predicts with obesity a risk of sleep apnea in young adults?

Sleepiness or chronic fatigue, which best predicts with obesity a risk of sleep apnea in young adults?

Isolated REM sleep behaviour disorder in the Tasmanian ISLAND Sleep Study: prevalence and profiles of prodromal dementia

AbstractBackgroundIdentifying people with isolated REM sleep behaviour disorder (iRBD) provides important opportunities for targeted dementia prevention as iRBD is a prodrome of Lewy Body dementia (LBD) and other neurodegenerative diseases (NDD). There have been no prevalence studies of iRBD in Australia and little is known about whether associated motor, cognitive, olfactory and circadian features influence the progression to different NDD. The Island Study Linking Ageing and Neurodegenerative Disease (ISLAND) Sleep Study aims to identify the iRBD prevalence in Tasmania and determine how different iRBD profiles predict progression to dementia and other NDD.MethodAdults aged 50+ years in Tasmania completed online questionnaires including the REM Sleep Behaviour Disorder Screening Questionnaire (RBDSQ), RBD single question screen (RBD1Q), Pittsburgh Sleep Quality Index (PSQI), and questions regarding dreaming, autonomic, motor s, and pain symptoms.Result2,905 participants have been recruited (mean (SD) age 64 (7.7) years; 26% male). 273 (9.4%) have ‘probable’ iRBD (pRBD) based on the RBDQ1. Compared to those without pRBD, the pRBD group have poorer sleep quality (66% vs 57%), greater autonomic dysfunction (median score 18 vs 13), more pain (particularly stabbing and itching pain), higher risk for sleep apnoea (30% vs 13%), more intense dreams (21% vs 8%), and more motor symptoms, including shaky limbs (16% vs 6%) and slurred speech (12% vs 6%).Conclusion2905 participants have been recruited (mean (SD) age 64 (7.7) years; 26% male). 273 (9.4%) have ‘probable’ iRBD (pRBD) based on the RBDQ1. Compared to those without pRBD, the pRBD group have poorer sleep quality (66% vs 57%), greater autonomic dysfunction (median score 18 vs 13), more pain (particularly stabbing and itching pain), higher risk for sleep apnoea (30% vs 13%), more intense dreams (21% vs 8%), and more motor symptoms, including shaky limbs (16% vs 6%) and slurred speech (12% vs 6%).

Prevalence of Obstructive Sleep Apnea Using Home Sleep Test in Taiwan During the Coronavirus Disease Pandemic.

Obstructive sleep apnea syndrome (OSAS) is a common disorder associated with serious sequelae. The current gold standard diagnostic method, polysomnography, is costly and time consuming and requires patients to stay overnight at a facility. This study aimed to reveal the prevalence of OSAS in general adult population using a home sleep test (HST) during the coronavirus disease 2019 (COVID-19) pandemic. This prospective cohort study was conducted by the Department of Otolaryngology, Taipei City Hospital, Taipei, Taiwan, between January 2020 and December 2021. A total of 1372 patients aged 30-70 years completed an HST using a Type 3 portable sleep monitor (PM). The apnea-hypopnea index (AHI) was analyzed to assess the association of OSAS with age, body mass index (BMI), sex, Epworth Sleepiness Scale (ESS) and the Sleep Apnea Risk Assessment questionnaire (STOP-Bang questionnaire) rating. The mean age of the patients (782 men, 57%; 590 women, 43%) was 49.24 ± 11.04 years. OSAS was detected in 954 (69.5%) patients with 399 (29.1%) mild OSAS; 246 (17.9%) moderate OSAS; and 309 (22.5%) severe OSAS. Among these, the prevalence of moderate-to-severe OSAS was 143 (10.4%) in women and 412 (30.0%) in men. The mean age was the highest (51.29 ± 11.29) in the mild OSAS group and lowest (47.08 ± 10.87) in the healthy group. OSAS severity was greater with increasing BMI, 23.39 ± 3.44 in the healthy group and 29.29 ± 5.01 in the severe OSAS group. A positive correlation was also noted between the ESS/STOP-Bang questionnaire rating and OSAS severity. The prevalence of OSAS in Taiwan was 69.5% in our study. It showed strong evidence that OSAS has important public health consequences and PMs are simple, fast, feasible, and cost-effective tools for OSAS screening in the home environment, especially during the COVID-19 pandemic.

Body Mass Index and Its Association with Daytime Sleepiness and Risk of Sleep Apnea Among Adults in International Islamic University Malaysia (IIUM) KuantanBody Mass Index and Its Association with Daytime Sleepiness and Risk of Sleep Apnea Among Adults in International Islamic University Malaysia (IIUM) Kuantan

Introduction: The prevalence of obesity keeps rising by the year, and Malaysia was revealed as the top country in Southeast Asia that has a high prevalence of obesity. Due to the rising obesity globally is feared that it may be associated with the increasing chance of having sleep apnea and excessive daytime sleepiness. Consequently, it may lead to poor work performance, unfortunate accidents, and premature death if not treated earlier. This research sought to identify the BMI values and their association with the risk of sleep apnea and daytime sleepiness among adults in IIUM Kuantan. Methods: By applying convenience sampling, 143 respondents were recruited in this cross-sectional study. The Berlin questionnaire and Epworth Sleepiness Scale were used as the research instruments to determine the risk of sleep apnea and daytime sleepiness among the respondents, respectively. Ordinal Logistic Regression and Pearson correlation were used to analyse the associations. Result: The mean (SD) BMI was 22.3 kg/m2 (4.33)- normal, and the mean score of daytime sleepiness was 9.92 (4.80)- higher than normal. Most respondents had a low risk of sleep apnea (87.4%), 5.6% showed a slightly increased risk, and 7.0% had a high risk of sleep apnea. There is a significant association between BMI and risk of sleep apnea (p&lt;0.05), as an increase in BMI (expressed in kg/m2) is associated with an increase in the odds of having a risk of sleep apnea. There is no significant association between BMI and daytime sleepiness (p&gt;0.05), as these variables are weakly and inversely correlated. Conclusion: This study found a significant association between BMI and risk of sleep apnea. However, we failed to confirm the association between BMI and daytime sleepiness. Due to the lack of BMI varieties, the researcher recommends focusing on overweight and obese to get a wide variation of BMI.

Assessment of risk of obstructive sleep apnea with thyroid eye disease and its activity.

To evaluate the association between obstructive sleep apnea (OSA) and thyroid eye disease (TED) and its effect on disease activity. A prospective case-control study was conducted from January 2020 to March 2022. All TED patients (group A) were clinically evaluated. The activity of thyroid eye disease was calculated based on the clinical activity score (CAS), and grading of severity was done according to the EUGOGO classification. All TED patients (group A) were screened for OSA using the Snoring Tired Observed Pressure (STOP)-Bang survey. Age- and gender-matched control group patients (group B) without TED were screened for OSA. One hundred TED patients and 138 control patients without TED were included in the respective groups. Sixty-two (62%) patients in group A and 48 (34.78%) patients in group B were having high risk of OSA, and this difference was statistically significant (P = 0.001). Further, in group A patients, on univariate analysis, TED activity was significantly associated with a high risk of OSA (P = 0.009). On multivariate logistic regression analysis, OSA also showed significant association with TED activity (odds ratio [OR]: 4.14, 95% confidence interval [CI]: 1.11-18.85 at 10% level; P = 0.05). Our study showed that OSA is significantly associated with TED disease and its activity. However, no significant association was found between OSA and severity of the disease.

Health Screening Among a Rural, Hourly Workforce: North Carolina SERVIRE Project

This study demonstrates the feasibility of a novel, business-partnered, and worksite-based approach to healthcare access to facilitate chronic disease screening and diagnosis among rural hourly workers. The prevalence of undiagnosed and untreated diabetes and hypertension among screening participants was determined. From February 2021 to June 2023, investigators partnered with 29 businesses to screen 1,114 workers. Health screenings included a demographic questionnaire, A1c testing for prediabetes (A1c of 5.7-6.4) and diabetes (A1c≥6.5), hypertension (Stage 1: systolic blood pressure of 130-139 mmHg; Stage 2: systolic blood pressure ≥140 mmHg), kidney disease (estimated glomerular filtration rate <60; urine protein ≥1+), and questionnaire assessment of stroke (CHA2DS2-VASc) and sleep apnea (STOP-bang) risk. Of the 1,114 individuals screened (n=632, 56.7% male; n=497, 44.6% Black)), 388 (36%) screened positive for prediabetes or diabetes. Diabetes was previously undiagnosed in 273 (70.4%) of these participants. More than half of the participants (n=680, 62.4%) had an elevated blood pressure reading during the screening, and the majority of these participants (n=445, 65.4%) had not been previously diagnosed with hypertension. In addition, 241 (21.6%) participants were at an increased risk of stroke (CHA2DS2-VASc≥2), and 182 (23.7%) had a STOP-Bang score ≥4, indicating an increased risk of obstructive sleep apnea. By partnering with local businesses to deliver worksite-based health screenings, high rates of undiagnosed and uncontrolled diabetes and hypertension were identified among the rural, hourly workforce. This worksite-based approach to healthcare access could facilitate early detection of chronic disease, improve patient engagement in the healthcare system, and ultimately yield better long-term public health outcomes.

Digital follow-up program for patients undergoing atrial fibrillation ablation: a pilot single-center study

Abstract Introduction Atrial fibrillation (AF) carries significant burden in health expenditure worldwide. Digital health technology may improve healthcare delivery, but its applicability in clinical practice and related outcomes remain a gap in evidence. Aim To report the implementation of a digital follow-up program (FUP) for patients submitted to AF ablation in an European center. Methods A digital FUP was implemented at a high-volume ablation center in 2020. The program featured a web platform for professionals, to record Clinician Reported Outcome Measurements (CROMs), during remote medical visits, and access Patient Reported Outcomes Measurements (PROMs). The program also included a mobile app for patients to report symptoms, vital signs, anthropometric and electrocardiographic data. Patients were invited to complete questionnaires at prespecified timepoints: Atrial Fibrillation Effect on qualiTy-of-life [AFEQT]; the Epworth and STOP-BANG for obstructive sleep apnea; nutritional questionnaire. Completeness rate was defined by the ratio of queries completed/queries sent at each timepoint. The mHealth App Usability Questionnaire (MAUQ) questionnaire was sent to patients and doctors; patients also received a Patient Reported Experience Measure (PREMs) 15 days after the ablation, from which a Net Promotor Score (NPS, -100 to 100) was calculated to express user’s satisfaction. This retrospective analysis includes data collected from December 2020 to September 2022. Results From the 305 ablations performed in this period, 253 patients were enrolled in the digital FUP: age 60±11 years, 67% male, 78% paroxysmal AF, body mass index 27.4±4.2 kg/m2. During a mean follow-up time of 11.9±5.8 months, 1120 CROMs were registered; 1449 PROMs were collected, including 5865 metrics reported by 90 different patients. App usage, measured by unique logins/month, was recorded in 54% of patients, of whom 13% submitted symptom checks weekly. 160 PREMs were registered; NPS scores for ablation and the app were 85.5 and 31.5, respectively [image]. Questionnaire overall completeness rate was: 54.5% for AFEQT; 14.4% for Epworth; 20.8% for STOP-BANG, that identified 55% of patients at high risk for sleep apnea. Nutritional assessment was completed by 18.7%; obese/pre-obese status was found in 21% and 48%, respectively; 18 patients were enrolled in a nutritional program. All doctors "agreed"/"strongly agreed" to overall satisfaction with the app. Conclusions The digital FUP was feasible and aided comorbidities assessment. Strategies to improve patient’s engagement and digital literacy are warranted. Further studies are needed to evaluate the platform’s impact on clinical outcomes.

Abstract 19123: Associations Between Multiple Dimensions of Poor Sleep and Life’s Essential 8 Cardiovascular Health Score During the Menopausal Transition: Findings From the AHA Research Goes Red Weight Study

Introduction: The sleep health metric in AHA Life’s Essential 8 (LE8), a measurement of cardiovascular health (CVH), consists only of sleep duration. Associations of other dimensions of sleep health including sleep quality with the LE8 CVH and its individual components have not yet been evaluated. Methods: Participants were 291 women (n=98 pre-, n=94 peri-, n=99 post-menopausal, mean age=50 ± 3.2yr) between 45-55y from the AHA Research Goes Red Weight Study, which utilized Verily’s online platform. Standardized questionnaires included the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), and Berlin questionnaire for risk of obstructive sleep apnea (OSA), and a 1-wk NIH ASA 24-Hour Dietary Assessment. The LE8 CVH and component scores were computed. Cross-sectional associations between sleep and overall CVH scores and individual metrics were tested using multivariable logistic regression models adjusted for age, race/ethnicity, education, employment, insurance, and menopausal status. Results: Half of women slept &lt;7 hours/night, 79% reported poor sleep quality (PSQI≥5), one-third had high-risk OSA phenotype, 51% reported insomnia symptoms (ISI≥8), and 12% had evening chronotype. Compared to pre-menopausal women (67%), significantly more post-(83%) and peri-menopausal (86%) women reported poor sleep quality (p&lt;0.01). Women with poor sleep quality had 3-fold higher odds of poor overall CVH score (p=.04). Women with high-risk OSA phenotype and evening chronotype also had ~3-fold higher risk of poor overall CVH scores (OR=3.58, CI=1.79-7.18, and OR=3.33, CI=1.45-7.69, respectively). Poor sleep quality was associated with greater odds of low score on the diet component (OR=2.97, CI=1.55-5.69). Insomnia symptoms were associated with poor score on the BMI component (OR=1.92, CI=1.15-3.21). High-risk OSA phenotype was associated with greater odds of poor scores on the blood pressure, blood glucose, and BMI components (OR=2.3, CI=1.2-4.3; OR=3.2, CI=1.5-7.1, and OR=11.6, CI=6.2-21.6). Conclusions: Multiple aspects of sleep other than duration were associated with overall LE8 CVH score, and individual metrics, among women across menopause. Findings support potential incorporation of sleep quality into CVH constructs.

Causal relationship between sleep apnea and non-alcoholic fatty liver disease: A Mendelian randomization study.

Observational studies indicate that sleep apnea is associated with non-alcoholic fatty liver disease (NAFLD) and its related metabolic features, independent of confounding factors including obesity. However, the causal relationships remain to be determined. Univariable and multivariable Mendelian randomization (MR) analyses were performed to investigate the causal relationship between sleep apnea and NAFLD, along with its typical features including liver function, glycemic traits and lipid profiles. Summary-level data for sleep apnea were obtained from the Finngen consortium (33,423 cases and 307,648 controls). Summary-level data for NAFLD were available from a GWAS meta-analysis (8434 cases and 770,180 controls), and data for 12 NAFLD-related features from corresponding published GWASs. The inverse variance weighted (IVW) analysis was employed as the primary statistical method. Bidirectional MR and CAUSE analysis were conducted to avoid reverse causality and false positive findings. In univariable MR analyses, we found evidence to support a causal effect of genetically predicted sleep apnea on NAFLD (OR = 1.50, 95% CI = 1.18-1.91) and HDL-C (β = -0.045, 95% CI = -0.090 to -0.001). In reverse MR, genetically predicted serum TG was associated with an increased risk of sleep apnea (OR = 1.07, 95% CI = 1.02-1.12), while genetically predicted HDL-C was associated with a decreased risk of sleep apnea (OR = 0.93, 95% CI = 0.89-0.98). After adjusting body mass index or educational attainment, none of these causal associations were retained. However, CAUSE method and MR analyses focusing on lipoprotein subfractions supported a causal effect of sleep apnea on HDL-C and HDL subfractions. This MR study indicated that sleep apnea has no direct causal association with NAFLD, elevated liver enzymes and insulin resistance. Our results showed suggestive inverse associations of genetically predicted sleep apnea on HDL-C and HDL subfractions, indicating that both HDL-C levels and HDL function may be causally implicated in sleep apnea.

Self-Reported Sleepiness, Fatigue and Risk of Obstructive Sleep Apnea Using the STOP BANG Components: Women’s Perspective

Introduction: About 2-4% of adults have obstructive sleep apnoea (OSA), a frequent chronic condition. The disorder is characterised by recurrent bouts of whole or partial collapse of the upper airway, primarily the oropharyngeal tract, while sleeping, which results in a decrease or stoppage of airflow. The aim of the study is to assess the relationship between the self-reported sleepiness, fatigue and the risk of Obstructive Sleep Apnea among the midlife women aged 40 to 65 years Methodology: This was a cross sectional study conducted in the field practice area of rural and urban health and training centre of a tertiary care teaching hospital, Chengalpattu district, Tamilnadu among 380 women aged 40 to 65 years. Results: Mean age of the study population was 49.69 (± 11.2). On risk categorization by STOP-BANG Questionnaire, it was found that 72.9% (277), 26.1% (99) and 1.1% (4) had low, intermediate and high risk for sleep apnea. 16.9% of the study participants had excessive daytime sleepiness. Fatigue severity scale of more than or equal to 36 was seen among 34.5% of the study participants. Conclusion: The STOP-Bang questionnaire has been shown in studies to be a quick, efficient, and accurate OSA screening tool. It can make it easier to allocate resources effectively for detecting and treating OSA that had not yet been recognised.

68 Interactive Effects of Sleep Apnea and Depression Symptoms on Cognition in Older Adults

Objective:Sleep deprivation and depressive symptoms have been shown to negatively impact cognitive function within older adult populations (Gilley, 2022; Donovan et al., 2016). However, there is minimal research on interactions between sleep disturbance and depressive symptoms in relation to their shared impact on cognitive impairment. The purpose of this study is to examine possible interactions between sleep disorders and depression and their relationship with cognition among relatively good functioning and healthy older adults.Participants and Methods:The sample was obtained from the Memory and Aging Project (Rush Alzheimer's Disease Center, Rush University, 2019) and consisted of 3,345 community dwelling older adults. The study analyzed data from 2552 women (76.3%) and 1093 men (23.7%). The average age of participants was 80 years and ranged from 45 to 98 years old. Measures used included the Berlin Questionnaire (risk for sleep apnea), Center for Epidemiological Studies Depression Scale (CES-D; depression), and a neuropsychological battery (visuospatial ability/perceptual reasoning and processing speed).Results:ANOVA analyses exhibited a significant main effect of depression on visuospatial ability/perceptual reasoning (p &lt;.001), processing speed (p &lt;.001), and semantic memory (p &lt;.001). No significant main effect was found for sleep apnea on these cognitive domains. However, when sleep apnea was analyzed between those with any depressive symptoms versus those without, significant interactions were found for visuospatial ability/perceptual reasoning (p =.027), processing speed (p &lt;.001), and semantic memory (p =.016). Sleep apnea symptoms had a greater detrimental effect on visuospatial skills and perceptual reasoning (F=4.90; p=.027) only when any depression symptom is present. In contrast, there was a steeper decline of processing speed when only depressive symptoms were present apart from sleep apnea symptoms (F=10.34; p =.001) Similarly, depressive symptoms had a greater negative effect on semantic memory for older adults who reported no sleep apnea symptoms compare to those who did (F=5.83, p=.016).Conclusions:The current study indicated that while sleep apnea was negatively related to several cognitive domains, the impact became greater with the presence of depression on visuospatial skills and perceptual reasoning among older adults. However, the detrimental impact of sleep apnea was somewhat less with the presence of depression for processing speed and semantic memory. This may be due to likely higher endorsements of depressive symptoms compared to sleep apnea symptoms within the study sample. These findings suggest that there are differential interactive effects of sleep impairment and depressive symptoms on cognitive domains among older adults. Considering the relationship that exists between depression and increased disease burden among older adults, it is crucial for clinicians to also take sleep behaviors into account when examining and treating their patients. Clinicians should be mindful of their older patient's sleep health and depression measures when cognitive declines are suspected. They also suggest that cognitive performance may be improved with treating any symptoms of sleep apnea and depression in older adults.

Obstructive sleep apnea risk factor for chronic kidney disease: A systematic review and meta-analysis

&lt;b&gt;Introduction: &lt;/b&gt;Obstructive sleep apnea (OSA) is related to chronic kidney disease (CKD), but its association is not fully understood.&lt;br /&gt; &lt;b&gt;Objective&lt;/b&gt;: To realize a systematic review with meta-analysis to determine the association between OSA and CKD.&lt;br /&gt; &lt;b&gt;Methods:&lt;/b&gt; Systematic review with meta-analysis of observational studies. The search was carried out in Embase, PubMed/Medline, Scopus, and Web of Science. The data were calculated by the hazard ratio (HR). The heterogeneity was identified by I squared.&lt;br /&gt; &lt;b&gt;Results:&lt;/b&gt; Five studies were included (n=6,710). The meta-analysis found an association between OSA and CKD (HR=2.00; confidence interval 95%=1.68-2.38).&lt;br /&gt; &lt;b&gt;Conclusions:&lt;/b&gt; We found an association between OSA and CKD.

High risk for obstructive sleep apnea and risk of hypertension in military personnel: The CHIEF sleep study

Rehabilitation of lower limb amputation in developing countries is quite challenging. Though there are basic to highly advanced prostheses available in India, the set-up is still facing difficulties in developing countries. Prosthetic management is difficult due to lack of availability of prostheses and reduced affordability among low income populations. In this review we highlighted the lower limb amputation and prosthetic rehabilitation status in India. Currently, India is advancing well in the rehabilitation field, but further studies are required to provide more evidence and recommendation.

Diagnostic Value of Neutrophil to Lymphocyte Ratio for Assessing Obstructive Sleep Apnea Risk in Surgical Patients

PurposeObstructive sleep apnea (OSA) is an important risk factor leading to perioperative complications in surgical patients. Neutrophil-to-lymphocyte ratio (NLR) is an important biomarker of increasing interest in recent years, and is used in the determination of systemic inflammatory response. DesignThe aim of this study was to evaluate the risk of OSA and the relationship between OSA risk and NLR in surgical patients. MethodsThe study was conducted in a tertiary care hospital between November 2021 and May 2022. The cross-sectional study included 604 patients who underwent surgery. OSA risk was evaluated with the STOP-Bang questionnaire in the preoperative evaluation in all patients. NLR was calculated as the ratio of neutrophil count to lymphocyte count. FindingsAccording to the STOP-Bang questionnaire, 62.3% of the patients had a high risk of OSA in the preoperative period. Patients who were male, elderly, obese, had hypertension, diabetes, chronic lung disease, and heart disease and polypharmacy were at greater risk of OSA. Patients at high risk of OSA had significantly higher NLR than patients at low risk of OSA. (2.65 vs 2.92, P.ß=.ß.024). NLR of 2.40 or higher predicted OSA risk with 58.8% sensitivity and 51.0% specificity (AUC.ß=.ß0.561) ConclusionsMost patients who were to undergo surgery had a high risk of OSA. NLR was higher in patients at high risk of OSA. Although the diagnostic efficacy is not high, NLR can be used to detect high OSA risk because it is a low-cost and easy to obtain biomarker.