Risk Of Sleep-related Breathing Disorders Research Articles

0471 Having a Surgical Aortic Valve Replacement? You Very Likely Have Obstructive Sleep Apnea

Abstract Introduction Patients with advanced aortic stenosis (AS) have a high risk of sleep-related breathing disorders (SRBD), yet prior research is limited to type III sleep apnea tests. Whereas the American Academy of Sleep Medicine recommends polysomnography for SRBD diagnosis in patients with significant cardiorespiratory disease, unattended studies are often more acceptable, especially to surgical candidates. We conducted this study to address the need for comprehensive sleep testing in patients with advanced AS. Methods We conducted unattended type II sleep tests in 23 adults aged 50 and older scheduled for surgical aortic valve replacement (SAVR) and not using positive airway pressure. We obtained demographics and medical history and administered Clinical Dementia Rating, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, and 9-item Patient Health Questionnaire. We characterize this pre-surgical sample and report SRBD prevalence. Results Average age of the sample was 68.3 ± 7.2 (mean ± SD), and 74% were male. Charlson comorbidity index was 2.0 ± 2.0. Three (13%) had a global CDR of 0.5, consistent with mild cognitive impairment. Mean PSQI scores were 7.0 ± 3.6, ESS 6.7 ± 4.0, and PHQ-9 4.6 ± 5.3. No subject had an AHI < 5: 7 had a score of 5–14, 8 of 15–29, and 8 of 30 or greater. Mean obstructive AHI was 25.3 ± 20.7, central AHI 1.9 ± 3.4, and respiratory arousal index 8.7 ± 6.2. Total sleep time 362.7 ± 82.6 min with sleep efficiency of 82.1% ± 8.6%. Sleep stage data to be presented. Conclusion All subjects in this sample not using positive airway pressure had an AHI ≥ 5. Sixteen subjects (70%) had an AHI ≥ 15, indicating moderate to severe sleep apnea due to predominantly obstructive events. These results strongly suggest that patients with severe AS, especially those undergoing SAVR, would benefit from evaluation for SRBD. Support (if any) This research was supported in part by the National Institute on Aging, K23AG072383. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Additional support provided by University of Rochester Medical Center funds through the Departments of Psychiatry and Cardiology/Cardiac Surgery.

Does Head and Neck Posture Affect Cone-Beam Computed Tomography Assessment of the Upper Airway?

Radiographic analysis is often used as a screening tool to assess for risk of sleep-related breathing disorders. This study aimed to address 2 questions: (1) Does head posture significantly affect the minimum cross-sectional area (MCA)? and (2) Is the NBC3 (nasion-basion-C3) angle a reliable measurement to control for alteration of head position in cone-beam computed tomography (CBCT) scans? Study design: prospective cohort study. Private practices affiliated with a research institution. convenience sample of adult volunteers. CBCT scans were taken in 2 conditions: baseline (natural head position, NHP) and 1 of 5 experimental conditions (head tilted up, head tilted down, sitting vs standing, use of chin-rest, and swallow variation). For the primary aim of our study, the primary predictor variable was head posture and the main outcome variable was percentage change in MCA. For the secondary aim, the primary predictor variable was head posture and the main outcome variable was degree change in NBC3 angle. Ninety subjects were included (age 40.7±13.7years, 70% female). Mean NBC3 at baseline was 112.4±8.3°. Head tilted down significantly decreased (-41.4±18.5mm2, P=.03∗) and head tilted up significantly increased MCA (+147.4±43.3mm2, P=.0018∗). Head tilted down significantly reduced the NBC3 angle measurement (-10.5±6.8°, P=.006) and head tilted up significantly increased the NBC3 angle measurement (+14.4±5.8°, P=.0004). A quadratic regression model was fitted with moderately strong correlation (R2=0.54) showing an exponential effect of small changes in the NBC3 angle on MCA, P<.0001. The model predicts that increasing NBC3 by+5 and+10° resulted in MCA changes of+25% and+88%, whereas a decrease in NBC3 by -5 and -10° results in MCA changes of -21% and -23%, respectively. Alterations in head posture significantly affect the MCA of the upper airway on CBCT. The NBC3 angle can be used to reliably assess changes in cranio-cervical extension and validate comparisons of MCA between CBCT scans for the same patient. A standardized protocol for CBCT acquisition is proposed.

Impact of Spina Bifida on Sleep Quality: Current Insights.

Spina bifida (SB) is one of the most common birth defects in children. The care for patients with SB continues to evolve, and there has been notable improvement in survival outcomes, degree of disability and quality of life for these children. However, patients with SB continue to remain at higher risk for sleep-related breathing disorders (SRBD), unexplained sudden death, and potential alterations in their sleep chronotype. Previous studies report on abnormalities in the spinal cord, brainstem function, and dysfunction of upper airway maintenance as the likely mechanisms behind SRBD that is commonly seen in SB. Most studies looking at prevalence of SRBD in SB have been retrospective studies. A recent prospective study identified a prevalence as high as 42% when a polysomnography (PSG) was completed on all patients regardless of symptomatology. Treatment options vary depending on the type and severity of SRBD and can range widely. Despite advances in care for patients with SB and SRBD, a subset of these patients with myelomeningocele (MMC) continue to experience sudden unexplained death. Studies continue to evaluate ways to stratify which of these patients may be at higher risk of this devastating outcome. Given that SRBD is potentially treatable, early assessment and intervention could become an integral part of a multidisciplinary treatment strategy to optimize long-term medical and neurodevelopmental outcomes for this patient population. By understanding the impact that SB may have on a patient's sleep quality, their biological chronotype and their potential of developing SRBD, a provider may help to optimize the care a patient with SB receives from birth into adulthood.

Sleep-related breathing disorders associated with intrathecal baclofen therapy to treat patients with cerebral palsy: A cohort study and discussion.

Patients with cerebral palsy and other static encephalopathies (CP) are known to be at increased risk of sleep-related breathing disorders (SRBD). Few studies have reviewed whether intrathecal baclofen (ITB) can contribute to SRBD. To assess the prevalence of SRBD in patients with CP receiving ITB by using nocturnal polysomnography (NPSG). We performed a retrospective chart review of patients receiving ITB who had NPSG at Children's Hospital Colorado (CHCO) and Seattle Children's Hospital (SCH) from 1995 to 2019. The Gross Motor Function Classification System (GMFCS) measured the severity of motor disability. Screening sleep questionnaires collected subjective data and NPSG provided objective data of SRBD. All patients except one were GMFCS 4 or 5 with median age at ITB pump placement of 9.7 years. The screening questionnaire for SRBD detected one or more nighttime symptoms in > 82% of all patient groups. Pre-ITB criteria for a SRBD was met in 83% of patients at CHCO and 91% at SCH. Post-ITB prevalence remained similarly high. NPSG identified a high prevalence of SRBD in these cohorts from CHCO and SCH. Our study showed neither improvement nor worsening of SRBD in patients receiving ITB.

Associations of Sedentary Behaviour, Physical Activity, Cardiorespiratory Fitness and Body Composition with Risk of Sleep-Related Breathing Disorders in Children with Overweight/Obesity: A Cross-Sectional Study.

The aim of this study was to examine the associations of sedentary behaviour, physical activity, cardiorespiratory fitness (CRF), and body composition parameters with risk of sleep-related breathing disorders (SRBD) in children with overweight/obesity. One-hundred and nine children (10.0 ± 1.1 years old, 45 girls) with overweight (n = 27) and obesity (n = 82) were included. Television viewing time was self-reported by using the Spanish adaptation of the “Youth Activity Profile” (YAP) questionnaire. Sedentary time and physical activity were measured with accelerometry. CRF was assessed with the 20-m shuttle-run test and body composition parameters with Dual-energy X-ray absorptiometry. SRBD were evaluated by using the Spanish version of the Pediatric Sleep Questionnaire. Television viewing time was positively associated with risk of SRBD (r = 0.222, p = 0.021). CRF was negatively correlated with risk of SRBD (r = −0.210, p = 0.030). Body composition parameters were positively associated with risk of SRBD (all p < 0.05), except fat mass index. Stepwise regression analyses showed that body mass index (BMI) explained the largest proportion of the variance in SRBD (r2 = 0.063, p = 0.01) and television viewing time was the only one added after BMI (r2 change = 0.048, p = 0.022). This study supports the notion that higher body weight status negatively influences risk of SRBD and adds that unhealthy behaviours could contribute to worsen SRBD, related to an increased risk of cardiovascular diseases. All the significant association observed in this manuscript were of small magnitude, indicating than other factors in addition to the one hereby studied contribute to explain the variance in SRBD.

Abstract WMP118: The Association Between Sleep Related Breathing Disorders and Neuropsychological Function in Pediatric Stroke

Introduction: Sleep-related breathing disorders (SRBDs) in childhood are associated with adverse outcomes including developmental and behavioral disorders. The association of SRBDs with pediatric stroke is poorly understood. We aimed to assess the risk of SRBDs in children with stroke or non-stroke high risk arteriopathies (NSA) and to evaluate their association with cognitive and behavioral function. Hypothesis: Children with stroke or NSA have a higher rate of SRBD and associated poor cognitive and behavioral function. Methods: We conducted a cross-sectional study of children with arterial ischemic stroke (AIS), cerebral sinovenous thrombosis (CSVT) and NSA such as moyamoya. All children completed the Pediatric Sleep Questionnaire (PSQ). High risk for SRBDs was defined as a PSQ score ≥0.33. Children completed the Adaptive Behavior Assessment System (ABAS-2) parent and teacher forms and/or The Wechsler Intelligence Scale for Children (WISC-V) within 1 year of completing the PSQ. Results: Overall, 213 were included (54% males, median age: 9 years [IQR 5-14]). Forty-nine children (23%) were at high risk of SRBDs. The risk of SRBDs did not vary with age, gender or stroke subtype: AIS (25%), CSVT (20%), other stroke subtypes (20%) and NSA (24%) (p= 0.8). Children with SRBD had higher mean BMI z-scores (0.9±1.5 vs 0.4±1.3, p=0.06). Twenty-four and 15 children underwent ABAS-2 parent and teacher assessment, respectively. The global adaptive composite scores of both forms significantly correlated with the total PSQ scores (r s =-0.6, p&lt;0.01 for the parent form and r s =-0.63, p=0.01 for the teacher form). Correlation coefficients remained statistically significant upon controlling for BMI. In 19 children who completed the WISC-V, those at risk of SRBDs (n=7) had significantly lower Full Scale IQ (70±24.7 vs 91±17, p=0.03), processing speed (55±44 vs 96±19, p=0.02) and working memory (77±23 vs 98±15, p=0.02) compared to children at no risk. Cognitive and behavioral function did not differ across stroke subtypes. Conclusions: Pediatric stroke or NSA is commonly associated with SRBDs which in turn is linked to significant decline in cognitive and behavioral function. Further studies are required to understand the underlying pathological mechanisms.

Incidence of children at risk for obstructive sleep apnea undergoing common day surgery procedures

ObjectiveThe purpose of this study was to evaluate the prevalence of sleep-related breathing disorders (SRBD) in children undergoing elective day surgery procedures. MethodsA validated Pediatric Sleep Questionnaire (PSQ) was distributed to the parents of children aged 2months to 18 years who met inclusion criteria and were undergoing urologic, otolaryngologic, and general surgical day surgery procedures a 3-month period of time. The prevalence of children at risk for pediatric SRBD was determined from PSQ results. ResultsFrom a total of 288 PSQ Questionnaires, 9.1% of urology, 11.1% of general surgery, and 51.9% of otolaryngology patients admitted to day surgery were found to be at risk for sleep disordered breathing. The median PSQ score for the children at risk was 9.2 for urological surgeries, 10.9 for general surgery, and 11.3 for otolaryngological procedures. ConclusionsThere is an increased prevalence of children at risk of SRBD awaiting common day surgery procedures than previously expected based on existing literature. Patients undergoing otolaryngological procedures were at greater risk of sleep-related breathing disorders when compared with patients undergoing urological or general surgical procedures. There may be a role for screening of pediatric patients with a PSQ prior to day-surgery. Level of evidenceType of study: prognosis study, level IV.

Prevalence of sleep-related breathing disorders among school children in Kars Turkey

Sleep-related breathing disorders (SRBDs) are highly prevalent and gradually increasing in school-aged children due to technological and social “jetlag” worldwide. This study aimed to determine the prevalence and associated factors of SRBDs among school children in Kars, Turkey. A total of 1,421 school-aged children (6–13 years old) were included. SRBDs were evaluated with the Pediatric Sleep Questionnaire (PSQ). This study also examined the children’s socio-demographic characteristics and their relationships with SRBDs. The prevalence of SRBDs was 17.2%. The study group’s mean age was 9.37 ± 1.91 years, and 54.2% were girls. There was a significant relationship between “positive” (≥0.33) PSQ results and low educational levels of the parents, household smoking, frequent infections, chronic diseases, poor relationships with friends and teachers, and academic success. A strong relationship was found between academic success and snoring, breathing problems, attention deficit/hyperactivity disorder, nocturnal enuresis, morning headaches, delayed growth, and parental obesity. The SRBDs risk was 1.504-fold higher in boys than in girls. The risk of SRBDs with frequent infections was 1.921-fold higher than without frequent infections. Chronic diseases were associated with a 2.212-fold increase in the risk of SRBDs. SRBDs increased the risk of poor academic success by 4.673 fold (1/0.214). This was the first study conducted with school children in this region. We believe it is important to evaluate the prevalence and associated factors of SRBDs in school-aged children because of their effects on academic success, especially in developing parts of Turkey that require well-educated human resources more than the developed areas.

Prevalence of sleep disorders in the Turkish adult population epidemiology of sleep study

Sleep disorders constitute an important public health problem. Prevalence of sleep disorders in Turkish adult population was investigated in a nationwide representative sample of 5021 Turkish adults (2598 women and 2423 men, response rate: 91%) by an interviewer-administered questionnaire. Insomnia was defined by the DSM-IV criteria, habitual snoring and risk for sleep-related breathing disorders (SDB) by the Berlin questionnaire, excessive daytime sleepiness (EDS) by the Epworth sleepiness scale score, and restless legs syndrome (RLS) by the complaints according to the International Restless Legs Syndrome Study Group criteria. Mean age of the participants was 40.7 ± 15.1 (range 18 to 90) years. Prevalence rates (men/women) were insomnia 15.3% (10.5%/20.2%; P < 0.001), high probability of SDB 13.7% (11.1%/20.2%; P < 0.001), EDS 5.4% (5.0%/5.7%; P: 0.09), RLS 5.2% (3.0%/7.3%; P < 0.001). Aging and female gender were associated with higher prevalence of sleep disorders except for habitual snoring. Prevalence rates of the sleep disorders among Turkish adults based on the widely used questionnaires were close to the lower end of the previous estimates reported from different parts of the world. These findings would help for the assessment of the health burden of sleep disorders and addressing the risk groups for planning and implementation of health care.

Longitudinal Polysomnographic Assessment from Acute to Subacute Phase in Infratentorial versus Supratentorial Stroke

Background: Regulation of sleep and sleep-related breathing resides in different brain structures. Vascular lesions can be expected to differ in their consequences on sleep depending on stroke topography. However, studies addressing the differences in sleep and sleep-related breathing depending on stroke topography are scarce. The aim of the present investigation was to compare the sleep and sleep-related breathing of patients with supratentorial versus infratentorial stroke. Methods: This study was part of the prospective multicenter study SAS-CARE-1 (Sleep-Disordered Breathing in Transient Ischemic Attack (TIA)/Ischemic Stroke and Continuous Positive Airway Pressure (CPAP) Treatment Efficacy (SAS-CARE); NCT01097967). We prospectively included 14 patients (13 male, age 66 ± 6 years) with infratentorial lesions and 14 patients (14 male, age 64 ± 7 years) with supratentorial lesions, matched for age and stroke severity. Polysomnography was recorded in all during the acute phase within 9 days after stroke onset and 3 months later. Results: During the acute phase after stroke, patients with infratentorial lesions had significantly more sleep-related breathing disorders than patients with supratentorial lesions with an apnea-hypopnea index >20 observed in 8 (57%) patients with infratentorial stroke and in only 2 (14%) patients with supratentorial stroke. Sleep-related breathing improved from the acute to the subacute phase (3 months), albeit remaining elevated in a significant proportion of subjects. Sleep parameters did not differ between the two patient groups but there was a general improvement of sleep from the acute to the subacute phase which was comparable for both patient groups. Although stroke severity was mild, recovery after 3 months was worse in patients with infratentorial stroke with 12 of 14 patients with supratentorial stroke being symptom free (NIHSS = 0), while this was the case for only 6 of 14 patients with infratentorial stroke. Conclusions: Patients with infratentorial lesions are at an increased risk for sleep-related breathing disorders, which are frequent in this group. Monitoring of sleep-related breathing is therefore especially recommended in patients with infratentorial stroke. Because of the absence of reliable differences in sleep parameters between the two patient groups, polygraphy, with reduced diagnostic costs, rather than polysomnography could be considered. The higher prevalence of sleep-related breathing disorders and the poorer recovery of patients with infratentorial lesions suggest that early treatment interventions should be considered.

Sensitivity and specificity of telemedicine-based long-term pulse-oximetry in comparison with cardiorespiratory polygraphy and polysomnography in patients with obstructive sleep apnoea syndrome

We investigated the feasibility of night-time pulse-oximetry telemedicine. We compared polysomnography (PSG) as the gold standard with simultaneously recorded pulse-oximetry from a wrist pulse-oximeter. The results were evaluated by a sleep specialist and compared with outpatient polygraphy. A total of 135 consecutive patients (mean age 55 years, mean body mass index 31.6 kg/m(2)) were studied. Patients with minor, moderate and severe PSG findings were grouped together and compared to those without PSG findings; the resulting sensitivity was 1 and specificity 0.35. In addition, patients with and without minor PSG findings were grouped together and compared to those with moderate and severe PSG findings; the resulting sensitivity was 0.66 and the specificity was 0.98. The receiver operating characteristic (ROC) of telemedically-evaluated oximetry was superior to that of outpatient polygraphy. In contrast, the automatic assessment of severity based on the Oxygen Desaturation Index was unsatisfactory. For patients suspected of sleep related breathing disorders (SRBD), telemedically-evaluated pulse-oximetry is able to identify those who should be referred to a sleep laboratory for definitive diagnosis and treatment. The technique appears to be suitable for first screening in all patients at risk for SRBD.

Insomnia and Sleep-Related Breathing Disorders

Insomnia disorder and obstructive sleep apnea are the two most common sleep disorders among adults. Historically, these conditions have been conceptualized as orthogonal, or insomnia has been considered a symptom of sleep apnea. Insomnia researchers have sought to exclude participants at risk for sleep-related breathing disorders (SRBD), and vice versa. In recent years, however, there has been a growing recognition of co-occurring insomnia disorder and SRBD and interest in the prevalence, consequences, and treatment of the two conditions when they co-occur. Although plagued by inconsistent diagnostic criteria and operational definitions, evidence from clinical and research samples consistently suggests high rates of comorbidity between the two disorders. More important, insomnia disorder and SRBD have additive negative effects. To date, only a few studies have explored the combined or sequential treatment of the conditions. Results support the importance of an integrated, interdisciplinary approach to sleep medicine. This article reviews the empirical literature to date and provides clinical recommendations as well as suggestions for future research.

Sleep and neuromuscular disorders in children

Children suffering from neuromuscular diseases are at an increased risk of sleep-related breathing disorders (SRBD) such as obstructive sleep apnea syndrome (OSAS) and hypoventilation as well as central sleep apnea, which is frequent in these patients due to diaphragmatic weakness. They are at higher risk for developing complications of nocturnal hypoxemia, including pulmonary hypertension, cor pulmonale and neurocognitive dysfunction. Neuromuscular disorders and OSAS are both prevalent disorders and frequently overlap. Sleep-related hypoventilation/hypoxemia due to neuromuscular diseases may be exacerbated in the presence of OSAS; these children are likely to experience greater severity and duration of sleep-related hypoxemia than are children with either disorder alone. Additionally, some of these children have reduced central neural chemoresponsiveness. The development of SRBD in these patients further impairs their quality of life and worsens their respiratory status. We review the literature on the diagnosis and treatment of SRBD in children with a variety of neuromuscular disorders.