Role Of Obstructive Sleep Apnea Research Articles

Abstract 14883: The Role of Obstructive Sleep Apnea in Hospitalization in Heart Failure With Preserved Ejection Fraction and Diabetes Mellitus

Introduction: Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous disease with diverse etiologies. Obstructive sleep apnea (OSA) is known to increase the risk of diastolic dysfunction and heart failure. OSA also increases the risk and severity of type 2 diabetes (DM2) independent of age and obesity. However, its role in patients with HFpEF and concomitant DM2 is unclear. Hypothesis: Our aim was to study the role of OSA in hospitalizations in patients with HFpEF and concomitant DM2. Methods: We did a retrospective chart analysis of 142 patients age (72 ± 11, 54.9% women) with HFpEF and known DM2 for five years after the initial diagnosis of HFpEF. Presence of OSA at the time of initial HFpEF diagnosis was noted based on the results of a documented sleep study. A multivariable cox-proportional hazard model was used to assess whether the presence of OSA had any significant impact on the risk of future HFpEF hospitalization. Kaplan-Meier analysis was used to calculate if OSA predicted time to future HFpEF hospitalization. Results: After a five year follow up, 63 (44.3%) participants developed HFpEF exacerbation. Patients were dichotomized based on presence (n=40, 28.1%) or absence (n=102, 71.8%) of OSA. In a multivariable model adjusted for baseline demographics, risk factors and medications, presence of OSA did not predict risk for a future HFpEF hospitalization (p=0.57, Table). Additionally, on Kaplan-Meier analysis, presence of OSA was not a significant predictor for HFpEF hospitalization (p=0.77, Figure). Conclusion: In patients with HFpEF and concomitant DM2, presence of OSA was not a predictor for future heart failure hospitalizations.

Obstructive Sleep Apnea and Cardiovascular Morbidities: A Review Article.

In obstructive sleep apnea (OSA), there are brief episodes of partial or total upper airway obstruction during sleep, which leads to apnea or hypopneas. Much attention is required to understand OSA's effects on the human body, owing to how common but under-diagnosed this disorder remains. Though the role of OSA in cardiovascular (CV) disease is commonly discussed, it remains unclear how it induces changes in the human body. The intermittent and recurrent hypoxia occurring at the cellular level in this condition is critical for the dramatic changes observed. Vascular endothelial cell (VEC) injury and other mechanisms seen in OSA lead to changes in the CV system. OSA can take a toll on a person's overall functioning, especially with so much importance in today's time on preventing and treating cardiac-related deaths. A total of 31 published articles were included from the PubMed database for our literature review. Most of the studies showed a strong association of OSA with hypertension, especially resistant hypertension. Findings were consistent with OSA's independent role in causing CV diseases, included heart failure, coronary artery disease (cardiac ischemia), arrhythmias, and ischemic stroke. Continuous Positive Airway Pressure (CPAP) is one of the reliable and beneficial treatments for OSA patients. OSA is a treatable and modifiable risk factor for cardiac events and related deaths. The primary purpose of our review article was to address any existing gaps between OSA and its effect on the human body with particular emphasis on cardiovascular changes.

Obstructive Sleep Apnea and Testosterone Replacement Therapy

The evidence on the role of obstructive sleep apnea (OSA) in the pathogenesis of hypogonadism and the impact of testosterone replacement therapy (TRT) in OSA patients are still contradictory. OSA is generally considered to be a relative contraindication as TRT is feared to worsen sleep apnea so that ventilatory capacity should be strictly investigated in advance and monitored thereafter. Few controlled studies have been released on the long-term effects of TRT in patients with OSA due to methodological limitations at study entry. Data from recent randomized placebo-controlled studies show a time-dependent influence on nocturnal hypoxia, and a positive impact after a longer time of exposure in selected patients. Since these results await further confirmation from larger studies, we suggest to use TRT cautiously in obese hypogonadal patients with hypoventilatory syndrome, especially if they are not on continuous positive airway pressure treatment.

How obesity affects nasal function in obstructive sleep apnea: anatomic and volumetric parameters

IntroductionObstructive sleep apnea is a consequence of upper airway collapse. Any obstructive sector in the upper airway can contribute to pharyngeal collapse. Obesity and obesity-related disorders play an important role in obstructive sleep apnea and its relationship with increased upper airway resistance. ObjectiveThis study was designed to evaluate the relationship between obesity and properties of the nasal cavity in patients with obstructive sleep apnea. MethodsThe study was conducted retrospectively by review of medical records of adult patients. The nasal obstruction symptom evaluation, NOSE instrument, was used to measure nasal obstruction. Sleep breathing disorders were evaluated by polysomnography exams. Nasal volume was obtained by computed tomography scans and volumetric reconstruction of nasal airway. Nasal anatomic alterations were assessed by nasal endoscopy. ResultsAnalysis of 83 patient records, among whom 54 were male and 29 females, found the mean body mass index of 28.69 kg/m2. Obese and non-obese groups were determined by using cut-off 30 kg/m2. In the comparison between groups, the obese group had a positive and significant correlation with apnea/hypopnea index (p = 0.02), NOSE instrument (p = 0.033) and inferior turbinate hypertrophy (p = 0.036), with odds ratio 1.983 (95% IC 1.048 − 3.753). nasal septum deviation (p = 0.126) and nasal airway volume evaluation (p = 0.177) showed no significant results. ConclusionObesity was significantly correlated with subjective nasal obstruction, NOSE scale, and inferior turbinate hypertrophy in patients with obstructive sleep apnea. There was no correlation with the nasal volume evaluation. Level of Evidence3b - Individual case-control study.

1337-P: Metabolomic Profile Associated with Obstructive Sleep Apnea Severity in Obese Pregnant Women with Gestational Diabetes

Background: Obstructive sleep apnea (OSA) is prevalent in obese women with gestational diabetes (GDM). In non-pregnant population, metabolomics profiles have been shown to differ between those with and without OSA. This study explored associations between OSA severity and metabolites in women with GDM. Methods: Eighty-two obese women with diet-controlled GDM had OSA assessment by a home monitor (mean gestational age, GA, 28 weeks). OSA severity was assessed by apnea hypopnea index (AHI). Metabolic profile was assayed from fasting serum samples via LC-MS using an untargeted approach. The metabolites were extracted and subjected to an Agilent 1290 UPLC coupled to an Agilent 6545 Q-TOF MS. Data were acquired using electrospray ionization (ESI) in positive and negative ion modes. The raw LC-MS data were processed using the OpenMS toolkit to detect and quantitate features and these LC-MS features were annotated using the Human Metabolite Database (HMDB) as a reference. The feature data were compared with OSA status, AHI, BMI and GA using limma in R. Correlation analyses of the continuous covariates (AHI, BMI, GA) were performed using Kendall’s Tau test. P-values were adjusted for multiple testing using Benjamini-Hochberg’s FDR correction. Results: Forty-three women (52.4%) had OSA, with a median AHI of 9.4. There were no significant differences in metabolomics profiles between those with and without OSA. However, differential analyses modeling in GA and pre-pregnancy BMI found 12 features that significantly associated with AHI. These features could be annotated to estradiols and phospholipids (e.g., Lysophospholipids, long-chain acyl carnitine, methyl-branched fatty acids) with higher levels related to higher AHI. Conclusion: Biomarkers including estradiols and phospholipids may be involved in pathogenesis of OSA in pregnant women with GDM. Targeted approach may help further identify these metabolites to better understand their role in OSA in this population. Disclosure S. Reutrakul: None. N. Chirakalwasan: None. S. Charoensri: None. S. Amnakkittikul: None. S. Saetung: None. H. Chen: None. G.E. Chlipala: None. Funding National Center for Advancing Translational Sciences (UL1TR002003); Mahidol University

Oral Appliances in the Management of Obstructive Sleep Apnea.

Obstructive sleep apnea (OSA) is a multifactorial condition, and an interdisciplinary approach to diagnosis forms the basis for effective treatment planning. Craniofacial structure and attached soft tissues and muscles play a central role in OSA. Evidence-based studies demonstrate the effectiveness of oral appliances for mandibular advancement and tongue stabilization in managing OSA, and current clinical standards of practice recommend the use of oral appliances to treat OSA when patients cannot tolerate continuous positive airway pressure (CPAP). Although effective, oral appliances are less predictable in managing OSA compared with CPAP therapy. Measures can be taken to improve predictability of oral appliance treatment.

The effect of obstructive sleep apnea surgery on laryngopharyngeal reflux with obstructive sleep apnea

Background: Obstructive sleep apnea (OSA) may play a role in the occurrence of laryngopharyngeal reflux (LPR). OSA surgery also may have a significant curative effect on LPR with OSA.Objectives: To analyze the role of OSA in LPR and the effect of OSA surgery on LPR with OSA.Methods: Forty-five OSA patients with LPR symptoms were enrolled and were divided into the LPR positive group (RSI > 13) and the LPR suspicious group (1 ≤ RSI ≤ 13) based on reflux symptom index (RSI). All the patients underwent OSA surgery. The RSI scores at three different time points postoperatively were compared with that preoperatively.Results: In the LPR positive and LPR suspicious group, the result revealed that there were significant differences in RSI score between one month, three months, six months after surgery and before surgery (p < .001 for all). Moreover, in the LPR positive group, there was a significant difference in RSI score among one month, three months and six months after surgery (p = .01).Conclusions and significance: The effect of OSA on LPR exists and OSA surgery can improve the symptoms of LPR with OSA obviously. For some LPR patients with OSA, the combination therapy of OSA and LPR is needed.

In-silico investigations of selective miRNA-gene targets and their validation studies in obstructive sleep apnea (OSA) patient cohorts

BackgroundObstructive sleep apnoea (OSA) is a prevalent form of sleep disordered breathing which results in sleep fragmentation and deprivation. Obesity and cardiovascular disorders are the major risk factors associated with OSA. Molecular analysis of the factors associated with OSA could demarcate the clinical analysis pattern in a population. ObjectiveThis study pertains to in-silico analyses of miRNA and their gene targets with validation for their potential role in OSA as putative biomarker candidates. MethodsmiRDB, TargetScan and miRanda databases were used to identify targets of miR-27 and let-7 that have documented role in OSA and co-related obesity and cardiovascular disorders. Quantitative PCR was used to analyze expression pattern of miR-27 and let-7 in obese and non-obese OSA patient cohorts with respective controls. In-silico analysis was done using PatchDoc to obtain atomic contact energy (ACE) scores that indicated the docked gene targets to the predicted miRNA structures. The docked structures were analysed using Maestro Suite 11 for the hydrogen and aromatic interactions. ResultsDownregulation of miR-27 and let-7 in OSA compared to controls was observed. In-silico data analysis was performed for gene targets (TGFBR1, TGFBR2, SMAD2, SMAD4, CRY2 and CNR1) of the selected miRNAs (miR-27 and let-7). Among all, CNR1 and CRY2 were found to be better targets for miR-27 and let-7 respectively as per ACE scores, ROC scores and expression fold change in OSA. ConclusionOur study gives insights to the expression profiling of miR-27 and let-7 and explore a set of potential target genes (CNR1 and CRY2) of these two miRNAs for a promising clinical relevance in OSA.

OBSTRUCTIVE SLEEP APNEA PREDICTS RECURRENCE OF ATRIAL ARRHYTHMIAS FOLLOWING CRYOBALLOON ABLATION IN PATIENTS WITH PAROXYSMAL ATRIAL FIBRILLATION

In spite of acute pulmonary vein isolation in cryoballoon ablation (CBA) for paroxysmal atrial fibrillation (AF), about one third of patients have recurrence of atrial arrhythmias (AA). Presence of obstructive sleep apnea (OSA) is a known risk factor for development of AF. However, the role of OSA

Abstract TP347: Obstructive Sleep Apnea Frequency in Intracerebral Hemorrhage

Introduction: Obstructive sleep apnea (OSA) is a treatable condition and well-established risk factor for ischemic stroke, but the prevalence in ICH is unknown. We aim to characterize the frequency of OSA in spontaneous intracerebral hemorrhage (ICH). Methods: The Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) study is a prospective observational study evaluating risk factors for ICH among whites, blacks, and Hispanics. OSA status was determined using two different strategies: (1) the Berlin Questionnaire, a validated screening tool to identify those with a high likelihood of OSA where “high risk” is defined as &gt; 1 point in at least 2 of 3 categories assessing snoring, fatigue, and hypertension, and (2) self-reported history of diagnosed sleep apnea. Results: We evaluated 3000 ICH cases. Within this group, 2896 (96.5%) completed the Berlin questionnaire, with 2064 (71%) patients being high risk for OSA. Compared to patients with low risk of OSA, those at high risk were more likely to be male (61% versus 53%, p&lt;0.001) with hypertension (93% versus 65%, p&lt;0.001), diabetes (32% versus 20%, p&lt;0.001), hyperlipidemia (49% versus 38%, p&lt;0.001), and higher BMI (29.8 +/- 8.1 versus 26.8 +/- 6.5, p&lt;0.001), and less likely to have lobar ICH location (29% versus 35%, p&lt;0.001). Self-reported history of prior sleep apnea diagnosis was present in only 175 (9.5%) of ICH cases. Conclusions: OSA is highly prevalent and underdiagnosed in our cohort of ICH patients. Given the effective treatments available for OSA, which have been shown to improve morbidity and mortality in patients with ischemic stroke, further studies are needed to assess the role of OSA as both a determinant of both risk and outcome in ICH.

The importance of obstructive sleep apnea in the development of metabolic syndrome and obesity

The aim of this study was to assess the role of obstructive sleep apnea (OSA) in the development of metabolic syndrome. 360 OSA patients were studied. Interactions with glucose intolerance, effects of treatment with continuous positive airway pressure (CPAP) were revealed.

The Potential Role of Obstructive Sleep Apnoea in Refractory Hypertension.

This review seeks to present an overview of the recently found association between refractory hypertension (RfH) and obstructive sleep apnoea (OSA). RfH was recently defined as an extreme phenotype of resistant hypertension characterized by the lack of blood pressure control despite using ≥ 5 antihypertensive drugs at optimal doses. Current data support that the pathophysiological pathway of both types of hypertension is different. The main mechanism involved in resistant hypertension is fluid retention whereas in the case of RfH is the sympathetic over-activity. OSA is now recognized as a cause of hypertension (especially in the case of difficult-to-treat hypertension). It seems that the biological mechanism linking OSA and arterial hypertension is the sympathetic over-activity related to the respiratory events (apnoeas and hypopnoeas) during the night. So, it is not surprising that, although the literature is scarce, some studies have found a very high prevalence of OSA and an excess of sympathetic activity in patients with RfH. Finally, a very recent study demonstrated that continuous positive airway pressure (CPAP) treatment, which controls sympathetic activation in OSA patients, achieves very significant reductions in blood pressure levels in RfH patients, even greater than in those with resistant (non-refractory) hypertension. The prevalence of OSA in patients with RfH is very high. CPAP treatment achieves a clinically significant reduction in blood pressure levels in those patients with RfH (especially in night readings). Patients with RfH must be sent to a sleep unit for a study.

Abdominal Obesity Is More Strongly Correlated with Obstructive Sleep Apnea than General Obesity in China: Results from Two Separated Observational and Longitudinal Studies.

Previous studies have reported that obesity can result in or worsen obstructive sleep apnea (OSA). However, whether abdominal or general obesity indices or visceral adiposity indicators have a stronger association with OSA remains unclear. This cross-sectional study included 4344 patients who underwent polysomnography (PSG) due to suspicion of OSA. We also performed a longitudinal study on 86 patients who underwent bariatric surgery to confirm the relationship between OSA and obesity. Data on overnight PSG parameters, biochemical biomarkers, and multiple anthropometric obesity indices were collected. In the cross-sectional study, waist circumference (WC) and body mass index (BMI) were independently associated with the apnea-hypopnea index (AHI) after adjusting for potential confounding factors (additional R2 = 0.232, standardized beta coefficient [Beta] = 0.210; and additional R2 = 0.015, Beta = 0.183, respectively). Logistic regression analysis showed similar results, as did stratified analysis of adult males aged ≤ 55years. Restricted cubic spline (RCS) analysis revealed a linear dose-response relationship between OSA and obesity. In the longitudinal study, no significant relationship was found between remission of OSA and improvement in WC and BMI (r = 0.252, p = 0.098; and r = 0.132, p = 0.395, respectively), whereas the change in the visceral adiposity indicator (lipid accumulation calculated according to WC and fasting triglycerides) was significantly correlated with ΔAHI (r = 0.322, p = 0.033). Abdominal obesity, rather than general obesity, appears to play a more important role in OSA.

1072 OSA and IPF Exacerbations: A Deadly Duo

Obstructive sleep apnea (OSA) is common in Idiopathic Pulmonary Fibrosis (IPF) patients. IPF Patients with poorly controlled OSA appear to have worse in quality of life and possibly higher mortality than those with well controlled OSA. The role of OSA in IPF exacerbation is currently unknown. A 71 y/o man with PMH of IPF and OSA (on nocturnal BIPAP 16/4) presented to the ER with worse cough, dyspnea, and hypoxia. He was admitted to the ICU with a diagnosis of IPF exacerbation. He was restarted on his home BIPAP settings. His dyspnea improved, but did not quite return to baseline. An inpatient BIPAP titration study showed that the patient had significant obstructive hypopneas, as well as hypoxia and tachycardia, until his BIPAP was titrated up to 22/10 cm. At this pressure, his tachycardia, hypoxia, and hypopneas resolved. The patient’s BIPAP was adjusted to the new settings. Over the next few days, his dyspnea improved, and he was discharged. About six weeks after discharge, the patient returned to the sleep clinic for follow up. Review of his BIPAP machine data showed that he had developed new central apneas (27 per hour; none previously noted). The patient was diagnosed with severe treatment-emergent central sleep apnea. BIPAP settings were reduced to 13/7. Non-adherence to nocturnal BIPAP may be a risk factor for hospital admission in patients with OSA and IPF. Patients experiencing an acute exacerbation of IPF may temporarily require higher BIPAP settings. However, continued use of higher pressures after resolution of the exacerbation may lead to emergence of central sleep apnea. o Bosi M et al. “OSA and Prolonged Oxygen Desaturation During Sleep are Strong Predictors of Poor Outcome in IPF.” Lung (2017) 195:643–651. o Mermigkis C et al. “Obstructive sleep apnea should be treated in patients with idiopathic pulmonary fibrosis.” Sleep Breath (2015) 19:385–391. o Kim JS et al. “Obstructive Sleep Apnea and Subclinical Interstitial Lung Disease in the Multi-Ethnic Study of Atherosclerosis (MESA).” Ann Am Thorac Soc Vol 14, No 12, pp 1786–1795, Dec 2017.

Sleep disorder-related headaches.

Migraine with and without aura, cluster headache, hypnic headache, and paroxysmal hemicranias are each reported as intrinsically related to sleep. Chronic migraine, chronic tension-type headache, and medication overuse headache may cause sleep disturbance. Otherwise, both headache and sleep disorder may be manifestations of a same systemic dysfunction. There is a vicious cycle linking sleep disorders and migraine. The poor quality or poor duration of sleep could be a trigger of migraine attack and migraineurs with poor sleep reported a higher headache frequency. Moreover, coping behaviors of migraineurs (e.g., going to sleep early to relieve migraine attacks) can be factors precipitating and perpetuating sleep disturbances themselves. During cluster headache, patients report a poor quality of sleep correlated with the amount of daylight. In particular, it was demonstrated that melatonin levels have influences on cluster headache attacks. Concerning the pathophysiology of hypnic headache, it has been hypothesized a possible role of obstructive sleep apnea in triggering nocturnal attacks: an increased number of apnea episodes has been reported in hypnic headache patients, but a lack of a temporal correlation of headache attacks with the drop of oxygen saturation has been observed. Tension-type headache is the most common headache with sleep dysregulation (lack of sleep or oversleeping) frequently reported as a triggering factor for acute attacks: management of sleep disturbances seems crucial in this form of headache.

Are nasal steroids effective in children with adenoid hypertrophy?

Objectives: Chronic nasal obstruction is a common disease of childhood. Adenotonsillar hypertrophy plays an important role in obstructive sleep apnea. The topical use of the aerosolized forms of corticosteroids therefore seems the most appropriate route to decrease systemic side effects. The aim of our study is to demonstrate the effect of topical mometasone furoate especially on the adenoid volume in patients without any allergic story. Methods: The study group consisting of 30 males and 25 females was administered topical nasal mometasone furoate steroid treatment. The 20 patients were in the control group where saline solution (0.9% NaCl) treatment was administered consisted of 12 males and 8 females. Nasopharyngeal X-rays before treatment revealed that 25 patients were Grade 2 and 30 patients were Grade 3 according to the Fujioka method. Results: Flexible endoscopy performed before the treatment revealed that 20 patients were Grade 2, 11 patients were Grade 3 and 24 patients were Grade 4. Nasal endoscopies performed after 6 weeks of intranasal topical steroid therapy revealed that 45 patients were Grade 1 and 10 patients were Grade 2. A statistically significant difference was present between endoscopic grades before and after treatment (p &amp;lt; 0.0001). Nasal endoscopies performed after 6 weeks in control group receiving saline solution treatment revealed Grade 2 in 7 patients, Grade 3 in 10 patients and Grade 4 in 3 patients. There was no statistically significant difference between in the prior and later grades of the control group (p = 0.3125). Conclusions: We believe that the use of intranasal steroids (mometasone furoate) for 6 weeks in patients with pediatric chronic nasal obstruction due to adenoid hypertrophy may be an effective treatment modality in alleviating symptoms and decreasing adenoid volume without causing systemic side effects.

Anatomic and Pathophysiologic Considerations in Surgical Treatment of Obstructive Sleep Apnea.

Evaluation of the upper airway is key for a successful surgical management. Proper evaluation can be done only with a good understanding of the anatomy and pathophysiology of the upper airway. The authors discuss surgical anatomy from a soft tissue and bony perspective in detail along with its clinical implications. The complex interaction among pharyngeal dilator tone, arousal threshold, respiratory control instability, and changes in lung volume during sleep play an important role in obstructive sleep apnea. Because all the anatomic and physiologic characteristics discussed have genetic predisposition, gene therapy may play a pivotal role in the future.

Role of Obstructive Sleep Apnea in Cognitive Impairment

Obstructive sleep apnea (OSA) is a prevalent sleep related breathing disorder characterized by repetitive collapse of the upper airways leading to intermittent hypoxia and sleep disruption. Clinically relevant neurocognitive, metabolic and cardiovascular disease often occurs in OSA. Systemic hypertension, coronary artery disease, type 2 diabetes mellitus, cerebral vascular infarctions and atrial fibrillation are among the most often cited conditions with causal connections to OSA. Emerging science suggest that untreated and undertreated OSA increases the risk of developing cognitive impairment, including vascular dementia and neurodegenerative disorders, like Alzheimer’s disease. As with OSA, cardiovascular disease and type 2 diabetes mellitus, the incidence of dementia increases with age. Given our rapidly aging population, dementia prevalence will significantly increase. The aim of this treatise is to review current literature linking OSA to dementia and explore putative mechanisms by which OSA might facilitate the development and progression of dementia.

Oral Appliances in the Management of Obstructive Sleep Apnea.

Obstructive sleep apnea (OSA) is a multifactorial condition, and an interdisciplinary approach to diagnosis forms the basis for effective treatment planning. Craniofacial structure and attached soft tissues and muscles play a central role in OSA. Evidence-based studies demonstrate the effectiveness of oral appliances for mandibular advancement and tongue stabilization in managing OSA, and current clinical standards of practice recommend the use of oral appliances to treat OSA when patients cannot tolerate continuous positive airway pressure (CPAP). Although effective, oral appliances are less predictable in managing OSA compared with CPAP therapy. Measures can be taken to improve predictability of oral appliance treatment.

Obesity cardiomyopathy: the role of obstructive sleep apnea and obesity hypoventilation syndrome.

The negative long-term health consequences of obesity are well known to both the medical profession and general public. Despite this, the number of obese and overweight individuals worldwide continues to steadily rise. Although obesity has long been associated with an increased risk for cardiovascular disease and mortality, the classification of a cardiomyopathy of obesity is a more recent development. Obesity cardiomyopathy is characterized as myocardial dysfunction or heart failure in obese individuals independent of other cardiovascular risk factors. The purpose of this report is to provide an overview of obesity cardiomyopathy and the proposed pathophysiological mechanisms underlying this disease, as well as to examine the link between obesity cardiomyopathy and sleep-related disorders.