Severity Of Sleep-disordered Breathing Research Articles

Prevalence, type, severity and determinants of sleep disordered breathing in acute myocardial infarction patients: the AMI-Sleep study

Abstract Background Sleep Disordered Breathing (SDB) is highly prevalent in patients with ischemic heart disease and often remains undiagnosed. Purpose We aimed to assess the prevalence, type, severity and determinants of SDB in patient hospitalized for acute myocardial infarction (AMI). Methods We prospectively enrolled a subset of patients hospitalized for AMI of the French Cohort of Myocardial Infarction Evaluation (FRENCHIE) registry included from January 2019 and December 2022 in the 16 AMI-Sleep-trained centers. Baseline and in-hospital information were collected through the FRENCHIE registry. A simplified polygraphy through ApneaLink Air+ was performed overnight during the initial hospitalization before discharge. Data were scored in centralized manner at a single center where trained physicians ascertained SDB characteristics (central or obstructive) and severity based on Apnea-Hypopnea index (AHI). SDB was defined by an AHI≥15/h. Multivariable logistic regression (adjusted for age, sex, diabetes, hypertension, smoking, body mass index, severity of the coronary artery disease, left ventricular ejection fraction [LVEF] at admission [or at discharge if missing] and use of Ticagrelor) was used to analyze the associations between characteristics of the patients at inclusion and SDB. Results Among 1752 patients, 955 (54.5 [52.1;56.9] %) had an AHI≥15/h. The prevalences of mild (AHI= 5-14.9), moderate (AHI=15-29.9) and severe (AHI≥30) SDB were 30.9%, 24.2% and 30.3% respectively. SDB characterization was technically possible in 712 patients (74.6%), and was found central in 72.2% of cases, obstructive in 12.9% and mixed in 15.4%. Male sex, age, BMI, diabetes, degree of severity of CAD, LVEF≤40% and treatment with Ticagrelor were independently associated with SDB. Conclusion More than half of the patients hospitalized for AMI had at least moderate SDB with a majority of them characterized as central. SDB diagnosis should be considered in this setting and particularly in very high cardiovascular risk patients with severe CAD.SDB determinants in AMI patients

Sleep disordered breathing and in-hospital prognosis in acute myocardial infarction patients: a subset of the AMI-Sleep study

Abstract Background Despite its high prevalence in patients with coronary artery disease (CAD), the association between sleep disordered breathing (SDB) and in-hospital prognosis is not well determined. Purpose We aimed to study in-hospital prognosis depending on the presence of SDB in patient hospitalized for acute myocardial infarction (AMI). Methods We prospectively enrolled a subset of patients hospitalized for AMI of the French Cohort of Myocardial Infarction Evaluation (FRENCHIE) registry included from January 2019 and December 2022 in the 16 AMI-Sleep-trained centers. Baseline and in-hospital information were collected through the FRENCHIE registry. A simplified polygraphy through ApneaLink Air+ was performed overnight during the initial hospitalization before discharge. Data were scored in centralized manner at a single center where trained physicians ascertained SDB severity based on Apnea-Hypopnea index (AHI). SDB screening was considered as positive for patients who have at least moderate SDB, defined by an AHI≥15/h. Results Among 1752 patients, 955 (54.5 [52.1;56.9] %) had at least moderate SDB. Compared with patients without SDB, SDB patients have major cardiac impairment including more 3-vessel CAD (26.8% vs 20.8%) and a lower admission left ventricular ejection fraction (52.2% vs 50.4%) associated with a higher use of non-invasive ventilation (3.8% vs 1.6% in non-SDB patients). SDB patients had also more in-hospital complications in particular more transfer to hospital intensive care (0.1% vs 0.9%) and an increased length of stay (4.8 vs 5.9 days). Conclusion More than half of the patients hospitalized for AMI had at least moderate SDB and presence of SDB was associated with more in-hospital morbidity. SDB screening should be considered to identify high risk sub-group of AMI patients.

Racial and ethnic and sex differences in at-home estimates of sleep-disordered breathing parameters among Mexican American, Black, and Non-Hispanic White adults.

Background Racial and ethnic and sex differences in sleep may exist, but there are limited data directly comparing objective estimates of sleep-disordered breathing (SDB), particularly in rapid eye movement (REM) versus non-rapid eye movement (NREM) sleep, among Black, Mexican American (MA) and non-Hispanic White (NHW) men and women. Our goal is to investigate health disparities in SDB in a new, diverse cohort of older adults. Research Question Do SDB parameters during REM and NREM sleep differ by race and ethnicity or sex in community-dwelling older adults?. Methods The Dormir Study conducted a comprehensive sleep examination among eligible participants enrolled in the ongoing community-based Health and Aging Brain Study-Health Disparities (HABS-HD) cohort (2020-4), among Black, MA, and NHW adults aged 50 years and older. Here we characterize racial and ethnic and sex differences in SDB indices assessed by an FDA-approved Peripheral Arterial Tonometry (PAT)-based home sleep testing system. Results We examined 821 participants, including 543 (66.1%) women, and 284 (34.6%) MA and 174 (21.2%) Black individuals, with a mean age of 66.6±8.5 years. Around half (50.5%) of the participants had moderate to severe SDB as defined by the respiratory event index (REI based on 3% desaturations) of ≥15/ hour, 72.7% with moderate to severe REM SDB (REM-REI ≥ 15/hour) and 39.5% with moderate to severe NREM SDB (NREM-REI ≥15/hour). The prevalence of SDB did not differ by race or sex. However, significant racial and ethnic and sex differences were observed for REM-specific SDB metrics. Overall, Black women had the highest REM REI, and NHW men had the lowest REM REI and REM ODI. After controlling for age, sex, education, income, employment status, cognitive status, BMI, history of hypertension, diabetes, stroke, and coronary heart disease, and sleep medication use, Black participants had a REM-REI that was 3 events per hour higher than that of NHW adults, while NREM-REI were similar. MA individuals had similar REM or NREM SDB parameters compared to NHW adults but exhibited higher average blood oxygen levels. Conclusions In this community-based cohort of middle- to older-aged NHW, MA, and Black adults, PAT-based measures of in-home sleep indicate a higher prevalence of REM SDB in Black adults, particularly Black women, compared to their NHW counterparts; this contrasts with the similar NREM parameters observed across racial and ethnic groups. Given the close link between REM SDB and adverse health outcomes, clinicians should pay more attention to this sleep apnea phenotype, especially in minoritized populations.

Study on cerebral oxygen saturation in children with sleep-disordered breathing.

To explore the association between the severity of sleep-disordered breathing, different types of respiratory events, peripheral oxygen saturation (SpO2), age and sleep stage on cerebral oxygen saturation (rSO2) in children. We enrolled children aged 4-14 years who were treated for snoring or mouth breathing at the Sleep Center of Beijing Children's Hospital, from February 2022 to July 2022. All children completed polysomnography, and SpO2, rSO2, and heart rate (HR) were recorded synchronously. A total of 70 children were included, including 16 (22.9%) with primary snoring, 38 (54.3%) with mild obstructive sleep apnea (OSA), and 16 (22.9%) with moderate-to-severe OSA. There were no significant differences in the mean rSO2 or minimum rSO2 among the primary snoring, mild OSA, and moderate-to-severe OSA groups (all p > 0.05). A total of 1119 respiratory events were included in the analysis. Regardless of the type of respiratory event, rSO2 and HR changes occur prior to fluctuations in SpO2. A mixed-effects model showed that ΔrSO2 was positively correlated with ΔSpO2, duration of respiratory event, mixed and obstructive apnea, central apnea, while negatively correlated with age and rapid eye movement (REM) sleep stage (all p < 0.05). Larger rSO2 fluctuations were impacted by a greater ΔSpO2, longer duration of respiratory events, younger age, apnea-related respiratory events and non-REM sleep stage. Thus, sleep disordered breathing in younger children warrants more attention. More research is needed to determine whether REM sleep has special protective effects on rSO2.

Utility of cardiac implantable electronic device algorithm for detecting severe sleep‐disordered breathing in cardiomyopathy

AbstractBackgroundHalf of patients with heart failure are estimated to have sleep‐disordered breathing (SDB). However, many are undiagnosed as they do not report typical symptoms. This study aims to evaluate the implantable cardiac defibrillator (ICD) sleep‐disordered breathing algorithm in a cohort of multi‐racial Asian patients for detection of SDB against polysomnography (PSG).MethodsIn this prospective pilot study, participants who fulfill the American College of Cardiology (ACC) indication for ICD were recruited. The ICD algorithm uses transthoracic impedance sensing to calculate respiratory disturbance index (RDI).ResultsTwenty‐four patients were enrolled between August 2020 and December 2021. All patients underwent PSG exams and were followed up for up to 12 months. Eighteen participants completed the PSG study as of August 23, 2022. Severe SDB (defined as PSG‐AHI ≥30 episodes/h) was diagnosed in 66.7% of the patients. No significant direct linear correlation was found between the PSG‐AHI measurements and the RDI measurements (adjusted r2 = .224, r = .473, p = .027). Applying a binary threshold cut‐off RDI value of 32 episodes/h for the detection of severe SDB yielded a sensitivity of 91.7% and specificity of 16.7%.ConclusionsTransthoracic impedance sensing with an advanced inbuilt algorithm may be helpful as a screening test in detecting severe SDB in patients with heart failure and cardiomyopathy, potentially by applying a binary threshold cut‐off value. This is the first study known to validate the algorithm in an exclusively multi‐ethnic Asian population with heart failure.

Comparison of patient-reported outcomes between alternative care provider-led and physician-led care for severe sleep disordered breathing: secondary analysis of a randomized clinical trial

BackgroundPrevious research has suggested that alternative (respiratory) care providers (ACP) may provide affordable, accessible care for sleep-disordered breathing (SDB) that decreases wait-times and improves clinical outcomes. The objective of this study was to compare ACP-led and sleep physician-led care for SDB on patient reported outcome and experiences, with a focus on general and health-related quality of life, sleepiness, and patient satisfaction.MethodsWe conducted a secondary analysis of a randomized trial in which participants with severe SDB were assigned to either ACP-led or physician-led management. We created longitudinal linear mixed models to assess the impacts of treatment arm and timepoint on total and domain-level scores of multiple patient-reported outcome measures and patient-reported experience measures.ResultsPatients in both treatment arms (ACP-led n = 81; sleep-physician = 75) reported improved outcomes on the Sleep Apnea Quality of Life Index, Health Utilities Index, and Epworth Sleepiness Scale. Patients in each group had similar and clinically meaningful improvements on domains assessing cognition, emotion, and social functioning. The linear mixed models suggested no significant difference between treatment arms on the patient-reported outcomes. However, scores significantly improved over time.ConclusionsManagement of SDB using ACPs was comparable to physician-led care, as measured bypatient-reported outcome and experience measures. While loss to follow-up limits our findings, these results provide some support for the use of this novel health service delivery model to improve access to high quality SDB care.Clinical trial registrationThis is analysis of data from the study registered Clinicaltrials.gov (NCT02191085).

A Position Modification Device for the Prevention of Supine Sleep During Pregnancy: A Randomised Crossover Trial.

To assess the effectiveness and acceptability of a pillow-like position modification device to reduce supine sleep during late pregnancy, and to determine the impacts on the severity of sleep-disordered breathing (SDB) and foetal well-being. Randomised cross-over study. Individuals in the third trimester of pregnancy receiving antenatal care at a tertiary maternity hospital in Australia. Participants used their own pillow for a control week and an intervention pillow for a week overnight, in randomised order. Sleep position and total sleep time for each night of both weeks were objectively monitored, with a sleep study and foetal heart rate monitoring performed on the last night of each week. Primary outcome = percentage of sleep time in the supine position; secondary outcomes = apnoea-hypopnoea index, foetal heart rate decelerations and birthweight centile. Forty-one individuals were randomised with data collected on 35 participants over 469 nights. There was no difference in percentage of total sleep time in the supine position overnight between the control or intervention pillow week (13.0% [6.1, 25.5] vs. 16.0% [5.6, 27.2], p = 0.81 with a mean difference of 2.5% [95% CI] = -0.7, 5.6, p = 0.12), and no difference in the severity of SDB or foetal heart rate decelerations across weeks. However, increased supine sleep was significantly related to a higher apnoea-hypopnoea index (rs = 0.37, p = 0.003), lower birthweight (rs = -0.45, p = 0.007) and lower birthweight centile (rs = -0.45, p = 0.006). The proportion of supine sleep each night of the week varied widely both within and across participants, despite awareness of side-sleeping recommendations. We found no evidence to suggest that the adoption of a pillow designed to discourage supine sleep was effective in late pregnancy, with women spending an average of 1 h per night supine. Alternative devices should be investigated, incorporating lessons learnt from this study to inform trials of supine sleep minimisation in pregnancy. Clinical Trial: (Australia New Zealand Clinical Trials Registry): ACTRN12620000371998.

Effect of sleep-disordered breathing on stable electroencephalographic characteristics during night sleep in patients with arterial hypertension

Introduction. Obstructive sleep apnea (OSA) is the most common sleep-disordered breathing condition. A significant number of OSA patients often present with cardiovascular comorbidities, particularly arterial hypertension. OSA is associated with changes in bioelectrical activity of the brain, such as slowing of electroencephalographic activity in the cortex and reduced interhemispheric synchronization. These changes can become pathophysiological markers of sleep-disordered breathing.Aim. To investigate the effect of sleep-disordered breathing on a range of quantitative electroencephalogram (EEG) characteristics during nighttime sleep in patients with arterial hypertension and clinically significant OSA.Materials and methods. The material for this retrospective study consisted of 84 polysomnographic records of patients predominantly diagnosed with arterial hypertension. Patients were divided into three groups based on the apneahypopnea index (AHI). Polysomnographic records were used to assess the synchronization measure of brain electrical activity between occipital EEG leads. The synchronization measure was evaluated using a method based on wavelet bicoherence calculation.Results. Statistically significant differences were observed in the low-frequency ranges Δf1-Δf4: 0.2-1.0 Hz, 0.8-1.6 Hz, 1.0-2.0 Hz, 1.0-4.0 Hz. In these frequencies, the interhemispheric synchronization measure significantly decreased with increasing severity of apnea.Conclusion. To determine the severity of obstructive sleep apnea, a parameter based on the synchronization measure evaluated from symmetrical occipital EEG signals in the frequency ranges 0.2-1.0 Hz, 0.8-1.6 Hz, 1.0-2.0 Hz, and 1.0-4.0 Hz can be considered. This may serve as the basis for developing and implementing new diagnostic tools for assessing the severity of sleep-disordered breathing in practice.

Correlates of sleep-disordered breathing and Cheyne-Stokes respiration in patients with atrial fibrillation who have undergone pulmonary vein isolation.

Sleep disordered breathing (SDB) is a common comorbidity in patients with atrial fibrillation (AF). Patients undergoing pulmonary vein isolation (PVI) for AF have a high prevalence of SDB. In previous studies, some patients with AF had Cheyne-Stokes respiration (CSR). The aim of the present study was to assess the prevalence of SDB and the correlates of SDB severity and CSR in AF patients who have undergone PVI. The study was conducted using a single-center observational design. All participants underwent a home sleep apnea test (ApneaLink Air, ResMed, Australia), which could determine the severity of SDB as assessed by the apnea-hypopnea index (AHI) and the percentage of CSR (%CSR) pattern. 139 AF patients who underwent PVI were included in the study. Overall, 38 (27.3%) patients had no SDB (AHI < 5), 53 (38.1%) had mild SDB (5 ≤ AHI < 15), 33 (23.7%) had moderate SDB (15 ≤ AHI < 30), and 15 (10.8%) had severe SDB (AHI ≥ 30). Correlates of the increased AHI included male sex (β = 0.23, p = 0.004), age (β = 0.19, p = 0.020), high body mass index (β = 0.31, p < 0.001), and β blockers usage (β = 0.18, p = 0.024). Conversely, correlates with the %CSR rate included male sex (β = 0.18, p = 0.020), age (β = 0.19, p = 0.015), non-paroxysmal AF (β = 0.22, p = 0.008), and high glycohemoglobin A1c (β = 0.36, p < 0.001) and N-terminal pro-brain natriuretic peptide (β = 0.24, p = 0.005) levels. SDB is prevalent in patients with AF who have undergone PVI; predisposing factors for SDB include male sex, older age, and obesity. CSR occurs in patients with AF who have undergone PVI; predisposing factors for CSR include male sex, older age, high left ventricular filling pressure, and abnormal blood glucose level.

Sleep-disordered breathing increases mortality in patients with diabetes.

Sleep-disordered breathing (SDB) and diabetes mellitus (DM) are often concomitant; however, data on the impact of SDB on mortality in the population with diabetes remain scarce. The population from the Sleep Heart Health Study, a multicenter prospective observational study representing 5780 patients with polysomnography and mortality data, including 453 patients with DM, was analyzed to assess the impact of SDB variables and the presence of DM on all-cause, cardiovascular disease (CVD), and non-CVD associated mortality. Survival analysis and proportional hazard regression models were used to calculate the adjusted hazard ratios (aHR) for mortality. Patients with DM and the average SpO2 >91.4% had significantly lower all-cause (aHR 0.52, CI 0.34-0.80) and CVD mortality risk (aHR 0.44, CI 0.22-0.87) as compared with patients with SpO2 below this value. Apnea-hypopnea index >31 (aHR 1.58, CI 1.10-2.28) and oxygen desaturation index >13.3 (aHR 1.58, CI 1.10-2.25) were associated with increased all-cause mortality in participants with DM on treatment. Sleep efficiency and proportion of rapid-eye movement (REM) sleep did not have any impact on mortality in patients with DM and thus differed significantly from individuals without DM, where increased all-cause mortality was observed in those with sleep efficiency <81.4% (aHR 0.77, CI 0.68-0.87) or REM sleep <14.9% (aHR 0.78, CI 0.68-0.89). Patients with diabetes on treatment and moderate to severe sleep-disordered breathing experience increased all-cause mortality. Reduced average oxygen saturation predicted both all-cause and cardiovascular death in the population with diabetes.

Variability in sleep architecture and alterations in circadian rhythms in patients with acute cerebral infarction accompanied by sleep-disordered breathing.

To continuously and dynamically monitor the sleep status of patients in the acute phase of cerebral infarction, and to investigate the characteristics of acute cerebral infarction(ACI)associated with sleep-disordered breathing (SDB), variations in sleep structure, and changes in sleep circadian rhythms. Patients with ACI within 48h of onset who were admitted to the Department of Neurology at Kailuan General Hospital from November 2020 to December 2022 were selected. Detailed baseline information such as age, gender, smoking history, drinking history, were recorded for the selected participants. From the beginning of their hospitalization, the selected participants were monitored for their sleep status continuously for 5 days using the Intelligent Mattress-based Sleep Monitoring Platform System(IMSMPS). Based on the heart rate data obtained from the monitoring, the interdaily stability (IS) and intradaily variability (IV) of the sleep circadian rhythm were calculated. 1,367 patients with ACI were selected. Monitoring results over 5 days indicated 147 cases (10.75%) without SDB, and 1,220 cases (89.25%) with SDB. Among the group with SDB, there were 248 cases (18.14%) with continuous mild SDB, 395 cases (28.90%) with moderate SDB, 295 cases (21.58%) with severe SDB, and 282 cases (20.63%) that fluctuated between different severity levels. Within this fluctuating group, 152 cases (53.90%) fluctuated between two severity levels, 120 cases (42.55%) between three levels, and 10 cases (3.55%) among all four levels. There were statistically significant differences (P < 0.05) in the sleep latency, sleep efficiency, non-rapid eye movement stages 1-2, rapid eye movement, proportion of non-rapid eye movement, proportion of rapid eye movement, wake after sleep onset, time out of bed, number of awakenings, respiratory variability index, and heart rate variability index among patients with ACI monitored from day 1 to 5. However, other monitored sleep structure parameters did not show statistically significant differences (P > 0.05). The coefficient of variation for all sleep monitoring parameters ranged between 14.54 and 36.57%. The IV in the SDB group was higher than in the group without SDB (P < 0.05), and the IS was lower than in the group without SDB (P < 0.05). Patients in the acute phase of cerebral infarction have a high probability of accompanying SDB. The sleep structure of these patients shows significant variability based on the onset time of the stroke, and some patients experience fluctuations among different severity levels of SDB. ACI accompanied by SDB can further reduce the IS of a patient's sleep circadian rhythm and increase its IV.

Sleep-disordered breathing in children with Chiari type I malformation.

The objective was to identify clinical and radiological factors associated with sleep-disordered breathing (SDB) in children with Chiari type I malformation (CIM) and to evaluate the efficacy of foramen magnum decompression (FMD) in resolving SDB. A retrospective chart review was conducted for all children evaluated for CIM at a single institution from 2002 to 2022, identifying all children who had undergone nocturnal polysomnography (PSG). Apnea-hypopnea index (AHI) score, sleep apnea type (obstructive, central, mixed, and unspecified), clinical manifestations, and radiological measurements were recorded. SDB was considered present when officially diagnosed in the PSG report. Logistic regression was performed to identify factors correlating with the presence of SDB. For children with SDB who underwent FMD, the Wilcoxon signed-rank test was used to assess AHI improvement. Of the 997 children referred for CIM, 310 completed PSG. SDB was diagnosed in 147 patients (overall prevalence 14.7%, 95% CI 12.7%-17.1%; prevalence among children with PSG 47.4%, 95% CI 41.9%-53%). Specific SDB diagnosis consisted of 33% of patients with central sleep apnea, 27% with obstructive sleep apnea, 9% mixed, and 31% unspecified. Lower cranial nerve (CN) dysfunction (OR 3.891, p = 0.009), tonsillar position (OR 1.049, p = 0.017), Chiari type 1.5 malformation (OR 1.862, p = 0.044), and BMI (OR 1.039, p = 0.036) were significantly associated with presence of SDB. Of the 310 patients who underwent PSG, 47 were originally categorized as asymptomatic: 27 (57%) of these asymptomatic patients were diagnosed with SDB on PSG. Of children diagnosed with SDB, 34 completed PSG before and after FMD. Median AHI score decreased from 6.5 preoperatively to 1.8 postoperatively, with a median (IQR) difference of -2.3 (-11.9 to 0.1) (p = 0.001). Twelve (35%) had resolution of SDB. The authors' findings suggest that the prevalence of SDB in children with CIM is high (15%-47%). Furthermore, lower CN dysfunction, Chiari type 1.5, lower tonsillar position, and higher BMI may be risk factors. Notably, SDB can be present even in the absence of clinical symptoms. This study also demonstrates that surgical intervention has the potential to reduce the severity of SDB. These results could help clinicians identify CIM patients at risk for SDB and those who may benefit from surgical decompression.

Sleep and Daytime Function in People with Spinal Cord Injury.

Cross-sectional cohort study. To determine the role of sleep-disordered breathing (SDB), insomnia symptoms and sleep quality in the daytime function and quality of life of veterans with spinal cord injury (SCI). A Veterans Administration (VA) medical center in the Midwestern US. Thirty-eight male veterans with SCI (22 cervical, 16 thoracic; mean [SD] age = 62.9[9.5] years) completed baseline assessments within a larger clinical trial. Measures assessed sleep apnea severity (apnea-hypopnea index, AHI), insomnia symptoms (Insomnia Severity Index, ISI), self-reported sleep quality (Pittsburg Sleep Quality Index, PSQI), daytime sleepiness (Epworth Sleepiness Scale, ESS), fatigue (Flinders Fatigue Scale, FFS), depression (Patient Health Questionnaire-9 item, PHQ-9 excluding sleep item), functioning (Spinal Cord Independence Measure, SCIM), and quality of life (World Health Organization Quality of Life, WHOQOL-BREF). Bivariate correlations (alpha p<.05) were used to assess relationships between sleep (AHI, ISI, PSQI, ESS) and function (FFS, PHQ-9, SCIM, WHOQOL-BREF). Mean AHI was 29.9(26.6), mean ISI was 9.38(6.2), mean PSQI was 9.0(4.6), and mean ESS was 7.0(5.2). There were no significant relationships between AHI and function measures. Significant relationships emerged between ISI and PHQ-9, some WHOQOL-BREF subscales, and SCIM as well as between PSQI and FFS, PHQ-9, and some WHOQOL-BREF subscales. Among Veterans with SCI, insomnia symptom severity and poor sleep quality were associated with worse functioning, whereas SDB severity was not. Insomnia and poor sleep quality represent modifiable contributors to poor daytime function. Research evaluating the impact of evidence-based insomnia treatments among individuals living with SCI is warranted.

An Inertial-Based Wearable System for Monitoring Vital Signs during Sleep.

This study explores the feasibility of a wearable system to monitor vital signs during sleep. The system incorporates five inertial measurement units (IMUs) located on the waist, the arms, and the legs. To evaluate the performance of a novel framework, twenty-three participants underwent a sleep study, and vital signs, including respiratory rate (RR) and heart rate (HR), were monitored via polysomnography (PSG). The dataset comprises individuals with varying severity of sleep-disordered breathing (SDB). Using a single IMU sensor positioned at the waist, strong correlations of more than 0.95 with the PSG-derived vital signs were obtained. Low inter-participant mean absolute errors of about 0.66 breaths/min and 1.32 beats/min were achieved, for RR and HR, respectively. The percentage of data available for analysis, representing the time coverage, was 98.3% for RR estimation and 78.3% for HR estimation. Nevertheless, the fusion of data from IMUs positioned at the arms and legs enhanced the inter-participant time coverage of HR estimation by over 15%. These findings imply that the proposed methodology can be used for vital sign monitoring during sleep, paving the way for a comprehensive understanding of sleep quality in individuals with SDB.

Machine learning-based detection of sleep-disordered breathing in hypertrophic cardiomyopathy

BackgroundHypertrophic cardiomyopathy (HCM) is often concomitant with sleep-disordered breathing (SDB), which can cause adverse cardiovascular events. Although an appropriate approach to SDB prevents cardiac remodelling, detection of concomitant SDB in...

Effects of Sleep-Disordered Breathing on Daytime Brain Activity in Community-Dwelling Older Adults

Abstract Introduction Sleep-disordered breathing (SDB) is associated with an increased risk of cardiovascular diseases. The present study aimed to examine the influence of SDB on daytime brain activity in the community-dwelling older adults. Material and Methods There were 81 consecutive volunteers aged 60 years or older (mean age 70.5 ± 4.8 years) who participated in the present study. Daytime brain activity was assessed by measuring the peak cortical oxygenated hemoglobin (OxyHb) levels and area under the near-infrared spectroscopy (NIRS) curve. The respiratory event index (REI) and 3% oxygen desaturation index (3%ODI) were evaluated using a home sleep-apnea test. Results The peak OxyHb and area under the NIRS curve were significantly lower in the participants with REI ≥ 15/h than those with REI &lt; 15/h. The body mass index (BMI), REI, 3%ODI, and Epworth sleepiness scale (ESS) scores were significantly correlated with peak OxyHb levels (BMI: r = -0.202, p = 0.035; REI: r = -0.307, p = 0.003; 3%ODI: r = -0.321, p = 0.003; and ESS score: r = -0.287, p = 0.005). Also, the BMI, REI, and 3%ODI were significantly correlated with the area under the NIRS curve (BMI: r = -0.306, p = 0.003; REI: r = -0.326, p = 0.002; and 3%ODI: r =-0.313, p = 0.002), and BMI was a significant factor associated with the area under the NIRS curve. Conclusions Brain activity during wakefulness was associated with SDB and BMI severity. A simple NIRS may yield unique information for characterizing the decline in daytime brain activity of the community-dwelling older adults.

Clinical characteristics, associated comorbidities and hospital outcomes of neonates with sleep disordered breathing: a retrospective cohort study

ObjectiveAwareness of the need for early identification and treatment of sleep disordered breathing (SDB) in neonates is increasing but is challenging. Unrecognised SDB can have negative neurodevelopmental consequences. Our study...

Potential determinants of nocturnal hypoxemic burden and its association with atrial fibrillation recurrence after catheter ablation

Abstract Background Sleep-disordered breathing (SDB) is present in approximately half of patients with atrial fibrillation (AF) scheduled for catheter ablation (CA) and coincides with an elevated nocturnal hypoxemia. Purpose To evaluate determinants of nocturnal hypoxemic burden metrics and its association with AF recurrence after CA in patients undergoing a systematic SDB management and treatment pathway. Methods Consecutive AF patients scheduled for CA without history of SDB and/or SDB screening were included. Patients were referred to a virtual SDB management pathway including mobile health supported overnight home sleep test. An apnoea-hypopnoea index (AHI) of 5 to &amp;lt;15 and ≥ 15 were interpreted as mild and moderate-to-severe SDB, respectively. Oximetry data from home sleep tests were analyzed by a computer algorithm to evaluate metrics of nocturnal hypoxemic burden: time spent below 90% oxygen desaturation (T90) based on acute desaturations (T90 desat) or non-specific drifts in oxygen desaturation (T90 non-spec). Patients were monitored for AF recurrences through standard 12-lead ECG or Holter ECG and/or smartphone-based photophletysmography (PPG) performed at 3- and 12-month follow up. Multiple regression analysis was employed to (1) evaluate determinants of nocturnal hypoxemic burden metrics and (2) identify predictors of AF recurrence during 12 months after CA (excluding 3 months blanking period). Results The analysis included 210 patients (42% female, mean age 64± 9 years). Median AHI was 14.7 [6.7-24.7], median T90desat was 0.25 [0.03-1.42] minutes, T90non-spec 0.26 [0.08-0.78] minutes. Overall, 101 (48%) patients were diagnosed with moderate-to-severe SDB and 68 (32%) had mild SDB. Of patients with moderate-to- severe SDB and mild SDB, 87% and 46%, respectively, received a SDB therapy recommendation. Multiple linear regression analysis identified diabetes mellitus (B 8.611 95%CI 1.350-15.871, p=0.020) and AHI ≥ 15 (B 5.886, 95%CI 1.793-9.979, p= 0.005) as predictors of T90non-spec. Thyroid dysfunction (B 1.849, 95%CI 0.623-3.075, p=0.003) and AHI ≥ 15 (B 2.161, 95%CI 1.320-3.001, p&amp;lt;0.001) were significant predictors of T90desat. During 12 months after CA, 65 (31%) patients had experienced at least one AF recurrence after the blanking period. After multiple Cox-regression, age (HR 1.032, 95%CI 1.002-1.063, p= 0.035) and BMI ≥ 25 (HR 2.029, 95%CI 1.032-3.989, p=0.040) remained predictors for AF recurrences. Conclusions In AF patients scheduled for CA, SDB (AHI ≥ 15) and thyroid dysfunction were predictors for nocturnal hypoxemic burden with repetitive desaturations (T90desat). SDB and diabetes mellitus were predictors for nocturnal hypoxemic burden without repetitive desaturations (T90non-spec). In patients with AF who followed a virtual SDB management and treatment pathway, SDB presence and nocturnal hypoxemic burden metrics did not emerge as predictors, whereas age and BMI (≥25) remained significant predictors for AF recurrence.

The surge in heart rate and blood pressure at respiratory event termination is dampened in children with down syndrome

BackgroundChildren with Down syndrome (DS) have a high prevalence of sleep disordered breathing (SDB) and altered cardiovascular autonomic control. We aimed to analyze the effect of DS on the surge in heart rate (HR) and pulse transit time (PTT, an inverse surrogate measure of blood pressure change) at respiratory event termination. Methods44 children (3–19 y) with DS and 44 typically developing (TD) children matched for SDB severity, age and sex underwent overnight polysomnography. Multilevel modelling determined the effect of DS on HR and PTT changes between a 10s pre-event to the latter half of each respiratory event (late-event) and 15s post-event during NREM and REM, accounting for SDB severity and event length. ResultsThe children with DS had a significantly smaller % change in HR late-event to post-event (NREM: DS 26.4 % ± 17.5 % (mean ± SD), TD 30.7 % ± 21.0 %; REM DS 16.9 % ± 15.3 %, TD 21.0 % ± 14.0 %; p < 0.05 for both) compared with TD children for obstructive events, and central events (13.2 % ± 17.0 %, TD 18.8 % ± 17.0 %; p < 0.01) during REM. %change in PTT was significantly smaller in the DS group during NREM and REM from pre-event and late-event to post-event compared with TD children for obstructive and central events. ConclusionThese results suggest children with DS have dampened HR and BP responses to respiratory events compared with TD children. Whether this is symptomatic of autonomic dysfunction or a protective factor for the cardiovascular system in children with DS remains to be elucidated.

Predicting heart failure symptoms from the apnoea-hypopnoea index determined by full- night polysomnography.

Sleep-disordered breathing (SDB) is closely related to cardiovascular diseases. The higher the apnoea-hypopnoea index (AHI), the higher the prevalence of cardiovascular diseases. Despite these findings suggesting a close link between SDB and heart failure, the relationship between the severity of SDB and the onset of heart failure symptoms in individuals without apparent heart failure symptoms (Heart Failure Stage A+B) remains poorly understood. Between December 2010 and June 2017, we conducted full-night polysomnography (PSG) at the Nippon Medical School Chiba Hokusoh Hospital, extracting patients who were at risk of heart failure (Stage A or B in the Heart Failure Guidelines). Using a median cut-off of AHI≥41.6 events/hour, we divided the patients into two groups and examined the composite endpoint of all-cause mortality plus hospitalization due to heart failure as the primary endpoint. We included 230 patients (mean age 63.0±12.5years, 78.3% males) meeting the selection criteria. When comparing the two groups, those with AHI<41.6 events/hour (L group, n=115) and those with AHI≥41.6 events/hour (H group, n=115), the H group had higher body mass index and higher serum triglyceride, and lower the frequency of acute coronary syndrome and lower estimated glomerular filtration rate than did the L group, but no other patient characteristics differed significantly. The H group had a significantly higher incidence of the composite endpoint than did the L group (10.6% vs. 2.6%, P=0.027). Factors associated with the composite endpoint were identified through multivariate analyses, with AHI, haemoglobin, and left atrial dimension emerging as significant factors (hazard ratio [HR]=1.02, 95% confidence interval [CI]=1.00-1.04, P=0.024; HR=0.71, 95% CI=0.54-0.94, P=0.017; and HR=1.10, 95% CI=1.03-1.18, P=0.006, respectively). Conversely, the minimum SpO2 during PSG (<80%) was not associated with the composite endpoint. In patients with SDB who are at risk of heart failure, severe SDB is associated with a high risk of all-cause mortality and the development of heart failure. Additionally, combining cardiac echocardiography and PSG data may improve risk stratification, offering potential assistance for early intervention. Further examination with a validation cohort is necessary.