Severity Of Sleep-disordered Breathing Research Articles

Sleep-Disordered Breathing, Advanced Age, and Diabetes Mellitus Are Associated with De Novo Atrial Fibrillation after Cardiac Surgery

Background: Postoperative de novo atrial fibrillation (POAF) is one of the most frequently encountered complications following cardiac surgery. Despite the identification of several risk factors, the link between sleep-disordered breathing (SDB) and POAF has barely been examined. The objective of this prospective observational study was to determine whether severe SDB is associated with POAF in patients after elective coronary artery bypass grafting (CABG) surgery. Study design and methods: The incidence and preoperative predictors of in-hospital POAF were assessed in 272 patients undergoing CABG surgery at the University Medical Center Regensburg (Germany). In-hospital POAF was detected by continuous telemetry-ECG monitoring and 12-lead resting ECGs within the first seven postoperative days. POAF that occurred after hospital discharge within 60 days post CABG surgery was classified as post-hospital POAF and was ascertained by standardized phone interviews together with the patients’ medical files, including routinely performed Holter-ECG monitoring at 60 days post CABG surgery. The night before surgery, portable SDB monitoring was used to assess the presence and type of severe SDB, defined by an apnea–hypopnea index ≥ 30/h. Results: The incidence of in-hospital POAF was significantly higher in patients with severe SDB compared to those without severe SDB (30% vs. 15%, p = 0.009). Patients with severe SDB suffered significantly more often from POAF at 60 days post CABG surgery compared to patients without severe SDB (14% vs. 5%, p = 0.042). Multivariable logistic regression analysis showed that severe SDB (odds ratio, OR [95% confidence interval, CI]: 2.23 [1.08; 4.61], p = 0.030), age ≥ 65 years (2.17 [1.04; 4.53], p = 0.038), and diabetes mellitus (2.27 [1.15; 4.48], p = 0.018) were significantly associated with in-hospital POAF. After additional adjustment for heart failure, the association between sleep apnea and postoperative atrial fibrillation was attenuated (1.99 [0.92; 4.31], p = 0.081). Conclusions: Amongst established risk factors, severe SDB was significantly associated with in-hospital POAF in patients undergoing CABG surgery. Whether SDB contributes to POAF independently of heart failure and whether risk for POAF may be alleviated by proper treatment of SDB merits further investigation.

Sleep-related breathing disorders in infants with spina bifida repaired prenatally and postnatally.

Advances in prenatal repair of myelomeningocele (MMC) have improved outcomes involving different organ systems. There is limited data on respiratory outcomes following prenatal surgical repair. We hypothesize there is no difference in respiratory outcomes between spina bifida (SB) patients who have undergone prenatal versus postnatal repair. We performed a retrospective study of 46 infants <1 year with SB seen at Children's Hospital Los Angeles from 2004-2022. Demographic data, timing of closure, neonatal course, Chiari II malformation (CIIM), ventriculoperitoneal shunt (VPS), polysomnography (PSG) results, and need for supplemental oxygen were collected. Unpaired t-test and Chi-square Test were used to analyze results. 31/46 had prenatal repair of MMC; average age at repair was 27 weeks post-conception (PCA). Average age at postnatal repair was 37 PCA. There was no difference in age at PSG. There was no difference in CIIM presence (p=0.61). 60% of patients with postnatal repair and 23% in the prenatal group underwent VPS placement (p=0.01). Patients with SB who've undergone closure of neural tube defect have persistent central apneas, obstructive apneas, and significant hypoxemia. There were no differences in the frequency or severity of sleep-disordered breathing in those with prenatal repair versus postnatal repair.

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...

Influence of Impaired Diffusing Capacity and Sleep-disordered Breathing on Nocturnal Hypoxemia and Health Outcomes in Men with and without HIV.

Nocturnal hypoxemia is common in sleep-disordered breathing (SDB) and is associated with increased morbidity and mortality. Although impaired diffusing capacity of the lungs for carbon monoxide (DLCO) is associated with daytime hypoxemia, its influence on SDB-related nocturnal hypoxemia is not known. To characterize the effects of DLCO impairment on SDB-related nocturnal hypoxemia and associated health outcomes. Data from a multi-center cohort of men with and without HIV, with concomitant measures of DLCO and home-based polysomnography (N=544), were analyzed. Multivariable quantile regression models characterized associations between DLCO and several measures of SDB-related hypoxemia (e.g., total sleep time with oxygen saturation [SpO2]<90% [T90]). Structural equation models assessed associations between impaired DLCO and SDB-related hypoxemia measures with prevalent hypertension and type 2 diabetes. DLCO impairment (<80% predicted) was associated with sleep-related hypoxemia. Participants with severe SDB (apnea-hypopnea index≥30 events/hr) and impaired DLCO had a higher T90 (median difference: 15.0%; [95% CI: 10.3,19.7]) and average SDB-related desaturation (median difference: 1.0; [0.5, 1.5]), and lower nadir SpO2 (median difference: -8.2%; [-11.4, -4.9]) and average SpO2 during sleep (median difference: -1.1%; [-2.1, -0.01]), than those with severe SDB and preserved DLCO. A higher T90 was associated with higher adjusted odds of prevalent hypertension (OR 1.39; [1.14,1.70]) and type 2 diabetes (OR 1.25; [1.07,1.46]). DLCO impairment in severe SDB was associated with sleep-related hypoxemia, prevalent hypertension and type 2 diabetes. Assessment of SDB should be considered in those with impaired DLCO to guide testing and risk-stratification strategies.

Long-term night-to-night variability of sleep-disordered breathing using a radar-based home sleep apnea test: a prospective cohort study.

Night-to-night variability of sleep-disordered breathing (SDB) limits the diagnostic accuracy of a single measurement. Multiple recordings using a reliable, affordable method could reduce the uncertainty and avoid misdiagnosis, which could be possible with radar-based home sleep apnea testing (HSAT). We recruited consecutive patients with suspected SDB and performed contactless radar-based HSAT with automated scoring (Sleepiz One) over ten nights. During the first night, patients were simultaneously measured with peripheral-arterial tonometry. Twenty-four of the 28 included patients could achieve a minimum of four measurements. The failure rate was 16% (201 of 238 measurements). The apnea-hypopnea index (AHI) and oxygen desaturation index were consistently lower with radar-based HSAT compared to peripheral arterial tonometry. The variability of the AHI was considerable, with a standard error of measurement of 5.2/h (95%CI 4.6-5.7/h) and a minimal detectable difference of 14.4/h (95%CI 12.7-15.9/h). Alcohol consumption partially accounted for the variability, with an AHI increase of 1.7/h (95%CI 0.6-2.8/h) for each standard drink. Based on a single measurement, 17% of patients were misdiagnosed, and 32% were misclassified for SDB severity. After five measurements, the mean AHI of the measured nights stabilized with no evidence of substantial changes with additional measurements. Night-to-night variability is considerable and stable over ten nights. HSAT using radar-based methods over multiple nights is feasible and well tolerated by patients. It could offer lower costs and allow for multiple-night testing to increase accuracy. However, validation and reducing the failure rate are necessary for implementation in the clinical routine. "Recording of Multiple Nights Using a New Contactless Device (Sleepiz One Connect) in Obstructive Sleep Apnea", ClinicalTrials.gov, NCT05134402.

Sleep apnea in patients undergoing coronary artery bypass grafting: Impact on perioperative outcomes.

Sleep-disordered breathing is common in patients with coronary artery disease undergoing coronary artery bypass grafting. Sleep-disordered breathing is associated with increased perioperative morbidity, arrhythmias (e.g. atrial fibrillation) and mortality. This study investigated the impact of sleep-disordered breathing on the postoperative course after coronary artery bypass grafting, including development of atrial fibrillation. This prospective single-centre cohort study included adults undergoing coronary artery bypass grafting. All were screened for sleep-disordered breathing (polygraphy) and atrial fibrillation (electrocardiogram) preoperatively; those with known sleep-disordered breathing or atrial fibrillation were excluded. Endpoints included new-onset atrial fibrillation, duration of mechanical ventilation, time in the intensive care unit, and postoperative infection. Regression analysis was performed to identify associations between sleep-disordered breathing and these outcomes. A total of 508 participants were included (80% male, median age 68 years). The prevalence of any (apnea-hypopnea index ≥ 5 per hr), moderate (apnea-hypopnea index = 15-30 per hr) and severe (apnea-hypopnea index > 30 per hr) sleep-disordered breathing was 52.9%, 9.3% and 10.2%, respectively. All-cause 30-day mortality was 0.98%. After adjustment for age and sex, severe sleep-disordered breathing was associated with longer respiratory ventilation support (crude odds ratio [95% confidence interval] 5.28 [2.18-12.77]; p < 0.001) and higher postoperative infection rates (crude odds ratio 3.32 [1.45-7.58]; p < 0.005), but not new-onset atrial fibrillation or mortality. New-onset atrial fibrillation was significantly associated with postoperative infection and prolonged hospital stay. The significant associations between sleep-disordered breathing and several adverse outcomes after coronary artery bypass grafting support the need for preoperative sleep-disordered breathing screening in individuals undergoing cardiac surgery.

Effect of sleep disordered breathing severity in children with Down syndrome on parental wellbeing and social support

IntroductionSleep disorders, particularly sleep disordered breathing (SDB), are common in children with Down syndrome (DS). We investigated the relationship between SDB severity and parental psychological wellbeing and their perception of social support. Methods44 children with DS (3–19 years) underwent overnight polysomnography and were categorised into three groups: primary snoring, Mild and Moderate/Severe obstructive sleep apnoea (OSA). Parents completed questionnaires about their child's behaviour (Child Behavior Checklist), sleep symptoms (Pediatric Sleep Survey Instrument) and SDB-related quality of life (OSA-18), together with the DUKE-UNC Functional Social Support (DUKE) and Psychological General Well-Being Index (PGWBI) questionnaires for themselves. 34 children completed a follow-up study after 2 years. ResultsThere were no significant differences between SDB severity groups for parental perceived social support or psychological wellbeing. Total scores on the DUKE were below average and PGWBI scores were indicative of moderate psychological distress in all three groups. Reduced perceived levels of social support were significantly correlated with externalising child behaviour and sleep disturbance. Diminished parental psychological wellbeing was also significantly correlated with increased sleep disturbances and reduced quality of life in children. At follow-up there were no significant changes in any questionnaire outcome, however parents of children with improved SDB severity had improved PGWBI vitality scores. ConclusionThe degree of parent-reported sleep disturbance in children with DS was linked to suboptimal perceived parental social support and poor psychological wellbeing. Our results emphasise the need for enhanced awareness of the detrimental effects of sleep problems in children with DS on parental wellbeing.

Influence of Obstructive Apnea Index on Persistent Left Ventricular Dysfunction in Patients with ST-Segment Elevation Myocardial Infarction.

Background: We retrospectively investigated the effects of the severity and classification of sleep-disordered breathing (SDB) on left ventricular (LV) function in patients with ST-segment elevation myocardial infarction (STEMI). Methods: A total of 115 patients with STEMIs underwent a sleep study using a multichannel frontopolar electroencephalography recording device (Sleep Profiler) one week after STEMI onset. We evaluated LV global longitudinal strain (LV-GLS) using two-dimensional echocardiography at one week and seven months. Patients were classified as no SDB (AHI < 5 events/h), obstructive SDB (over 50% of apnea events are obstructive), and central SDB (over 50% of apnea events are central). Due to the device's limitations in distinguishing obstructive from central hypopnea, SDB classification was based on apnea index percentages. Results: The obstructive apnea index (OAI) was significantly associated with LV-GLS at one week (r = 0.24, p = 0.027) and seven months (r = 0.21, p = 0.020). No such correlations were found for the central apnea index and SDB classification. Multivariable regression analysis showed that the OAI was independently associated with LV-GLS at one week (β = 0.24, p = 0.002) and seven months (β = 0.20, p = 0.008). Conclusions: OAI is associated with persistent LV dysfunction assessed by LV-GLS in STEMI.

Prevalence of central sleep apnea among veterans and response rate to continuous positive airway pressure therapy.

Sleep-disordered breathing (SDB) is common in the Veteran population. In this retrospective study, we investigated the prevalence of comorbid central and obstructive SDB and the response rate to PAP among Veterans. Veterans were screened from a single VA medical center who had polysomnography (PSG) study from 2017 to 2021 to ascertain the presence, severity, and type of SDB by measuring the apnea-hypopnea index (AHI) and central apnea index (CAI). Patients were excluded if they did not have complete studies (diagnostic and PAP titration studies). The inclusion criteria for these analyses were central sleep apnea (CSA) defined as AHI ≥ 10 events/hour and CAI ≥ 5 events/hour. Diagnostic "CSA only" was defined as AHI ≥ 10 events/hour and CAI ≥ 50% of AHI. "OSA only" was defined if AHI ≥ 10 events/hour and CAI < 5 events/hour. Comorbid central and obstructive sleep apnea (COSA) was defined if AHI ≥ 10 events/hour and CAI > 5 events/hour but < 50% of AHI. The responsiveness to PAP therapy was determined based on the CAI < 5 events/hour on the titration study. A total of 90 patients met the inclusion criteria and from those 64 Veterans were found to have COSA (71%), 18 (20%) were CSA only, and 8 (9%) were OSA only. A total of 22 (24.4%) Veterans diagnosed with CSA or COSA were responsive to PAP therapy. Sixty days after treatment initiation, both responsive and nonresponsive groups had significant decreases in AHI and CAI (p < 0.05). Comorbid central and obstructive SDB is common among Veterans. The response to PAP therapy is suboptimal but improves over time.

LOOK AHEAD SLEEP: STUDY DESIGN AND BASELINE CHARACTERISTICS

Abstract Older adults with obesity and type 2 diabetes (T2D) are at elevated risk for mild cognitive impairment (MCI) and dementia. Compared with younger persons, older adults are more likely to have sleep-disordered breathing (SDB), which is also common among adults with T2D and obesity and is associated with higher risk of dementia. The Look AHEAD Sleep (LA-Sleep) study investigates links of SDB and circadian rest/activity rhythms with cognitive performance, MCI, and dementia in older adults with T2D and obesity/overweight enrolled in Look AHEAD Aging (LA-A). LA-Sleep participants completed cognitive measures at baseline and were randomized to sleep measurement in the first (2022-2023) or second year (2023-2024). Sleep measures include assessments of SDB (WatchPAT), circadian rest/activity rhythms (ActiGraph) and daily sleep diary. Of those who enrolled in LA-A, 62.8% consented to LA-Sleep. To date in 203 participants have provided data from WatchPAT and 107 provided actigraphy data. Participants were a mean (±SD) age of 76.1±5.4 y, had a mean BMI of 34.2±6.7 kg/m2, 56.7% identified as female, and 75.4% were Non-Hispanic White, 12.3% Non-Hispanic Black, and 6.9% Hispanic. Approximately 90.2% had &amp;gt;high school education. Of participants with obesity in 2018-2020, 27.9% (41/147) had an apnea hypopnea index (AHI) of ≥15 to &amp;lt;30/h (moderate SDB) and 20.4% (30/147) had ≥30 events/h (severe SDB). Mean actigraphy-estimated total sleep time was 7.1±1.4 h, and mean wake after sleep onset was 62.5±31.0 min/night. Among adults with T2D and overweight/obesity, a high proportion have SDB and sleep fragmentation, potentially increasing risk for dementia.

Effect of sleep-disordered breathing on recovery in patients with “wake-up” stroke

Background. Wake-up stroke (WUS) is often combined with sleep-disordered breathing and may potentially have a more unfavorable course.Objective — to evaluate the association between the time of stroke onset and the pattern of sleep-disordered breathing, as well as the effect of wake-up stroke on stroke recovery and stroke severity in patients with ischemic stroke.Design and methods. We included patients 18–85 years old with acute ischemic stroke admitted within 24 hours of symptom onset to the neurological resuscitation unit, and performed polygraphy within the first day of hospitalization to assess the parameters and severity of sleep-disordered breathing. In 2018–2023, 2122 patients were screened, polygraphy was performed in 639 patients, and data from 292 patients were included in the final analysis. Stroke severity was assessed using the NIHSS scale, stroke type was determined using the TOAST classification. WUS was considered when symptoms were detected upon awakening. Functional status was assessed by the Barthel index, and rehabilitation outcomes by the modified Rankin scale. The cumulative end point included death from any cause, new nonfatal myocardial infarction, new nonfatal stroke/transient ischemic attack, emergency revascularization, or emergency hospitalization due to exacerbation of cardiovascular disease.Results. WUS was detected in 101 patients (34,6 %). The WUS group had more frequent diabetes mellitus and higher NIHSS (p = 0,021) and Barthel index (p = 0,026) at discharge, less frequent thrombolytic therapy and emergency endovascular procedures (p = 0,007) which in most cases was associated with hospitalization in time beyond the therapeutic window (p &lt; 0,001). Endpoints were reached in 21,6 % with a median follow-up of 209 days. No significant differences were found in the main indices of sleep-disordered breathing in groups of different severity and pathogenetic type of stroke. The most significant factors related to Barthel index were stroke severity at discharge (p &lt; 0,001) and age (p &lt; 0,001). Stroke severity at discharge was most influenced by thrombolytic therapy (p = 0,006) and stroke severity on admission (p &lt; 0,001).Conclusions. Our study did not show the previously described higher incidence of sleep-disordered breathing in WUS. The best outcomes were in subjects who received reperfusion therapy. Patients with WUS should be hospitalized in a hospital where reperfusion therapy is available. Lower Barthel index values at discharge of patients with WUS may characterize their lower rehabilitation potential.

Look AHEAD Sleep: Study Design and Baseline Characteristics

AbstractBackgroundOlder adults with obesity (body mass index [BMI] ≥30 kg/m2) and type‐2 diabetes (T2D) have increased risks for mild cognitive impairment (MCI) and dementia. Sleep‐disordered breathing (SDB) is common in older adults and those with T2D and obesity, and has been linked to increased risk of Alzheimer’s disease (AD) and Alzheimer’s disease‐related dementias (ADRD). SDB may represent a unique and modifiable pathway that elevates the risk of cognitive decline among patients with T2D and obesity. Yet, few studies have examined associations between SDB and cognitive outcomes among persons with T2D and obesity. Addressing this gap is critical as the prevalence of metabolic disorders is increasing, placing a growing population at risk for MCI, and AD/ADRD. Look AHEAD Sleep (LA‐Sleep) was designed to study associations of SDB and circadian rhythms with cognitive function in older adults with a history of these conditions. Here, we report initial baseline characteristics of LA‐Sleep cohort.MethodParticipants enrolled in Look AHEAD Aging (LA‐A), a continuation of the Look AHEAD cohort study, were eligible to participate in LA‐Sleep. Participants completed cognitive assessments and were randomized to have a sleep assessment in either Year 1 (2022‐2023) or 2 (2023‐2024). Year 1 participants completed sleep questionnaires and received in‐home sleep assessment devices (WatchPAT and ActiGraph) and a sleep diary by mail.ResultOf 1,522 who consented to LA‐A, 952 agreed to LA‐Sleep and to date, 161 have provided year 1 WatchPAT (n = 161) or Actigraph (n = 107) data. There were more females (55.3%) than males; the average (±SD) age was 76.1±5.4 y; average BMI was 34.3±7.0; and 10.6% of the sample was Non‐Hispanic Black, 6.2% Hispanic, and 76.4% Non‐Hispanic White. Most had more than a high school education (90.1%). Of those with obesity in 2018‐2020, 20.0% had severe SDB (apnea hypopnea index ≥30). Overall mean actigraphic‐estimated sleep duration was 7.1±1.4 hours, sleep efficiency (total sleep time/time in bed) was 87.0%, and wake‐after‐sleep‐onset was 62.5±31.0 minutes/night.ConclusionAmong an older adult cohort with T2D and overweight or obesity, a high proportion of participants have severe SDB and high levels of sleep fragmentation, placing them at increased risk for cognitive impairment.

Evaluation of Minimum Recording Time and the Influence of Time in the Supine Position on Out-of-Center Sleep Tests

Abstract Introduction The prevalence of moderate to severe sleep-disordered breathing is of 17% among men aged between 50 and 70-years, and of 9% among women in the same age group. In Brazil, obstructive sleep apnea (OSA) is also highly prevalent, and it is associated with metabolic and cardiovascular impacts, excessive daytime sleepiness, and increasing risk of traffic accidents. Laboratory-based polysomnography is the gold standard test for OSA diagnosis. However, its complexity has led to the search for alternatives to simplify the diagnosis, such as the out-of-center sleep test (OCST). Objectives To discusses the minimum OCST recording time and the potential effects of the supine position on this parameter. Data Synthesis We conducted a search on the PubMed, Web of Science, Scopus, and Embase databases to identify relevant studies on OCST recording time and a possible association with body position. We used a combination of terms, including Obstructive Sleep Apnea and Home Monitoring OR Home Care Services OR Portable Monitoring AND Supine OR Position OR Recording Time OR Positional Obstructive Sleep Apnea. The references of the selected articles were also reviewed to find other relevant studies. Through our approach, eighteen articles were retrieved and included in the present study. Conclusion Since OCSTs are conducted in an unattended environment, with potential signal loss during the night, it is crucial to determine the minimum recording time to validate the test and assess how the time spent in the supine position affects this parameter. After reviewing the literature, this topic remains to be clarified, and additional studies should focus on that matter.

Novel metrics of sleep-disordered breathing are associated with outcome after ischemic stroke

Objective/backgroundStandard measures of sleep-disordered breathing (SDB) that rely on count data may not sufficiently capture SDB severity or reflect downstream consequences of SDB. We hypothesized that novel metrics derived from pulse rate, oxygen saturation, and nasal pressure would be associated with stroke outcomes. Patients/methodsShortly after ischemic stroke, participants in a population-based study were offered ApneaLink Plus testing. Signal analysis was used to generate 166 metrics from the nasal pressure cannula and finger probe, categorized as: autonomic (based on pulse rate variability), oximetry-derived, nasal pressure-derived, and mixed oxygen and nasal pressure-derived measures. Three-month outcome assessments included functional and cognitive outcomes and stroke recurrence. Tobit regression and Cox proportional hazards models were used to examine associations between each sleep apnea metric and the three outcomes, unadjusted and adjusted for multiple potential confounders. Models were adjusted for multiple comparisons. ResultsOf the 530 participants, the median age was 65 (IQR: 57, 73), 49 % were female, and 64 % were Mexican American. Without covariate adjustment, 23 of 166 variables were associated with functional outcome, 43 were associated with cognitive outcome, and 1 was associated with stroke recurrence. After adjustment, 7 mixed, oximetry, or nasal pressure-based metrics and 1 autonomic metric were associated with functional outcome, but none was associated with cognitive outcome or stroke recurrence. ConclusionsMany novel metrics of SDB were associated with important stroke outcomes, and 8 novel metrics were associated with functional outcome in adjusted models. This raises hypotheses about pathways by which SDB may negatively impact stroke outcomes.

Postoperative Outcomes of Intracapsular Tonsillectomy With Coblation: A Systematic Review and Meta-Analysis.

Following tonsillectomy, postoperative pain and hemorrhage from the tonsillar bed are causes of significant morbidity. Intracapsular tonsillectomy with Coblation is suggested to minimize such morbidity while remaining efficacious in long-term outcomes. This systematic review and meta-analysis assessed short-term morbidity and long-term outcomes from intracapsular tonsillectomy with Coblation, focusing primarily on posttonsillectomy hemorrhage. Medline, Embase, and the Cochrane Library. Guided by PRISMA guidelines, studies on intracapsular tonsillectomy with Coblation published between December 2002 and July 2022 evaluating frequency of posttonsillectomy hemorrhage were screened. Studies without primary data were excluded. Meta-analysis was conducted using the random-effect model. The primary outcome was the proportion of patients who experienced posttonsillectomy hemorrhage. The secondary outcomes were posttonsillectomy pain, the proportion requiring revision tonsillectomy, and severity of sleep-disordered breathing measured by polysomnography outcomes. From 14 studies there were 9821 patients. The proportion of total posttonsillectomy hemorrhage was 1.0% (95% confidence interval [CI] 0.5%-1.6%, n = 9821). The proportion experiencing primary hemorrhage, secondary hemorrhage, and those requiring further tonsil surgery were 0.1% (95% CI 0.0%-0.1%; study n = 7), 0.8% (95% CI0.2%-1.4%; study n = 7), and 1.4% (95% CI 0.6%-2.2%; study n = 6), respectively. Mean reduction in apnea-hypopnea index was -16.0 events per hour (95% CI -8.8 to -23.3, study n = 3) and mean increase in oxygen nadir was 5.9% (95% CI2.6%-9.1%, study n = 3). Intracapsular tonsillectomy with Coblation has been demonstrated to have a low rate of posttonsillectomy hemorrhage. Data regarding long-term tonsil regrowth and need for reoperation were encouraging of the efficacy of this technique.

Abstract 18481: Paroxysmal Atrial Fibrillation and Sleep Apnea: Diurnal Patterning of Autonomic Function and Influence of CPAP Therapy

Introduction: Autonomic nervous system (ANS) dysfunction is implicated in sleep-disordered breathing (SDB) and atrial fibrillation (AF). Hypothesis: We hypothesize that ANS measures of heart rate variability (HRV) exhibit diurnal differences in paroxysmal AF(PAF) relative to SDB severity and is impacted by continuous positive airway pressure (CPAP). Methods: Data from the Sleep Apnea and Atrial Fibrillation Biomarkers and Electrophysiologic Atrial Triggers (SAFEBEAT) study including PAF (7-24 day ECG monitoring), concomitant actigraphy and SDB from polysomnography at baseline and 3-months post-CPAP were analyzed. Linear mixed-effects models were used to assess SDB (apnea hypopnea index (AHI), hypoxia (%sleep time with SaO2&lt;90% and nadir SaO2) and diurnal average HRV (frequency domain (sympathovagal)): low-frequency range (LF), high-frequency range (HF), LF/HF; time domain: mean of normal RR interval (MNN), standard deviation of NN intervals (SDNN), SD1(Poincare plot standard deviation) and effect of 3-month CPAP. Results: In 44869 five-minute epochs from 109 participants with SDB and PAF, during wakefulness, associations of AHI and LFP, nadir SaO2 with sympathovagal measures (LFP, LHR) and time domain measures (SDNN, SD2) were observed. A sleep-wake significant interaction was observed with all HRV measures and stronger associations in wake than sleep. Baseline to follow-up CPAP time domain measures were increased during wakefulness (MNN, SDNN, RMSSD, CV, SD1, and SD2) and increased during sleep (MNN, SD2, LHR). Conclusions: Diurnal variation of autonomic measures in moderate to severe SDB was observed and association with SDB severity was more pronounced during wakefulness; CPAP influenced autonomic function. These findings in earlier onset AF may contribute to electrophysiological remodeling with implications for ANS-specific chronobiology in SDB.

Prevalence of Sleep-Disordered Breathing in Prader-Willi Syndrome.

Sleep-disordered breathing (SDB) is common in patients with Prader-Willi Syndrome (PWS). However, the prevalence of SDB varies widely between studies. Early identification of SDB and factors contributing to its incidence is essential, particularly when considering growth hormone (GH) therapy. The aims of the study were to describe the prevalence and phenotypes of sleep-disordered breathing (SDB) in patients with Prader-Willi syndrome (PWS) and to determine the effects of age, gender, symptoms, GH therapy and body mass index on SDB severity. This study was a retrospective chart review of all patients with genetically confirmed Prader-Willi syndrome who underwent diagnostic overnight polysomnography (PSG) in the sleep laboratory at Sidra Medicine. Clinical and PSG data of enrolled patients were collected. We identified 20 patients (nine males, eleven females) with PWS who had overnight sleep polysomnography (PSG) at a median age (IQR) of 5.83 (2.7-12) years. The median apnea-hypopnea index (AHI) was 8.55 (IQR 5.8-16.9) events/hour. The median REM-AHI was 27.8 (IQR 15-50.6) events/hour. The median obstructive apnea-hypopnea index (OAHI) was 7.29 (IQR 1.8-13.5) events/hour. The median central apnea-hypopnea index (CAHI) was 1.77 (IQR 0.6-4.1) events/hour. Nineteen patients (95%) demonstrated SDB by polysomnography (PSG) based on AHI ≥1.5 events/hour. Nine patients (45%) were diagnosed with obstructive sleep apnea (OSA). Three patients (15%) were diagnosed with central sleep apnea (CSA). Seven patients (35%) were diagnosed with mixed sleep apnea. No correlations were observed between AHI and age, gender, BMI, symptoms, or GH therapy. However, REM-AHI was significantly correlated with BMI (P=0.031). This study shows a high prevalence of SDB among our patients with PWS. Obstructive sleep apnea was the predominant phenotype. BMI was the only predictor for high REM-AHI. Further studies of large cohorts are warranted to define SDB in PWS and design the appropriate treatment.

Relationships between Heart Chamber Morphology or Function and Respiratory Parameters in Patients with HFrEF and Various Types of Sleep-Disordered Breathing.

Sleep-disordered breathing (SDB), i.e., central sleep apnea (CSA) and obstructive sleep apnea (OSA), affects the prognosis of patients with heart failure with reduced ejection fraction (HFrEF). The study assessed the relationships between heart chamber size or function and respiratory parameters in patients with HFrEF and various types of SDB. The 84 participants were patients aged 68.3 ± 8.4 years (80% men) with an average left ventricular ejection fraction (LVEF) of 25.5 ± 6.85% who qualified for cardioverter-defibrillator implantation with or without cardiac resynchronization therapy. SDB, defined by an apnea-hypopnea index (AHI) ≥ five events/hour, was diagnosed in 76 patients (90.5%); SDB was severe in 31 (36.9%), moderate in 26 (31.0%), and mild in 19 (22.6%). CSA was the most common type of SDB (64 patients, 76.2%). A direct proportional relationship existed only in the CSA group between LVEF or stroke volume (SV) and AHI (p = 0.02 and p = 0.07), and between LVEF or SV and the percentage of total sleep time spent with hemoglobin oxygen saturation < 90% (p = 0.06 and p = 0.07). In contrast, the OSA group was the only group in which right ventricle size showed a positive relationship with AHI (for basal linear dimension [RVD1] p = 0.06), mean duration of the respiratory event (for RVD1 p = 0.03, for proximal outflow diameter [RVOT proximal] p = 0.009), and maximum duration of respiratory event (for RVD1 p = 0.049, for RVOT proximal p = 0.006). We concluded that in HFrEF patients, SDB severity is related to LV systolic function and SV only in CSA, whereas RV size correlates primarily with apnea/hypopnea episode duration in OSA.

O019 Sleep spindles are reduced in children with Down syndrome and sleep disordered breathing

Abstract Background Children with Down syndrome (DS) are at increased risk of sleep disordered breathing (SDB), which is associated with sleep disruption affecting daytime functioning. There is growing evidence that sleep spindles may serve as a sensitive marker of sleep quality. We investigated sleep spindle activity and its relationship with daytime functioning in children with DS compared to typically developing (TD) children matched for SDB severity. Methods Children with DS and SDB (n=44) and TD children matched for age, sex and SDB severity underwent overnight polysomnography. Fast or Slow sleep spindles were identified manually during N2 and N3 sleep. Spindle activity was characterised as spindle number, density (number of spindles/h) and intensity (density x average duration) on central (C) and frontal (F) electrodes. Parents completed the Child Behavior Checklist (CBCL) and OSA-18 questionnaires. Results Spindle number, density, and intensity were lower in the children with DS compared to TD children for F Slow and F Slow&amp;Fast spindles combined (p&amp;lt;0.001 for all). In children with DS, there were no correlations between the density of any spindle type and subscales of the CBCL, however, spindle number, density and intensity for C Fast and C Slow&amp;Fast were negatively correlated with OSA-18 emotional symptoms and caregiver concerns and C Fast number, density and intensity were also negatively correlated with daytime function and total problems. Conclusions The reduced spindle activity in the children with DS, indicates sleep micro-architecture is disrupted and this disruption may underpin the negative effects of SDB on quality of life and behaviour.

Sleep spindles are reduced in children with Down syndrome and sleep-disordered breathing.

Children with Down syndrome (DS) are at increased risk of sleep-disordered breathing (SDB). We investigated sleep spindle activity, as a marker of sleep quality, and its relationship with daytime functioning in children with DS compared to typically developing (TD) children. Children with DS and SDB (n = 44) and TD children matched for age, sex and SDB severity underwent overnight polysomnography. Fast or Slow sleep spindles were identified manually during N2/N3 sleep. Spindle activity was characterized as spindle number, density (number of spindles/h) and intensity (density × average duration) on central (C) and frontal (F) electrodes. Parents completed the Child Behavior Check List and OSA-18 questionnaires. In children with DS, spindle activity was lower compared to TD children for F Slow and F Slow&Fast spindles combined (p < 0.001 for all). Furthermore, there were no correlations between spindle activity and CBCL subscales; however, spindle activity for C Fast and C Slow&Fast was negatively correlated with OSA-18 emotional symptoms and caregiver concerns and C Fast activity was also negatively correlated with daytime function and total problems. Reduced spindle activity in children with DS may underpin the increased sleep disruption and negative effects of SDB on quality of life and behavior. Children with Down syndrome (DS) are at increased risk of sleep-disordered breathing (SDB), which is associated with sleep disruption affecting daytime functioning. Sleep spindles are a sensitive marker of sleep quality. We identified for the first time that children with DS had reduced sleep spindle activity compared to typically developing children matched for SDB severity. The reduced spindle activity likely underpins the more disrupted sleep and may be associated with reduced daytime functioning and quality of life and may also be an early biomarker for an increased risk of developing dementia later in life in children with DS.