Sleep Apnea Syndrome Patients Research Articles

Assessing the effects of HMGCR, LPL, and PCSK9 inhibition on sleep apnea: Mendelian randomization analysis of drug targets.

To investigate the use of lipid-lowering drugs and abnormal serum lipid levels in patients at risk of sleep apnea syndrome. Three types of Mendelian randomization (MR) analyses were used. First, a 2-sample Mendelian randomization (TSMR) analysis was used to investigate the association between sleep apnea syndrome risk and serum lipid levels. Multivariate Mendelian randomization (MVMR) analysis was subsequently used to investigate the effects of confounding variables on SAS incidence of sleep apnea syndrome. Finally, drug-target Mendelian randomization (DMR) analysis was used to analyze the association between lipid-lowering drug use and sleep apnea syndrome risk. According to the TSMR analysis, the serum HDL-C concentration was negatively correlated with sleep apnea syndrome (OR = 0.904; 95% CI = 0.845-0.967; P = .003). Serum TG levels were positively correlated with sleep apnea syndrome (OR = 1.081; 95% CI = 1.003-1.163; P = .039). The association between serum HDL-C levels and sleep apnea syndrome in patients with MVMR was consistent with the results in patients with TSMR (OR = 0.731; 95% CI = 0.500-1.071; P = 3.94E-05). According to our DMR analysis, HMGCR and PCSK9, which act by lowering serum LDL-C levels, were inversely associated with the risk of sleep apnea syndrome (OR = 0.627; 95% CI = 0.511-0.767; P = 6.30E-06) (OR = 0.775; 95% CI = 0.677-0.888; P = .0002). LPL, that lowered serum TG levels, was positively associated with the risk of sleep apnea syndrome (OR = 1.193; 95% CI = 1.101-1.294; P = 1.77E-05). Our analysis suggested that high serum HDL-C levels may reduce the risk of sleep apnea syndrome. Low serum TG levels have a protective effect against sleep apnea syndrome. The DMR results suggested that the use of HMGCR lipid-lowering drugs (such as statins) and PCSK9 inhibitors has a protective effect against sleep apnea syndrome. However, LPL-based lipid-lowering drugs may increase the risk of sleep apnea syndrome.

The Kir channel in the nucleus tractus solitarius integrates the chemosensory system with REM sleep executive machinery for homeostatic balance

The locus coeruleus (LC), nucleus tractus solitarius (NTS), and retrotrapezoid nucleus (RTN) are critical chemosensory regions in the brainstem. In the LC, acid-sensing ion channels and proton pumps serve as H+ sensors and facilitate the transition from non-rapid eye movement (NREM) to rapid eye movement (REM) sleep. Interestingly, the potassium inward rectifier (KIR) channels in the LC, NTS, and RTN also act as H+-sensors and are a primary target for improving sleep in obstructive sleep apnea and Rett syndrome patients. However, the role of Kir channels in NREM to REM sleep transition for H+ homeostasis is not known. Male Wistar rats were surgically prepared for chronic sleep–wake recording and drug delivery into the LC, NTS, and RTN. In different animal cohorts, microinjections of the Kir channel inhibitor, barium chloride (BaCl2), at concentrations of 1 mM (low dose) and 2 mM (high dose) in the LC and RTN significantly increased wakefulness and decreased NREM sleep. However, BaCl2 microinjection into the LC notably reduced REM sleep, whereas it didn’t change in the RTN-injected group. Interestingly, BaCl2 microinjections into the NTS significantly decreased wakefulness and increased the percent amount of NREM and REM sleep. Additionally, with the infusion of BaCl2 into the NTS, the mean REM sleep episode numbers significantly increased, but the length of the REM sleep episode didn’t change. These findings suggest that the Kir channels in the NTS, but not in the LC and RTN, modulate state transition from NREM to REM sleep.

Multimodal echocardiography for assessing whether left ventricular geometry affects right atrial phasic function in patients with obstructive sleep apnea syndrome: A cross-sectional observational study.

Recent studies have shown that right atrial (RA) function are important predictors of cardiovascular morbidity and mortality. However, the study data about RA phasic function in obstructive sleep apnea syndrome (OSAS) patients are scarce, especially based on the left ventricular geometry. So, we aimed to assess the influence of left ventricular geometry on RA phasic function in OSAS patients via a multimodal echocardiographic approach. Total of 235 OSAS patients were enrolled in this cross-section study and underwent complete clinical, polysomnography, and echocardiography examinations. The OSAS patients were divided into four groups based on left ventricular mass index (LVMI) and relative wall thickness (RWT): normal geometry (NG), concentric remodeling (CR), concentric hypertrophy (CH), and eccentric hypertrophy (EH). RA phasic function was evaluated via multimodal echocardiography approach (two-dimensional echocardiography biplane method [2DE]; two-dimensional speckle-tracking echocardiography [2D-STE]; and three-dimensional echocardiography [3DE]). The multiple linear regression analysis was used to determine the relationship between left ventricular geometry and RA phasic function. The RA volume and indices increased from NG to CR to EH to CH. RA total emptying fraction and RA strain during systole decreased from NG to CR to EH to CH. RA passive emptying fraction and RA strain during early diastole similarly decreased. RA active emptying fraction and RA strain during late diastole also gradually increased similarly. In analyses that adjusted for gender, age, body mass index, systolic blood pressure, apnea-hypopnea index, LVMI, systolic pulmonary artery pressure, and right ventricular free wall thickness, CH was associated with RA reservoir and conduit function via 2DE area-length method, whereas CH and EH were associated with RA reservoir and conduit function via 2D-STE and 3DE method. Further, CH was associated with RA booster pump function via 2DE area-length method, 2D-STE, and 3DE method. The RA volumes and phasic function varied with left ventricular geometry via multimodal echocardiography approach. CH had the apparent negative effect on RA phasic function.

Prevalence of Obstructive Sleep Apnoea in patients with primary nasal and nasopharyngeal pathologies.

The aim of this study was to study the prevalence of obstructive sleep apnea syndrome in patients with nasal and nasopharyngeal pathologies. A total of 60 consenting patients between the age of 14 to 60 years with primary nasal and nasopharyngeal pathologies were taken up for the study. These patients underwent history taking, detailed clinical examination including BMI, diagnostic nasal endoscopy and overnight polysomnography. The polysomnography results of people with different pathologies were compared and analysed. Based on the analysis it was arrived that isolated pathologies like septal deviation, nasal polypi and adenoid hypertrophy provided a statistically significant association with occurrence and severity of OSA. Also, that patients with combined pathologies were more proportionately affected by OSA than those with isolated pathologies. Nasal and nasopharyngeal pathologies have significant association with obstructive sleep apnea syndrome and all patients with these pathologies need to undergo polysomnography along with other routine investigations.

Continuous positive airway pressure treatment in obstructive sleep apnea syndrome patients with hypertension

Aims: To assess the prevalence and general characteristics of obstructive sleep apnea syndrome in patients with hypertension, investigate the relationship between obstructive sleep apnea syndrome and blood pressure, and the effectiveness of continuous positive pressure ventilation treatment after 1 month in hypertensive patients with obstructive sleep apnea. Methods: Cross-sectional descriptive study with follow-up after 1 month in hypertensive patients treated at the Hue University of Medicine and Pharmacy Hospital with respiratory polygraphy from January 2021 to June 2023. Patients were given history, clinical examination, anthropometric measurements, Lipid profile test, intravenous glucose, Epworth scale assessment, CPAP treatment and re-evaluated after 1 month. Results: 134 patients were registered for the study from 01/2021 to 06/2023. Hypertensive patients with OSAS were 73.13%. BMI in the OSAS (+) group was 22.84 ± 3.04 kg/m2 and was statistically significantly greater than the OSAS (-) group: 22.79 ± 3.07 kg/m2 (p<0.05). Neck circumference in the OSAS (+) group was 37.45 ± 2.44 cm, which was statistically significantly larger than the OSAS (-) group: 36.36 ± 1.57 cm (p<0.05). The rate of loud snoring during sleep and excessive daytime sleepiness in the OSAS patient group was statistically significantly higher than in the group without this syndrome (p<0.05 and p<0.01). The average systolic blood pressure in the OSAS (+) group was 154.79 ± 13.32 mm Hg and was statistically significantly higher than the OSAS (-) group (p<0.01). AHI has a moderate positive correlation with systolic blood pressure (r = 0.45, p<0.01) and diastolic blood pressure (r = 0.34, p<0.01). CPAP treatment improved systolic and diastolic blood pressure and symptoms of excessive daytime sleepiness. Conclusion: There is a relationship between obstructive sleep apnea syndrome and hypertension. CPAP treatment improves blood pressure and daytime sleepiness.

SOMNOLOGIC SCREENING AND MONITORING IN PATIENTS IN THE ACUTE PERIOD OF ISCHEMIC STROKE

Summary. Cerebral stroke – is one of the leading causes of morbidity and mortality, the frequency of which is constantly increasing and is about 1 million people per year in Europe; and from 13 to 35% of these patients die within the first 30 days of treatment, and 20-40% of patients who survived, are dependent on the external physical assistance and only about 10% return to a full-quality life. A significant part of patients with ischemic stroke has obstructive sleep breathing disorders, which are often the cause of the stroke development and significantly complicate its course, primarily due to the impaired airway patency, numerous episodes of apnea/hypopnea and hypoxemia, hypercapnia, etc. A comprehensive study of the frequency of the obstructive sleep apnea syndrome development and its degree of severity, its inherent ventilation and oxygenation disorders against the background of standard treatment and in combination with noninvasive respiratory support in patients with ischemic stroke, can play an important positive role on the way to the improvement of the results of treatment and rehabilitation. Objective. To study changes in ventilation and oxygenation in patients in the acute period of ischemic stroke, depending on the method of intensive therapy. Methods. Ischemic patients were performed a questionnaire survey and screening monitoring to find sleep breathing disorders («SomnoChek micro», Weinman, Germany), based on the results of which there were formed two groups: traditional stroke treatment and in combination with auto-CPAP support, which was performed with the help of «ResMed Air Sence-i» (Australia). To control the effectiveness of respiratory support, «SomnoChek micro» (Weinman, Germany) and «Masimo SafetyNet» (Masimo, USA) were used, the obtained somnological indices were processed statistically. Results. The frequency of detection of obstructive sleep apnea syndrome in patients with ischemic stroke in the acute period is 44%. The initial values of the apnea/hypopnea index (AHI) did not statistically significantly differ from each other and were 51.38±20.31/hour in the patients of the experimental group, and 51.21±20.27/hour in patients of the control group. During the 7th day, the AHI values in patients of the experimental group, whose traditional treatment of ischemic stroke was supplemented with sessions of CPAP-therapy at night, statistically significantly decreased at 89.2% compared to the initial data and were 5.54±1.98/hour, which are normal values and indicate the rapid and high efficiency of CPAP-support and its good tolerability by patients. In patients of the control group receiving only traditional treatment, the AHI values remained high, within pathological values and were 46.73±20.21/hour. When comparing reliable AHI intervals in observation groups, their 8.4-fold difference was determined. Against the background of CPAP-therapy, during the 7th day of observation, a statistically significant decrease in hypercapnia was determined in the patients of the experimental group, namely a decrease in the average PnCO2 at 23% compared to the initial level up to the limit of 37.57±1.04 mm Hg. Against the background of the use of CPAPtherapy in patients of the experimental group during the 7th day of observation, there was found a decrease (p<0.001) of snoring at 92.1% (12.6-fold), compared to the initial level up to the limit of 2.43±2.22%, which indicates a stable restoration and maintenance of free patency of the upper respiratory tract under the influence of CPAP-support. Conclusion. Manifestations of obstructive sleep apnea syndrome in patients with ischemic stroke in the acute period were found in 88 people (44%), of which 68% had a moderate and severe form of nocturnal breathing disorders that required respiratory correction. Standardized medicinal therapy and early rehabilitation of patients with ischemic stroke does not affect the course and severity of the accompanying syndrome of obstructive sleep apnea and needs to be supplemented with methods of non-invasive respiratory support. In patients with ischemic stroke against the background of auto CPAP-therapy, positive dynamics was recorded in terms of correction of obstructive sleep apnea syndrome: a steady tendency or normalization of somnologic indices, ventilation, oxygenation, cessation of snoring. A clinical problem remains the low patients’ adherence to the use of CPAP-support and its tolerability, despite the absolute indications for its use.

Improved levels of checkpoint molecule PD-L1 on peripheral blood monocyte subsets in obstructive sleep apnea syndrome patients upon hypoglossal nerve stimulation.

Oxidative stress in patients suffering from obstructive sleep apnea syndrome (OSAS) is associated with a low-grade systemic inflammation, immune disturbance, and increased invasion of monocytes into the endothelium. Besides continuous positive airway pressure (PAP), hypoglossal nerve stimulation (HNS) has become a promising treatment option for patients with OSAS. We aimed to analyse the influence of HNS therapy on the cellular characteristics relevant for adhesion and immune regulation of circulating CD14/CD16 monocyte subsets. Whole blood flow cytometric measurements were performed to analyse the expression levels of different adhesion molecules and checkpoint molecule PD-L1 (programmed death-ligand 1) in connection with pro-inflammatory plasma cytokine IL-8 and the clinical values of BMI (body mass index), AHI (apnea-hypopnea index), ODI (oxygen desaturation index), and ESS (Epworth sleepiness scale) upon HNS treatment. Hypoglossal nerve stimulation treatment significantly improved the expression of adhesion molecule CD162 (P-selectin receptor) on non-classical monocytes and significantly downregulated the expression of PD-L1 on all three monocyte subsets. We conclude that the holistic improvement of different parameters such as the oxygenation of the peripheral blood, a reduced systemic inflammation, and the individual sleeping situation upon HNS respiratory support, leads to an improved immunologic situation.

Clinical characteristics of obstructive sleep apnea in patients with heart failure

Aims: To investigate the clinical characteristics of obstructive sleep apnea syndrome in patients with heart failure (HF).
 Patients and Methods: From 9/2020 to 9/2021, patients with chronic HF (European Society of Cardiology’s criteria) and obstructive sleep apnea (American Academy of Sleep Medicine’s criteria) were enrolled into the study. Clinical examination, blood test, echocardiography, polysomnography, ventilatory polygraphy were performed in all patients.
 Results: 63 patients were included: 54 male (85.7%), 9 female (14.3%), age 69.57 ± 13.08, BMI 28.63 ± 4.16 kg/m2, neck size >40 cm: 69.3%, 100% male and 88.9% female had waist circumference ≥90 cm, hypertension 78.4%, diabetes 47.6%, HFrEF 12 (18%), HFmrEF 5 (7.9%), HFpEF 46 (73%). 68.3% patients had Epworth ≥10, snoring 92.1%. Compared to patients with apnea-hypopnea index (AHI) <15 and AHI 15-30, patients with AHI>30 had thicker interventricular septum, higher left ventricular mass (LVM) and LVM index, lower e’ velocity, higher E/e’ ratio, higher left atrial volume index, higher systolic artery pulmonary pressure, p<0.05. Multivariate regression showed that age, body mass index, neck size, HbA1C were independent predictors of high AHI, p<0.05.
 Conclusions: Majority of patients with chronic HF and obstructive sleep apnea were male, old age, overweight/obesity, and had large neck size. Hypertension and diabetes and heart failure with preserved ejection fraction were prevalent. Patients with AHI>30 had higher interventricular septal thickness, higher LVM and LVM index, lower e’ velocity, higher E/e’ ratio, higher left atrial volume index, higher systolic artery pulmonary pressure, p<0.05. Age, body mass index, neck size, HbA1C were independent predictors of high AHI, p<0.05.

Sleep disordered breathing assessment in patient with slowly progressive neuromuscular disease

BackgroundSleep-disordered breathing (SDB) is common in patients with neuromuscular diseases (NMD). Focusing on hypercapnia may lead to the neglect of other SDB such as obstructive and/or central sleep apnea syndrome (SAS). Our objectives were to assess the risk of inappropriate SDB management according to different screening strategies and to evaluate the prevalence and determinants of isolated and overlapping sleep apnea in patients with slowly progressive NMD. MethodsThis monocentric, cross-sectional, retrospective study analyzed medical records of adult NMD patients referred to a sleep department. Diagnostic strategies, including respiratory polygraphy (RP), nocturnal transcutaneous capnography (tcCO2), and blood gases (BG), were assessed for their performance in diagnosing SDB. Demographics and pulmonary function test results were compared between patients with or without SDB to identify predictors. ResultsAmong the 149 patients who underwent a full diagnostic panel (RP + tcCO2 + BG), 109 were diagnosed with SDB. Of these, 33% had isolated SAS, and central apneas were predominant. Using single diagnostic strategies would lead to inappropriate SDB management in two thirds of patients. A combination of 2 diagnostic tools resulted respectively in 21.1, 22.9 and 42.2 % of inappropriate SDB management for RP + tcCO2, RP + BG and tcCO2 + BG. ConclusionThe significant prevalence of sleep apnea syndrome in patients with slowly progressive NMD highlights the need for increased awareness among clinicians. Improved diagnostics involve a systematic approach addressing both sleep apnea and diurnal and nocturnal alveolar hypoventilation to avoid inappropriate management and limit the consequences of SDB.

An exploratory study evaluating the use of coping strategies while driving in obstructive sleep apnoea syndrome patients and controls.

Sleepiness while driving is potentially fatal, and it is recommended that a driver who starts to feel tired should stop and have a rest. However, some may use various countermeasures to try to stay alert. We devised a questionnaire that assessed various potential coping strategies that might be used against fatigue and compared them between obstructive sleep apnoea syndrome (OSAS) patients and controls and with sleepiness in general (Epworth Sleepiness Scale (ESS)), specifically while driving (Driving Sleepiness Scale (DSS)) and driving incidents. 119 untreated OSAS patients (male 82%, body mass index (BMI) 37±8 kg·m-2, ESS 14±5, DSS 3±2, oxygen desaturation index (ODI) 39±15) and 105 controls (male 70%, BMI 28±6 kg·m-2, ESS 4±3, DSS 7±6) matched for age and driving experience were recruited. All completed a questionnaire relating to their experience over the last year, which included sleepiness in general, sleepiness specifically while driving, 10 questions about various coping strategies they might adopt in order to avoid sleepiness and their history of incidents while driving. As compared to controls, nearly a third of OSAS patients (29.4%) used more than three coping strategies "frequently". OSAS patients who used more than three such strategies had worse ESS (17±4 versus 12±5, p<0.0001); were more likely to feel sleepy while driving (10±8 versus 5±7, p=0.0002) and had more reported accidents (22.85% versus 2.38%, p=0.0002) as compared to OSAS patients who used less than three strategies. There was no difference in patient demographics, severity of OSAS, driving experience or episodes of nodding at the wheel and reported near miss events. Untreated OSAS patients frequently use certain strategies which could be surrogate markers of sleepiness. Enquiring about such strategies in clinical practice may aid the clinician in identifying the patients who are at risk of driving incidents and to advise appropriately.

Evaluation of the risk of sudden cardiac death in obstructive sleep apnea syndrome patients with Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio

Aims: Obstructive sleep apnea syndrome (OSAS) is a disorder characterized by recurrent collapse of the upper airway during sleep. OSAS is associated with an increased risk of cardiovascular morbidity and mortality. Tpeak to Trend (Tp-e) interval, the Tp-e interval/QT interval (Tp-e/QT) ratio, and the Tp-e interval/corrected QT interval (Tp-e/QTc) ratio, are associated with ventricular arrhythmias and sudden cardiac death in various disease groups. we aimed to investigate the relationship between changes in the new arrhythmia markers Tp-e interval, Tp-e/QT and Tp-e/QTc ratios in OSAS patients. Methods: The study looked at 45 people with OSAS (32 men) over the age of 18 and 43 healthy people (27 men) who were diagnosed with OSAS through polysomnography in a sleep lab. Tp-e interval, Tp-e/QT and Tp-e/QTc ratios were calculated on the ECG. Results: The QT interval was shorter in the patient group than in the control group, in contrast to the QTc interval, which was comparable between groups (p = 0.006 and 0.810 in the patient and control groups, respectively). The Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio were significantly higher in PHPT patients included in the patient group compared to those included in the control group (p&lt;0.01 in total). Conclusion: The Tp-e interval, Tp-e/QT, and Tp-e/QTc ratios were prolonged in OSAS patients. These findings suggest that OSAS patients may be predisposed to severe ventricular arrhythmias.

Effects of CPAP treatment on electroencephalographic activity in patients with obstructive sleep apnea syndrome during deep sleep: Preliminary findings of a cross-sectional study.

Study objectives: To investigate whether electroencephalographic (EEG) activities during non-rapid eye movement sleep stage 3 (N3) in obstructive sleep apnea syndrome (OSAS) patients were changed with continuous positive airway pressure (CPAP) treatment.Methods: A cross-sectional study of EEG activity during N3 sleep was conducted in 15 patients with moderate to severe OSAS without and with CPAP treatment compared to 15 normal controls. The amplitude, and absolute and relative power of delta, theta, alpha and beta waves as well as the absolute power ratio of slow to fast EEG waves (i.e., absolute power of delta and theta waves/absolute power of alpha and beta waves) and the spectral power density of 0-30Hz EEG activities were analyzed.Results: CPAP significantly increased N3 sleep, the absolute and relative powers, amplitudes of delta and theta waves, and absolute power ratio of slow to fast EEG waves, but decreased relative alpha and beta powers during N3 sleep. However, there were no significant differences in those parameters between the OSAS patients with CPAP treatment and normal controls.Conclusions: CPAP prolongs N3 sleep and increases the power and amplitude of slow EEG waves during N3 sleep, which indicates an improvement in sleep quality and further provides evidence for recommendation of CPAP treatment for OSAS patients.

Intermittent hypoxia increased the expression of ESM1 and ICAM-1 in vascular endothelial cells via the downregulation of microRNA-181a1.

Sleep apnea syndrome (SAS) exposes cells throughout the body to intermittent hypoxia (IH). Intermittent hypoxia is a risk factor not only for hypertension and insulin resistance but also for vascular dysfunction. We have reported correlations between IH, insulin resistance and hypertension. However, the details of why IH leads to vascular dysfunction remain unclear. In this study, we investigated inflammation-related transcripts in vascular endothelial cells (human HUEhT-1 and mouse UV2) exposed to IH by real-time RT-PCR and found that intercellular adhesion molecule-1 (ICAM-1) and endothelial cell-specific molecule-1 (ESM1) mRNAs were significantly increased. ELISA confirmed that, in the UV2 cell medium, ICAM-1 and ESM1 were significantly increased by IH. However, the promoter activities of ICAM-1 and ESM1 were not upregulated. On the other hand, IH treatment significantly decreased microRNA (miR)-181a1 in IH-treated cells. The introduction of miR-181a1 mimic but not miR-181a1 mimic NC abolished the IH-induced upregulation of Ican-1 and ESM1. These results indicated that ICAM-1 and ESM1 were upregulated by IH via the IH-induced downregulation of miR-181a1 in vascular endothelial cells and suggested that SAS patients developed atherosclerosis via the IH-induced upregulation of ICAM-1 and ESM1.

Study of Haematocrit Level in Obstructive Sleep Apnea Syndrome

Obstructive Sleep Apnea Syndrome can lead to oxyhaemoglobin desaturation and has the possibility of stimulating erythropoiesis, leading to an increased haematocrit. The aim of this study is to identify the level of haematocrit in obstructive sleep apnea syndrome (OSAS) patients and to determine the correlation between haematocrit levels and the severity of obstructive sleep apnea syndrome (OSAS). This is a descriptive cross-sectional study at Hospital Universiti Sains Malaysia. All consented patients were interviewed and underwent a polysomnography (PSG) study. The severity of OSAS was based on the apnea–hypopnea index (AHI) and average oxygen desaturation. The blood haematocrit level was also obtained. Thirty-six OSAS patients were in the study group, and 17 patients were in the control group. The mean haematocrit level in the control group was 41.6 (2.5 SD), whereas in the study group the mean haematocrit level was 44.0 (3.27 SD). Pearson correlation analysis showed there was no significant correlation between AHI and haematocrit level (p-value: 0.392), however, there is a significant correlation between haematocrit levels and average oxygen saturation level (P-value: 0.022). The independent t-test between mean haematocrit level between OSAS group and control group showed that there was a significant difference between the mean haematocrit level among the control and OSAS groups. The increased level of haematocrit is significantly correlated with average oxygen desaturation but not with AHI in OSAS patient. Average oxygen desaturation can be considered as a parameter to assess severity and hypoxic stress in OSA patients.

Evaluation of Ventricular Arrhythmia Markers in Obstructive Sleep Apnea Syndrome Patients

Aim: Obstructive sleep apnea syndrome (OSAS) is a prevalent sleep condition marked by recurrent upper airway blockages causing intermittent hypoxia, fragmented sleep, and autonomic nervous system issues. Significant emphasis has been paid to the connection between OSAS and the development of ventricular arrhythmias in recent years. The index of cardiac electrophysiological balance (ICEB) represents a new measure designed to predict the likelihood of ventricular arrhythmias.&#x0D; Material and Methods: Forty OSAS patients and 40 healthy controls were enrolled in the research. Clinical and demographic variables of both groups were evaluated. Electrocardiogram was taken and routine blood values of the patients were studied. The ICEB is computed by dividing the QT interval by the QRS duration (QT/QRS). Apnea-hypopnea index was used to evaluate the severity of OSAS.&#x0D; Results: The body-mass index value of OSAS patients was significantly higher than HCs (p=0.002). No significant smoking status difference between OSAS patients and HCs (p=0.822). As a result, QT, QTc, and ICEB were substantially greater in OSAS patients than in HCs (p

Effects of obstructive sleep apnea on retinal microvasculature.

To detect retinal microvascular variations in obstructive sleep apnea syndrome patients. This prospective, observational case-control study included healthy controls and patients with mild, moderate, and severe obstructive sleep apnea syndrome. Vascular parameters, foveal avascular area, and flow areas in macula-centered, 6.00×6.00 mm2 scan size optical coherence tomography angiography images were compared. The control group had the highest whole image, parafoveal, and perifoveal vessel density among the groups in both superficial and the deep capillary plexus (all P<0.05). Rapid eye movement sleep apnoea-hypopnoea index was reversely correlated with whole (Rho=-0.195, P=0.034), parafoveal (Rho=-0.242, P=0.008), perifoveal (Rho=-0.187, P=0.045) vessel density in the superficial capillary plexus, and whole (Rho=-0.186, P=0.046), parafoveal (Rho=-0.260, P=0.004), perifoveal (Rho=-0.189, P=0.043) vessel density in the deep capillary plexus, though the mean and non-rapid eye movement sleep apnoea-hypopnoea index related with only parafoveal vessel density in the superficial capillary plexus (Rho=-0.213, P=0.020; Rho=-0.191, P=0.038) and the deep capillary plexus (Rho=-0.254, P=0.005; Rho=-0.194, P=0.035). This study shows decreased vessel density and its reverse correlation with the apnoea-hypopnoea index in patients with obstructive sleep apnea syndrome.

A Piezoresistive Array-Based Force Sensing Technique for Sleeping Posture and Respiratory Rate Detection for SAS Patients

Sleep apnea syndrome (SAS) is a high incidence respiratory disorder disease with potential mortality risk. Thus, researchers continuously present diverse techniques to monitor sleeping posture and respiratory rate (RR) which are closely correlated to the occurrence of SAS. Current techniques can implement high detection accuracy in both sleeping posture and RR, nevertheless, some undesired attributes still remain, such as high device cost, personal privacy leakage, and heavy burden on hardware. To satisfy the expectations, in this paper, we develop an integrated sleep monitoring system, based on flexible piezoresistive architectures and machine learning algorithms, in a low-cost and privacy protection manner. The experimental results successfully demonstrate the feasibility of the proposed technique, by showing a high sleeping posture classification accuracy of 98.1% and RR estimation accuracy of 97.5%, indicating a strong potential in practical utilization for SAS patients.

Chronobiology discrepancies between patients with acute type a aortic dissection complicated with and without sleep apnea syndrome: a single-center seven-year retrospective study

BackgroundThe present study aimed to investigate the differences in chronobiology and prevention between patients with acute type-A aortic dissection (ATAAD) complicated with sleep apnea syndrome (SAS) and without sleep apnea syndrome (non-SAS).MethodsWe retrospectively analyzed the clinical information of ATAAD patients using hospital medical records and regional meteorological and chronological information between January 2013 and December 2019.ResultsAn early mortality rate of 16.9% (196 out of 1160 cases) was observed, comprising 95 cases of aortic rupture before surgery and 101 surgery-related deaths. Eighty-one of the 964 survivors were screened for SAS using complete morphological characteristics. Of these patients, 291 (33.0%) suffered from SAS, while 590 (67.0%) had no SAS. Based on a Circular Von Mises distribution analysis, the non-SAS patients experienced a significant morning peak in the occurrence of ATAAD at 10:04 (r1 = 0.148, p < 0.01). In contrast, the SAS patients experienced a significantly different (non-SAS vs. SAS, U2 = 0.947, p < 0.001) nighttime peak at 23:48 (r2 = 0.489, p < 0.01). Moreover, both non-SAS (Z = 39.770, P < 0.001) and SAS (Z = 55.663, P < 0.001) patients showed a comparable peak during January (non-SAS vs. SAS, U2 = 0.173, p > 0.05). Furthermore, SAS patients experienced a peak on Fridays (χ2 = 36.419, p < 0.001), whereas there was no significant difference in the weekly distribution in non-SAS patients (χ2 = 11.315, p = 0.079).ConclusionsThe analyses showed that both SAS and non-SAS patients showed distinct rhythmicity in ATAAD onset. These findings highlight the chronobiological triggers within different ATAAD subpopulations and may contribute to the prevention of this potentially fatal occurrence.

Obstructive sleep apnea in patients with type 2 diabetes mellitus in Egyptian population

BackgroundSleep disordered breathing (SDB) is a widespread disorder with a wide range of harmful outcomes including obstructive sleep apnea (OSA), central sleep apnea (CSA), or sleep-related hypoventilation.PurposeThe aim of the present study was to screen for the occurrence of sleep apnea syndrome in patients with type 2 diabetes mellitus (DM) and to evaluate the relation between the presence of sleep apnea and the level of glycemic control.MethodsThis was a prospective clinical study that enrolled 59 patients who were previously diagnosed as type 2 DM. Sleep study level IV was done using overnight recording of oxygen saturation and pulse.ResultsAmong the studied patients, 42 were females and 17 were males, Their mean age was 59.76 ± 11.13 years. Obstructive sleep apnea was diagnosed in 46 patients (78%). Thirty three (86.8%) patients among those with uncontrolled glycemic level were diagnosed as OSA, whereas 13(61.9%) patients with controlled glycemic level were diagnosed as OSA showing statistically significant difference, p = 0.047. There was no correlation between either HbA1c, age, Mallampati score, or BMI and ODI but there was a correlation between STOP-BANG questionnaire and ODI (P = 0.036). The variables that were significantly related to presence of OSA, were comorbidities, ESS, Mallampati score, STOP-BANG, and sleep symptoms (nocturia and snoring) P value (0.029), (0.031), (0.022), (0.005), (0.049), and (0.012), respectively.ConclusionPatients with type 2 diabetes showed a significant high prevalence of OSA. With significant higher prevalence among patients with uncontrolled DM versus controlled DM.

Comparison among three different follow-up models for obstructive sleep apnea syndrome patients: focus on the physiotherapist's role.

In obstructive sleep apnea syndrome (OSAS) subjects different follow-up modalities have been proposed to improve adherence to the continuous positive airway pressure (CPAP) device. This retrospective study compares three different health professional approaches dedicated to caring OSAS patients in three consecutive follow-up periods of 15 months each. The three different follow-up models are: i) physician-oriented follow-up (P-F); ii) physiotherapist-oriented follow-up (PT-F); and iii) tele-titration plus PT-oriented follow-up (TT-PT-F). Health personal visits and actions delivered, patients' adherence, CPAP efficacy, and problems under CPAP use were considered for comparison. Data from 122 OSAS patients with a new prescription of CPAP were analyzed: 39 (32.0%) in the P-F, 38 (31.1%) in the PT-F, and 45 (36.9%) in the TT-PT-F period. We found a reduction over time (from 40.9% in P-F to 8.2% in TT-PT-F, p<0.001) in patients missing the 1-year follow-up visit. The PT-F and TT-PT-F lead to a reduction in physician visits in comparison to P-F (5.2% and 8.9% vs 100%, p<0.001) with no differences in time to the first follow-up visit, CPAP efficacy, and patients' adherence among the three periods. More device-related problems were found in the PT-F (57.8%), compared with the PF (25.6%) period (p<0.001); the most common troubles were mask problems evaluated in 26.2% of cases. In conclusion, different follow-up models offer similar efficacy and short-term adherence for CPAP leading to a significant reduction in physician visits under the PT-F with or without tele-titration, being mask problems as the most commonly treated. Further analysis should be useful to define the best cost-efficacy follow-up intervention.