Sleep Apnea In Adults Research Articles

Obstructive sleep apnoea and 12-month weight loss in adults with class 3 obesity attending a multidisciplinary weight management program

BackgroundAlthough there is a strong association between obesity and obstructive sleep apnoea (OSA), the effects of OSA and CPAP therapy on weight loss are less well known. The aim of this study in adults with class 3 obesity attending a multidisciplinary weight management program was to assess the relationship between OSA and CPAP usage, and 12-month weight change.MethodsA retrospective cohort study of all patients commencing an intensive multidisciplinary publicly funded weight management program in Sydney, Australia, between March 2018 and March 2019. OSA was diagnosed using laboratory overnight sleep studies. Demographic and clinical data, and use of CPAP therapy was collected at baseline and 12 months. CPAP use was confirmed if used ≥4 h on average per night on download.ResultsOf the 178 patients who joined the program, 111 (62.4 %) completed 12 months in the program. At baseline, 63.1 % (n=70) of patients had OSA, of whom 54.3 % (n=38) were using CPAP. The non-OSA group had more females compared to the OSA with CPAP group and OSA without CPAP group (90.2 % vs. 57.9 % and 62.5 %, respectively; p=0.003), but there were no significant baseline differences in BMI (50.4±9.3 vs. 52.1±8.7 and 50.3±9.5 kg/m2, respectively; p=0.636). There was significant weight loss across all three groups at 12 months. However, there were no statistically significant differences across groups in the percentage of body weight loss (OSA with CPAP: 6.3±5.6 %, OSA without CPAP: 6.8±6.9 %, non-OSA: 7.2±6.5 %; p=0.844), or the proportion of patients who achieved ≥5 % body weight loss (OSA with CPAP: 57.9 %, OSA without CPAP: 59.4 %, non-OSA: 65.9 %; p=0.743). In patients with T2DM, there was a significant reduction in HbA1c from baseline to 12 months (7.8±1.7 % to 7.3±1.4 %, p=0.03), with no difference between groups (p=0.997).ConclusionsThis multidisciplinary weight management program resulted in significant weight loss at 12 months, regardless of OSA diagnosis or CPAP use in adults with class 3 obesity. Larger studies are needed to further investigate the effects of severity of OSA status and CPAP use in weight management programs. Until completed, this study suggests that the focus should remain on implementing lifestyle changes and weight management regardless of OSA status.

Correlations between home sleep apnea tests and polysomnography outcomes do not fully reflect the diagnostic accuracy of these tests.

The clinical performance of home sleep apnea tests (HSATs) can be described by their (diagnostic) accuracy, defined as the percentage agreement with the obstructive sleep apnea severity category (normal, mild, moderate, and severe) based on polysomnography. Rather than reporting on accuracy, there has been a strong reliance in the literature to report correlation coefficients between the apnea-hypopnea index of HSATs and polysomnography to support claims of diagnostic performance. This is surprising, as it has been well described that correlation coefficients are inadequate to evaluate equivalence between 2 parameters. The aim of this study was to systematically investigate the magnitude of the discrepancies between correlation coefficients and diagnostic accuracy reported in or retrievable from HSAT validation studies. We compared the discrepancy between accuracy and apnea-hypopnea index correlation coefficients of all validation papers that met the inclusion criteria. A total of 20 papers were retained, representing a participant pool of 1,652. The weighted average apnea-hypopnea index correlation across all 20 papers was 0.82 and the weighted average accuracy was 0.61, highlighting a discrepancy of 0.21 and an overall misdiagnosis rate of 39%. The results of our study confirm the need for increased scientific rigor in selecting primary performance endpoints to support clinical performance claims of HSATs. Massie F, Van Pee B, Bergmann J. Correlations between home sleep apnea tests and polysomnography outcomes do not fully reflect the diagnostic accuracy of these tests. J Clin Sleep Med. 2022;18(3):871-876.

A novel, simple, and accurate pulse oximetry indicator for screening adult obstructive sleep apnea.

The objective of the study was to develop a multiparametric oximetry indicator (IMp-SpO2) to diagnose obstructive sleep apnea in adults. This was an observational, retrospective study of diagnostic accuracy. We included adults who had had a diagnostic polysomnography with few artifacts and a total sleep time of at least 180 min in the sleep laboratory. Obstructive sleep apnea (OSA) was defined as an apnea-hypopnea index (AHI) ≥ 5. The database was randomly divided into an experimental (Exp-G) and validation (Val-G) group. The program calculated several parameters of oxygen saturation variability (Par-VarSpO2): (a) oxygen desaturation index (ODI ≥ 3, 4%) and (b) 90, 95, and 97.5 percentiles of both the number of oxygen desaturations ≥ 3 and 4% (P90-97.5 OD3/4 W5-60) and SpO2 standard deviations in moving windows from 5 to 60 min (P90-P97.5 SDSpO2 W5-10). Area under the ROC curve (AUC-ROC), sensitivity, specificity, positive/negative likelihood ratios, and accuracy were calculated. Of 1141 adults included in the study, experimental (571) and validation group (570) were similar (women 47% vs 45%, BMI 27.5 kg/m2 vs 27.2 kg/m2, and AHI 11.7 vs 12, p NS). The IMp-SpO2 developed in the experimental group consisted of a combination of 10 parameters of oxygen saturation variability. The presence of at least one IMp-SpO2 variable had a high diagnostic performance for OSA (sensitivity/specificity/accuracy: Exp-G: 92.8/94/93.2%; Val-G: 93/95.2/93.7%). The IMp-SpO2 AUC-ROC was higher (Exp-G 0.934, Val-G 0.941) than most of the Par-VarSpO2 (0.898-0.929, p < 0.05). The IMp-SpO2 showed a > 90% accuracy for OSA diagnosis in adults.

Moderate obstructive sleep apnea and cardiovascular outcomes in older adults: a propensity score-matched multicenter study (CPAGE-MODE study).

Obstructive sleep apnea (OSA) has been associated with cardiovascular events (CVEs), although recent randomized controlled trials have not demonstrated that long-term continuous positive airway pressure (CPAP) prevents CVEs. Our objective was to determine the effect of CPAP on older adults with moderate OSA regarding CVE reduction. An observational and multicenter study of a cohort of older adults (> 70 years of age) diagnosed with moderate OSA (apnea-hypopnea index 15.0-29.9 events/h) was conducted. Two groups were formed: (1) CPAP treatment and (2) standard of care. The primary endpoint was CVE occurrence after OSA diagnosis. Association with CPAP treatment was assessed by propensity score matching and inverse weighting probability. Secondary endpoints were incidence of CVE separately and time to first CVE. A total of 614 patients were included. After matching, 236 older adults (111 men, mean age 75.9 ± 4.7 years) with a follow-up of 47 months (interquartile range: 29.6-64.0 months) were considered for primary and secondary endpoint evaluations. Forty-one patients presented at least 1 CVE (17.4%): 20 were in the standard-of-care group (16.9%) and 21 were in the CPAP group (17.8%), with a relative risk of 1.05 (95% confidence interval [CI], 0.60-1.83; P = .43) for CPAP treatment. Inverse probability weighting of the initial 614 patients determined an adjusted relative risk of 1.24 (95% CI, 0.79-1.96; P = .35) for CPAP treatment. No statistical differences were found in secondary endpoint analyses. CPAP should not be prescribed to reduce CVE probability in older adults with moderate OSA. López-Padilla D, Terán-Tinedo J, Cerezo-Lajas A, etal. Moderate obstructive sleep apnea and cardiovascular outcomes in older adults: a propensity score-matched multicenter study (CPAGE-MODE study). J Clin Sleep Med. 2022;18(2):553-561.

Obstructive Sleep Apnea in Adults: What Primary Care Physicians Need to Know.

Obstructive sleep apnea (OSA) remains a prominent disease state characterized as the recurrent collapse of the upper airway while sleeping and is estimated to plague 936 million adults globally. Although the initial clinical presentation of OSA appears harmless, it increases the risk of cardiovascular diseases such as heart failure, stroke, and hypertension; metabolic disorders; and an overall decrease in quality of life, in addition to increasing mortality. Current treatment of OSA includes lifestyle changes, behavioral modification, mandibular advancement devices, surgical treatment, and continuous positive airway pressure, which remains the gold standard. It is crucial to identify OSA early on and initiate treatment to mitigate the adverse health risks it imposes. This review will discuss the pathophysiology, epidemiology, management strategies, and medical treatment of OSA.

Diagnostic accuracy of screening questionnaires for obstructive sleep apnoea in adults in different clinical cohorts: a systematic review and meta-analysis.

PurposeThe majority of individuals with clinically significant obstructive sleep apnoea (OSA) are undiagnosed and untreated. A simple screening tool may support risk stratification, identification, and appropriate management of at-risk patients. Therefore, this systematic review and meta-analysis evaluated and compared the accuracy and clinical utility of existing screening questionnaires for identifying OSA in different clinical cohorts.MethodsWe conducted a systematic review and meta-analysis of observational studies assessing the diagnostic value of OSA screening questionnaires. We identified prospective studies, validated against polysomnography, and published to December 2020 from online databases. To pool the results, we used random effects bivariate binomial meta-analysis.ResultsWe included 38 studies across three clinical cohorts in the meta-analysis. In the sleep clinic cohort, the Berlin questionnaire’s pooled sensitivity for apnoea-hypopnoea index (AHI) ≥ 5, ≥ 15, and ≥ 30 was 85%, 84%, and 89%, and pooled specificity was 43%, 30%, and 33%, respectively. The STOP questionnaire’s pooled sensitivity for AHI ≥ 5, ≥ 15, and ≥ 30 was 90%, 90%, and 95%, and pooled specificity was 31%, 29%, and 21%. The pooled sensitivity of the STOP-Bang questionnaire for AHI ≥ 5, ≥ 15, and ≥ 30 was 92%, 95%, and 96%, and pooled specificity was 35%, 27%, and 28%. In the surgical cohort (AHI ≥ 15), the Berlin and STOP-Bang questionnaires’ pooled sensitivity were 76% and 90% and pooled specificity 47% and 27%.ConclusionAmong the identified questionnaires, the STOP-Bang questionnaire had the highest sensitivity to detect OSA but lacked specificity. Subgroup analysis considering other at-risk populations was not possible. Our observations are limited by the low certainty level in available data.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11325-021-02450-9.

Arousal-based scoring of obstructive hypopneas.

Obstructive sleep apnea in adults is diagnosed by an apnea-hypopnea index (AHI) above five (at least five apneas and/or hypopneas per hour of sleep). Though the definition of apneas has remained stable, the scoring criteria for hypopneas has varied throughout the years. There is even more evidence now that scoring respiratory events associated with arousals should be included in the diagnosis of obstructive sleep apnea, as these patients may benefit from treatment. Recent studies, trials and meta-analyses have demonstrated that respiratory events associated with arousal are associated with symptoms, such as poor sleep quality and excessive daytime sleepiness. These arousal-based hypopneas have also been noted to carry a risk of hypertension and other adverse health consequences. Requiring a 4% oxygen desaturation for hypopneas may miss patients that may benefit from treatment for obstructive sleep apnea. These patients are typically younger, nonobese, and women as they have been found to have respiratory events causing sleep fragmentation versus significant oxygen desaturation as compared with other populations.

Obstructive sleep apnea and injury events in Taiwanese adults: A retrospective cohort study.

The aim of this study was to examine the association between obstructive sleep apnea (OSA) diagnosis and diverse types of injuries. This population-based retrospective cohort study compared records from 2000 to 2013 in the Taiwan National Health Insurance Research Database. 3025 patients identified with OSA were compared against the control cohort consisting of 12,100 age- and sex-matched patients. Cox proportional hazards regression analysis was performed to estimate the effects of OSA on injury risk. Patients with OSA exhibited a significantly higher overall incidence of injury of 2599 per 100,000 person-years compared to the control cohort (2248 per 100,000 person-years). After the confounding factors were considered, subjects with OSA showed a higher risk of injury than subjects in the control group (adjusted hazard ratio [HR]=1.78, 95% confidence interval [CI]=1.64-1.93). The risk of unintentional injury (traffic, poisoning, falls) and intentional injury (suicide) in the group of patients with OSA was higher than that in the controls. Our study strongly supports the conclusion that adults with OSA are at increased risk of injury. The present results indicate the significance of OSA as a predictor of injury risk, which will provide valuable information for clinical practice and injury prevention.

High flow nasal cannula therapy for obstructive sleep apnea in adults.

Obstructive sleep apnea hypopnea syndrome (OSAHS) is characterized by the aggravation of upper airway constriction or obstruction, and it is associated with high incidence of various metabolic diseases and high mortality. Continuous positive airway pressure (CPAP) is now recommended as the first-line therapy for OSAHS, but its application is limited by its unsatisfactory patient tolerance. Previous studies have showed that high flow nasal cannula (HFNC) may improve symptoms insome patients withOSAHS. Therefore, the aim of the present study was to evaluate the effect of HFNC on OSAHS in a larger cohort than in previous researchand to study the details of its therapeutic characteristics. Polysomnography recording with and without HFNC was performed in 56 OSAHS patients with a wide spectrum of disease severity. Subgroups were divided by different treatment response criteria to identify the effect of this device. Of 56 patients enrolled, 9 were of mild severity (AHI, 5to<15 events/h), 30 were of moderate severity(AHI, 15to<30 events/h), and17 patients were severe (AHI ≥ 30 events/h); 34 patients were younger than 50years old and 22 patients wereolder than 50years old. AHI decreased significantly(from 26.9 ± 14.7 to 21.5 ± 17.0 events/h, p < 0.001) after HFNC treatment in general. The subjects of responder group accounted for 21%. There was anegativecorrelationbetweenthe difference of AI and the difference of HI in nonresponder group before and after HFNC treatment, and thenegativecorrelation was strong (Pearson's test, r = - 0.804, p = 0.000). Of the patients with mild to moderate severity, 76% achieved any AHI reduction and 24% ofpatients achieved at least 50% reductionin AHI. Older patients (the age of responder group 52.6 ± 11.7 vs. nonresponder group 43.7 ± 12.1years old, p < 0.05), especially patients older than 50years, had a better response rate (≤ 50years 9% vs. > 50years 41%, p = 0.007). HFNC may be useful in treating patients with OSAHS, especially older patients and those with mild to moderate severity. HFNC may be an alternative treatment when patients are intolerant of CPAP.

Evaluating YouTube Videos on Hypoglossal Nerve Stimulation as a Resource for Patients.

This study evaluated the quality and comprehensiveness of YouTube videos on hypoglossal nerve stimulation (HNS) for patients. This study also investigated the relationship between video content, video metrics, and popularity. Cross-sectional study. We identified 150 videos using three search terms: "inspire sleep apnea," "hypoglossal nerve stimulation," and "upper airway stimulation." Videos that were unrelated to the use of HNS for obstructive sleep apnea in adults, operating room recordings, lectures for medical professionals, non-English, or non-audio were excluded. Video quality and comprehensiveness were assessed using modified DISCERN criterion (range: 5-25) and novel content criterion (range: 0-12), respectively. Secondary outcomes included video metrics (views, likes, dislikes, comments, and days since upload) and Video Power Index to measure popularity. Outcomes were stratified by video uploader source (medical institutions, medical companies, individual users, other). Users searched YouTube for "inspire sleep apnea" 2.48 times more in 2020 than in 2018. We identified 67 videos for review, with the majority coming from medical institutions (70.2%). Overall, the average-modified DISCERN (13.65 ± 4.88) and novel content (3.87 ± 2.09) scores were low and did not differ between medical institutions or other uploader sources. Higher quality and more comprehensive video content did not correlate with popularity. Overall quality and comprehensiveness of information of HNS YouTube videos was low. Given the high demand for information on HNS, there is opportunity for medical institutions to implement new strategies to improve both video content and visibility to patients. NA Laryngoscope, 131:E2827-E2832, 2021.

Referral of adults with obstructive sleep apnea for surgical consultation: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment.

This systematic review provides supporting evidence for the accompanying clinical practice guideline on the referral of adults with obstructive sleep apnea (OSA) for surgical consultation. The American Academy of Sleep Medicine commissioned a task force of experts in sleep medicine. A systematic review was conducted to identify studies that compared the use of upper airway sleep apnea surgery or bariatric surgery to no treatment as well as studies that reported on patient-important and physiologic outcomes pre- and postoperatively. Statistical analyses were performed to determine the clinical significance of using surgery to treat obstructive sleep apnea in adults. Finally, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) process was used to assess the evidence for making recommendations. The literature search resulted in 274 studies that provided data suitable for statistical analyses. The analyses demonstrated that surgery as a rescue therapy results in a clinically significant reduction in excessive sleepiness, snoring, blood pressure (BP), apnea-hypopnea index (AHI), respiratory disturbance index (RDI), and oxygen desaturation index (ODI); an increase in lowest oxygen saturation (LSAT) and sleep quality; and an improvement in quality of life in adults with OSA who are intolerant or unaccepting of positive airway pressure (PAP) therapy. The analyses demonstrated that surgery as an adjunctive therapy results in a clinically significant reduction in optimal PAP pressure and improvement in PAP adherence in adults with OSA who are intolerant or unaccepting of PAP due to side effects associated with high pressure requirements. The analyses also demonstrated that surgery as an initial treatment results in a clinically significant reduction in AHI/RDI, sleepiness, snoring, BP, and ODI and an increase in LSAT in adults with OSA and major anatomical obstruction. Analysis of bariatric surgery data showed a clinically significant reduction in BP, AHI/RDI, sleepiness, snoring, optimal PAP level, BMI, and ODI and an increase in LSAT in adults with OSA and obesity. Analyses of very limited evidence suggested that upper airway surgery does not result in a clinically significant increase in risk of serious persistent adverse events and suggested that bariatric surgery may result in a clinically significant risk of iron malabsorption that may be managed with iron supplements. The task force provided a detailed summary of the evidence along with the quality of evidence, the balance of benefits and harms, patient values and preferences, and resource use considerations. Kent D, Stanley J, Aurora RN, etal. Referral of adults with obstructive sleep apnea for surgical consultation: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment. J Clin Sleep Med. 2021;17(12):2507-2531.

Modification and accuracy of the STOP-Bang questionnaire for screening obstructive sleep apnea in adults

Objective:To assess the accuracy of the STOP-Bang questionnaire（SBQ） about screening for obstructive sleep apnea（OSA） in adults, and to establish appropriate cutoffs for body mass index（BMI）, neck circumference（NC）, age, and SBQ score for this population in combination with the body size characteristics of the study subjects, and to evaluate the accuracy of the SBQ for combined screening with waist to height ratio（WHtR）. Methods:The data were collected from October, 2019 to November, 2020 at the Affiliated Hospital of Guizhou Medical University, and 218 patients with suspicious OSA were included in this study, all of them completed the SBQ and underwent overnight PSG. SBQ screening and PSG were tested in a blinded concurrent manner. Using the PSG results as the gold standard, the subjects were divided into a diseased group with moderate to severe OSA and a non-diseased group based on apnea hypopnea index. According to SBQ screening results, the subjects were divided into a positive group with moderate severe OSA and negative group. And calculated in the form of four-fold table, the optimal cutoffs were determined by adjusting age, BMI, NC, and SBQ score cutoffs, and calculating the sensitivity, specificity, positive predictive value（PPV）, negative predictive value（NPV）, Youden index, and area under the receiver operating characteristic curve（ROC）. And the modified version of SBQ was combined with WHtR for joint diagnosis to evaluate the accuracy of combined screening. Results:With all 218 patients completing the experiment, 159（72.94%） patients were in the moderate-severe group. The original SBQ had a sensitivity of 93.71%, specificity of 47.46%, PPV of 82.80%, NPV of 73.70%, Youden index of 0.41, and area under the ROC curve（AUC） of 0.71 for predicting moderate to severe OSA. When adjusting the BMI cutoff to 30 kg/m², NC cutoff to 40 cm, and age cutoff to 50 years, the modified SBQ had a sensitivity of 95.60%, specificity of 47.46%, PPV of 83.10%, NPV of 80.00%, Youden index of 0.43, and AUC of 0.72 for predicting moderate to severe OSA. When the modified SBQ score was 4 or more as the cutoff value, the highest Youden index and AUC were 0.54, 0.77 respectively. When the modified SBQ≥3 points were combined with WHtR>0.55, the highest Youden index and AUC were 0.58, 0.79 respectively. Conclusion:SBQ is effective in screening for moderate to severe OSA and better screening accuracy can be achieved by using a modified version of the SBQ（BMI>30 kg/m², NC>40 cm, age>50 years）. The maximum diagnostic accuracy can be achieved when the modified SBQ total score was 4 or more as the cutoff. Those with the modified SBQ total score=3 and WHtR>0.55 can be classified as high risk for moderate to severe OSA, and the modified version of SBQ can be a screening tool to identify moderate to severe OSA.

Sex Differences in the Association Between Risk of Obstructive Sleep Apnea, Insomnia, and Frailty in Older Adults.

PurposeTo analyze the association between risk of obstructive sleep apnea (OSA), insomnia, sleepiness and self-assessed sleep duration with frailty in older adults.Patients and MethodsCross-sectional study with 1643 older adults (60 to 97 years old) who participated in round 6 (2019) of the Cohort of Obesity Sarcopenia and Obesity in Older Adults of the Mexican Institute of Social Security. The Berlin Questionnaire was used to assess risk of OSA, the Athens Insomnia Scale for insomnia, the Epworth Scale for sleepiness, and sleep duration by self-report. Frailty was assessed with the frailty criteria proposed by Fried. Sociodemographic and health variables were also collected. Statistical analysis was performed with logistic regression and was stratified by sex.ResultsThis study included 1643 participants (823 men and 820 women). Mean age was 67.1 ± 5.9 years. The percentage of frail older adults was 10.5% (n = 172), with risk of OSA 26.1% (n = 429), with insomnia 30.3% (n = 497) and with sleepiness 18.9% (n = 310). In all participants, risk of OSA and insomnia were associated with frailty. In the stratified analysis by sex, the association between risk of OSA and frailty was observed in women (odds ratio (OR) = 1.84, 95% confidence interval (CI) 1.05, 3.22), but not in men (OR = 1.19, 95% CI: 0.65, 2.19). Insomnia was significantly associated with frailty in women (OR = 2.38, 95% CI: 1.35, 4.20) and in men (OR = 1.88, 95% CI: 1.01, 3.52). Neither sleepiness nor sleep duration was associated with frailty.ConclusionIn community-dwelling older adults, both the risk of OSA and insomnia conferred greater odds of presenting frailty in women. It is required to implement strategies aimed at improving sleep hygiene and detecting patients with OSA and insomnia.

The relationship between three-dimensional craniofacial and upper airway anatomical variables and severity of obstructive sleep apnoea in adults.

The aim of this study was to evaluate the relationship between three-dimensional craniofacial and upper airway anatomical variables and severity of obstructive sleep apnoea (OSA) using cone beam computed tomography (CBCT). This was a prospective observational study, consisted of 95 adult OSA whose polysomnography and CBCT were available. Three-dimensional craniofacial and upper airway anatomical analysis were performed using 12 CBCT variables, including sagittal and vertical jaw relationships, maxillary width, the volume, length and minimum axial area of upper airway. The severity of OSA was evaluated through the apnea-hypopnea index (AHI). A hierarchical regression was performed to analyze the relationship between OSA severity and craniofacial and upper airway anatomical variables after controlling patients' demographic characteristics (gender, age, and BMI). After controlling patients' gender, age, and BMI, individual CBCT variables including MAA, V-RPA, L-RPA and Go-Me were related to AHI. The final hierarchical regression model with demographic variables in Step 1 and CBCT variables (MAA, L-RPA and Go-Me) in Step 2 indicated that CBCT variables added additional explanatory power for AHI (ΔF(3,88) = 5.176, P = 0.002). Among these variables, L-RPA and Go-Me were statistically significant (P < 0.05). The OSA severity was expressed by AHI alone. Three-dimensional craniofacial and upper airway morphology played an essential role in OSA severity. The most relevant anatomical characteristic with OSA severity were the length of retropalatal airway and mandibular body, which could be used to recognize severe OSA patients and as estimators for selecting the most appropriate treatment modality for OSA patients.

Age Related Effects of Sleep Apnea in Adults: A Polysomnographic Study

Background: Age is a risk factor of obstructive sleep apnea (OSA). It has been shown that OSA progresses over time, full-night polysomnographic sleep study is considered to be the gold standard method for the diagnosis of obstructive sleep apnea syndrome (OSAS). Objective: This study aims to determine the effect of age on sleep apnea patients. Patients and Methods: A cross sectional study that included 95 patients conducted at a sleep laboratory in the ENT Department, Sohag University Hospital and in the Clinical Neurophysiology Unit, Cairo University. The study population age range was (20-60). All participants were subjected to personal history taking, detailed sleep history, medical history, general examination, ENT examination, Epworth sleepiness score (ESS), and polysomnography. Results: Mean age was (43.99 ± 10.96). The male-to-female ratio was 1.7/1.3. Mean BMI was 35.27 ± 7.19. Mallampati score of grade II and III represented the majority of the patients (83.1%). The range of oropharyngeal collapse (tonsil collapse) was ranging from (no collapse-100%), with a mean of (62.31±25.50). The mean value of the Epworth sleep scale score in all patients was 8.09 ± 4.26. The mean of apnea hypopnea index (AHI) was 24.08 ± 28.33. Average O2 was 82.73 ± 31.61. A statistically significant linear correlation was observed between age and BMI, the circumference of the waist and neck, duration of complaints, and collapse of the tonsils (p <0.05). Conclusion: Prevalence estimates of OSA increased continuously with age. Obesity could play an important role in elderly patients with OSAS and BMI could be a significant variable in determining the severity of OSAS in elderly patients.

Evaluation of a Modified STOP-BANG Questionnaire for Sleep Apnea in Adults from the Korean General Population

Background and Objective There are few studies assessing diagnostic accuracy of the STOP-BANG questionnaire, which is a screening tool for detecting obstructive sleep apnea (OSA), in the general population. Our study aimed to develop a modified version of this screening questionnaire and compare its diagnostic accuracy to the standard version in general Korean adults. Methods A cross-sectional polysomnographic study was conducted among 2065 male and female participants aged 48–79 years, who were members of a population-based cohort study. Half of them were assigned to the exploratory sample and the other half to the validation sample. Results In this study, 958 individuals (487 in an exploratory sample) were identified to have OSA. To develop a model in an exploratory sample, stepwise analysis was used with information from the standard version and additional variables; snoring, witnessed breathing cessation, hypertension, body mass index > 25 kg/m2, age groups, male, diabetes, and waist circumference > 85 cm were included in a final modified model. In the evaluation of diagnostic accuracy in a validation sample, the modified model showed higher sensitivity [79.1%, 95% confidence interval (CI): 77.3, 80.9] in detecting severe OSA than that of the standard version model (66.0%, 95% CI: 64.0, 68.0). Overall accuracy indicated as area under the receiver-operating characteristic curve for the modified model was greater (p = 0.001) than that of the standard version model. Conclusions These findings suggest that the modified version of the STOP-BANG questionnaire may be useful in detecting severe OSA in general adults. Key words: Obstructive sleep apnea, Mass screening, Polysomnography

Alternate Day Fasting Combined With a Low Carbohydrate Diet: Effect on Sleep Quality, Duration, Insomnia Severity and Risk of Obstructive Sleep Apnea in Adults With Obesity

ObjectivesAlternate day fasting combined with a low carbohydrate diet (ADF-LC) is an effective weight loss regimen. Whether the weight loss induced by ADF-LC can improve sleep remains unknown. This study examined an ADF-LC diet’s effect on sleep quality, duration, insomnia severity, and the risk of obstructive sleep apnea. MethodsAdults with obesity (n = 31) participated in ADF (600 kcal “fast day”; ad libitum intake “feast day”) with a low-carbohydrate diet (30% carbohydrates, 35% protein, and 35% fat). The 6-month trial consisted of a 3-month weight-loss period followed by a 3-month weight maintenance period. ResultsReductions in body weight (–5 ± 1 kg, P < 0.001) and fat mass (–4 ± 1 kg, P < 0.01) were noted during the weight-loss period, and these reductions were sustained during the weight maintenance period. Lean mass and visceral fat remained unchanged. The Pittsburgh Sleep Quality Index (PSQI) score indicated poor sleep quality at baseline (6.4 ± 0.7) with no change by month 3 or 6, versus baseline. ISI score indicated subthreshold insomnia at baseline (8.5 ± 1.0), with no change by month 3 or 6, versus baseline. The % of subjects with a high risk of obstructive sleep apnea was 45% at baseline, with no change by month 3 or 6. Wake time, bedtime, and sleep duration remained unchanged. ConclusionsThe ADF-LC diet does not impact sleep quality, duration, insomnia severity, or the risk of obstructive sleep apnea in adults with obesity. Funding SourcesNestle Health Sciences.

PCV3 Risk of Obstructive Sleep Apnea in Adults with Treatment Resistant Hypertension: A Population-Based Cohort Study

Prior research has demonstrated an association between Obstructive sleep apnea (OSA) and Treatment Resistant Hypertension (TRH), defined as occurrence of overlapping use of ≥4 antihypertensives for a period of greater than 60 days. However, the risk of OSA in patients with TRH has not been quantified accurately. We sought to evaluate OSA risk in patients with TRH compared to those with treated, but non-resistant hypertension (non-TRH) using a time dependent exposure analysis. We conducted a retrospective cohort study of patients with treated hypertension (hypertension diagnosis + ≥2 antihypertensive drug claims within 1 year) using IBM MarketScan® commercial claims database from January 2008 to December 2018. We excluded beneficiaries without 12 months of continuous enrollment before the second antihypertensive fill date (index date of cohort entry) and those having the outcome (OSA: identified by ICD codes) in the 12-month pre-index period. Follow-up started from the index date until the earliest of: first occurrence of OSA, end of continuous enrollment, or study end date (December 31st, 2018). The primary analysis was via Cox proportional hazard regression with OSA as the dependent variable, and time-dependent exposure (non-TRH vs. TRH) and baseline covariates (demographic, clinical comorbidities, prescription medication use and healthcare utilization patterns) as independent variables. Of 2,354,346 patients with treated hypertension (mean-age: 50 years, 52% male), 49,542 met TRH criteria. The crude incidence rates of OSA were 34.2 and 17.7 per 1,000 person-years in TRH patients and non-TRH patients, respectively. In the adjusted Cox Proportional Hazard Regression model, TRH remained associated with a 72% increased risk of OSA (Hazard Ratio (HR): 1.72; 95% CI, 1.67-1.78) compared to non-TRH. Our data suggests that patients with TRH are at higher risk of incident OSA. More frequent OSA screening and regular monitoring is needed in this population.

Surgery for obstructive sleep apnoea in adults

Surgery for obstructive sleep apnoea in adults

Incremental health care utilization and expenditures for sleep disorders in the United States.

To determine the incremental increases in health care utilization and expenditures associated with sleep disorders. Adults with a diagnosis of a sleep disorder (International Classification of Diseases, 10th Revision, code G47.x) within the medical conditions file of the 2018 Medical Expenditure Panel Survey medical conditions file were identified. This dataset was then linked to the consolidated expenditures file and comparisons in health care utilization and expenditures were made between those with and without sleep disorders. Multivariate analyses, adjusted for demographics and comorbidities, were conducted for these comparisons. Overall, 5.6% ± 0.2% of the study population had been diagnosed with a sleep disorder, representing approximately 13.6 ± 0.6 million adults in the United States. Those with sleep disorders were more likely to be non-Hispanic, White, and female, with a higher proportion with public insurance and higher Charlson Comorbidity Scores. Adults with sleep disorders were found to have increased utilization of office visits (16.3 ± 0.8 vs 8.7 ± 0.3, P < .001), emergency room visits (0.52 ± 0.03 vs 0.37 ± 0.02, P < .001), and prescriptions (39.7 ± 1.2 vs 21.9 ± 0.4, P < .001) vs those without sleep disorders. The additional incremental health care expenses for those with sleep disorders were increased in all examined measures: total health care expense ($6,975 ± $800, P < .001), total office-based expenditures ($1,694 ± $277, P < .001), total prescription expenditures ($2,574 ± $364, P < .001), and total self-expenditures for prescriptions ($195 ± $32, P < .001). Sleep disorders are associated with significantly higher rates of health care utilization and expenditures. By using the conservative prevalence estimate found in this study, the overall incremental health care costs of sleep disorders in the United States represents approximately $94.9 billion. Huyett P, Bhattacharyya N. Incremental health care utilization and expenditures for sleep disorders in the United States. J Clin Sleep Med. 2021;17(10):1981-1986.