Sleep-disordered Breathing Group Research Articles

Early screening of sleep disordered breathing in hospitalized stroke patients high-resolution pulse oximetry as prognostic and early intervention tools in patients with acute stroke and sleep apnea (HOPES TRIAL).

Sleep Disordered Breathing (SDB) has been shown to increase the risk of stroke and despite recommendations, routine evaluation for SDB in acute stroke is not consistent across institutions. The necessary logistics and expertise required to conduct sleep studies in hospitalized patients remain a significant barrier. This study aims to evaluate the feasibility of high-resolution pulse-oximetry (HRPO) for the screening of SDB in acute stroke. Secondarily, considering impact of SDB on acute stroke, we investigated whether SDB at acute stroke predicts functional outcome at discharge and at 3 months post-stroke. Patients with acute mild to moderate ischemic stroke underwent an overnight HRPO within 48h of admission. Patients were divided into SDB and no-SDB groups based on oxygen desaturations index(ODI > 10/h). Stepwise multivariate logistic regression analysis was applied to identify the relevant predictors of functional outcome (favorable [mRS 1-2 points] versus unfavorable [mrS > = 3 points]). Of the 142 consecutively screened patients, 96 were included in the analysis. Of these, 33/96 (34%) were identified as having SDB and were more likely to have unfavorable mRS scores as compared to those without SDB (odds ratio = 2.70, p-value = 0.032). HRPO may be a low-cost and easily administered screening method to detect SDB among patients hospitalized for acute ischemic stroke. Patients with SDB (as defined by ODI) have a higher burden of neurological deficits as compared to those without SDB during hospitalization.

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

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

Impact of Comorbid Sleep-Disordered Breathing and Atrial Fibrillation on the Long-Term Outcome After Ischemic Stroke.

Sleep-disordered breathing (SDB) and atrial fibrillation (AF) are highly prevalent in patients with stroke and are recognized as independent risk factors for stroke. Little is known about the impact of comorbid SDB and AF on long-term outcomes after stroke. In this prospective cohort study, 353 patients with acute ischemic stroke or transient ischemic attacks were analyzed. Patients were screened for SDB by respiratory polygraphy during acute hospitalization. Screening for AF was performed using a 7-day ECG up to 3× in the first 6 months. Follow-up visits were scheduled at 1, 3, 12, 24, and 36 months poststroke. Cox regression models adjusted for various factors (age, sex, body mass index, hypertension, diabetes, dyslipidemia, and heart failure) were used to assess the impact of comorbid SDB and AF on subsequent death or cerebro-cardiovascular events. Among 353 patients (299 ischemic stroke and 54 transient ischemic attacks), median age, 67 (interquartile range, 57-74) years with 63% males. Moderate-to-severe SDB (apnea-hypopnea index score, ≥15/h) was present in 118 (33.4%) patients. Among the 56 (15.9%) patients with AF, 28 had comorbid moderate-to-severe SDB and AF. Over 36 months, there were 12 deaths and 67 recurrent cerebro-cardiovascular events. Patients with comorbid moderate-to-severe SDB and AF had a higher risk of subsequent death or cerebro-cardiovascular events compared with those with only moderate-to-severe SDB without AF (hazard ratio, 2.49 [95% CI, 1.18-5.24]) and to those without moderate-to-severe SDB or AF (hazard ratio, 2.25 [95% CI, 1.12-4.50]). However, no significant difference was found between the comorbid moderate-to-severe SDB and AF group and the group with only AF without moderate-to-severe SDB (hazard ratio, 1.64 [95% CI, 0.62-4.36]). Comorbid moderate-to-severe SDB and AF significantly increase the risk of long-term mortality or recurrent cerebro-cardiovascular events after acute ischemic stroke. Considering both conditions as cumulative and modifiable cerebro-cardiovascular risk factors is of interest for the management of acute stroke. URL: https://www.clinicaltrials.gov; Unique identifier: NCT02559739.

Cortical grey matter changes, behavior and cognition in children with sleep disordered breathing.

This paper investigated cortical thickness and volumetric changes in children to better understand the impact of obstructive sleep disordered breathing (SDB) on the neurodevelopment of specific regions of the brain. We also aimed to investigate how these changes were related to the behavioral and cognitive deficits observed in the condition. Neuroimaging, behavioral, and sleep data were obtained from 30 children (15 non-snoring controls, 15 referred for assessment of SDB) aged 7 to 17 years. Gyral-based regions of interest were identified using the Desikan-Killiany atlas. Student's t-tests were used to compare regions of interest between the controls and SDB groups. We found that the cortical thickness was significantly greater in the right caudal anterior cingulate and right cuneus regions and there were volumetric increases in the left caudal middle frontal, bilateral rostral anterior cingulate, left, right, and bilateral caudate brain regions in children with SDB compared with controls. Neither cortical thickness nor volumetric changes were associated with behavioral or cognitive measures. The findings of this study indicate disruptions to neural developmental processes occurring in structural regions of the brain; however, these changes appear unrelated to behavioural or cognitive outcomes.

Clinical and financial impact of sleep disordered breathing on heart failure admissions

BackgroundThe impact of sleep disordered breathing (SDB) on heart failure (HF) is increasingly recognized. However, limited data exist in support of quantification of the clinical and financial impact of SDB on HF hospitalizations.MethodsA sleep-heart registry included all patients who underwent inpatient sleep testing during hospitalization for HF at a single cardiac center. Readmission data and actual costs of readmissions were obtained from the institutional honest broker. Patients were classified based on the inpatient sleep study as having no SDB, obstructive sleep apnea (OSA), or central sleep apnea (CSA). Cumulative cardiac readmission rates and costs through 3 and 6 months post-discharge were calculated. Unadjusted and adjusted (age, sex, body mass index, and left ventricular ejection fraction) modeling of cost was performed.ResultsThe cohort consisted of 1547 patients, 393 (25%) had no SDB, 438 (28%) had CSA, and 716 (46%) had OSA. Within 6 months of discharge, 195 CSA patients (45%), 264 OSA patients (37%), and 109 no SDB patients (28%) required cardiovascular readmissions. Similarly, 3- and 6-month mortality rates were higher in both SDB groups than those with no SDB. Both unadjusted and adjusted readmission costs were higher in the OSA and CSA groups compared to no SDB group at 3 and 6 months post-discharge with the CSA and OSA group costs nearly double (~ $16,000) the no SDB group (~ $9000) through 6 months.InterpretationPreviously undiagnosed OSA and CSA are common in patients hospitalized with HF and are associated with increased readmissions rate and mortality.

The effects of sleep disordered breathing on sleep spindle activity in children and the relationship with sleep, behavior and neurocognition

Study objectivesObstructive sleep disordered breathing (SDB), has adverse neurocognitive and behavioral sequelae in children, despite conventional measures of sleep disruption being unaffected. There is growing evidence that sleep spindles may serve as a more sensitive marker of sleep quality. We investigated the relationship between sleep spindles and sleep fragmentation and neurocognition across the spectrum of SDB severity in children. MethodsChildren 3–12 years old referred for clinical assessment of SDB and age matched control children from the community were recruited and underwent polysomnography. Sleep spindles were identified manually during N2 and N3 sleep. Spindle activity was characterised as spindle number, density (number of spindles/h) and intensity (spindle density x average spindle duration). Children completed a battery of tests assessing global intellectual ability, language, attention, visuospatial ability, sensorimotor skills, adaptive behaviors and skills and problem behaviors and emotional difficulties. ResultsChildren were grouped into control, Primary Snoring, Mild OSA and Moderate/severe OSA, N = 10/group. All measures of spindle activity were lower in the SDB groups compared to the Control children and this reached statistical significance for Mild OSA (p < 0.05 for all). Higher spindle indices were associated with better performance on executive function and visual ability assessments but poorer performance on auditory attention and communication skills. Higher spindle indices were associated with better behavior. ConclusionThe reduced spindle activity observed in the children with SDB, particularly Mild OSA, indicates that sleep micro-architecture is disrupted and that this disruption may underpin the negative effects of SDB on attention, learning and memory.

O069 The effects of sleep disordered breathing on sleep spindle activity in children and the relationship with neurocognition

Abstract Introduction Conventional sleep macro-architecture measures of sleep disruption have not been associated with the adverse neurocognitive sequelae of sleep disordered breathing (SDB). Sleep spindles protecting the sleeping brain from external sensory stimuli and can serve as markers of sleep integrity. We investigated the relationship between sleep spindles and sleep fragmentation and neurocognition across the spectrum of SDB in children. Methods Children 3-12y referred for clinical assessment of SDB and age matched control children from the community were recruited. Sleep spindles were identified manually during N2 and N3 sleep. Spindle activity was characterised as spindle number, spindle density (number of spindles/ h) and spindle intensity (spindle density x average spindle duration). The Stanford-Binet Intelligence Scales measured global intellectual ability and the NeuroPSYchological assessment (NEPSY-II) measured language, attention, visuospatial ability and sensorimotor skills. Results Children were grouped into control, Primary Snoring, Mild OSA and Moderate/severe OSA, N=10/ group. All measures of spindle activity were lower in the SDB groups compared to the Control children and this reached statistical significance for Mild OSA (p&amp;lt;0.05 for all). Spindle activity was not correlated with any measure of the Stanford-Binet. Overall, all measures of spindle activity were positively correlated with the Design Copy and the Inhibition Naming combined scale score and negatively correlated with Auditory Attention subscales of the NEPSY-II. Conclusion The reduced spindle activity observed in the children with SDB, particularly Mild OSA, indicates that sleep micro-architecture is disrupted and that this disruption may underpin the negative effects of SDB on attention, learning and memory.

Abstract 13376: Sleep-Disordered Breathing is Associated With Larger Ventricular Repolarization Instability

Introduction: Sleep-disordered breathing (SDB) is a common disorder in the general population that is associated with adverse cardiovascular events, such as sudden cardiac death, but the underlying mechanisms are unclear. Hypothesis: Ventricular repolarization instability is greater in those with severe SDB than those without SDB, independent of other risk factors. Methods: Among the participants of the Sleep Heart Health Study (SHHS), we identified those with SDB who had no diagnosed cardiovascular disease or other factors that could affect cardiac repolarization. Severe SDB was defined as having a respiratory disturbance index (RDI) &gt; 33 events/hour (top 95%ile of the SHHS cohort). We also identified a group of participants matched to the severe SDB group on age, sex, BMI, and race and had RDI &lt; 1.33 events/hour (bottom 25%ile; without SDB). Each group consisted of 61 (45 M and 16 F) participants. Oxygen saturation levels (SpO 2 ) were used to measure hypoxemia burden as the percentage of sleep time with SpO 2 &lt; 90% (T90). Heart rate (HR), heart rate variability (SDNN), and QT variability index (QTVI, a measure of ventricular repolarization instability) were calculated from one-lead ECG recordings. Student’s t- test was used to assess statistical associations. Results: The SDB group had a larger T90 than those without SDB (11.39 ± 1.42% vs 1.32 ± 0.61%, P &lt; 0.001). Participants with SDB also had greater mean HR (P = 0.028), SDNN (P = 0.017), and QTVI (P = 0.027) than those without SDB. Based on a multivariable linear model that included hypoxemia burden, age, BMI, and smoking status, T90 was the only independent predictor of QTVI (P = 0.022). Conclusion: SDB is associated with higher HR, HRV, and QTVI, an indicator of increased instability in ventricular repolarization leading to increased risk for cardiac arrhythmias and sudden cardiac death. The severity of the destabilizing effect of SDB on ventricular repolarization appears to be modified by hypoxemia burden.

Laryngopharyngeal Reflux in Sleep-Disordered Breathing Patients.

Our study aims to evaluate the distribution of laryngopharyngeal reflux (LPR) in patients with sleep-disordered breathing (SDB) via the Reflux Symptom Index (RSI) and to describe the sleep architecture in SDB patients with and without LPR. A cross-sectional, descriptive study was conducted. Patients with SDB were identified via the Epworth Sleepiness Scale (ESS) and STOP-BANG questionnaire; they were then screened with the RSI and physical examination for LPR. PSG was performed to evaluate obstructive sleep apnea (OSA). Of 45 patients, 15 were scored as having LPR via the RSI. Utilizing the Respiratory Disturbance Index (RDI), patients were further classified into four groups: 9 non-LPR with non-OSA SDB, 21 non-LPR with OSA, 4 LPR with non-OSA SDB, and 11 LPR with OSA. The prevalence of LPR was 30.8% in the non-OSA SDB group and 34.4% in the OSA group. All SDB parameters in both groups were similar. SDB patients with high body mass index tended to have LPR and/or OSA. Average ESS scores in the four groups suggested excessive daytime sleepiness, and patients with LPR had higher ESS scores. Regardless of LPR status, SDB patients had a lower percentage of REM sleep and a higher percentage of light sleep. The incidence of LPR in OSA patients was similar in non-OSA SDB patients. REM sleep percentage decreased in the four groups, with the non-OSA SDB group having the lowest percentage of REM sleep; light sleep percentage increased in the four groups, with the OSA group having the highest percentage of light sleep.

Role of Oral Microbiota Biofilms in Recurrent Tonsillitis and Sleep‐Disordered Breathing in Children

Aims &amp; HypothesisThe palatine tonsils are aggregates of lymphoid tissue in the lateral oropharynx. In children, tonsillar enlargement can lead to upper airway obstruction and sleep‐disordered breathing (SDB). The reason for tonsillar enlargement in some children, and not others is unknown. We have investigated the role of the tonsillar microbiota in tonsillar enlargement. The role of bacterial biofilms in RT and SDB was investigated through comparisons of tonsil histopathology, mixed‐species biofilm's microbiota composition and biofilm phenotypes. We hypothesized that the SDB tonsillar phenotype has distinct biofilm forming bacterial communities driving tonsillar hyperplasia compared to recurrent tonsillitis.MethodsTonsils were acquired via tonsillectomy from children with RT or SDB. Tonsils were stained to assess florid reactive lymphoid hyperplasia (FRLH). In situ microbiota characterization was assessed by 16S rRNA gene sequencing and overall bacterial biomass was assessed by 16S qPCR. Tonsillar bacteria were extracted and grown in BHI media for in vitro assays. Oral microbiota biofilms were characterized using the Calgary Biofilm Device and “O’Toole” assay. Biofilm biomass was assessed by spectrophotometry using crystal violet staining. Bacterial adhesion/invasion assays were performed by infecting pharyngeal carcinoma cell lines Det‐562 with tonsil microbiota from RT and SDB groups. Immune profile of Det‐562 cells infected with RT and SDB microbiota (t=3 hours) was assessed by cytokine multiplex analysis.ResultsHistopathological analysis showed higher FRLH of the enlarged lymph node in the SDB group compared to RT group. Microbiota analysis has shown that the tonsil's microbiota composition and bacterial biomass did not significantly differ between tonsils that were taken out due to SDB and those taken out for recurrent tonsillitis. Calgary Biofilm Device biofilm assays indicated that the SDB multi‐species biofilms have higher biomass compared to RT biofilms. Microbiota from SDB group were more adhesive/invasive to Det‐562 cells compared to RT bacteria after 3 hours incubation. Cytokine profiling showed increased expression of granulocyte‐macrophage colony‐stimulating factor (GM‐CSF), pro‐inflammatory cytokines IL‐1β, IL‐2, IL‐12 and interferon gamma (IFNγ) in Det‐562 cells exposed to SDB microbiota compared to RT.ConclusionsOur results indicate that SDB and RT tonsils have distinct histopathological signatures. In situ tonsillar microbiota composition and bacterial load did not differ between SDB and RT groups. In vitro assays showed that SDB tonsils exhibit increases in both multi‐species biofilm mass and bacterial adhesion/invasion to epithelial surfaces. These results also suggest that SDB bacterial biofilms lead to greater inflammation of the tonsils, confirmed by the elevated levels of FRLH and increased expression of pro‐inflammatory mediators. This study sheds light on the role pathobionts released from dysbiotic oral microbiota biofilms in the development of tonsillitis.

Associations Between Sleep-Disordered Breathing and Behavioral and Cognitive Functions in Children With and Without Attention-Deficit/Hyperactivity Disorder.

Sleep-related problems are highly prevalent comorbidities in Attention-Deficit/Hyperactivity Disorder (ADHD). This study aimed to investigate the associations between sleep-disordered breathing (SDB) and behavioral and cognitive functions in children with and without ADHD. A total of 341 children were included (ADHD group: 155, control group: 186; age: 6-10 years). The participants' sleep-related symptoms were assessed using a parent-rated questionnaire, and they were categorized into low- and high-risk SDB groups based on their scores. Behavioral symptoms were assessed using the Behavioral Assessment System for Children, Second Edition (BASC-2), and cognitive sustained attention and inhibitory control were assessed using a computer-based continuous performance test. In the ADHD group, the high-risk SDB children showed significantly higher scores than the low-risk SDB group in externalizing problems (F=4.22; P=0.042), including hyperactivity (F=4.65; P=0.033) and attention problems (F=8.19; P=0.005), but not internalizing problems. Meanwhile, in the control group, the high-risk SDB children showed significantly higher scores than the low-risk SDB group in internalizing problems (F=9.89; P=0.002), depression (F=9.45; P=0.002), and somatization (F=7.83; P=0.006), as well as in externalizing problems (F=7.72; P=0.006), including hyperactivity (F=6.23; P=0.013), aggression (F=5.00; P=0.027), and conduct problems (F=6.79; P=0.010). Contrary to the behavioral outcomes, none of the attention performance subscale scores showed significant differences between the high- and low-risk SDB groups in either the ADHD or control group. The present findings suggest that SDB is associated with behavioral problems in children with ADHD and controls, with stronger associations in control children. On the contrary, SDB has no association with cognitive attention performance. This study extends our understanding of the associations of SDB with behavioral symptoms and cognitive functions in children.

Impact of sleep-disordered breathing on ventricular tachyarrhythmias after left ventricular assist device implantation.

Sleep-disordered breathing (SDB) is associated with an increased risk of adverse events in patients with heart failure (HF); however, its impact in patients implanted with a left ventricular assist device (LVAD) remains unclear. We aimed to investigate the prevalence of SDB in patients with LVAD and its impact on their clinical outcomes. Fifty consecutive patients with LVAD who underwent portable sleep monitoring between September 2017 and April 2018 were prospectively enrolled, and they were followed up for 170 ± 36days. According to their respiratory disturbance indexes (RDIs), they were categorized into the SDB group (RDI ≥ 15, n = 12) and the non-SDB group (RDI < 15, n = 38). The incidence of adverse events during the follow-up period was investigated after enrollment. Multivariate logistic regression analysis revealed significant differences in SDB in LVAD-implanted patients in terms of the logarithmic transformation brain natriuretic peptide (BNP) values (p = 0.005). The optimal BNP cut-off value for SDB prediction in LVAD-implanted patients was 300pg/mL (sensitivity: 58.3%, specificity: 94.7%). During follow-up, ventricular tachyarrhythmias (VTas) occurred significantly more frequently in the SDB group (4 [33%] vs. 2 [5%] patients,p = 0.02); Atrial tachyarrhythmia (ATa) also tended to occur more frequently in the SDB group (2 [25%] vs. 2 [2%] patients, p = 0.07). SBD was prevalent in 24% of the LVAD-implanted patients with advanced HF. Furthermore, SDB was significantly associated with high BNP levels and was also potentially associated with subsequent incidence of VTa in patients with LVAD.

P065 Heart Rate and Heart Rate Variability in paediatric sleep disordered breathing: Is LF a proxy for vascular motor tone

Abstract In children, sleep disordered breathing (SDB) is associated with changes in cardiac and vascular remodeling and hence may alter cardiac rhythm. Heart rate variability (HRV) measured during different sleep stages and at discreet times across the night, where vascular tone is known to change, provides an opportunity to better understand the effect of SDB on the cardiac function. 50 children diagnosed with SDB and 51 healthy children underwent overnight polysomnography to determine sleep staging. HRV (mean NN, SDNN, RMSSD, LF, HF, and LF:HF) was determined for the following segments pre-sleep; 3 slow wave sleep and 3 segments during rapid eye movement sleep (SWS1, SWS2, REM3, REM2, REM1). Children with SDB demonstrated higher heart rate (decreased mean NN) in all sleep segments. All HRV variables were similar between groups pre-sleep and REM3 and SWS3. LF and LF:HF were significantly lower in SWS1&amp;2 and REM1 while as were SDNN and rMSSD were lower in the SDB group in REM1&amp;2. LF remained low in the SDB group but rose to pre sleep levels in the control group. Children with SDB have increased heart rate across the night even when HRV is similar between the groups. This suggests intrinsic changes to the cardiac components that determine heart rate. The HRV difference between groups was greatest post acrophase (body temperature dropping) and post nadir (body temperature rising) of the circadian cycle. We propose that impaired peripheral vascular control and sustained cardiac remodelling may underlie the heart rate and HRV changes observed in children with SDB.

Assessment of sleep-disordered breathing in pediatric otitis media with effusion

Given the role of adenoid in the pathogenesis of otitis media with effusion (OME) and sleep-disordered breathing (SDB), the present study aimed to investigate the sleep quality and the impact of adenoidectomy on improvement of sleep symptoms in children with OME. Children with SDB or OME, aged 3-12 years, were prospectively enrolled before undergoing adenoidectomy in a tertiary medical center. The symptom severity of obstructive sleep apnea syndrome (OSAS) was evaluated by OSA-18 questionnaire on the day before and 6 months after surgery. In total, 79 pediatric patients including 50 children with SDB and 29 children with OME were enrolled. The mean total OSA-18 score was 56.5±15.1 and ten (34.5%) children experienced moderate to severe symptoms of OSAS as indicated by OSA-18 score≥60 in OME group. After surgery, patients in both SDB and OME groups experienced improvement (both p<0.001) and presented no difference in the scores of OSA-18. The proportional change in OSA-18 scores after surgery was related to pre-operative OSA-18 scores and BMI in OME patients (rs=0.400 and 0.542, p=0.047 and 0.008), and to pre-operative OSA-18 scores in patients with SDB (rs=0.393, p=0.008). Children with OME experienced significant symptoms of OSAS and associated impairment of quality of life. Adenoidectomy is effective in the improvement of sleep symptoms in these patients. Comprehensive assessment of sleep breathing as planning surgery for OME children is suggested.

Tissue microbiota in nasopharyngeal adenoid and its association with pneumococcal carriage

The microbial colonization in the nasopharynx is a prerequisite for the onset of infectious diseases. For successful infection, pathogens should overcome host defenses as well as compete effectively with the resident microbiota. Hence, elucidating the richness and diversity of the microbiome at the site of pathogen colonization is pivotal. Here, we investigated the adenoidal tissue microbiota collected through adenoidectomy to evaluate the impact of Streptococcus pneumoniae. Prospectively, children with sleep-disordered breathing (SDB) and otitis media with effusion (OME) were enrolled. During adenoidectomy, the nasopharyngeal swab and adenoid tissues were collected to determine the pneumococcal carriage and tissue microbiota, using multiplex PCR and 16S ribosomal RNA (16S rRNA) pyrosequencing. A total of 66 pediatric patients comprising 38 children with SDB and 28 children with OME were enrolled. There was no difference between the bacterial cultures from the surface of the nasopharyngeal adenoid in the SDB and OME groups. Thirty-four samples (17 SDB and 17 OME) underwent 16S rRNA pyrosequencing and fulfilled the criteria for further analysis. The Shannon diversity index for the samples from the SDB patients was found to be higher than that observed for the samples from OME patients, although the difference was not significant (p = 0.095). The Shannon diversity index for the samples negative for the pneumococcal carriage was significantly higher than that for the samples positive for pneumococcal carriage (p = 0.038). Alloprevotella, Staphylococcus, Moraxella, and Neisseriaceae were significantly dominant in the samples positive for the pneumococcal carriage. Dialister was significantly less present in the adenoid tissue positive for the pneumococcal carriage. Streptococcus pneumoniae, one of the most common pathogens of the airway, significantly influences the composition and diversity of the microbiota in the nasopharyngeal adenoid. Thus, bacterial community analysis based on 16S rRNA pyrosequencing allows for better understanding of the relationship between the adenoidal microbial communities.

479 The association of QTc and QT Variability with Severity of Sleep Disordered Breathing

Abstract Introduction The apneas and hypopneas that characterize sleep-disordered breathing (SDB) are associated with QTc prolongation and increased QT variability. There have been mixed results as to whether QTc and QT variability increase with increasing SDB severity. This study assesses whether QTc prolongation and QT variability are likely to increase with increasing severity of SDB in a large multi-center cohort. Methods 200 subjects with no SDB and approximately 600 with three levels of SDB (mild, moderate, severe) were randomly selected from the Sleep Heart Health study and matched by age, gender and BMI. SDB was defined as an apnea/hypopnea index ≥5. Respiratory and electrocardiograms (ECG) signals from polysomnography studies were analyzed. Bazett’s heart rate correction was used to calculate QTc. QT variability was measured as standard deviation of QT intervals (SDQT) and short-term interval QT variability (STVQT), at 5-minute intervals. Subjects were excluded if there were missing data or low-quality ECG. Results Seven hundred and seventy-one subjects (age 68±10 years, 51% female, 92% Caucasian) were included. One hundred and sixty-five subjects had no SDB, 235 mild, 195 moderate and 176 had severe SDB. The mean (SD) QTc was 422(29), 411(26), 419 (34) and 418 (36) ms for the no SDB, mild, moderate, and severe SDB groups, respectively (p=0.017). The mean (SD) STVQT was 7 (9), 11 (16), 8 (9) and 9 (11) for the no SDB, mild, moderate severe SDB groups, respectively (p=&amp;lt;0.001). The mean (SD) STVQT was 3 (2), 4 (4), 4 (3) and 4(4) for the no SDB, mild, moderate severe SDB groups, respectively (p=&amp;lt;0.001). There was no statistically linear relationship between QT prolongation or QT variability and SBD severity. Conclusion QTc duration and QT variability were not increased with SDB severity. Support (if any) American Academy of Sleep Medicine Foundation (203-JF-18), National Institutes of Health (HL126140), University of Arizona Health Sciences Career Development Award (5299903), and University of Arizona Faculty Seed Grant (5833261)

The beneficial impact of cardiac rehabilitation on obstructive sleep apnea in patients with coronary artery disease.

To assess the impact of cardiac rehabilitation for decreasing sleep-disordered breathing in patients with coronary artery disease. The study included 121 patients aged 60.01 ± 10.08 years, 101 of whom were men, with an increased pretest probability of OSA. The cardiac rehabilitation program lasted 21-25 days. The improvement in cardiorespiratory fitness was assessed using the changes in peak metabolic equivalents, the maximal heart rate achieved, the proportion of the age- and sex-predicted maximal heart rate, and the Six-Minute Walk Test distance. Level 3 portable sleep tests with respiratory event index assessments were performed in 113 patients on admission and discharge. Increases were achieved in metabolic equivalents (Δ1.20; 95% confidence interval [CI], 0.95-1.40; P < .0001), maximal heart rate (-Δ7.5 beats per minute; 95% CI, 5.00-10.50; P < .0001), proportion of age- and sex-predicted maximal heart rate (Δ5.50%; 95% CI, 4.00-7.50; P < .0001), and the Six-Minute Walk Test distance (Δ91.00 m; 95% CI, 62.50-120.00; P < .0001). Sleep-disordered breathing was diagnosed in 94 (83.19%) patients: moderate in 28 (24.8%) patients and severe in 27 (23.9%) patients, with a respiratory event index of 19.75 (interquartile range, 17.20-24.00) and 47.50 (interquartile range, 35.96-56.78), respectively. OSA was dominant in 90.40% of patients. The respiratory event index reduction achieved in the sleep-disordered breathing group was -Δ3.65 (95% CI, -6.30 to -1.25; P = .003) and was in parallel to the improvement in cardiorespiratory fitness in the subgroups with the highest effort load and with severe sleep-disordered breathing: -Δ6.40 (95% CI, -11.40 to -1.90; P = .03) and -Δ11.00 (95% CI, -18.65 to -4.40; P = .003), respectively. High-intensity exercise training during cardiac rehabilitation resulted in a significant decrease in OSA, when severe, in parallel with an improvement in cardiorespiratory fitness in patients with coronary artery disease.

Correlation between upper airway dimension and TMJ position in patients with sleep disordered breathing

ABSTRACT Objective The goal was to perform a 10-year retrospective study on the correlation between sleep disordered breathing (SDB) and upper airway dimensions, as well as the relation between SDB status and TMJ position. The study also examined links between airway dimensions and TMJ position. Methods Patients were categorized into Control (n = 28) or SDB (n = 45). Cone beam (CBCT) data was analyzed using InVivo5™. Results Although there were distinctive features within the SDB group, these did not show a correlation of significance with airway dimensions. SDB patients were more likely to have their condyles posteriorly seated. Other factors, such as presence of TMD, limited mouth opening, and pain upon palpation of masticatory muscles also significantly affected the TMJ position. Volumetric airway analysis showed links to TMJ position. Conclusion SDB patients have a smaller airway volume and have a significant relationship between airway volume and TMJ position with their condyles seated more posteriorly.

Sleep disordered breathing and subjective excessive daytime sleepiness in relation to the risk of motor vehicle crash: the Toon Health Study

Sleep disordered breathing (SDB) is a significant cause of motor vehicle crash (MVC). We conducted a prospective cohort study among 1047 Japanese community-dwellers to detect whether the presence or absence of subjective excessive daytime sleepiness (EDS) affect the association of SDB with a risk of MVC. SDB was assessed by a single airflow monitor which measured the respiratory disturbance index (RDI) during one-night, and participants were classified into the SDB group (RDI ≥ 10) and non-SDB group (RDI < 10). Subjective EDS was defined as Japanese version of Epworth Sleepiness Scale scores ≥ 11. A follow-up questionnaire five years after the baseline ascertained history of MVC over the period. Multivariable logistic regression analysis examined the association between SDB and MVC after stratification by subjective EDS. The multivariable-adjusted odds ratios (95% confidence interval) for MVC among the female SDB group were 1.66 (1.05–2.63) compared with the non-SDB group, and this association was more evident in females without subjective EDS [1.84(1.02–3.32)], but not among those with subjective EDS. There was no significant association in males. These findings indicate that SDB screening should be recommended regardless of subjective EDS to prevent SDB-related MVC among general population, particularly in females.

Impact of Central Sleep Apnea on the Cost of Heart Failure Readmissions

Background Central sleep apnea (CSA) has a high prevalence in hospitalized patients with heart failure with reduced ejection fraction and is independently associated with increased readmissions in these patients. However, the economic impact of previously undiagnosed CSA on heart failure related readmissions remains poorly understood. Methods We used an established inception cohort of heart failure patients who had surveillance inpatient sleep testing (The OSU-Sleep Heart Program) during their hospitalization. Patients were followed up post-discharge and the number and cost of readmissions and vital status were tracked. Sleep disordered breathing (SDB) status was classified based on the sleep study into CSA, obstructive sleep apnea (OSA) or no SDB. The primary comparisons were between the CSA and no SDB groups. Results Between 2008 and 2012, 1547 consecutive patients admitted for heart failure underwent sleep studies during hospitalization. Of those, 438 patients had CSA and 393 had no SDB. The 3-month readmission rate was 33.6% for CSA and 20.4% with no SDB (p Conclusions Previously undiagnosed CSA is associated with increased readmissions in heart failure patients regardless of underlying ejection fraction. Furthermore, CSA was independently associated with increased cost of heart failure readmissions at both 3 months and 6 months. Patients with HF and CSA represent a high cost cohort of patients admitted for heart failure and can be considered a target population for potential readmission reduction interventions.