Sleep-disordered Breathing In Adults Research Articles

Assessment of Sleep Disorders in Patients with CVID.

Inborn errors of immunity have been associated with reduced health-related quality of life and increased fatigue. Sleep disorders, which have been shown to contribute to fatigue and other health concerns, are prevalent in the general population, but there are limited studies evaluating these conditions in patients with common variable immunodeficiency (CVID). Our aim was to evaluate the prevalence of fatigue, sleep disturbances, and sleep-disordered breathing in adults with CVID. Patients completed 4 validated, self-administered questionnaires and a 1-night disposable home sleep apnea test. Our results demonstrated increased median Patient-Reported Outcomes Measurement Information System fatigue scores of 58.7 in patients with CVID in addition to clinically significant fatigue as measured by Fatigue Severity Scale score (median, 5.2) and overall poor sleep quality based on global Pittsburgh Sleep Quality Index score (median, 9.0). For CVID patients who completed the home sleep apnea test, 76.9% met criteria for sleep-disordered breathing with an Apnea-Hypopnea Index score of 5 or greater. The results of our study indicate that patients with CVID may have increased rates of undiagnosed sleep disorders that may contribute to increased fatigue and reduced health-related quality of life.

ДИХАЛЬНІ РОЗЛАДИ ПІД ЧАС СНУ У ДОРОСЛИХ: ТЕМИ ПОТОЧНИХ НАУКОВИХ ДОСЛІДЖЕНЬ ТА ОСНОВНІ ОНОВЛЕННЯ ПРАКТИЧНИХ РЕКОМЕНДАЦІЙ

Respiratory disorders during sleep are an urgent and multifaceted problem of clinical medicine, in which the insufficient practical implementation of medical care for patients does not correspond to fundamental scientific achievements. The aim of this review was to assess the significant updates of practical recommendations for the diagnosis and treatment of sleep-disordered breathing in adults. The global lack of practical success in the treatment of patients with sleep-related breathing disorders supports the high relevance of the problem and prompts new research in pathology (biomarkers, structural disorders, risk factors, etc.) and modification of devices for diagnosis and therapy. Today, the classification of sleep-related breathing disorders has been updated. The functional criteria of polysomnography in determining ventilation disorders have been clarified. Diagnostic criteria for disorders associated with obstructive and central sleep apnea have undergone minor changes. Updated practice guidelines for obstructive sleep apnea include failure of CPAP therapy, revised indications for positional therapy, and upper airway or bariatric surgery. Updates in the treatment of central sleep apnea relate to the functional state of the heart and the type of respiratory disorder. In heart failure with a reduced ejection fraction adaptive servo-ventilation is contraindicated, in hypercapnia and/or hypoventilation during the rapid phase of sleep non-invasive lung ventilation is required. Current updates recommend positive airway pressure therapy (CPAP-therapy for concomitant severe obstructive sleep apnea) in stable outpatients with obesity-hypoventilation syndrome, and noninvasive ventilation in hospitalized patients with respiratory failure. General approaches to treatment remain constant: ventilatory disorders require appropriate mechanical correction. Key words: sleep-related breathing disorders, obstructive sleep apnea, central sleep apnea.

Quality measures for the care of adult patients with obstructive sleep apnea: 2022 update after measure maintenance.

Lloyd R, Morgenthaler TI, Donald R, etal. Quality measures for the care of adult patients with obstructive sleep apnea: 2022 update after measure maintenance. J Clin Sleep Med. 2022;18(11):2673-2680.

Sleep-Disordered Breathing in Adults with Precapillary Pulmonary Hypertension: Prevalence and Predictors of Nocturnal Hypoxemia.

To evaluate the frequency of sleep-disordered breathing (SDB) and predictors of the presence of nocturnal desaturation in adults with pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension. Outpatients with a hemodynamic diagnosis of precapillary pulmonary hypertension who underwent portable polysomnography were evaluated. Diagnosis and severity of SDB were assessed using three well-established respiratory disturbance index (RDI) thresholds: 5.0/h, 15.0/h, and 30.0/h, while nocturnal hypoxemia was defined by the average oxygen saturation (SpO2) < 90%. Multiple linear regression analysis evaluated the potential relationships among explanatory variables with the dependent variable (average SpO2 values), with comparisons based on the standardized regression coefficient (β). The R-squared(R2; coefficient of determination) was used to evaluate the goodness-of-fit measure forthelinear regressionmodel. Thirty-six adults were evaluated (69.4% females). The majority of the participants (75.0%) had SDB (26 with obstructive sleep apnea [OSA] and one with central sleep apnea [CSA]); while 50% of them had nocturnal hypoxemia. In the linear regression model (R2 = 0.391), the mean pulmonary artery pressure [mPAP] (β -0.668; p = 0.030) emerged as the only independent parameter of the average SpO2. Our study found that the majority of the participants had some type of SDB with a marked predominance of OSA over CSA, while half of them had nocturnal desaturation. Neither clinical and hemodynamic parameters nor the RDI was a predictor of nocturnal desaturation, except for mPAP measured during a right heart catheterization, which emerged as the only independent and significant predictor of average SpO2.

Protocolizing perioperative OSA screening and management: moving in the right direction.

Protocolizing perioperative OSA screening and management: moving in the right direction.

Diet as adjunctive therapy for sleep apnea risk: not only how much but also what to eat.

Diet as adjunctive therapy for sleep apnea risk: not only how much but also what to eat.

Classification of Factors Effect on Sleep in Individuals with Down Syndrome.

Background: Sleep disordered breathing (SDB) is a frequent disorder with serious adverse health consequences in people with Down syndrome (DS). This study aims to evaluate and classify sleep and physical activity (PA) characteristics in adults with DS. Methods: Forty participants with DS wore an accelerometer for seven consecutive days to measure physical activity and sleep–wake patterns. The corresponding data were also obtained by survey and polysomnography. The apnea-hypopnea index (AHI) is calculated from the number of apneas and hypopneas per hour of sleep according to international guidelines. Results: Polysomnography showed SDB based on AHI in 95% of adults: 50% had severe SDB, 22.5% presented moderate and 22.5% mild SDB, predominantly in males. They had poor sleep quality (80.1%) and low PA levels. Using statistical classification methods, we observed three clusters with two opposite profiles. Clusters 2 and 3 showed low PA indices (daily steps: 5719 and 5310, respectively) and severe SDB (AHI = 33.6 and 55.5 events/h), high age and high gonial angle. Cluster 1 showed high PA (mean count of daily steps: 6908) and mild to moderate SDB (AHI = 16.8 events/h), low age and low gonial angle. Conclusions: Our findings suggest that there are different profiles (age, gender, obesity, gonial angle) that are associated with SDB in adults with DS. These results suggest that this may represent important factors to consider when planning health promotion and prevention.

Opioids and obstructive sleep apnea.

Freire C, Sennes LU, Polotsky VY. Opioids and obstructive sleep apnea. J Clin Sleep Med. 2022;18(2):647-652.

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.

Automatic wavelet-based assessment of behavioral sleep using multichannel electrocorticography in rats.

During the last decade, the reportedprevalence of sleep-disordered breathing in adults has been rapidly increasing. Therefore, automatic methods of sleep assessment are of particular interest. In a framework of translational neuroscience, this study introduces a reliable automatic detection system of behavioral sleep in laboratory rats based on the signal recorded at the cortical surface without requiring electromyography. Experimental data were obtained in 16 adult male WAG/Rij rats at the age of 9 months. Electrocorticographic signals (ECoG) were recorded in freely moving rats during the entire day (22.5 ± 2.2 h). Automatic wavelet-based assessment of behavioral sleep (BS) was proposed. The performance of this wavelet-based method was validated in a group of rats with genetic predisposition to absence epilepsy (n=16) based on visual analysis of their behavior in simultaneously recorded video. The accuracy of automatic sleep detection was 98% over a 24-h period. An automatic BS assessment method can be adjusted for detecting short arousals during sleep (microarousals) with various duration. These findings suggest that automatic wavelet-based assessment of behavioral sleep can be used for assessment of sleep quality. Current analysis indicates atemporal relationship between microarousals, sleep, and epileptic discharges in genetically prone subjects.

Effect of interventions to reduce wait times for diagnosis and treatment of sleep-disordered breathing in adults: A systematic review

RATIONALE: Sleep disordered breathing (SDB) is associated with adverse health consequences that can be mitigated through timely and effective management. Guidelines provide wait time targets, but the evidence supporting them is unclear. The purpose of this systematic review was to explore the relationship between interventions to improve wait times for SDB and the effects on patient or provider outcomes. METHODS: A targeted search of medical databases was performed from database inception to June 2017. Included studies described an intervention intended to reduce wait times for the diagnosis or treatment of SDB and reported on a patient- or provider-level outcome. RESULTS: The search produced 2,944 abstracts and 51 articles underwent full text review. Ten articles were included in the final review. Five trials reported wait times to diagnosis and treatment, 3 studies described wait times for diagnosis only and 2 studies discussed time to treatment exclusively. All studies were of moderate methodological quality. Wait times were improved in most studies, but due to short follow-up periods a clear relationship with improved health outcomes was rarely established. The variety of interventions limited the characterization of specific wait-times reduction strategies that could reliably improve outcomes. CONCLUSIONS: This review highlights the scarcity of studies but suggests a possible clinical benefit of interventions to reduce wait times. However, generalizability is limited and the short follow-up periods likely underestimate potential positive impacts of reduced wait times. Further studies are needed to better characterize this relationship and to identify additional interventions to deliver more timely patient care.

Sleep telemedicine training in fellowship programs: a survey of program directors.

Telemedicine is a novel modality of health care delivery that can improve patients' access to sleep medicine services, but little is known about telemedicine training during sleep medicine fellowship. We studied telemedicine training prevalence, use, and attitudes of program directors (PDs) and other faculty members, PDs' receptiveness to a standardized telemedicine curriculum, and whether PDs have reviewed existing American Academy of Sleep Medicine (AASM) sleep telemedicine reference materials. This was an anonymous online survey of all 86 PDs of accredited sleep medicine fellowships in the United States. Response rate was 45%. Thirteen (33.3%) of the PDs already offer telemedicine experience to their trainees, although none use a standard telemedicine curriculum. Among the 26 (66.7%) PDs not offering telemedicine experience, 38.5% plan to do so and 53.9% agree that it would benefit fellows. Most PDs (57.9%) report faculty using telemedicine now or within the next 3 years. Many PDs agree that telemedicine is technically feasible, but relatively few agree it is financially feasible (82.1% and 38%, respectively). Few PDs have reviewed both primary AASM telemedicine reference materials. Overall, 64.1% of PDs agree that a national sleep telemedicine curriculum could be useful. Although only a minority of current sleep medicine fellows are exposed to telemedicine, it is likely that most will get some exposure in the next 3 years. PDs' attitudes toward telemedicine vary significantly with respect to feasibility and importance to their programs. Nevertheless, most PDs believe a standardized sleep telemedicine training curriculum could be useful.

Нарушения дыхания во сне у людей разных возрастных групп

Obstructive apnea syndrome (OSA) is the most common sleep-disordered breathing in adults and children. It is unknown whether the OSA in children and adults are different syndromes, or a single disease that begins in infancy. Here, we consider the risk factors and features of the obstructive sleep apnea in different age categories: infants born prematurely and suffering from bronchopulmonary dysplasia (BPD), overweight adolescents, and 25-64 years old adults. We demonstrate that the sleep-disordered breathing decreases the saturation in all groups. Premature infants with BPD and pulmonary hypertension (PH) had more desaturation episodes than the group without PH. Adolescents with excessive body weight and obesity had higher blood pressure, lipid and glucose levels. OSA was associated with higher values ​​of lipid metabolism and creatinine levels in adults.

Apraxia in children and adults with obstructive sleep apnea syndrome.

Early in life impairment of orofacial growth leads to sleep-disordered breathing (SDB). Normal lingual gnosis and praxis are part of this early development related to the normal sensorimotor development of the tongue and surrounding oral musculature. The aim of this retrospective study was to explore if lingual praxia is impaired in both SDB children and adults and if there is an association to craniofacial morphology. The ability to perform simple tongue maneuvers was investigated in 100 prepubertal SDB children and 150 SDB adults (shown with polysomnography). All individuals had a clinical investigation by specialists to assess any orofacial growth impairment and the elements potentially behind this impairment. In a subgroup of individuals both able and unable to perform the maneuvers, we also performed a blind recognition of forms placed in the mouth. A subgroup of pediatric and adult SDB patients presented evidence not only of orofacial growth impairment, but also apraxia independent of age and severity of OSA. By 3 years of age, children should be able to perform requested tongue maneuvers and have oral form recognition. Abnormal gnosis-praxis was noted, independent of age in SDB children and adults, demonstrating that an abnormal functioning of the tongue in the oral cavity during early development can be detected. Both children and adults with SDB may present similar absences of normal oral development very early in life and a similar presentation of apraxia, suggesting that the distinction of SDB in children versus adults may not be relevant.

Ascending aortic blood flow velocity is increased in children with primary snoring/mild sleep-disordered breathing and associated with an increase in CD8 + T cells expressing TNFα and IFNγ.

Sleep-disordered breathing (SDB) is associated with cardiovascular disease and systemic inflammation in adults but this remains to be explored in children, especially in children with the most common form of SDB, i.e. primary snoring/mild SDB. This pilot study investigated the relationship between the cardiovascular function and inflammation in children with mild SDB. Nineteen participants aged 5-14years underwent overnight polysomnography, cardiac magnetic resonance imaging (aortic blood flow velocity and left and right ventricular systolic function) and assessment for inflammatory markers (intracellular cytokine analysis of T cells by flow cytometry). Parents also completed the Sleep Disturbances Scale for Children (SDSC). Children with mild SDB exhibited increased ascending aortic peak systolic velocity compared to controls (SDB 119.95m/s vs. control 101.49m/s, p<0.05). No significant group differences were observed for left and right ventricular ejection fraction or mean aortic blood flow velocity from either the ascending aorta or pulmonary artery. Children with mild SDB had increased inflammatory markers as demonstrated by elevated T cell interferon gamma (IFNγ) (SDB 52±4% vs. control 25±3% positive cells, p<0.005) and tumour necrosis factor alpha (TNFα) (SDB 39±4% vs. control 20±2% positive cells, p<0.005) expression from CD8+ cells. A strong positive correlation was observed between ascending aorta peak blood flow velocity and both TNFα and IFNγ (TNFα, r=0.54, p<0.03; IFNγ, r=0.63, p<0.005, respectively). Polysomnography revealed that oxygen saturation (SaO2) nadir was significantly lower in children with mild SDB compared to controls (SDB 92.3±2.7% vs. control 94.4±1.6%, p<0.05). A lower SaO2 nadir was associated with an increased ascending aorta peak systolic velocity (r=-0.48, p<0.05). As well, both a lower SaO2 nadir and an increased ascending aorta peak systolic velocity were associated with higher SDSC Sleep-Disordered Breathing and Disorder of Initiating and Maintaining Sleep subscale scores but not the polysomnographic-derived Obstructive Apnea-Hypopnea Index. The finding of elevated ascending aortic peak systolic blood flow velocity and its association with increased inflammatory markers suggests that the profile of cardiovascular changes noted in adult SDB may also occur in children with mild SDB.

Less Is More: Sleep Disordered Breathing and Medication

SESSION TITLE: Student/Resident Case Report Poster - Sleep Disorders SESSION TYPE: Student/Resident Case Report Poster PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM INTRODUCTION: Opioids and benzodiazepines can worsen or precipitate sleep disordered breathing (central and obstructive), sleep-related hypoxemia/hypoventilation and result in periodic or erratic breathing patterns. CASE PRESENTATION: A 62 year old woman with a history of chronic headache/back pain, anxiety, lacunar infarction, cerebral amyloid angiopathy, hypertension, Hashimoto’s thyroiditis and diabetes mellitus was referred to the sleep clinic. She was diagnosed with OSA of unknown severity over 10 years ago. She underwent 3 follow up polysomnograms (PSG) and was on bi-level PAP in the spontaneous mode at 25/20 cm water pressure with supplemental oxygen bled in at 4 L/min at the time of presentation. In the same time interval, dependence on opioid/benzodiazepine medication had escalated. She complained of severe daytime sleepiness, falling asleep in conversation and at meals with an Epworth Sleepiness Score of 17. She had ongoing issues with imbalance,falls, cognitive impairment and chronic pain. BMI was 33. PSG revealed an AHI of 25, RDI of 37 and central apnea (CA) index of 4/hour. On CPAP, AHI was 32 and CA index 28. On Bi-Level PAP in the spontaneous mode, AHI was 81, mostly CA. On adaptive servoventilation (ASV) at maximal EPAP, AHI was 28 with persistent CA. She was prescribed CPAP at 10 cm water as most obstructive events appeared to be eliminated at this pressure, with the understanding that it was crucial to her therapy and symptoms to decrease the use of opioid/benzodiazepine medications. Over the next 2 months, she successfully decreased diazepam from 20 to 5mg daily, oxycodone ER from 240 to 80mg and short-acting oxycodone from qid to a once daily dose. Subsequent PSG showed elimination of most sleep disordered breathing/hypoxemia on CPAP at 12 cm water and no evidence of hypoventilation on arterial blood gas. DISCUSSION: Prior research has shown a dose-response relationship between opioid/benzodiazepine medications and sleep disordered breathing but this varies depending on the type of drug. It can be challenging to control sleep disordered breathing in these patients. Although difficult, we have to encourage patients to decrease/discontinue these medications safely in tandem with optimizing PAP therapy. CONCLUSIONS: CPAP therapy alone was sufficient in our complex patient after significantly decreasing opioid and benzodiazepine medications. Reference #1: Webster LR, Choi Y, Desai H, Webster L, Grant BJ. Sleep-disordered breathing and chronic opioid therapy. Pain Med. 2008 May-Jun;9(4):425-32 Reference #2: Correa D, Farney RJ, Chung F, Prasad A, Lam D, Wong J. Chronic opioid use and central sleep apnea: a review of the prevalence, mechanisms, and perioperative considerations. Anesth Analg. 2015 Jun;120(6):1273-85. Reference #3: Mason M, Cates CJ, Smith I. Effects of opioid, hypnotic and sedating medications on sleep-disordered breathing in adults with obstructive sleep apnoea. Cochrane Database Syst Rev. 2015 Jul 14;7:CD011090. DISCLOSURE: The following authors have nothing to disclose: Brendon Colaco, Meghna Mansukhani No Product/Research Disclosure Information

Quality Assessment of Systematic Reviews on the Efficacy of Oral Appliance Therapy for Adult and Pediatric Sleep-Disordered Breathing.

To assess the methodological quality of published systematic reviews (SRs) and meta-analyses (MAs) about the efficacy of oral appliances (OA) in the management of adult and pediatric sleep-disordered breathing (SDB). SRs/MAs that evaluated the efficacy of OA therapy on the treatment of SDB in human subjects of all age groups were sought. Multiple electronic databases were searched for articles published in any language from the database's inception until January 2016. Two reviewers independently selected and then assessed the methodological quality of the studies using the Assessment of Multiple Systematic Reviews (AMSTAR) measurement tool. Thirteen reviews on adult SDB were included (2 SRs and 11 SRs with MAs). Of those, seven were medium quality and six were high quality. Only four reviews were included on pediatric SDB (3 SRs and 1 SR with MA). Three of these were of high quality and one was medium quality. The identified limitations in the included reviews were failing to reference the excluded studies or describe reasons for exclusion, lack of applying valid criteria to assess the quality of included studies, lack of publication bias assessment, and absence of conflicts of interest reporting. Overall, SRs/MAs on OA therapy for adult and pediatric SDB were conducted with acceptable methodological quality. High AMSTAR scores should not be extrapolated as a proxy of the methodological quality of the included evidence. There is a need for more primary studies and then that information can be used to be synthesized through SRs on pediatric SDB.

Prevalence, Awareness and Reporting of Symptoms of Obstructive Sleep Apnoea among Hospitalized Adult Patients in Nigeria: A Multicenter Study.

Obstructive sleep apnoea is the most common form of sleep-disordered breathing in adults and children. It is associated with many adverse health consequences. The objectives this study were to determine the prevalence, awareness and reporting of symptoms of obstructive sleep apnoea among hospitalized adult patients in Nigeria. This was a multicenter cross-sectional study involving 1420 adult patients admitted to general medical and surgical wards of selected hospitals from March to April 2013. A questionnaire embedded with Berlin questionnaire, Epworth sleepiness scale and questions on level of awareness and reporting of symptoms of sleep apnoea was used for data collection. One-third of the patients (33.4%) reported snoring, 16.3% had excessive daytime sleepiness, 10.0% experienced daytime fatigue, and 8.0% experienced drowsy driving. Approximately 5% reported witnessed apnoea and 18.0% had high risks for obstructive sleep apnoea. The frequency of high risk for sleep apnoea increased with age and declined after 65 years and also increased with the body mass index. Snoring, excessive daytime sleepiness and high risk for obstructive sleep apnoea were more common in patients with chronic medical conditions and who were admitted to the urban hospitals. The majority were not aware that snoring (77.3%) and excessive daytime sleepiness (65.8%) constitute a medical problem, and only 4.5% reported these symptoms to their doctors. The level of awareness and under-reporting of sleep apnoea symptoms are poor. The high prevalence of obstructive sleep apnoea symptoms from this study should form the basis for screening hospitalized patients with chronic medical condition across the country.

Sleep-disordered breathing and nocturnal hypoxemia in young adults with sickle cell disease

Sleep-disordered breathing (SDB) is reported in up to 69% of adolescents and children with sickle cell disease (SCD) [1], but data regarding the prevalence of SDB in adults with SCD are limited. In order to obtain a preliminary assessment of the frequency and degree of sleep-related hypoxemia and potential associations with cardiovascular function in adults with SCD, we conducted overnight sleep studies, 6-min walk tests, echocardiograms, and hematologic and chemistry panels, calculated the Pittsburgh sleep quality index (PSQI), and conducted fatigue- and health-related quality-of-life measurement in 20 young adults with SCD visiting a sickle cell clinic for routine care. Sleep apnea, defined as an apnea–hypopnea index (AHI) > 5 events/h, was found in 50% of patients. Traditional clinical indicators, such as obesity, the presence of snoring, and reported sleep complaints, did not reliably differentiate them. The patients with AHI > 5 had higher mean systolic blood pressure (p = 0.03), evidence of impaired left ventricular diastolic function (i.e., increased mitral valve E/A ratio, p = 0.05), a trend toward higher reduction in 6-min walk distances (p = 0.06), and lower health-related quality-of-life scores (p ≤ 0.01). Three of nine patients with more severe anemia (total Hb < 9.0) showed nocturnal hypoxemia in the absence of sleep apnea. As prolonged and frequent hypoxemic episodes likely increase risks for vaso-occlusive, cardiovascular, and neurologic complications of SCD, these results suggest that the prevalence and severity of SDB should be investigated further in studies of larger patient populations. If confirmed, these findings could identify opportunities to prevent or reduce nocturnal hypoxia and improve outcomes.

Clinical Correlates of Sleep-Disordered Breathing and Nocturnal Hypoxemia in Sickle Cell Disease

Cardiopulmonary complications are the major cause of morbidity and mortality in sickle cell disease (SCD). In the general population, obstructive sleep apnea (OSA), has been associated with daytime sleepiness and increased risk for all-cause morbidity and mortality due to cardiovascular disease, systemic hypertension, pulmonary hypertension, and stroke-all of which are complications of SCD. Multiple small cohort studies have demonstrated that sleep-disordered breathing (SDB) is common among children and adolescents with SCD, but we do not understand the risk factors and clinical consequences of SDB in this population. Additionally, the prevalence of SDB in adults with SCD is unknown. We hypothesized that SDB and nocturnal hypoxemia are common across the lifespan in SCD and that the clinical presentation of SDB among SCD patients may be different from the general population without SCD. We performed a retrospective chart review of the overnight sleep studies performed at Boston Medical Center to gain greater understanding of the risk factors and clinical correlates of SDB in this population. We identified 29 patients with SCD who had a full polysomnogram for clinical purposes between 2012-2015. We obtained medical histories and steady state laboratory test results on these patients. Symptoms of SDB were assessed via the Epworth Sleepiness Scale (ESS). We evaluated the sleep studies for apneas, hypopneas, snoring, and the degree of hypoxemia. Data were analyzed using SAS, version 9.3. The 29 patients had a median age of 15.3 years (range 4 to 60), 66% were male, 43% were overweight or obese, and 86% had either the HbSS or HbSβ0 genotype 82% of these patients had at least one prior episode of the acute chest syndrome and 46% carried a diagnosis of asthma. Overall, the group had a median hemoglobin concentration of 9.7 (range 6.1-13.3) g/dL and median reticulocyte percentage of 7.3% (range 2.8-23.3%). 28% of the subjects had elevated scores on the ESS reflective of increased daytime sleepiness. Moderate to severe snoring, typically associated with OSA in the general population, was observed in 35% of patients. However, 48% of our patients met diagnostic criteria for OSA (defined as an apnea/hypopnea index [AHI] > 5), suggesting that a history of snoring may not be a sensitive marker to identify OSA risk in this population. Additionally, 17% of patients were considered to have nocturnal hypoxemia defined as greater than 5% of total sleep time with an oxygen saturation below 90%; this included 13% of those with OSA and 21% of those without OSA (p=0.65). In total, 38% of SCD patients referred for a sleep study had neither OSA nor nocturnal hypoxemia.Comparing the adults (n=14) and children (n=15) showed some differences across the lifespan. AHI and ESS scores were significantly higher in adults, while the resting oxygen saturation was lower. HbSS or HbSβ0 patients typically had lower BMIs but similar findings on sleep studies compared to those with HbSC disease. Those with moderate to severe OSA were older (p=0.006), more likely to be overweight or obese and had both significantly higher hemoglobin concentrations (p=0.04) and lower reticulocyte counts (p=0.03) compared to those without moderate-severe OSA. Nocturnal hypoxemia was associated with a history of asthma (p=0.01), an increased reticulocyte percentage (p=0.005) and white blood cell count (p=0.006), and a reduced awake oxygen saturation (p=0.002) compared to those without significant nocturnal hypoxemia. Interestingly, increased age, BMI, or ESS scores were not associated with nocturnal hypoxemia.Results from this small retrospective cohort study suggest that SDB in SCD is more complex than in the general population. SDB in SCD is common and not solely due to OSA. Additionally, traditional risk factors for OSA such as snoring and daytime sleepiness may not be present in SCD patients who have polysomnographic abnormalities. While this study needs to be confirmed with a larger prospective screening study, our findings suggest that intermittent nocturnal hypoxemia is potentially a modifiable cardiovascular risk factor in SCD. DisclosuresKlings:Pfizer: Consultancy; Actelion Pharmaceuticals: Research Funding.