Sleep-disordered Breathing In Patients Research Articles

Machine learning-based detection of sleep-disordered breathing in hypertrophic cardiomyopathy

BackgroundHypertrophic cardiomyopathy (HCM) is often concomitant with sleep-disordered breathing (SDB), which can cause adverse cardiovascular events. Although an appropriate approach to SDB prevents cardiac remodelling, detection of concomitant SDB in...

The epidemiological characteristics of sleep disordered breathing in congestive heart failure: A prospective, single centre study in Southeast Asia.

The presence of sleep-disordered breathing (SDB) in congestive heart failure (CHF) is associated with poor prognosis and is underdiagnosed despite advances in CHF management. The prevalence of SDB in CHF remains understudied in South East Asia. A prospective, observational single-centre study was conducted where 116 consecutive patients in a specialised heart failure clinic underwent level 1, attended polysomnography (PSG). The prevalence of SDB was 78% using the apnoea-hypopnea index (AHI), AHI ⩾ 5/h threshold, and 59% with the AHI ⩾ 15/h threshold. Obstructive sleep apnoea (OSA) was the predominant type of SDB and was associated with increased body mass index and neck circumference. STOP-BANG was predictive of SDB, especially in men. Central sleep apnoea (CSA) patients had worse sleep indexes and lower awake arterial carbon dioxide. SDB was also homogenously present in preserved ejection fraction (EF) CHF. Most of the CHF patients were found to have SDB with the utility of PSG. Local CHF guidelines should include sleep testing for all patients with CHF.The study is registered on ClinicalTrials.gov (NCT05332223) as 'The Epidemiological Characteristics of SDB in Patients with Reduced or Preserved EF CHF'.

An expedited model for identifying potential patients with periodic leg movements.

Periodic leg movements during sleep (PLMS) may have crucial consequences in adults. This study aimed to identify baseline characteristics, symptoms, or questionnaires that could help to identify sleep-disordered breathing patients with significant PLMS. Patients aged 20-80 years who underwent polysomnography for assessing sleep disturbance were included. Various factors such as sex, age, body measurements, symptoms, apnea-hypopnea index (AHI), and sleep quality scales were analysed to determine the presence of PLMS. The study included 1480 patients with a mean age of 46.4 ± 13.4 years, among whom 110 (7.4%) had significant PLMS with a PLM index of 15 or higher. There were no significant differences observed in terms of sex or BMI between patients with and without significant PLMS. However, the odds ratios (OR) for PLMS were 4.33, 4.41, and 4.23 in patients who were aged over 50 years, had insomnia, or had an ESS score of less than 10, respectively. Notably, the OR increased up to 67.89 times in patients who presented with all three risk factors. Our analysis identified significant risk factors for PLMS: age over 50, self-reported insomnia, and lower daytime sleepiness levels. These findings aid in identifying potential PLMS patients, facilitating confirmatory examinations and managing associated comorbidities.

Nomogram for predicting moderate-to-severe sleep-disordered breathing in patients with acute ischaemic stroke: a retrospective cohort study

ObjectivesModerate-to-severe sleep-disordered breathing (SDB) is prevalent in patients with acute ischaemic stroke (AIS) and is associated with an increased risk of unfavourable prognosis. We aimed to develop and validate a...

Slow Deep Breathing in Patients Following Double Lumen Catheter Insertion Experiencing Acute Pain Nursing Problems: A Case Report

Inserting a double-lumen catheter (CDL) in hemodialysis patients results in adverse effects, specifically pain. Pain is a disagreeable sensation caused by tissue injury involving sensory and emotional components. Pain management is a nursing care option for individuals experiencing pain. Pain can be managed by non-pharmacological methods, such as the Slow Deep Breathing (SDB) technique. This case study aims to assess the intervention for sleep-disordered breathing in patients with chronic renal disease following central venous catheter installation, focusing on acute pain nursing issues. This article used a case report style focused on a single patient in the treatment room. The effectiveness of the SDB intervention was evaluated by the Numeric Rating Scale (NRS) and by monitoring the patient's blood pressure, pulse, and respiration. The intervention resulted in a decrease in the NRS score from 2 to 0. Additionally, the blood pressure value decreased to normal, the pulse remained within the normal range, and there was no change in the patient's respiratory value for three days post-intervention. Expanding the use of SDB therapies to a more diverse group of patients will enhance the evidence supporting the effectiveness of these interventions.

Study of the prevalence and predictive factors of sleep-disordered breathing in patients with interstitial lung diseases

BackgroundInterstitial lung diseases (ILDs) are parenchymal lung conditions that are chronic, progressive, and have a high morbidity and mortality rate. Due to restrictions in their gas exchange and ventilatory dysfunction, ILD patients are probably at risk for sleep-disordered breathing (SDB).MethodologySixty-nine patients with diffuse parenchymal lung diseases identified by high-resolution computed tomography (HRCT) chest were included in the study. All patients were assessed by the STOP-BANG questionnaire (SBQ), Epworth sleepiness scale (ESS), and full-night polysomnography (PSG) for diagnosis and classification of SDB. The aim of the study is to examine the prevalence and risk factors for SDB in ILD.ResultsAmong the study group hypersensitivity pneumonitis (HP) was the most prevalent ILD, accounting for 63.8% of cases. Out of 69 individuals, 42 (60.9%) had SDB, 57.1% of those with SDB had obstructive sleep apnea (OSA), and the majority of those with OSA had mild degrees (21.7%, n = 15).ConclusionOSA is significantly common in ILD patients. Higher left atrium diameter and oxygen desaturation index (ODI) are predictive factors of SDB. To facilitate early diagnosis and therapy, PSG should be performed on ILD patients at high risk (such as males, individuals with high ESS scores, SBQ scores, and left atrium diameter).Trial registrationRetrospectively registered, registration number is NCT06012526, date of registration August 25, 2023.

Sleep Breathing Disorders in patients with Neuromuscular Disease, an integrative review

Sleep Breathing Disorders in patients with Neuromuscular Disease, an integrative review

Sleep-disordered breathing in patients with pulmonary hypertension

Sleep-disordered breathing in patients with pulmonary hypertension

Adaptive servo-ventilation for sleep-disordered breathing in patients with heart failure with reduced ejection fraction (ADVENT-HF): a multicentre, multinational, parallel-group, open-label, phase 3 randomised controlled trial

In patients with heart failure and reduced ejection fraction, sleep-disordered breathing, comprising obstructive sleep apnoea (OSA) and central sleep apnoea (CSA), is associated with increased morbidity, mortality, and sleep disruption. We hypothesised that treating sleep-disordered breathing with a peak-flow triggered adaptive servo-ventilation (ASV) device would improve cardiovascular outcomes in patients with heart failure and reduced ejection fraction. We conducted a multicentre, multinational, parallel-group, open-label, phase 3 randomised controlled trial of peak-flow triggered ASV in patients aged 18 years or older with heart failure and reduced ejection fraction (left ventricular ejection fraction ≤45%) who were stabilised on optimal medical therapy with co-existing sleep-disordered breathing (apnoea-hypopnoea index [AHI] ≥15 events/h of sleep), with concealed allocation and blinded outcome assessments. The trial was carried out at 49 hospitals in nine countries. Sleep-disordered breathing was stratified into predominantly OSA with an Epworth Sleepiness Scale score of 10 or lower or predominantly CSA. Participants were randomly assigned to standard optimal treatment alone or standard optimal treatment with the addition of ASV (1:1), stratified by study site and sleep apnoea type (ie, CSA or OSA), with permuted blocks of sizes 4 and 6 in random order. Clinical evaluations were performed and Minnesota Living with Heart Failure Questionnaire, Epworth Sleepiness Scale, and New York Heart Association class were assessed at months 1, 3, and 6 following randomisation and every 6 months thereafter to a maximum of 5 years. The primary endpoint was the cumulative incidence of the composite of all-cause mortality, first admission to hospital for a cardiovascular reason, new onset atrial fibrillation or flutter, and delivery of an appropriate cardioverter-defibrillator shock. All-cause mortality was a secondary endpoint. Analysis for the primary outcome was done in the intention-to-treat population. This trial is registered with ClinicalTrials.gov (NCT01128816) and the International Standard Randomised Controlled Trial Number Register (ISRCTN67500535), and the trial is complete. The first and last enrolments were Sept 22, 2010, and March 20, 2021. Enrolments terminated prematurely due to COVID-19-related restrictions. 1127 patients were screened, of whom 731 (65%) patients were randomly assigned to receive standard care (n=375; mean AHI 42·8 events per h of sleep [SD 20·9]) or standard care plus ASV (n=356; 43·3 events per h of sleep [20·5]). Follow-up of all patients ended at the latest on June 15, 2021, when the trial was terminated prematurely due to a recall of the ASV device due to potential disintegration of the motor sound-abatement material. Over the course of the trial, 41 (6%) of participants withdrew consent and 34 (5%) were lost to follow-up. In the ASV group, the mean AHI decreased to 2·8-3·7 events per h over the course of the trial, with associated improvements in sleep quality assessed 1 month following randomisation. Over a mean follow-up period of 3·6 years (SD 1·6), ASV had no effect on the primary composite outcome (180 events in the control group vs 166 in the ASV group; hazard ratio [HR] 0·95, 95% CI 0·77-1·18; p=0·67) or the secondary endpoint of all-cause mortality (88 deaths in the control group vs. 76 in the ASV group; 0·89, 0·66-1·21; p=0·47). For patients with OSA, the HR for all-cause mortality was 1·00 (0·68-1·46; p=0·98) and for CSA was 0·74 (0·44-1·23; p=0·25). No safety issue related to ASV use was identified. In patients with heart failure and reduced ejection fraction and sleep-disordered breathing, ASV had no effect on the primary composite outcome or mortality but eliminated sleep-disordered breathing safely. Canadian Institutes of Health Research and Philips RS North America.

Preoperative sleep-disordered breathing and craniofacial abnormalities are risk factors for postoperative sleep-disordered breathing in patients undergoing skin-flap oropharyngeal reconstruction surgery for oral cavity cancer: a prospective case-control study.

After oropharyngeal reconstruction surgery, excessive flap volume within the oral cavity may increase the risk of pharyngeal obstruction during sleep. This prospective observational study aimed to test a hypothesis that the skin-flap oropharyngeal reconstructive surgery increases nocturnal apnea-hypopnea index (nAHI, primary variable) after surgery. Adult patients undergoing oropharyngeal reconstruction surgery participated in this study. The hypothesis was tested by comparing the results of portable type 4 sleep study and craniofacial assessments with lateral head and neck computed tomography scout image before and after surgery. Multiple linear regression analyses were performed to identify predictors for nAHI increase after the surgery. In 15 patients, apostoperative sleep study was performed at 41 (27, 59) (median (IQR)) days after the surgery. nAHI did not increase after the surgery (mean (95% CI), 13.0 (7.2 to 18.7) to 18.4 (10.2 to 26.6) events.hour-1, p = 0.277), while apnea index significantly increased after the surgery (p = 0.026). Use of the pedicle flap for the oropharyngeal reconstruction (p = 0.051), small mandible (p = 0.008), longer lower face (0.005), and larger tongue size (p = 0.008) were independent predictors for worsening of nAHI after surgery. Hospital stay was significantly longer in patients with the pedicle flap (n = 8) than in those with the free flap (n = 7) (p = 0.014), and the period of hospital stay was directly associated with increase of nAHI after surgery (r = 0.788, p < 0.001, n = 15). Oropharyngeal reconstruction surgery worsens sleep-disordered breathing in some patients with craniofacial and surgical risk factors. UMIN Clinical Trial Registry (UMIN000036260, March 22, 2019), https://rctportal.niph.go.jp/s/detail/um?trial_id=UMIN000036260.

Progression of obstructive sleep apnoea after renal denervation is not associated with hypertension exaggeration

PurposeIn a cohort, observational prospective trial, we assessed the long-term dynamics of sleep-disordered breathing in patients with resistant hypertension after renal denervation and their association with blood pressure change at remote follow-up.Materials and methodsTwenty-eight patients with stable hypertension who were recruited for endovascular radiofrequency renal denervation in 2012–2019 and had valid both baseline and follow-up sleep study, were included in the analysis. All patients underwent physical examination, anthropometry, office and ambulatory blood pressure measurements, blood and urine tests, kidney visualization, and full polysomnography before and within 12–36 months after renal denervation.ResultsThe average follow-up comprised 30.1 ± 8.4 months. At long-term follow-up, no significant changes in creatinine level, estimated glomerular filtration rate, body mass index were registered. There was a significant increase in sleep apnea severity indices: the mean change in apnea-hypopnea index comprised 9.0(-21.1;25.2) episodes/h, in oxygen desaturation index 6.5(-16.8;35.9) episodes/h, in the average SpO2 -1.7(-5.6;1.9)%. Over 12-month follow-up, there were no significant differences in blood pressure response in patients with and without sleep apnea. The baseline apnea-hypopnea and oxygen desaturation indices and the mean SpO2 were associated with the circadian blood pressure profile at follow-up, but did not correlate with the blood pressure response.ConclusionsAlthough the severity of sleep apnea worsens at > 12 months follow-up after renal denervation, this is not associated with hypertension exaggeration.

Estimation of antihypertensive effect after initiating continuous positive airway pressure treatment in Japanese patients with sleep disordered breathing

Abstract Introduction It is true that patients with cardiovascular diseases including hypertension have already suffered from sleep disordered breathing (SDB). Furthermore, Continuous Positive Airway Pressure (CPAP) treatment shows antihypertensive effect by improving sympathetic nervous activity. On the other hand, we reported that CPAP treatment had a beneficial effect on hypertension, but 70% patients still remain inadequately treated. As a result, we need the strict blood pressure follow up for patient with SDB after initiating CPAP treatment at ESC congress 2022. Purpose Our aim in this study is to estimate the antihypertensive effect after initiating CPAP treatment, also estimate the differences of CPAP effect by focusing on Japanese non-obese body. Methods All patients were conducted full night polysomnography. One-hundred eighty patients showed obstructive SDB {apnea hypopnea index (AHI) &amp;gt;20/hour}, and CPAP treatment were initiated. We divided into three groups by using body mass index (BMI). Group A showed BMI &amp;lt; 25 kg/m2 (n = 59). Group B showed 25 ≦BMI &amp;lt; 30 kg/m2 (n = 68), and Group C showed 30 ≦ BMI kg/m2 (n = 53). If patients had already taken blood pressure-lowering agents, they had to continue blood pressure-lowering agents without changing other agents or dose intensification. According to Japanese society of hypertension guidelines for the managements of hypertension 2019 (JSH2019), we estimated the improvement of blood pressure to assess effectiveness of CPAP treatment after six-month follow up. Results The study group consisted of 180 SDB patients (152 males, 28 females). The mean age was 53 ± 12 years. Figure 1 showed polysomnographic data before initiating CPAP treatment. Group A was significantly lower apnea hypopnea index (AHI) than in Group B and C (p &amp;lt; 0.0001). Figure 2 showed the changes of blood pressure after initiating CPAP treatment (six-month). There was no significant difference respect to changes of systolic blood pressure (ΔSBP), but Group A showed the tendency for worsening SBP compared with other groups. Conclusions We could estimate that CPAP treatment had only limited effects in antihypertensive effect for Japanese patients, who especially had non-obese body and lower AHI level. We need the strict blood pressure follow up for patient with SDB after initiating CPAP treatment.Figure

Obstructive sleep apnea syndrome in the continuum of uncontrolled hypertension

Aim. To assess frequency and severity of sleep breathing disorders in patients with uncontrolled hypertension among patients referred to a sleep laboratory.Materials and methods. 113 patients aged 18-80 years with arterial hypertension (AH) were included. All patients underwent sleep cardiorespiratory monitoring, general clinical and laboratory diagnostics. Uncontrolled hypertension was defined as systolic blood pressure (BP) &gt;140 mm Hg, or diastolic BP &gt;90 mm Hg. in case of permanent antihypertensive therapy (AHT) taking.Results. Among all patients with uncontrolled hypertension (Group 1; n=42, 37,2%), 95,2% had obstructive sleep apnea syndrome (OSA). Compared with the controlled hypertension group (Group 2), AHI and ODI were higher in Group 1 (AHI 28,0 events/hour [14,8; 51,8] vs. 17,5 events/hour [8,7; 39,0], p=0,03; ODI 25,3 events/hour [14,4; 50,6] versus 17,1 events/hour [8,5; 37,0], p=0,04). In addition, these parameters turned out to be markers of uncontrolled hypertension (AHI &gt;19,9 events/hour, AUC=0,62, p=0,03; OR 3,23, 95%; CI 1,7-6,1, p=0,00; ODI &gt;19,5 events/hour, AUC=0,62, p=0,03; OR 3,07, 95% CI 1,7-5,7, p=0,01). The level of systolic BP &gt;146 mm Hg. turned out to be a marker of the moderate or severe OSA (AUC=0,66, p=0,00; OR 4,45, 95% CI 1,811,2, p=0,00).Conclusion. High incidence of moderate or severe OSA in patients with uncontrolled hypertension emphasizes the importance of sleep breathing disorders examining in these patients. Timely diagnostics and treatment of OSA probably will allow to provide better BP levels control and thus will lead to reducing of cardiovascular risk.

Sleep-disordered breathing in children with Prader-Willi Syndrome cannot be attributed solely to increased body weight

BackgroundSleep disordered breathing is common in obese people. One of the main characteristics of patients with PWS is excess body weight. In this population study we aimed to investigate the differences in sleep disordered breathing (SDB) in overweight and obese children with Prader-Willi syndrome (PWS) and obese children. Methods27 children previously diagnosed with PWS and 24 obese peers, matched by age and gender were recruited and underwent a 12-channel overnight polysomnography (PSG) with oxygen saturation, snoring and body position recorded. Patient (caregiver) reported data on sleep abnormalities and data on other chronic, perinatal and bihevioural conditions were also collected. ResultsMean apnea-hypopnoea index (AHI) was higher in the PWS group than in the control obese children (5.37±7.47 and 1.97±5.35, respectively, p<0.001). REM latency was lower in the PWS group compared to obese controls (89.22 ± 49.92 vs 164.62 ± 91.05, p = 0.001). Both the duration of longest apnoeic episodes and the average duration of apnoeic episodes were higher in the PWS group compared to obese controls (21.04 ± 14.78 vs 8.79 ± 5.6, p = 0.002 and 12.15 ± 3.13 vs 8.79 ± 5.5, p = 0.003, respectively). Total awakeness time and the microarousal index were also higher in the PWS group compared to control obese children (56.59 ± 4.14 vs 29.54 ± 30.67, p = 0.002 and 3.45 ± 3.55 vs 2.36 ± 1.49, p = 0.046, respectively). Both average and lowest oxygen saturation rates were lower in children with PWS compared to obese controls (96.16 ± 1.55 vs 97.87 ± 2.11, p = 0.002 and 84.74 ± 5.67 vs 88.87 ± 4.63, p = 0.007). Slow wave sleep time was also significantly lower in the PWS group compared to obese controls (24.20 ± 7.75 vs 30.07 ± 6.93, p = 0.003). Parent/caregiver reported. ConclusionsSDB was more common in children with PWS, suggesting that the etiology of SDB in patients with PWS is multifactorial, likely related to the clinical manifestations of the syndrome and cannot be attributed solely to obesity.

Impact of sleep-disordered breathing on overnight changes in arterial stiffness in patients with acute heart failure.

Overnight increases in arterial stiffness associated with sleep-disordered breathing may adversely affect patients with acute heart failure. Thus, we investigated overnight changes in arterial stiffness and their association with sleep-disordered breathing in patients hospitalized for acute heart failure. Consecutive patients with acute heart failure were enrolled. All participants underwent overnight full polysomnography following the initial improvement of acute signs and symptoms of acute heart failure. The arterial stiffness parameter, cardio-ankle vascular index (CAVI), was assessed before and after polysomnography. Overall, 60 patients (86.7% men) were analyzed. CAVI significantly increased overnight (from 8.4 ± 1.6 at night to 9.1 ± 1.7 in the morning, P < 0.001) in addition to systolic and diastolic blood pressure (from 114.1 mmHg to 121.6 mmHg, P < 0.001; and from 70.1 mmHg to 78.2 mmHg, P < 0.001, respectively). Overnight increase in CAVI (ΔCAVI ≥ 0) was observed in 42 patients (70%). The ΔCAVI ≥ 0 group was likely to have moderate-to-severe sleep-disordered breathing (i.e., apnea-hypopnea index ≥15, 55.6% vs 80.9%, P = 0.047) and greater obstructive respiratory events (29.4% vs 58.5%, P = 0.041). In multivariable analysis, moderate-to-severe sleep-disordered breathing and greater obstructive respiratory events were independently correlated with an overnight increase in CAVI (P = 0.033 and P = 0.042, respectively). In patients hospitalized for acute heart failure, arterial stiffness, as assessed by CAVI, significantly increased overnight. Moderate-to-severe sleep-disordered breathing and obstructive respiratory events may play an important role in the overnight increase in cardio-ankle vascular index.

Measurement of peripheral arterial tone to detect sleep-disordered breathing in patients with heart failure.

Sleep-disordered breathing is highly prevalent in patients with heart failure and isrelated to increased mortality and morbidity. The gold standard for sleep diagnostic is polysomnography in a sleep laboratory. Measurement of peripheral arterial tone with awrist-worn diagnostic device is a promising method to detect sleep-disordered breathing without major technical effort. We prospectively enrolled patients with heart failure with reduced ejection fraction for measurement of the peripheral arterial tone and polysomnography simultaneously during one night in thesleep laboratory. Raw data of polysomnography was analyzed blindlyby sleep core lab personneland compared with automatic algorithm-based sleep results of measurement of theperipheral arterial tone. A total of 25 patients provided comparable sleep results. All patients had sleep-disordered breathing and were identified by measurement of the peripheral arterial tone. The comparison of apnea-hypopnea index between peripheral arterial tone 38.8 ± 17.4/h and polysomnography 44.5 ± 17.9/h revealed a bias of - 5.7 ± 9.8/h with limits of agreement of ± 19.2/h in Bland-Altman analysis but showed high and significant Pearson correlation (r = 0.848, p < 0.001). The findings suggest that measurement of the peripheral arterial tone may be useful to identify sleep-disordered breathing in patients with heart failure with reduced ejection fraction.

Pulse rate variability predicted cardiovascular disease in sleep disordered breathing: The Guangdong sleep health study

ObjectivesPulse rate variability (PRV) predicts stroke in patients with sleep disordered breathing (SDB). However, the relationship between PRV and cardiovascular disease (CVD) was unknown in SDB. MethodsThis was a cross-sectional study. Community residents in Guangdong were investigated. Sleep study were conducted with a type Ⅳ sleep monitoring. PRV parameters was assessed from the pulse waveforms derived from the sleep monitoring. Results3747 participants were enrolled. The mean age was 53.9 ± 12.7 years. 1149 (30.7%) were diagnosed as SDB. PRV parameters, except for the averages of pulse-to-pulse intervals (ANN), were higher in participants with SDB than those without. After adjusting for traditional CVD risk factors, deceleration capacity of rate (DC), ANN, and the percentage of pulse-to-pulse interval differences that were more than 50 ms (PNN50) were correlated with CVD risk in participants with SDB (OR were 0.826, 1.002, and 1.285; P were 0.003, 0.009, and 0.010), but not in participants without SDB. There was no interaction effect between DC, ANN, PNN50 and oxygen desaturation index. In hierarchical analysis, DC and ANN were predictors for CVD in SDB patients with age <60 years, male, overweight, diabetes, and normal lipid metabolism. PNN50 was predictor for CVD in the elderly SDB patients without overweight, diabetes or dyslipidemia. ConclusionsPRV parameters may be specific predictors for CVD in SDB. PNN50 was a potent biomarker for CVD risk in the elderly with SDB, event without traditional CVD risk factors.

Screening for sleep disordered breathing among children hospitalized for asthma exacerbation.

Sleep disordered breathing (SDB) may exacerbate asthma and is a treatable comorbidity. To design and implement a screening process for SDB in patients hospitalized for asthma exacerbation using quality improvement (QI) methods. We sought to improve screening for SDB from zero to 60% from July 2019 to December 2020. A multidisciplinary team used QI methods to screen for SDB using the Michigan pediatric sleep questionnaire (PSQ) in patients 2-18 years hospitalized for asthma exacerbation. Key interventions included: pairing the PSQ screen with another element of routine care (the asthma risk factor screen), educating staff and physicians, engaging respiratory therapists to complete the PSQ and document scores, and modifying the electronic medical record (asthma order set and flowsheet for PSQ score documentation). A run chart tracked progress and descriptive statistics were generated. There were 2067 patients admitted for asthma exacerbation during this project. The PSQ was completed for 1531 patients (74%) overall. Of screened patients, 360 (24%) had a positive PSQ; the mean age was 8.6 years. Approximately 14 months after the project began, ~90% of children admitted for asthma were being screened; subsequently, >80% of patients were being screened until May 2022. Screening with the PSQ occurred approximately 90% of the time when routine asthma risk screens were completed. A screening process for SDB was successfully implemented and appeared feasible and sustainable. The high proportion of positive screens reinforces the importance of evaluating for SDB in the high-risk population of children requiring hospitalization for asthma exacerbation.

Hyperfructosemia in sleep disordered breathing: metabolome analysis of Nagahama study

Sleep disordered breathing (SDB), mainly obstructive sleep apnea (OSA), constitutes a major health problem due to the large number of patients. Intermittent hypoxia caused by SDB induces alterations in metabolic function. Nevertheless, metabolites characteristic for SDB are largely unknown. In this study, we performed gas chromatography-mass spectrometry-based targeted metabolome analysis using data from The Nagahama Study (n = 6373). SDB-related metabolites were defined based on their variable importance score in orthogonal partial least squares discriminant analysis and fold changes in normalized peak-intensity levels between moderate-severe SDB patients and participants without SDB. We identified 20 metabolites as SDB-related, and interestingly, these metabolites were frequently included in pathways related to fructose. Multivariate analysis revealed that moderate-severe SDB was a significant factor for increased plasma fructose levels (β = 0.210, P = 0.006, generalized linear model) even after the adjustment of confounding factors. We further investigated changes in plasma fructose levels after continuous positive airway pressure (CPAP) treatment using samples from patients with OSA (n = 60) diagnosed by polysomnography at Kyoto University Hospital, and found that patients with marked hypoxemia exhibited prominent hyperfructosemia and their plasma fructose levels lowered after CPAP treatment. These data suggest that hyperfructosemia is the abnormality characteristic to SDB, which can be reduced by CPAP treatment.

The impact of central and obstructive respiratory events on cerebral oxygenation in adults with sleep disordered breathing

Obstructive sleep apnea (OSA) and central sleep apnea (CSA) are two main types of sleep disordered breathing (SDB). While the changes in cerebral hemodynamics triggered by OSA events have been well studied using near-infrared spectroscopy (NIRS), they are essentially unknown in CSA in adults. Therefore, in this study, we compared the changes in cerebral oxygenation between OSA and CSA events in adult patients using NIRS. Cerebral tissue oxygen saturation (StO2) in 13 severe SDB patients who had both CSA and OSA events was measured using frequency-domain NIRS. The changes in cerebral StO2 desaturation and blood volume (BV) in the first hour of natural sleep were compared between different types of respiratory events (i.e., 277 sleep hypopneas, 161 OSAs and 113 CSAs) with linear mixed-effect models controlling for confounders. All respiratory events occurred during non-rapid eye movement (NREM) sleep. We found that apnea events induced greater cerebral desaturations and BV fluctuations compared to hypopneas, but there was no difference between OSA and CSA. These results suggest that cerebral autoregulation in our patients are still capable to counteract the pathomechanisms of apneas, in particularly the negative intrathoracic pressure (ITP) caused by OSA events. Otherwise larger BV fluctuations in OSA compared to CSA should be observed due to the negative ITP that reduces cardiac stroke volume and leads to lower systematic blood supply. Our study suggests that OSA and CSA may have similar impact on cerebral oxygenation during NREM sleep in adult patients with SDB.