Sleep-disordered Breathing Parameters Research Articles

Phrenic nerve stimulation for central sleep apnea: a single institution experience.

Phrenic nerve stimulation (PNS) was approved by the Food and Drug Administration (FDA) to treat moderate to severe central sleep apnea. We report here, results of a retrospective study regarding our institutional outcomes at one year. In this study we evaluated the change in the apnea hypopnea index, epworth sleepiness score, and functional outcomes of sleep score at one year post implant. This is a retrospective analysis of patients ≥ 18 years of age who had PNS implanted for moderate to severe CSA at the Ohio State University Wexner Medical Center apnea between Feb 1, 2018 to July 1, 2021. Sleep disordered breathing parameters and objective sleepiness as measured by the Epworth Sleepiness Scale (ESS) scores, and Functional Outcomes of Sleep Questionnaire (FOSQ) scores were assessed at baseline and one-year post-implant. Twenty-two patients were implanted with PNS at OSU between February 1, 2018 and May, 31, 2022. The AHI showed a statistically significant decrease from a median of 40 events/hour at baseline to 18 at follow-up (p-value = 0.003). The CAI decreased from 16 events/hour to 2 events/hour (p-value of 0.001). The obstructive apnea index, mixed apnea index, and hypopnea index did not significantly change. The ESS scores had a statistically significant improvement from a median score of 12 to 9 (p-value = 0.028). While the FOSQ showed a trend to improvement from 15.0 to 17.8, it was not statistically significant (p-value of 0.086). Our study found that PNS therapy for moderate to severe CSA improves overall AHI and CAI. Objective sleepiness as measured by the ESS also improved at one-year post implant.

Ambient ultrafine particles exacerbate oxygen desaturation during sleep in patients with chronic obstructive pulmonary disease: New insights into the effect spectrum of ultrafine particles on susceptible populations

The health effects of ultrafine particles (UFPs) are of growing global concern, but the epidemiological evidence remains limited. Sleep-disordered breathing (SDB) characterized by hypoxemia is a prevalent condition linked to many debilitating chronic diseases. However, the role of UFPs in the development of SDB is lacking. Therefore, this prospective panel study was performed to specifically investigate the association of short-term exposure to UFPs with SDB parameters in patients with chronic obstructive pulmonary disease (COPD). Ninety-one COPD patients completed 226 clinical visits in Beijing, China. Personal exposure to ambient UFPs of 0–7 days was estimated based on infiltration factor and time-activity pattern. Real-time monitoring of sleep oxygen saturation, spirometry, respiratory questionnaires and airway inflammation detection were performed at each clinical visit. Generalized estimating equation was used to estimate the effects of UFPs. Exposure to UFPs was significantly associated with increased oxygen desaturation index (ODI) and percent of the time with oxygen saturation below 90 % (T90), with estimates of 21.50 % (95%CI: 6.38 %, 38.76 %) and 18.75 % (95%CI: 2.83 %, 37.14 %), respectively, per 3442 particles/cm3 increment of UFPs at lag 0–3 h. Particularly, UFPs' exposure within 0–7 days was positively associated with the concentration of alveolar nitric oxide (CaNO), and alveolar eosinophilic inflammation measured by CaNO exceeding 5 ppb was associated with 29.63 % and 33.48 % increases in ODI and T90, respectively. In addition, amplified effects on oxygen desaturation were observed in current smokers. Notably, individuals with better lung function and activity tolerance were more affected by ambient UFPs due to longer time spent outdoors. To our knowledge, this is the first study to link UFPs to hypoxemia during sleep and uncover the key role of alveolar eosinophilic inflammation. Our findings provide new insights into the effect spectrum of UFPs and potential environmental and behavioral intervention strategies to protect susceptible populations.

Effect of Sleep-Disordered Breathing on Exercise Capacity after Myocardial Infarction - A Cross-Sectional Study.

Exercise capacity reflects the cardiovascular risk after myocardial infarction (MI). The study aims to evaluate the impact of sleep-disordered breathing (SDB) on exercise capacity after MI. Consecutive patients referring to outpatient cardiac rehabilitation up to 28 days after MI and participating in the Polish Managed Care after Acute Myocardial Infarction (MC-AMI) program were included. On admission, we assessed the presence and the severity of SDB using the home sleep apnea test (HSAT), patients' maximum exercise capacity on a treadmill exercise stress test (EST), and a 6-minute walk test (6MWT), as well as the effect of SDB on the results obtained. In the multivariate analysis, we verified the strength of the observed associations concerning age, anthropometric parameters, and left ventricular ejection fraction (LVEF). A total of 254 patients aged 60.00 (interquartile range 51.00-67.00), including 39 (15.4%) women, with technically adequate HSAT, constituted the study group. Mild SDB was found in 82 (32.3%), moderate in 54 (21.3%), and severe in 51 (20.1%) patients. Among those diagnosed with SDB, obstructive sleep apnea (OSA) was dominant in 167 (89.8%). With the worsening of SDB, the distance in 6MWT and the maximum physical exertion achieved in EST, expressed in metabolic equivalents (METs) and maximal heart rate (MHR), decreased. The linear regression analysis confirmed the following: (1) inversely proportional relationship between the respiratory event index and METs, MHR, and 6MWT distance (p = 0.005, p = 0.008, and p = 0.004), and the maximum apnea duration and MET and 6MWT distance (p = 0.042 and p = 0.002); and (2) directly proportional relationship between mean arterial oxygen saturation ( ) during sleep and MET, MHR, and 6MWT distance (p = 0.019, p = 0.006, and p = 0.013), and minimum and MET and MHR (p = 0.040 and p 0.001). However, the independent risk factors for impaired exercise capacity, determined using multivariable regression analysis, were age, female sex, higher body mass index (BMI), and decreased LVEF, but not SDB parameters. SDB negatively impacts exercise capacity after MI. However, the strength of this association may be less pronounced due to the interaction of risk factors common for SDB and impaired exercise capacity, e.g., sex, age, BMI, and LVEF.

0057 The Impact of Cortical Oxygenation During Sleep-Disordered Breathing on Cognition

Abstract Introduction Untreated sleep-disordered breathing (SDB) has been reported as a common risk for dementia. However, the association between current SDB parameters (i.e., AHI) and cognition is not straightforward. To examine the impact of cortical oxygenation during SDB on cognition in older adults, we measured the coherence of oxyHb and SpO2 during SDB, in which a higher level can represent less protection against systemic hypoxia, is associated with cognition in older adults. Methods Thirty-eight community-dwelling, healthy older adults without dementia (20 women) were recruited. The mean and standard deviation (SD) of age was 72.6±6.4years. All participants underwent comprehensive neuropsychiatric evaluation of short and long-term verbal memory(Wechsler Memory Scale & Rey Auditory Verbal Learning Test), Executive Functioning (Delis-Kaplan Executive Function System), verbal naming abilities (Boston Naming Test), and visuo-spatial ability (Judgment of Line Orientation). We performed a simultaneous PSG and NIRS recording overnight at the participants’ houses. We measured the mean max coherence of oxyHb and SpO2 and analyzed its correlation to cognition. Results The mean and SD of total sleep time, N1, N2, N3, and REM were 392.8±71.8 min, 65.5±60.3min, 210.7±68.5min, 53.1±30.9min, and 63.5±25.4 min. The mean and SD of AHI were 21±17.4 events/hour. The mean and SD of the max coherence ratio were 0.78±0.10. Linear regression analysis found higher coherence of oxyHb and SpO2 to be significantly correlated, after Bonferroni Correction, with a poorer score on the age-corrected BNT score (t = -3.174, p = .003), covaried for gender and education. Conclusion Higher coherence of oxyHb and SpO2 during SDB may predict poorer verbal naming abilities in older adult Support (if any) National Instutite on Aging

Effects of continuous positive airway pressure on very short-term blood pressure variability associated with sleep-disordered breathing by pulse transit time-based blood pressure measurements.

Blood pressure (BP) variability (BPV) is a predictor of cardiovascular outcomes independently of BP absolute values. We previously reported that pulse transit time (PTT) enables monitoring beat-to-beat BP, identifying a strong relationship between the extent of very short-term BPV and the severity of sleep-disordered breathing (SDB). Here, we investigated the effects of continuous positive airway pressure (CPAP) on very short-term BPV. We studied 66 patients (mean age 62 years old, 73% male) with newly diagnosed SDB who underwent full polysomnography on two consecutive days for diagnosis (baseline) and CPAP, together with PTT-driven BP continuous recording. PTT index was defined as the average number of acute transient rises in BP (≥12 mmHg) within 30 s/h. CPAP treatment effectively improved SDB parameters, and attenuated PTT-based BP absolute values during the night-time. Very short-term BPV that includes PTT index and standard deviation (SD) of systolic PTT-BP was significantly reduced by CPAP therapy. The changes in PTT index from baseline to CPAP were positively correlated with the changes in apnea-hypopnea index, obstructive apnea index (OAI), oxygen desaturation index, minimal SpO 2 , and mean SpO 2 . Multivariate regression analysis revealed that changes in OAI and minimal SpO 2 , as well as heart failure, were the independent factors in determining the reduction of PTT index following CPAP. PTT-driven BP monitoring discovered the favorable effects of CPAP on very short-term BPV associated with SDB events. Targeting very short-term BPV may be a novel approach to identifying individuals who experience greater benefits from CPAP.

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.

0715 Diagnosis of Sleep Disordered Breathing in Patients with Interstitial Lung Disease: A Retrospective Evaluation of Polysomnogram and Home Sleep Apnea Testing Using Peripheral Arterial Tonometry

Abstract Introduction Previous studies have shown that sleep disordered breathing (SDB) is common in patients with Interstitial Lung Disease (ILD), and oximetry is often used for screening prior to further diagnostic testing. Current guidelines recommend polysomnography (PSG) for diagnosis of SDB in patients with significant pulmonary disease, however, home sleep apnea tests (HSAT) are increasingly used in clinical practice for a variety of reasons despite lack of evidence regarding accuracy in this population. In this study, we evaluate the correlation between screening oximetry, a commercial brand HSAT (WatchPAT®) and PSG to examine the diagnostic accuracy of this HSAT technology in patients with ILD. Methods The institution electronic medical record was screened for patients with a diagnosis code for ILD who underwent screening oximetry followed by PSG or HSAT using peripheral arterial tonometry from July 1, 2012 to present. Clinical review confirmed presence of ILD according to American Thoracic Society guidelines. Among the respective cohorts, Paired Wilcoxon Test was used to compare the oximetry 4% oxygen desaturation index (ODI) to the HSAT ODI and PSG apnea-hypopnea index (AHI) as well as percent time spent below oxyhemoglobin saturation of 89%. Spearman correlation was used to correlate the oximetry ODI and parameters of SDB on HSAT and PSG. Results Data was analyzed for 25 patients who had undergone oximetry/HSAT and for 25 patients who had undergone oximetry/PSG. Oximetry ODI showed no significant difference from PSG AHI (p = 0.2635) or between HSAT ODI (p = 0.0755), and no difference was seen in hypoxic time between oximetry and PSG (p = 0.9789). Hypoxic time on HSAT was significantly longer than that on oximetry (p < 0.001). Using HSAT ODI as the standard, HSAT AHI and respiratory disturbance index (RDI) showed rs of 0.9638 and 0.8913 respectively, while oximetry ODI was 0.3893. Compared to PSG AHI, the PSG RDI and oximetry ODI rs were 0.9759 and 0.7407 respectively. Conclusion Among patients with ILD, screening oximetry appears to correlate more strongly with indices of SDB and hypoxic time on PSG rather than HSAT. Further studies are warranted to evaluate efficacy of additional HSAT testing modalities in this patient population. Support (If Any)

Co-exposure to multiple air pollutants and sleep disordered breathing in patients with or without obstructive sleep apnea: A cross-sectional study

BackgroundAir pollution may be a contributing risk factor for obstructive sleep apnea (OSA). However, the health effects of co-exposure to multiple air pollutants on OSA patients remain unclear. ObjectivesTo assess the joint effect of multi-pollutant on sleep disordered breathing (SDB) parameters in patients with or without OSA and identify the dominant pollutants. MethodsA total of 2524 outpatients from April 2020 to May 2021 were recruited in this cross-sectional study. Ambient air pollutant data were obtained from the nearest central monitoring stations to participants’ residential address. SDB parameters were measured by the ApneaLink devices, including apnea-hypopnea index (AHI), hypopnea index (HI), oxygen desaturation index (ODI), average oxygen saturation (SpO2), percentage sleep time with <90% saturation (T90), and desaturation. Bayesian kernel machine regression (BKMR) was applied to evaluate the effects of multiple pollutants. ResultsSignificant associations were observed between air pollutants and SDB parameters (including increases in AHI, HI, ODI, and desaturation) among patients with OSA. Co-exposure to air pollutants was positively correlated with AHI, HI, and ODI. PM10 and O3 dominated the effects of pollutant mixtures on OSA, with the highest posterior inclusion probability (PIP) values of 0.592 and 0.640, respectively. Stratified analysis showed that, compared to male patients with OSA, stronger effects on the SDB parameters were observed in female patients. Stronger associations were also found in the warm season than those in the cold season. ConclusionCo-exposure to air pollutants was associated with SDB parameters among patients with OSA, PM10 and O3 might play the dominant roles.

The rate of decrease in oxygen desaturation during severe obstructive sleep apnea syndrome is correlated with subjective excessive daytime sleepiness.

To explore factors that influence subjective excessive daytime sleepiness (EDS) in patients with severe obstructive sleep apnea syndrome (OSAS). Patients with snoring seen at the Sleep Medicine Center of The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University between October 2018 and November 2019 were included in this study. All patients underwent polysomnography (PSG). Noninvasive frequency-domain analysis was used to assess the autonomic nervous system regulation of the heart, with the low frequency (LF)/high frequency (HF) power ratio used to represent the sympathetic-parasympathetic balance. Daytime sleepiness was evaluated by the Epworth sleepiness scale (ESS). Overnight apnea episodes were included for analyses. The rate of pulse oxyhemoglobin saturation (SpO2) decrease was measured as the change in the percentage of SpO2 per second after obstructive apnea and was expressed as the oxygen desaturation rate (ODR). A total of 101 patients with severe OSAS were enrolled in this study and were further divided into two groups: the EDS group (ESS > 10, n = 52) and the non-EDS group (ESS ≤ 10, n = 49). The apnea-hypopnea index (AHI), respiratory effort-related arousals (RERAs), and LF/HF power ratio were significantly higher in the EDS group than in the non-EDS group (AHI: 69.9 ± 14.5 vs. 57.9 ± 16.1 events/h; RERAs: 42.2 ± 16.7 vs. 30.4 ± 13.7 events/h; LF/HF power ratio: 2.9 ± 0.8% vs. 2.4 ± 0.9%, all p < 0.001). Multiple linear regression analyses revealed that after adjusting for covariates expected to affect this relationship, ESS scores were correlated with ODR (β = 0.520, p < 0.001) and LF/HF power ratio (β = 0.155, p = 0.028), rather than with the traditional sleep-disordered breathing parameters. Compared with the traditional PSG parameters, both ODR and an increased LF/HF power ratio were more closely related to daytime sleepiness, especially ODR.

The Structure of SleepDisordered Breathing and Cognitive Impairment in Cerebrovascular Diseases

Abstract. Obstructive sleep apnea syndrome (OSAS) is considered one of the risk factors for cognitive impairment (CogI). The role of central apnea (CA) in the development of CI has not been established. Aim — to study the features of the structure of sleep-disordered breathing (SDB) in patients with chronic cerebrovascular disease (CVD) and clarify their significance as a risk factor for CogI. Material and methods. 100 patients (50 men, 50 women) at the age of 65 (58; 74.5) years were examined. Most had arterial hypertension (AH) and atherosclerosis of the brachiocephalic arteries; less commonly, stable forms of coronary artery disease and diabetes mellitus (DM) type 2. All patients were diagnosed with stage I–II dyscirculatory encephalopathy. Previously, non-disabling stroke was suffered by 37% of patients (mRS 0–2 points). Everyone completed the MoCA test. SDB was verified during cardiorespiratory monitoring (CT-04-3R (M), “INKART”, St. Petersburg). We estimated the number of episodes of SDB, obstructive apnea, CA, apnea/hypopnea index (AHI), duration and degree of desaturation. The correlation, discriminant and ROC analysis, the calculation of the odds ratio (OR) and the confidence interval (CI) of the occurrence of the event are performed. Results. SDB (AHI ≥ 5) according to the type of OSAS and CA were detected in 82% of patients. The average AHI was 13 (8; 21). CogI (MoCA &lt; 26) were detected in 28% of patients without SDB and 52% of patients with SDB (p = 0.03). The relationship between the assessment of MoCA and AHI (Spearman, r = –0.24, p = 0.02) was established. A discriminant analysis with step-by-step inclusion of cardiovascular risk factors and SDB parameters revealed that CA, the degree of AH, age and DM are associated with the development of CN (Wilks’s Lambda: 0.75542; approx. F(4,73) = 5.9087, p &lt; 0.0004). A threshold value of CA ≥ 5 was established (AUC 0.741, 95% CI 0.595–0.828; sensitivity 64%, specificity 76%), while the OR is 5.5 (95% CI 2.09–14.90). Conclusion. In 82% of patients with chronic CVD, SDB is detected, which is associated with a twofold increase in the frequency of CogI. Moreover, the most significant is the presence in the SDB structure of 5 or more episodes of CA, which serve not as a cause of CogI, but as a marker of more severe structural and functional cerebral changes.

Relationship between obstructive sleep apnoea during rapid eye movement sleep and metabolic syndrome parameters in patients with type 2 diabetes mellitus.

Sleep-disordered breathing (SDB) is associated with hypertension, poor glycemic control and dyslipidemia. Usually, apnoea events tend to be more prominent during rapid eye movement (REM) sleep than non-REM (NREM) sleep. We examined which SDB parameters are associated with blood pressure (BP), HbA1c and lipid profile in patients with type 2 diabetes (T2D). A total of 185 patients with T2D who underwent polysomnography were analysed. Exclusion criteria were: the presence of pulmonary diseases, central sleep apnoea, treated SDB, or REM sleep < 30 min. To predict BP, HbA1c, and lipid profiles, we performed multiple linear regression analyses adjusted for known risk factors. Subsequently, we performed multivariable logistic regression analyses. Patient characteristics (mean ± standard deviation/median) were as follows: age 58.0 ± 11.8 years, body mass index 26.0 kg/m2 (24.1-28.9 kg/m2 ), systolic BP 134 ± 19 mmHg, mean BP 98 ± 14 mmHg, HbA1c 7.4% (6.8-8.4%), triglyceride 143 mg/dL (97-195 mg/dL), non-high density lipoprotein (non-HDL) cholesterol 143 mg/dL (120-163 mg/dL), REM-apnoea-hypopnea index (AHI) 35.1/h (21.1-53.1/h). The analyses revealed that REM-AHI was independently associated with systolic and mean BP, whereas NREM-AHI was not. A statistically significant association was not observed between REM-AHI and HbA1c or lipid profile. In patients with T2D, REM-AHI was associated with systolic and mean BP. The alteration of BP, associated with SDB during REM sleep, may be an important pathophysiological link between SDB and cardiovascular diseases.

The effect of acute exposure to morphine on breathing variability and cardiopulmonary coupling in men with obstructive sleep apnea: A randomized controlled trial.

Opioid-related deaths from respiratory depression are increasing but there is only limited information on the effect of morphine on breathing during sleep. This study aimed to detect and quantify opioid-induced cardiorespiratory pattern changes during sleep in obstructive sleep apnea (OSA) patients using novel automated methods and correlate these with conventional polysomnography (PSG) measures. Under a randomized double-blind placebo-controlled crossover design, 60 male OSA patients attended two one-night visits to the sleep laboratory, at least a week apart. Either a 40-mg controlled-release oral morphine dose or placebo was administered. Breathing during sleep was measured by standard in-laboratory PSG. We analysed the inter-breath interval (IBI) from the PSG flow channel to quantify breathing irregularity. Cardiopulmonary coupling (CPC) was analysed using the PSG electrocardiogram (ECG) channel. Following the consumption of morphine, the 60 OSA patients had fewer breaths (p=.0006), a longer inter-breath interval (p<.0001) and more irregular breathing with increased IBI coefficient of variation (CV) (p=.0015) compared to the placebo night. A higher CPC sleep quality index was found with morphine use. The change of key IBI and CPC parameters was significantly correlated with the change of key PSG sleep-disordered breathing parameters. In conclusion, 40mg controlled-release morphine resulted in a longer breathing cycle and increased breathing irregularity but generally more stable sleep in OSA patients. The significant links between the IBI and CPC techniques and a range of PSG sleep-disordered breathing parameters may suggest a practical value as surrogate overnight cardiorespiratory measurements, because both respiratory flow and ECG can be detected by small portable devices.

Blood Oxygen, Sleep Disordered Breathing, and Respiratory Instability in Patients With Chronic Heart Failure - PROST Subanalysis.

Background: Respiratory stability index (RSI), a semi-quantitative measure of respiratory instability, was found to reflect congestive and other clinical status of acutely decompensated heart failure in the PROST study. Given that the association between RSI and another important factors affecting respiration, such as peripheral oxygen saturation (SpO2), and the influence of oxygen inhalation on this association were undetermined, and that the association between common sleep-disordered breathing (SDB) parameters and RSI was unknown, we performed a subanalysis using PROST data.Methods and Results: Correlation analyses were performed to evaluate the relationships between RSI, SpO2, and other SDB parameters (3% oxygen desaturation index [3%ODI], respiratory disturbance index [RDI]) using Spearman’s rank correlation. RSI and overnight mean SpO2 were not significantly correlated either after admission (n=38) or before discharge (n=36; r=0.27, P=0.10 and r=0.05, P=0.76, respectively). This correlation was also not affected by presence or absence of oxygen inhalation. 3%ODI, RDI and RSI were significantly and inversely correlated both after admission and before discharge.Conclusions: RSI and blood oxygen level were not significantly correlated irrespective of oxygen inhalation, while the SDB parameters were significantly correlated, suggesting that RSI reflects lung congestion independently of blood oxygen concentration and, thus, can be a useful indicator of the non-invasive assessment of lung congestion.

Influence of Sleep-Disordered Breathing on Quality of Life and Exercise Capacity in Lung Transplant Recipients.

The prevalence of sleep-disordered breathing (SDB) after lung transplantation (LTX) is high. It is well-established that SDB is associated with decreased health-related quality of life (HRQoL), but the impact of SDB on exercise capacity is less clear. In this study we investigated HRQoL and exercise capacity in LTX recipients with or without SDB. In addition, we also investigated associations between sleep parameters and both HRQoL and exercise capacity. There were 53 stable LTX recipients (age>18years, 31 males, time from LTX 9-120months) enrolled into the study. They all underwent polysomnography examination. HRQoL was assessed using the Short Form-36 (SF-36). Exercise capacity was measured using the 6-min walk test and cardiopulmonary exercise testing (CPET). We found inverse correlations between severity of SDB and both the predicted maximal workload (r=0.24, p=0.04) and maximal oxygen uptake (r=-0.26, p=0.03) during CPET. Relative oxygen uptake positively correlated with sleep efficiency (r=0.27, p=0.03). SF-36 scores did not differ between patients with and without SDB, and were not significantly associated with SDB parameters. In conclusion, the presence of SDB is associated with a slight reduction in maximal exercise capacity in LTX recipients, and there is no appreciable relationship between SDB and HRQoL.

Optimization of Early Rehabilitation of Patients with Ischemic Stroke and Sleep-Disordered Breathing

Introduction: Sleep-disordered breathing (SDB) is detected in 70% of stroke patients and impedes functional rehabilitation; it also increases the length of hospital stay and the risk of stroke recurrence and fatal outcome. Objective: To study the dynamics of SDB in its correlation with neurological disorders in stroke patients and to develop the approaches to optimization of early rehabilitation. Materials and methods: Seventy eight patients with acute ischemic stroke were examined. SDB was verified by cardiorespiratory monitoring; neurological deficit was assessed with the NIHSS and mRS scales. Examination was performed upon admission (days 2–5 post stroke) and repeated 3 weeks after. The effect of SDB correction on neurological recovery was studied for positional therapy (elevated head of bed by 30°) in combination with oxygen therapy (insufflation of O2 with maintenance of saturation level not less than 95% under digital sensor control). Results: Upon admission, SDB was revealed in 88% of patients; moderate and severe disorders being predominant (the apnea/hypopnea index (AHI) ≥ 15 h–1), most frequently presenting as obstructive apnea. In patients with AHI < 15 h–1, the positive dynamics of neurological disorders (p < 0.04) was observed along with stable SDB parameters. Neurological improvement (р < 0.05) was present in patients with AHI ≥ 15 h–1, which was associated with lesser severity of SDB. A direct correlation between the severity of neurological disorders and AHI after 3 weeks from the onset was revealed: RNIHSS/AHI = 0.45 (р = 0.003) and RmRS/AHI = 0.44 (р = 0.004). Patients with AHI ≥ 15 h–1 were divided into 2 groups: group A (no interventions) and group B (with application of positional and oxygen therapy in the night sleep during 7 days). A positive effect of therapy on restoration of neurological functions, along with a decrease in AHI, was revealed. Conclusions: SDB is a frequent and persistent disorder in patients with ischemic stroke. Early detection and correction of SDB should be regarded as an important component of post-stroke rehabilitation.

Relationship between Sleep Disordered Breathing during Rapid Eye Movement Sleep and Coronary Risk Factors in Patients with Type 2 Diabetes Mellitus

Sleep disordered breathing (SDB) is associated with hypertension, poor glycemic control and dyslipidemia. In general, apnea events are more prominent during rapid eye movement (REM) sleep than non-REM (NREM) sleep. Reportedly, only REM-AHI is associated with hypertension and HbA1c. We examined which SDB parameters are associated with BP, HbA1c and lipid profile in type 2 diabetes (T2D) patients. We analyzed 185 T2D patients who underwent polysomnography after excluding patients with pulmonary diseases, central sleep apnea, treated SDB or REM sleep &amp;lt; 30 minutes. We performed multiple linear regression analyses to predict BP, HbA1c and lipid profiles adjusted for known risk factors. Patients characteristics (mean±SD/median(IQR)): age 58.0 ± 11.8 yo, BMI 26.0 (24.1-28.9) kg/m2, systolic BP 134 ± 19.1 mmHg, mean BP 97.5 ± 13.8 mmHg, HbA1c 7.4 (6.8-8.4) %, TG 143 (97-195) mg/dL, non-HDL cholesterol 143 (120-163) mg/dL, REM-AHI 35.1 (21.1-53.1) /h. The analyses revealed REM-AHI was independently associated with systolic and mean BP whereas NREM-AHI was not (Fig. 1). No statistically significant association was observed between REM-AHI and HbA1c or lipid profile. REM-AHI was associated with systolic and mean BP in T2D patients. BP alteration associated with SDB during REM sleep may be an important pathophysiology linking between SDB and cardiovascular diseases. Disclosure T. Uchida: None. A. Nishimura: None. S. Kikuno: None. K. Nagasawa: None. M. Okubo: None. T. Kasai: None. K. Narui: None. Y. Mori: None.

SLEEP DISORDERED BREATHING IN RENAL TRANSPLANT PATIENTS

Objective: Sleep disordered breathing (SDB) is a pervasive problem in stage 5 CKD patients maintained on regular dialysis treatment. Renal transplantation improves SDB but the longitudinal, long term evolution of SDB after kidney grafting has not been investigated. The issue is relevant because renal transplantation abolishes uremic toxicity but introduces classical risk factors for SDB, like overweight and obesity. Design and method: We investigated the long term evolution of polysomnographic recordings in 221 stable renal transplant patients. Overall 404 recordings over a median time of 3 years (interquartile range 2 – 4) were performed. Longitudinal analysis was performed by the linear mixed model (LMM). Results: The apnea-hypopnea index (AHI) in renal transplant patients was 5.44 ± SD 0.75 and the corresponding number of O2 desaturation (Des O2) episodes was 4.40 ± 0.60. The number of patients with AHI > 5 (the threshold for identifying mild SDB) rose from 25% at baseline to 43% at the end of the follow up. Over follow-up the AHI rose to 9.94 ± 2.37 (P < 0.001) and the number of desaturation episodes to 5.55 ± 2.1 (P = 0.010) which went along with a decline in the mean O2-saturation overnight (Mean SatO2: from 95.08 ± 0.14 to 94.64 ± 0.32,P = 0.001). LMM showed that age, sex, BMI, ESA treatment but neither eGFR nor the presence of proteinuria associated with the AHI. On multivariate analyses only male gender (3.42; 95%CI: 0.35 to 6.49; P = 0.003) and BMI (0.87; 95% CI 0.46 to 1.27; P < 0.001) associated with the AHI evolution over follow-up. Similar associations were registered also for the other parameters of SDB (Des O2, Mean Sat O2). Conclusions: Even though renal transplantation produces an early improvement in SDB in renal transplant patients, this treatment does not stabilize the disturbance which gradually re-emerges over longitudinal observation. Among risk factors underlying the risk of SDB re-emergence after transplantation the rise in BMI, i.e. a modifiable risk factor, appears to be of paramount importance. Tackling the surge of SDB after transplantation is of obvious relevance because this disturbance is a potent driver of sympathetic over-activity and of the attendant risk of cardiovascular events in this population.

The Impact of Bariatric Surgery on Sleep Disordered Breathing Parameters From Overnight Polysomnography and Home Sleep Apnea Test.

BackgroundObstructive sleep apnea (OSA) is a common sleep disorder, especially in patients with obesity. Bariatric surgery is an effective tool to reduce weight and treat co-morbid diseases in patients with morbid obesity. One of these disorders is OSA. The most common bariatric procedures currently performed are Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (LSG).ObjectivesOur study demonstrates that bariatric surgery is a very effective tool to reduce the severity of OSA, if not resolve it.MethodsThe medical charts of nine patients who had OSA and underwent bariatric surgery (LSG or RYGB) were reviewed and the apnea-hypopnea index (AHI) was compared before and after surgery. The study was conducted at the Sanford sleep center which is affiliated with the University of North Dakota School of Medicine.ResultsOne patient was excluded from the statistical analysis since he was the only male patient, the remaining nine female patients had a significant reduction in AHI after surgery. The mean AHI before surgery was 40 events per hour and seven events per hour after surgery (P 0.004). The mean follow-up with sleep study after surgery was 16 months. The mean reduction in AHI was 80%. There was also an improvement in oxygen saturation (SpO2) before and after surgery (90% and 94% respectively, P 0.008).ConclusionThe study confirms the significant reduction in AHI after bariatric surgery in female patients with OSA especially short term (one to two years postoperatively).

Optimization of early rehabilitation of patients with ischemic stroke and sleep-disordered breathing

Abstract Introduction. Sleep-disordered breathing (SDB) is detected in 70% of stroke patients and impedes functional rehabilitation; it also increases the length of hospital stay and the risk of stroke recurrence and fatal outcome. Objective : to study the dynamics of SDB in its correlation with neurological disorders in stroke patients and to develop the approaches to optimization of early rehabilitation. Materials and methods . A total of 78 patients with acute ischemic stroke were examined. SDB was verified by cardiorespiratory monitoring; the neurological deficit was assessed using the NIHSS and mRS scales. Examination was carried out upon admission (days 2–5 post stroke) and again after 3 weeks. The effect of SDB correction on effectiveness of neurological recovery was studied using positional therapy (position elevated by 30 о ) in combination with oxygen therapy (insufflation of O 2 with the saturation level maintained no less than 95% under control of a digital sensor). Results . Upon admission, SDB was revealed in 88% of patients; moderate and severe disorders being predominant (the apnea/hypopnea index (AHI) ≥15 h -1 ), most frequently presenting as obstructive apnea. In patients with AHI < 15 h -1 , the positive dynamics of neurological disorders (p<0.04) were observed along with stable SDB parameters. Neurological improvement (р<0.05) was observed in patients with AHI ≥ 15 h -1 , which was associated with decreased severity of SDB. A direct correlation between the severity of neurological disorders and AHI after 3 weeks was revealed: R NIHSS/AHI = 0.45 (р=0.003), R mRS/AHI = 0.44 (р=0.004). Patients with AHI ≥ 15 h -1 were distributed into 2 groups: group A (without corrective interventions) and group B (the use of positional and oxygen therapy during the night sleep during 7 days). A positive effect of the course of corrective therapy on restoration of neurological functions, along with a decrease in AHI, was revealed. Conclusions . SDB is a frequent and persistent disorder in patients with ischemic stroke. Early detection and correction of SDB should be regarded as an important component of post-stroke rehabilitation.

Transvenous stimulation of the phrenic nerve for the treatment of central sleep apnoea: 12 months' experience with the remedē® System.

Patients with central sleep apnoea (CSA) often have poor quality of life and are at increased risk of morbidity and mortality. This study sought to evaluate the 12-month clinical outcomes of patients with CSA treated with unilateral transvenous phrenic nerve stimulation in the prospective, multicentre, non-randomized remedē® System pilot study. Forty-seven patients with CSA were treated with the remedē® System (Respicardia Inc., Minnetonka, MN, USA) for a minimum of 3 months. Sleep-disordered breathing parameters were evaluated by polysomnography (PSG) at 3, 6, and 12-month follow-up. Sleep symptoms and quality of life were also evaluated. Forty-one patients completed all follow-up PSGs and were included in the analysis. At 12 months, there was sustained improvement compared with baseline in the apnoea-hypopnoea index (49.9 ± 15.1 vs. 27.5 ± 18.3 events/h, P < 0.001) and central apnoea index (28.2 ± 15.0 vs. 6.0 ± 9.2 events/h, P < 0.001). Sustained improvement in the oxygen desaturation index (46.1 ± 19.1 vs. 26.9 ± 18.0 events/h, P < 0.001), rapid eye movement sleep (11.4 ± 6.1% vs. 17.1 ± 8.0%, P < 0.001), and sleep efficiency (69.3 ± 16.9% vs. 75.6 ± 17.1%, P = 0.024) were also observed. There were also continued favourable effects on sleepiness and quality of life. Three deaths unrelated to remedē® System therapy and five serious adverse events occurred over 12 months of follow-up. The present study demonstrates that in patients with CSA, unilateral transvenous phrenic nerve stimulation is associated with sustained improvement in key sleep parameters, sleep symptoms, and quality of life over 12 months of follow-up.