Screening For Sleep-disordered Breathing Research Articles

Update: kardiovaskuläre Schlafmedizin

Atemstörungen im Schlaf kommen bei Herzpatienten häufig vor – z. T. ohne die klassischen Symptome. Häufig weisen sie jedoch internistische Symptome auf, die bislang therapieresistent waren. Die Polygrafie hilft hier, Risikopatienten zu identifizieren. Neben Verhaltensregeln zählen Beatmungsmaßnahmen zu den Therapieoptionen, so z. B. CPAP bei OSA und Herzinsuffizienz. Bei ZSA und Herzinsuffizienz ist die adaptive Servoventilation nicht empfohlen.

Application value of the NoSAS score for screening sleep-disordered breathing.

Diagnosis of sleep-disordered breathing (SDB) requires overnight polysomnography (PSG). Because of the cost and low availability of these procedures, the NoSAS score was developed to identify subjects at high risk of SDB. To evaluate the clinical utility of the NoSAS score for screening patients with SDB in China and to compare the predictive value of the NoSAS score with the Epworth Sleepiness Scale (ESS), we used the STOP-Bang questionnaire and the Berlin questionnaire. In our study, we retrospectively reviewed the existing clinical data of patients who underwent an overnight PSG for suspected SDB from June 2014 to September 2017 at the sleep medical center of Guangdong Medical University Affiliated Second Hospital. The information we collected included all parts of the NoSAS score, the ESS, the STOP-Bang questionnaire and the Berlin questionnaire. Based on the severity of SDB determined by the apnea-hypopnea index (AHI), the patients were classified into four groups of primary snoring (<5 events/h), mild SBD (AHI ≥5 and <15 events/h), moderate SBD (AHI ≥15 and ≤30 events/h) and severe SBD (>30 events/h). We calculated the sensitivity, specificity, positive predictive value, negative predictive value and area under the receiver operating characteristic curve of the five questionnaires to compare their relative efficacy for screening SDB. A total of 479 consecutive patients (374 males and 105 females) ranging in age from 18 to 80 years old (mean ± SD, 48.9±14.4 years old) were recruited into this study. When using the standard of AHI ≥5 for diagnosing SDB, the NoSAS score had the largest area under the curve (AUC) (AUC =0.734), and the Berlin questionnaire (AUC =0.732) came second. Both exhibited a better predictive value than the ESS score and the STOP-Bang questionnaire. Using NoSAS ≥8 to predict AHI ≥5 events/h, AHI ≥15 events/h and AHI >30 events/h, the sensitivity and specificity were 0.590 and 0.707, 0.649 and 0.626, and 0.644 and 0.562, respectively; for the STOP-Bang questionnaire, the values were 0.721 and 0.512, 0.752 and 0.440, and 0.763 and 0.399, respectively; and for the Berlin questionnaire, the values were 0.721 and 0.512, 0.752 and 0.440, and 0.763 and 0.399, respectively. The NoSAS score and the Berlin questionnaire both exhibited good predictive value for SDB patients. NoSAS is a more suitable questionnaire to use in clinic for the conveniences but the similar performance with another questionnaire.

A Novel Artificial Neural Network Based Sleep-Disordered Breathing Screening Tool.

This study evaluated a novel artificial neural network (ANN) based sleep-disordered breathing (SDB) screening tool incorporating nocturnal pulse oximetry with demographic, anatomic, and clinical data. The tool was compatible with 6 categories of apnea-hypopnea index (AHI) with 4% oxyhemoglobin desaturation threshold, ≥ 5, 10, 15, 20, 25, and 30 events/h. Using a general population dataset, the training set included 2,280 subjects, whereas the test set included 470 subjects. The input of this tool was a set of 22 variables. The tool had six neural network models for each AHI threshold. Several metrics were explored to evaluate the performance of the tool: area under the receiver operating characteristic curve (AUC), sensitivity, specificity, positive predictive value, negative predictive value, and 95% confidence interval (CI). The AUC was 0.904, 0.912, 0.913, 0.926, 0.930, and 0.954, respectively, with models of AHI ≥ 5, 10, 15, 20, 25, and 30 events/h thresholds. The sensitivities of all neural network models were higher than 95%. The AHI ≥ 30 events/h model had the maximum sensitivity: 98.31% (95% CI: 95.01%-100%). The results of this study suggested that the ANN based SDB screening tool can be used to identify the presence or absence of SDB. Future validation should be performed in other populations to determine the practicability of this screening tool in sleep clinics and other at-risk populations.

Interactions of Sleep Apnea, the Autonomic Nervous System, and Its Impact on Cardiac Arrhythmias

Sleep-disordered breathing (SDB) is an independent risk factor for cardiovascular disease. SDB-related changes in the autonomic nervous system (ANS) and the association between obstructive sleep apnea and atrial fibrillation (Afib) have been extensively researched. SDB has also been associated with occurrence of ventricular arrhythmias. We evaluated the effects of SDB on the ANS and its relationship with ventricular and supraventricular arrhythmias. The ANS is an important regulator of the cardiovascular system and contributes to the development of cardiovascular diseases including hypertension and coronary artery disease. SDB has an important influence on the ANS and contributes to electromechanical remodeling of the left atrium via a number of mechanisms, increasing susceptibility to Afib. There is evidence that these mechanisms also affect the ventricular myocardium and therefore lead to ventricular arrhythmias. Effective treatment of SDB reduces the rate of Afib recurrence and seems to reduce ventricular arrhythmogenicity. SDB has an important impact on the ANS and therefore plays a major role in the development of cardiac arrhythmias. Although SDB screening of patients with Afib is recommended by current guidelines, SDB remains underdiagnosed. Additional research is needed to clarify the role of SDB and its treatment in ventricular arrhythmias.

Influence of sleep-disordered breathing assessed by pulse oximetry on long-term clinical outcomes in patients who underwent percutaneous coronary intervention.

Sleep-disordered breathing (SDB) has been recognized as an important risk factor for coronary artery disease (CAD). However, SDB was not fully examined, because sleep studies are limited. Nocturnal pulse oximetry has been suggested to be a useful tool for evaluating SDB. Therefore, the aim of this study was to investigate the influence of SDB assessed by nocturnal pulse oximetry on clinical outcomes in patients who underwent percutaneous coronary intervention (PCI). We conducted a prospective, multicenter, observational cohort study, wherein SDB was assessed by finger pulse oximetry in patients who underwent PCI from January 2014 to December 2016. SDB was defined as 4% oxygen desaturation index of 5 and higher. The primary endpoint was major adverse cardiac or cerebrovascular event (MACCE), defined as a composite of all-cause mortality, acute coronary syndrome, and/or stroke. Of 539 patients, 296 (54.9%) had SDB. MACCE occurred in 32 patients (5.8%) during a median follow-up of 1.9years. The cumulative incidence of MACCE was significantly higher in patients with SDB (P = 0.0134). In the stepwise multivariable Cox proportional model, the presence of SDB was a significant predictor of MACCE (hazard ratio 2.26; 95% confidence interval 1.05-5.4, P = 0.036). SDB determined by nocturnal pulse oximetry was associated with worse clinical outcomes in patients who underwent PCI. Screening for SDB with nocturnal pulse oximetry was considered to be important for risk stratification in patients with CAD.

Intracerebral hemorrhage and sleep-disordered breathing

Objective/BackgroundLimited data are available on sleep-disordered breathing (SDB) following intracerebral hemorrhage (ICH). Our aim was to characterize the objective measures of post-ICH SDB and questionnaire-reported pre-ICH sleep characteristics, overall and by ethnicity. Patients/MethodsParticipants with ICH who were enrolled in the population-based Brain Attack Surveillance in Corpus Christi project (2010–2016) reported their pre-ICH sleep duration and completed the Berlin Questionnaire to characterize pre-ICH risk of SDB. A subsample was screened for SDB (respiratory event index ≥10) using ApneaLink Plus portable monitoring. Ethnic differences in post-ICH SDB or questionnaire-reported pre-ICH sleep characteristics were assessed using a log binomial model or a linear regression model or a Fisher's exact test. ResultsICH cases (n = 298) were enrolled (median age = 68 years, 67% Mexican American). Among 62 cases with complete ApneaLink data, median time to post-ICH SDB screening was 11 days (IQR: 6, 19). Post-ICH SDB prevalence was 46.8% (95% CI: 34.4–59.2), and this rate did not differ by ethnicity (p = 1.0). Berlin Questionnaires for 109 of the 298 ICH cases (36.6% (95% CI: 31.1–42.0)) suggested a high risk for pre-ICH SDB, and the median pre-ICH sleep duration was eight hours (IQR: 6, 8). After adjusting for confounders, there was no difference in ethnicity in high risk for pre-ICH SDB or pre-ICH sleep duration. ConclusionsNearly half of the patients had objective confirmation of SDB after ICH, and more than one-third had questionnaire evidence of high risk for pre-ICH SDB. Opportunities to address SDB may be common both before and after ICH.

Validation of the NoSAS Score for the Screening of Sleep-Disordered Breathing: A Hospital-Based Retrospective Study in China.

This study was conducted to validate the NoSAS score in clinical populations and to compare it with the Berlin, STOP, and STOP-Bang questionnaires, as well as the Epworth Sleepiness Scale (ESS), in screening for sleep-disordered breathing (SDB). A retrospective analysis was conducted of all patients aged 18 to 80 years who had completed a full-night polysomnography (PSG) at the sleep center of the First Affiliated Hospital of Guangzhou Medical University from October 2012 to November 2016. Patients who had incomplete or unanswered questionnaires were excluded. The data for the NoSAS score, ESS, STOP, STOP-Bang, and Berlin questionnaires were collected, after which the NoSAS score was compared against the other questionnaires for SDB screening. A total of 2,208 participants were enrolled in this study. The NoSAS scores, which ranged from 0 to 17 and allocated a threshold of 8 points, identified individuals at risk of clinically significant SDB (defined as an apnea-hypopnea index [AHI] cutoff of ≥ 20 events/h), with an area under the curve (AUC) of 0.707. The NoSAS score performed significantly better than the STOP (AUC 0.655) and STOP-Bang (AUC 0.704) questionnaires and the ESS (AUC 0.642), and it was at par with the Berlin (AUC 0.697) scores for SDB screening. A significant correlation was found between the AHI and NoSAS score (r = .386, P < .001). The NoSAS score is a simple, efficient, and easy method for screening SDB in the clinical setting, especially in moderate to severe SDB. It demonstrates a moderately high level of sensitivity for SDB.

Predictors of sleep-disordered breathing in pregnancy

Sleep-disordered breathing (SDB) is common in pregnancy, but there are limited data on predictors. The objective of this study was to develop predictive models of sleep-disordered breathing during pregnancy. Nulliparous women completed validated questionnaires to assess for symptoms related to snoring, fatigue, excessive daytime sleepiness, insomnia, and restless leg syndrome. The questionnaires included questions regarding the timing of sleep and sleep duration, work schedules (eg, shift work, night work), sleep positions, and previously diagnosed sleep disorders. Frequent snoring was defined as self-reported snoring ≥3 days per week. Participants underwent in-home portable sleep studies for sleep-disordered breathing assessment in early (6-15 weeks gestation) and mid pregnancy (22-31 weeks gestation). Sleep-disordered breathing was characterized by an apnea hypopnea index that included all apneas, plus hypopneas with ≥3% oxygen desaturation. For primary analyses, an apnea hypopnea index ≥5 events per hour was used to define sleep-disordered breathing. Odds ratios and 95% confidence intervals were calculated for predictor variables. Predictive ability of the logistic models was estimated with area under the receiver-operating-characteristic curves, along with sensitivities, specificities, and positive and negative predictive values and likelihood ratios. Among 3705 women who were enrolled, data were available for 3264 and 2512 women in early and mid pregnancy, respectively. The corresponding prevalence of sleep-disordered breathing was 3.6% and 8.3%, respectively. At each time point in gestation, frequent snoring, chronic hypertension, greater maternal age, body mass index, neck circumference, and systolic blood pressure were associated most strongly with an increased risk of sleep-disordered breathing. Logistic regression models that included current age, body mass index, and frequent snoring predicted sleep-disordered breathing in early pregnancy, sleep-disordered breathing in mid pregnancy, and new onset sleep-disordered breathing in mid pregnancy with 10-fold cross-validated area under the receiver-operating-characteristic curves of 0.870, 0.838, and 0.809. We provide a supplement with expanded tables, integrated predictiveness, classification curves, and an predicted probability calculator. Among nulliparous pregnant women, logistic regression models with just 3 variables (ie, age, body mass index, and frequent snoring) achieved good prediction of prevalent and incident sleep-disordered breathing. These results can help with screening for sleep-disordered breathing in the clinical setting and for future clinical treatment trials.

Abstract WP272: Sleep-disordered Breathing is Associated With Worse Stroke Outcomes in Mexican Americans

Objective: Post-stroke sleep-disordered breathing (SDB) is prevalent and may be linked to poor stroke recovery but population-based studies in diverse populations are lacking. Our objective was to examine the association between SDB measured soon after stroke and stroke outcomes and to determine whether associations vary by ethnicity in the population-based Brain Attack Surveillance in Corpus Christi (BASIC) Project. Methods: Ischemic stroke (IS) patients were offered SDB screening with the ApneaLink Plus™; SDB was defined as apnea-hypopnea index (AHI) ≥ 10 events per hour. Patient data were collected from interviews and medical records. Functional, neurologic, cognitive, and quality of life (QOL) outcomes were ascertained at 90-days by patient or proxy interviews. Regression models were used to examine associations between SDB and outcomes adjusted for confounders. Interaction terms were used to investigate differences by ethnicity. Results: 232 NHW and 393 MA IS patients had a successful SDB screening and completed a 90-day interview. Median age was 65 years (IQR:58-75) among MAs and 67 (IQR:58-77) among NHWs. Post-stroke SDB was 68.7% in MAs [median AHI: 16 (IQR:8-26)] and 52.6% in NHWs [median AHI: 10 (IQR:6-23)]. Patients with SDB were more likely to be MA and to have diabetes, hypertension, and higher BMI but less likely to smoke than those without SDB. SDB was associated with worse functional, neurologic, cognitive, and QOL outcomes in MAs but not NHWs (Table). Conclusions: SDB is associated with worse stroke outcomes in MAs but not NHWs, the reasons for which should be explored. SDB treatment in MAs may improve outcomes in this subgroup and lessen ethnic stroke outcome disparities.

Wake-up stroke is not associated with sleep-disordered breathing in women.

We sought to investigate the frequency of wake-up stroke (WUS) and its association with sleep-disordered breathing (SDB) in women. Within a population-based study, women with acute ischemic stroke were asked about their stroke symptom onset time. SDB screening was performed with the well-validated ApneaLink Plus device; SDB was defined by a respiratory event index ≥10. Logistic regression was used to test the association between SDB presence and severity and WUS unadjusted and adjusted for potential confounders including prestroke depression and sleep duration. Among 466 participants, the median age was 67.0 years (interquartile range [IQR] 58.0, 77.0), 55% were Mexican American, and the median initial NIH Stroke Scale score was 3.0 (IQR 1.0, 6.0). Stroke symptom onset occurred during nocturnal sleep (25.3%), during a nap (3.9%), during wakefulness (65.9%), or unknown (4.9%). In those with SDB screening performed (n = 259), a median of 11 days (IQR 5, 17) poststroke, WUS was not associated with the presence or severity (respiratory event index) of SDB in unadjusted or adjusted analysis. In this population-based study, WUS represented about 30% of all generally mild severity ischemic strokes in women and was not associated with SDB.

Prevalence of obstructive sleep apnoea in acute coronary syndrome: Routine screening in intensive coronary care units

IntroductionIncreased evidence has shown that, despite the maximum care afforded to patients admitted with acute coronary syndromes (ACS), a residual risk of mortality remains, in which obstructive sleep apnoea (OSA) appears to be a largely undiagnosed factor, particularly in the intensive cardiac care unit (ICCU). The purpose of this study is to determine whether the systematic screening for sleep-disordered breathing (SDB) is feasible and may be recommended. The aims of our study are to determine: (1) The estimated prevalence of OSA in patients admitted to the ICCU for ACS determined by a validated, user-friendly portable screening device; (2) The feasibility of the screening in this context; (3) To assess any negative impact of OSA on the severity of ACS. Patients and methodsThis is an observational study of 101 patients admitted to the ICCU for ACS showing no clinical evidence of heart failure (HF). In the 24–72hours following admission, they underwent an overnight sleep study using a 3-channel portable screening device with automatic analysis. ResultsSixty-two out of the 101 patients proved positive to the screening test, and its feasibility was acceptable. OSA patients tended to have greater peak levels of hs-cTnT (3685±3576ng/L versus 2830±3333ng/L, P=0.08) than the non-OSA group. Compared with the non-OSA group, OSA patients presented more severe ACS, with a greater average GRACE score at admission of 112.2±26.3 (versus 98.4±19.2, P<0.001). In the OSA group, we found a statistically significant inverse correlation between the apnoea-hypopnea index (AHI) and the left ventricular ejection fraction (LVEF) in the linear regression analysis (r=−0.26; P=0.037). ConclusionsA systematic screening of patients in the ICCU is acceptable. OSA is frequently found in the acute phase of ischaemic heart disease and its presence is associated with more severe ACS and a poorer left ventricle systolic function.

Update: Cardiovascular Sleep Medicine

The prevalence of sleep-disordered breathing (SDB) is high in patients with cardiovascular diseases. Typical symptoms like daytime sleepiness can be absent and those patients may report unspecific, therapy-resistant symptoms related to their underlying disease. Particularly sleep-related symptoms like nocturia, nocturnal dyspnea and pectangina can be present. Based on the results of recently published studies, the treatment of central sleep apnea in patients with symptomatic, systolic heart failure by adaptive servo-ventilation is no longer recommended. Although the treatment of obstructive sleep apnea did not prevent cardiovascular events, it improved snoring, daytime sleepiness and health-related quality of life. Furthermore, studies imply that treatment of SDB should be considered as an adjunct treatment modality in patients with hypertension and atrial fibrillation. Due to the high prevalence, screening for SDB can help to identify patients at high cardiovascular risk.

Sleep-disordered breathing: clinical features, pathophysiology and diagnosis.

In recent decades, the association between sleep-disordered breathing (SDB) and cardio- and cerebrovascular diseases (including hypertension, coronary heart disease and stroke) has been the focus of interest of both clinicians and researchers. A growing concern is the increasing prevalence of SDB in the general population, which can be partly explained by the rise in obesity prevalence and population aging, as well as by the development of enhanced diagnostic tools and approaches. Because of evidence of adverse long-term effects of SDB on cardiovascular morbidity and overall mortality, systematic screening for SDB should be considered for populations at risk. The evidence of a long-term benefit of treatment for SDB, however, is still controversial and the best management approaches are still unclear. This article summarises available epidemiological data and focuses on the main pathophysiological mechanisms linking SDB to cardio- and cerebrovascular disorders. We will also give a critical overview of the current diagnostic procedures. The available treatment approaches and their prognostic effects on cardio- and cerebrovascular health will be discussed in a second paper.

Sleep-Disordered Breathing, Postoperative Delirium, and Cognitive Impairment

Sleep-disordered breathing (SDB) is highly prevalent in the general population and has been associated with cognitive impairment in older individuals. Delirium is an acute decline in cognitive function and attention that often occurs after surgery, especially in older individuals. Several recent studies suggest an association between SDB and postoperative delirium. The aim of this systematic review is to examine the current literature on SDB, postoperative delirium, and cognitive impairment and to discuss the pathophysiology and perioperative considerations. A literature search was performed of Medline (1946-2016), Medline In-Process (June 2016), Embase (1947-2016), Cochrane Central Register of Controlled Trials (May 2016), and Cochrane Database of Systematic Reviews (2005 to June 2016). Inclusion criteria for studies were (1) polysomnography confirmed SDB; (2) postoperative delirium or cognitive impairment confirmed by a validated diagnostic tool; and (3) publications in the English language. All study designs including randomized controlled trials and observational studies were included. The literature search identified 2 studies on SDB and postoperative delirium, 15 studies on SDB and cognitive impairment, and 5 studies on the effect of continuous positive airway pressure on cognitive impairment and delirium in older individuals. SDB was associated with cognitive impairment, and this systematic review revealed that SDB may be a risk factor for postoperative delirium, especially in older individuals. Although the pathophysiology of SDB and postoperative delirium is unclear and effective treatments for SDB to reduce the incidence of delirium have not been studied extensively, preliminary evidence suggests that continuous positive airway pressure therapy may lower the risk of delirium. Health care professionals need to be aware that undiagnosed SDB may contribute to postoperative delirium. Preoperative screening for SDB and strategies to reduce the risk for postoperative delirium may be helpful in older individuals. Further studies are needed to clarify the relationship between SDB and postoperative delirium and elucidate the pathophysiology of postoperative delirium through SDB.

Validation of NoSAS score for screening of sleep-disordered breathing in a multiethnic Asian population.

The NoSAS score was developed to identify subjects at high risk of sleep-disordered breathing (SDB). We aimed to validate the NoSAS score in a multiethnic Asian cohort and compare its performance to the STOP-Bang and Berlin questionnaires. A sample of 242 subjects selected from a population-based cohort in Singapore completed home-based sleep testing with an Embletta device (type 3 monitor). All subjects were given the STOP-Bang and Berlin questionnaires for self-administration prior to the sleep study. The NoSAS score was subsequently calculated based on available demographic data and Berlin questionnaire responses. The prevalence of severe SDB, defined as an apnea-hypopnea index cutoff of ≥30 events/h, was 10.7%. The number of subjects who were classified as high risk by the NoSAS score and STOP-Bang and Berlin questionnaires were 76 (31.4%), 89 (36.8%), and 79 (32.6%), respectively. The sensitivity, specificity, and negative and positive predictive values of the NoSAS score to predict severe SDB were 69.2, 73.1, 95.2, and 23.7%, respectively. The STOP-Bang and Berlin questionnaires performed similarly to the NoSAS score, with area under the curve (AUC) values of all three questionnaires clustered around 0.682-0.748. Compared to the STOP-Bang (94.8%) and Berlin questionnaires (96.3%), the NoSAS score (95.2%) had equally high negative predictive value in ruling out severe SDB. The NoSAS score performed similarly to the STOP-Bang and Berlin questionnaires in a multiethnic Asian cohort. All three questionnaires had high negative predictive values in ruling out severe SDB and may have utility as screening tools.

Intermittent hypoxia due to sleep apnea syndrome in patients with type 2 diabetes mellitus

To evaluate the possible association between intermittent hypoxia (IH) and HbA1c in patients with insufficient control type of 2 diabetes mellitus (T2DM). In this cross-sectional study 183 patients with HbAc1≥7% underwent three-channel overnight monitoring (ApneaLink) and completed Berlin Questionnaire, Epworth Sleepiness Scale and Pittsburgh Sleep Quality Index. Patients were divided in two groups, based on the cut-off value of oxygen desaturation index≥15. There were 79 (43%) patients with intermittent hypoxia, which was associated with poorer glycaemic control, defined as HbA1c>8.7% (sample median) in the univariate analysis and after adjustment for body mass index OR 2,40 (CI 1.21-4.95, p=0.021). Neither of three questionnaires yielded satisfactory results as a screening method in patients with T2DM. There is a need to implement instrumental screening of sleep-disordered breathing in this population and to study the effects of CPAP-therapy on glycaemic control and carbohydrate metabolism.

Preoperative Screening for Sleep-Disordered Breathing in Children: A Systematic Literature Review

Clinicians frequently underestimate or do not assess sleep-disordered breathing (SDB) in children in ambulatory surgical centers. Identifying the disorder and obtaining information relevant to anesthesia management can be assisted by the use of a standard questionnaire during preoperative assessment. We wanted to determine whether a preoperative screening tool increases clinician awareness of SDB in children and leads to a decrease in perioperative respiratory adverse events. We reviewed 21 articles to identify reliable screening tools for pediatric SDB in ambulatory surgical centers and selected six articles for the review. We concluded that the Snoring, Trouble Breathing, Un-Refreshed questionnaire is a reliable preoperative SDB identification tool and that awareness of preexisting SDB in children presenting for surgery in ambulatory surgical centers aids in designing a patient-specific plan of care to reduce perioperative respiratory adverse events. Standardizing the use of the Snoring, Trouble Breathing, Un-Refreshed questionnaire during the preoperative evaluation is a safety measure for pediatric surgical patients.

GW27-e0676 Application of Holter ECG for screening sleep disordered breathing in coronary slow flow phenomenon

To study the correlation between sleep disordered breathing (SDB) and coronary slow flow phenomenon (CSFP). Holter ECG is, to some extent, valuable for screening SDB in CSFP. Select patients who undergwent coronary angiography for being suspected of coronary heart disease during the period from

Attention deficit hyperactivity disorder and sleep disordered breathing in children

Children and adolescents suffering from attention deficit hyperactivity disorder (ADHD) and/or sleep disordered breathing (SDB) may present with similar symptoms, including inattention, irritability, and hyperactivity. SDB is under-diagnosed in young people and is not often recognized in patients with ADHD; we hypothesize that treating sleep disordered breathing in ADHD patients may diminish symptoms and reduce ADHD-focused pharmacotherapy. A Medline search was performed using the criteria for ADHD and SDB. English language publications through January, 2012 were surveyed. Correlation between these two disorders is confounded due to methodological errors in research. The investigations lack consistency due to studies with small sample size, a dearth of diagnostic polysomnography (PSG) to detect SDB, varying definitions for the apnea/hypopnea index, and lack of uniform evaluations to diagnose ADHD. Despite methodological inconsistencies, the data suggests that treating SDB may have a productive impact on treatment outcomes in children with mild ADHD. Patients with ADHD symptomatology should receive SDB screening. In those with comorbid SDB and ADHD, an adenotonsillectomy (AT) may improve the prognosis. Treatment of SDB coexisting with ADHD aims to decrease clinical symptoms, reduce pharmacotherapy, and promote better health.

Speckle tracking echocardiography in chronic obstructive pulmonary disease and overlapping obstructive sleep apnea.

BackgroundCOPD and congestive heart failure represent two disease entities of growing global burden that share common etiological features. Therefore, we aimed to identify the degree of left ventricular (LV) dysfunction in COPD as a function of COPD severity stages and concurrently placed particular emphasis on the presence of overlapping obstructive sleep apnea (OSA).MethodsA total of 85 COPD outpatients (64.1±10.4 years, 54.1% males) and 20 controls, matched for age, sex, and smoking habits, underwent speckle tracking echocardiography for LV longitudinal strain imaging. Complementary 12-lead electrocardiography, laboratory testing, and overnight screening for sleep-disordered breathing using the SOMNOcheck micro® device were performed.ResultsContrary to conventional echocardiographic parameters, speckle tracking echocardiography revealed significant impairment in global LV strain among COPD patients compared to control smokers (−13.3%±5.4% vs −17.1%±1.8%, P=0.04). On a regional level, the apical septal LV strain was reduced in COPD (P=0.003) and associated with the degree of COPD severity (P=0.02). With regard to electrocardiographic findings, COPD patients exhibited a significantly higher mean heart rate than controls (71.4±13.0 beats per minute vs 60.3±7.7 beats per minute, P=0.001) that additionally increased over Global Initiative for Chronic Obstructive Lung Disease stages (P=0.01). Albeit not statistically significant, COPD led to elevated N-terminal pro-brain natriuretic peptide levels (453.2±909.0 pg/mL vs 96.8±70.0 pg/mL, P=0.08). As to somnological testing, the portion of COPD patients exhibiting overlapping OSA accounted for 5.9% and did not significantly vary either in comparison to controls (P=0.07) or throughout the COPD Global Initiative for Chronic Obstructive Lung Disease stages (P=0.49). COPD-OSA overlap solely correlated with nocturnal hypoxemic events, whereas LV performance status was unrelated to coexisting OSA.ConclusionTo conclude, COPD itself seems to be accompanied with decreased LV deformation properties that worsen over COPD severity stages, but do not vary in case of overlapping OSA.