Sleep Studies In Patients Research Articles

PD33-12 RELATIONSHIP OF SLEEP-RELATED FACTORS TO NOCTURIA IN THE ABSENCE OF SLEEP DISORDERS

You have accessJournal of UrologyCME1 Apr 2023PD33-12 RELATIONSHIP OF SLEEP-RELATED FACTORS TO NOCTURIA IN THE ABSENCE OF SLEEP DISORDERS Lakshay Khosla, Aaron J. Huang, Susan Gong, Jason M. Lazar, Jeffrey P. Weiss, and Abdo E. Kabarriti Lakshay KhoslaLakshay Khosla More articles by this author , Aaron J. HuangAaron J. Huang More articles by this author , Susan GongSusan Gong More articles by this author , Jason M. LazarJason M. Lazar More articles by this author , Jeffrey P. WeissJeffrey P. Weiss More articles by this author , and Abdo E. KabarritiAbdo E. Kabarriti More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003326.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In the absence of sleep disorders, sleep-related factors (sleep duration, snoring, etc.) might disrupt the sleep cycle and be associated with nocturia. The purpose of this study was to evaluate the association between sleep-related factors and nocturia. METHODS: The National Health and Nutrition Examination Survey (NHANES) database from 2005/06 to 2017/18 was analyzed for respondents who completed questionnaires pertaining to nocturia and sleep. Respondents with conditions impacting nocturia (sleep disorders, chronic kidney disease, etc.) were excluded. After weighing, the prevalence of nocturia for responses to sleep-related factors (hours of sleep, work schedule, snoring, snorting or stopping breathing, and sleepiness) was analyzed using chi-squared analysis and the association of sleep-related factors to nocturia, accounting for age, gender, race, and BMI, was determined using univariate and multivariate regression. RESULTS: 23,895 respondents (11,672 males and 12,223 females; mean age, SD=45.2, 20.1 years) were included. Significant differences were noted for the prevalence of nocturia for responses to most sleep-related factors except work schedules (Figure 1). On univariate analysis, nocturia was associated with age (OR=1.035, p<0.001), BMI (OR=1.038, p<0.001), sleeping <6 hours (OR=1.603, p<0.001) or >8 hours (OR=1.673, p<0.001), snoring ≥5 nights per week (OR=1.192, p=0.004), snorting or stopping breathing 3-4 nights (OR=1.425, p<0.001) to ≥5 nights per week (OR=1.528, p<0.001), and feeling sleepy 5-15 times (OR=1.579, p<0.001) to 16-30 times per month (OR=1.970, p<0.001). Work schedule differences showed no significant odds of nocturia. On multivariate analysis, age (OR=1.035, p<0.001), BMI (OR=1.032, p<0.001), and sleepiness (OR=1.169, p<0.001) were associated with nocturia. CONCLUSIONS: While most sleep-related factors were associated with nocturia in the absence of sleep disorders, only sleepiness showed an association on multivariate analysis in this relatively young population. The relationship between sleepiness and nocturia may be mediated by a variety of intrinsic issues related to sleep quality; therefore, further research utilizing sleep studies in patients with nocturia is needed. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e918 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Lakshay Khosla More articles by this author Aaron J. Huang More articles by this author Susan Gong More articles by this author Jason M. Lazar More articles by this author Jeffrey P. Weiss More articles by this author Abdo E. Kabarriti More articles by this author Expand All Advertisement PDF downloadLoading ...

BS P03 Safety of Laparoscopic Cholecystectomy in patients with BMI &amp;gt; 35 kg/m2 without preoperative screening for Obstructive Sleep Apnoea

Abstract Background Preoperative Obstructive Sleep Apnoea (OSA) screening, followed by sleep studies as indicated, is commonly performed for patients undergoing bariatric surgery in our hospital but not for patients with similar weight undergoing other surgeries such as laparoscopic cholecystectomy. The purpose of this audit was to understand if laparoscopic cholecystectomy can be performed safely in patients with a Body Mass Index (BMI) ≥35 kg/m2 without such screening. Methods Patients with a BMI ≥ 35 kg/m2 undergoing elective laparoscopic cholecystectomy between 2nd May 2014 and 4th April 2022 were included. Patients with known OSA were excluded and no patients were referred for sleep studies. Data on patient demographics, co-morbidities, and any intraoperative or postoperative surgical complications were extracted and analysed. Univariate associations between different preoperative and operative variables and 30-day morbidity were studied using the Fisher's exact test. Results A total of 434 patients were included in the audit (64 male, 370 female). The mean age was 49 +/- 15 years. The mean weight and BMI were 110 +/- 20 kg (range 70–79kg) and 37 +/- 6 kg/m2 respectively. The mean operating time was 70 +/- 31 minutes (median=62). Approximately, 92% (398/434) had a day case procedure. The readmission rate at 30-day was 1% (5/434). There were no intraoperative complications. 17 patients had post-operative complications including deep vein thrombosis (n=2), leak in transverse colon secondary to cholecysto-colic fistula (n=1), wound infection (n=9), bile leak and post-op ERCP (n=3), common bile duct stone requiring ERCP (n=1) and pneumonia (n=1). No patients required ITU or HDU admission for further organ support. The 30-day mortality rate was 0% (0/434) while the 30-day morbidity rate was 3.9% (17/434). ASA grade, previous abdominal surgery, hypertension, diabetes, dyslipidemia, smoking history, chronic obstructive pulmonary disease, ischemic heart disease, fatty liver disease, preoperative liver reducing diet, number of ports, and conversion to laparotomy were not associated with increased 30-day morbidity rate (p&amp;lt;0.05) on univariate analysis. Higher BMI values (≥40 and ≥50 kg/m2) were also not associated with increased 30-day morbidity rate (p&amp;lt;0.05). Conclusions This audit demonstrated that laparoscopic cholecystectomy can be performed safely without the need for preoperative sleep studies in patients with BMI ≥35 kg/m2.

Accuracy of Detecting Obstructive Sleep Apnea Using Ambulatory Sleep Studies in Patients With Syndromic Craniosynostosis

Obstructive sleep apnea (OSA) is seen in up to two-third of the patients with syndromic craniosynostosis. Gold standard to diagnose OSA is the hospital-based polysomnography, although alternatively ambulatory home sleep apnea devices are available. Aim of this study was to assess (1) accuracy of ambulatory sleep studies, (2) clinical decision making following sleep studies, and (3) course of OSA during long-term follow-up. A retrospective cohort study was performed in children with syndromic craniosynostosis, of whom polysomnographies and home sleep apnea device recordings were collected. Measurements of apnea-hypopnea index, respiratory event index, total sleep/recording time, heart rate, oxygen saturation, and oxygen desaturation index were derived from the sleep studies. Primary clinical care subsequent to the sleep studies was determined using electronic patient files. In total, 123 patients were included, with 149 polysomnographies and 108 ambulatory studies. Performing an ambulatory study was associated with increased age at time of measurement (OR=1.1, 95% CI=1.02 to 1.17, P =0.01). No significant difference was found between the 2 types of sleep studies regarding sleep study parameters. Subsequent to sleep studies, patients with no-mild OSA had expectant care whereas patients with moderate-severe OSA underwent OSA-related treatment. OSA was most prevalent up to the age of 5 years, but also noticeable after the age of 10 years in patients with the Crouzon syndrome. Ambulatory sleep studies are reliable for diagnosing OSA in older children and can be used to determine clinical decision-making. Hence, we recommend implementing ambulatory sleep studies in a protocolized management.

SLEEP DISORDERS AND THEIR COMPLEX REHABILITATION USING TRANSCRANIAL MAGNETIC STIMULATION IN POST-STROKE REHABILITATION: STUDY DESIGN

In the Republic of Bashkortostan, a new original study of sleep-in patients in the recovery period of cerebral stroke is planned. One of the goals will be to improve the algorithms of sleep disorders management in complex post-stroke rehabilitation using rhythmic transcranial magnetic stimulation (rTMS). In this paper, we present the design of this study using modern instrumental and clinical technologies for the diagnosis of sleep disorders and rehabilitation. The work will be of practical importance in rehabilitation medicine and neurology for improving the quality of life of patients who have suffered acute cerebral circulatory disorders. We plan to study sleep disorders in patients in the early recovery period of stroke using clinical and polysomnographic techniques, to evaluate the safety and clinical effectiveness of rTMS in the studied patients with sleep disorders, to study the duration of the effects of rTMS on sleep normalization. The successful completion of the study will help to add to algorithms for correcting sleep disorders in post-stroke rehabilitation using transcranial magnetic stimulation.

Adherence to prescribed overnight sleep study in patients suspected of sleep apnea: problem size and influential factors.

Despite the serious consequences of sleep apnea, some patients do not follow their physicians' advice to undergo a sleep study. The present study aimed to determine the rate of adherence and influencing factors in conducting a polysomnography test in patients suspected of obstructivesleep apnea. This qualitative and quantitative analysis was conducted between July 2017 and November 2019 on patients suspected of sleep apnea. The quantitative analysis aimed at determining the rate of adherence through a retrospective cross-sectional study. The qualitative content analysis was conducted on purposefully selected subgroup ofpatients suspected of obstructive sleep apnea who were referred for polysomnography. The required data were collected through the semi-structured in-depth interviews and then recorded, transcribed, and analyzed using SPSS.22 and MAXQDA10. Quantitative part: Of 311 patients (mean age: 47.6 ± 13.1 years) referred for polysomnography, 283 patients (91%)were at a high risk of developing obstructive sleep apnea. Among those referred for polysomnography, 31% (n = 95) adhered to recommendations for a sleep study. Qualitative part: Factors affecting adherence to polysomnography were categorized as "barriers" and "triggers." Barriers included inadequate knowledge, psychological factors, cost, and the service system. Triggers included adequate knowledge and tangible experience of consequencesof the illness. The majority of patients at risk of developing obstructive sleep apnea did not follow the recommendation for polysomnography, indicating a need for systematic interventions. Among the identified barriers, knowledge and psychological factors are modifiable ones that can be addressed with the patient. We theorize that raising awareness among patients by providing additional information and eliminating concerns may help to increase the rate of adherence. Insurance coverage or subsidy to reduce the sleep study costs may also be an effective strategy to increase adherence to recommendations for polysomnography.

Outcome of Cardiac Monitor During Sleep Study for Screening of Subclinical Atrial Fibrillation.

BackgroundThere is growing evidence of a strong association between obstructive sleep apnea (OSA) and cardiovascular co-morbidities including atrial fibrillation (AF). We wanted to assess the usefulness of the overnight cardiac monitoring to screen for AF during the sleep study in patients newly diagnosed with OSA, in order to establish the usefulness of overnight active screening for subclinical AF during the sleep study in these patients.MethodsA retrospective study in patients with new diagnosis of OSA carried out between January 2014 and December 2019 in the sleep clinic at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. All patients newly diagnosed with OSA (apnea-hypopnea index >5) were selected to undergo a clinical questionnaire regarding symptoms, co-morbidities and risk factors. Subjects with history of cardiac arrhythmias or having anti-arrhythmic treatment were excluded. Eligible patients underwent an overnight rhythm monitoring to screen for AF or any rhythm disturbance.ResultsWe included 250 respective patients with OSA, 54% were males and 82% aged more than 35 years. The majority of patients were married (83%), of Saudi nationality (81%), and 90% were overweight or obese, apnea hypopnea index (AHI) was mild (5-14) in 30%, moderate (15-29) in 38% and severe (30 or more) in 32% of the patients. No cardiac arrhythmia was detected in all the study population, while only two patients complained of palpitations and was due to sinus tachycardia. Assessment of other risk factors showed 26% cases of diabetes mellitus, 39% of hypertension, 1% of renal failure, 9% of ischemic heart disease, 17% of thyroid dysfunction, 6% of stroke and 4% of dyslipidemia.ConclusionThe findings of this study show null incidence of cardiac arrhythmia during the apnea-hypopnea episodes in a cohort of patients with confirmed OSA. However, in view of the frequently reported association, the screening for subclinical atrial fibrillation needs long-term rhythm surveillance and should be targeted to symptomatic patients.

Blood pressure monitoring in sleep: time to wake up.

Hypertension is a highly common condition with well-established adverse consequences. Ambulatory blood pressure monitoring has repeatedly been shown to better predict cardiovascular outcomes and mortality, compared to single office visit blood pressure. Non-dipping of sleep-time blood pressure is an independent marker for increased cardiovascular risk. We review blood pressure variability and the challenges of blood pressure monitoring during sleep. Although pathological sleep such as obstructive sleep apnea has been associated with non-dipping of sleep-time blood pressure, blood pressure is not routinely measured during sleep due to lack of unobtrusive blood pressure monitoring technology. Second, we review existing noninvasive continuous blood pressure monitoring technologies. Lastly, we propose including sleep-time blood pressure monitoring during sleep studies and including sleep studies in patients undergoing ambulatory blood pressure monitoring.

Indication of CPAP without a sleep study in patients with high pretest probability of obstructive sleep apnea.

To evaluate the performance of clinical criteria (CC) for diagnosis and initiation of empirical treatment with continuous positive airway pressure (CPAP) in patients with suspected obstructive sleep apnea (OSA) compared with the treatment decision based on sleep studies (polysomnography or respiratory polygraphy), guidelines, and experience of participating physicians. This was a simulated intention-to-treat study in a retrospective (G1) and prospective (G2) cohort. Four observers (two per group) called CC1 and CC2 reviewed the sleep questionnaires and indicated CPAP if the patients presented snoring, frequent apneas (≥ 3-4/week), body mass index (BMI) > 25 kg/m2, sleepiness (Epworth > 11), or tiredness (at least 3-4 times per week) and some comorbidity (hypertension, coronary/cerebrovascular event, diabetes). Ten independent observers formed two groups of five (FD1 and FD2) and were blinded to each other's opinion. These observers in FD1 and FD2 decided CPAP treatment based on guidelines of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) or guidelines of the American Academy of Sleep Medicine (AASM) and factored in their own opinion. Sensitivity (S), specificity (Sp), and positive/negative likelihood ratios (LR+/-) were calculated with the test method: CC1/2, and the reference method: majority decision of FD1/2. A total of 653 patients (264 women, 40%) were studied. Median age was 54 years, BMI 28 kg/m2, and apnea hypopnea index (AHI) 16.5 events/h. S ranged from 21 to 25% (p 0.60), Sp 96.1 to 97.6% (p 0.39), and LR+ of clinical criteria 6.4 to 8.9 (p 0.52). CPAP indication without a previous sleep study showed a low sensitivity (≅ 22%) but a specificity greater than 95% in patients with high pretest probability for OSA (snoring, report of frequent apneas, BMI > 25 kg/m2 and sleepiness or tiredness plus comorbidity).

SLEEP OUTCOMES FROM AWAKE-HF, A RANDOMIZED CLINICAL TRIAL WITH OPEN-LABEL EXTENSION OF SACUBITRIL/VALSARTAN VERSUS ENALAPRIL IN PATIENTS WITH HEART FAILURE WITH REDUCED EJECTION FRACTION

The AWAKE-HF study evaluated the effect of sacubitril/valsartan (S/V) versus enalapril on sleep using actigraphy and a home sleep study in patients (pts) with heart failure with reduced ejection fraction (HFrEF). Pts 18 to 80 years of age with New York Heart Association (NYHA) class II/III HFrEF

Use of Berlin questionnaire in comparison to polysomnography and home sleep study in patients with obstructive sleep apnea

BackgroundObstructive sleep apnea syndrome (OSAS) is a common disorder with significant morbidity and mortality. We aimed to evaluate the predictive accuracy of the Berlin questionnaire in patients with suspected OSAS undergoing PSG in the sleep laboratory setting against those going through the Embletta™ portable diagnostic system (Embletta PDS) at home.MethodsPatients with suspected OSAS were recruited from respiratory clinics to complete Berlin questionnaire and Epworth Sleepiness Score (ESS). Patients were randomized to undergo either home-based sleep test (group A) or hospital-based polysomnography (PSG) (group B).ResultsThree hundreds and sixteen subjects with newly referred suspected OSAS were recruited and randomized into group A (n = 157) and group B (n = 159). The prevalence of moderate to severe OSAS defined as apnea-hypopnea index (AHI) ≥ 15/h was 54%. The Berlin questionnaire identified 69.7% (n = 99) of subjects as high risk in group A and 77.5% (n = 100) in group B. The sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of the questionnaire to predict an AHI ≥ 15/h as diagnosed by PSG was 78, 23, 67 and 35%. When compared with Embletta PDS, the specificity and NPV increased to 48 and 63%. The area under the Receiver Operator Curve (ROC) based on PSG (AUC = 0.539, 95%CI 0.417, 0.661) and based on home Embletta (AUC = 0.712, 95%CI 0.617, 0.907).ConclusionsThe questionnaire was not reliable in predicting OSAS through PSG AHI whereas there was some predictive ability in discriminating patients with OSAS from normal subjects based on home Embletta sleep test.Trial registrationThe study was registered at ClinicalTrials.gov (Identifier: NCT01828216) on 10 April 2013.

A study of sleep in patients undergoing ostomy for intrapelvic tumors

A study of sleep in patients undergoing ostomy for intrapelvic tumors

Can Number of Sites of Obstruction Be Predicted on a Level 3 Home Sleep Study?

Objective: To assess the number of levels of obstruction on a level 3 home sleep study in patients with obstructive sleep apnea. Study Design: This is a prospective study. Setting: Tertiary referral centre. Subjects and Methods: All the patients with the complaints of snoring, excessive daytime sleepiness, were evaluated for OSA. Complete history was taken and a thorough clinical examination was done followed by fibreoptic nasopharyngoscopy to determine the sites of obstructions. Patients were categorised into group A and group B based on the number of levels of obstruction. A level 3 home sleep study also was done for these patients. We tried to correlate the polysomnographic variables between the two groups. Results: There was a significant difference between the two groups in a number of PSG parameters. Patients in A group had lower number of apnoeas, obstructive apnoeas, hypopneas, AHI index, flow limitation and BMI as compared to patients in group B and the difference was statistically significant. We have devised a score using 3 parameters AHI, Flow limitation with snoring and BMI, the Deenadayal’s (DDS) scoring system. The minimum scoring would be 3 and maximum score would be 6. Based on scoring the probable number of obstructions can be identified. Conclusion: Sleep study report can yield a lot of information regarding the number of levels of obstruction. A critical analysis is required while doing the same. Till date there have been no reports in literature identifying number of levels of obstruction on PSG.

Prevalence and Predictors of Arrhythmia in Patients with Obstructive Sleep Apnea.

ObjectivesTo assess the prevalence and types of arrhythmias in Saudi OSA patients and to identify predictors of arrhythmia in this group of patients.MethodsThis case-control study included all patients who underwent level I attended overnight polysomnography between 2009 and 2012. Electrocardiographic data collected during sleep studies of patients with and without OSA were manually reviewed.ResultsThe study comprised 498 patients (394 OSA patients and 104 non-OSA patients (controls). The prevalence of arrhythmia in OSA patients was higher than that in the controls (26.9% vs. 11.5%; p=0.001). Comparing OSA patients and controls showed: premature atrial contraction (10.2%vs.2.9%;p=0.019), premature ventricular contraction (PVC) (19.3%vs.9.6%;p=0.02), non-isolated PVC (bi/tri/qua) 10.8%vs.2.3%;p=0.04) and atrial fibrillation (1.6%vs.0%;p=0.001). Multiple logistic regression analysis revealed that, patients with OSA had twice the odds of having any cardiac arrhythmia (OR 1.91; CI 95% 1.27-3.11; p <0.05).ConclusionsPatients with OSA had a higher prevalence of arrhythmia compared to controls, and OSA is a predictor of arrhythmia during sleep.

Síndrome de apnea-hipopnea obstructiva del sueño y enfermedades respiratorias

El síndrome de apnea-hipopnea obstructiva del sueño (SAHOS) es una enfermedad sistémica con afectación de múltiples órganos. El presente artículo trata la relación que existe entre el SAHOS y algunas enfermedades que comprometen el sistema respiratorio como son la enfermedad pulmonar obstructiva crónica, el asma, la tos crónica, el síndrome de hipoventilación alveolar y la fibrosis pulmonar. Por lo general, cada una de estas afectaciones se diagnostica por separado, pero es importante conocer su relación de coexistencia para definir la necesidad de realizar estudios del sueño diagnósticos a los pacientes con enfermedades respiratorias, en especial cuando hay un grado desproporcionado de hipertensión pulmonar al esperado por solo la presencia de la enfermedad respiratoria.

Can telemetry data obviate the need for sleep studies in Pierre Robin Sequence?

ObjectiveThis study looks to correlate telemetry data gathered on patients with Pierre Robin Sequence (PRS) with sleep study data. Strong correlation might allow obstructive sleep apnea (OSA) to be reasonably predicted without the need for sleep study. MethodsCharts from forty-six infants with PRS who presented to our children's hospital between 2005 and 2015 and received a polysomnogram (PSG) prior to surgical intervention were retrospectively reviewed. Correlations and scatterplots were used to compare average daily oxygen nadir, overall oxygen nadir, and average number of daily desaturations from telemetry data with apnea-hypopnea index (AHI) and oxygen nadir on sleep study. Results were also categorized into groups of AHI ≥ or <10 and oxygen nadir ≥ or <80% for chi-squared analysis. ResultsOur data did not show significant correlations between telemetry data and sleep study data. Patients with O2 nadir below 80% on telemetry were not more likely to have an O2 nadir below 80% on sleep study. Patients with an average O2 nadir below 80% did show some correlation with having an AHI greater than 10 on sleep study but this relationship did not reach significance. Of 22 patients who did not have any desaturations on telemetry below 80%, 16 (73%) had an AHI >10 on sleep study. ConclusionsIn the workup of infants with PRS, the index of suspicion is high for OSA. In our series, telemetry data was not useful in ruling out severe OSA. Thus our data do not support forgoing sleep study in patients with PRS and concern for OSA despite normal telemetry patterns.

Correlation of Lateral Cephalogram and Flexible Laryngoscopy with Sleep Study in Obstructive Sleep Apnea.

Objective. To study the correlation between lateral cephalogram, flexible laryngoscopy, and sleep study in patients diagnosed with obstructive sleep apnea (OSA). Background. Screening tools should be devised for predicting OSA which could be performed on an outpatient basis. With this aim we studied the skeletal and soft tissue characteristics of proven OSA patients. Methods. A prospective study was performed in patients diagnosed with obstructive sleep apnea by sleep study. They were evaluated clinically and subjected to lateral cephalometry and nasopharyngolaryngoscopy. The findings were matched to see if they corresponded to AHI of sleep study in severity. An attempt was made to see whether the data predicted the patients who would benefit from oral appliance or surgery as the definitive treatment in indicated cases. Results. A retropalatal collapse seen on endoscopy could be equated to the distance from mandibular plane to hyoid (MP-H) of lateral cephalometry and both corresponded to severity of AHI. At the retroglossal region, there was a significant correlation with MP-H, length of the soft palate, and AHI. Conclusion. There is significant correlation of lateral cephalogram and awake flexible nasopharyngolaryngoscopy with AHI in OSA. In unison they form an excellent screening tool for snorers.

Circulation time measurement from sleep studies in patients with obstructive sleep apnea.

Lung to finger circulation time (LFCT) can be estimated from polysomnography (PSG) in the presence of an apneic event by using oxygen as an indicator and a finger as the site of detection. The purpose of this study was to refine the methodology of LFCT measurement and to compare LFCT in patients with obstructive sleep apnea (OSA) with and without heart failure (HF). In a retrospective manner, 10 LFCT measurements per patient were made from the PSG in 171 consecutive patients with a diagnosis of OSA who were divided into two groups: (a) those with a clinical history of underlying HF (N = 42) and (b) those without HF (N = 129). Mean values were compared between the two groups. We also examined associations of LFCT with various factors in each group and the combined group separately using multiple regression analysis. Gender and age were significantly associated with LFCT in patients with OSA alone. Use of β-blockers was associated with LFCT in the group with OSA with HF. Among the entire cohort, HF, β-blocker, gender, and age were found to be significantly associated with LFCT. The presence of HF was the strongest predictor of a prolonged LFCT (adjusted mean LFCT: OSA only = 18.5 [95% CI: 17.2-19.7 sec] vs. OSA with HF = 26.1 [95% CI: 24.3-28.0 sec], p < 0.0001). LFCT can be reliably measured and is prolonged in patients with OSA and underlying HF. LFCT based on PSG may be a useful marker for detection of coexisting HF in patients with OSA.

Prognostic implication of obstructive sleep apnea diagnosed by post-discharge sleep study in patients presenting with acute coronary syndrome

ObjectiveWe aimed to determine the prognostic implications of obstructive sleep apnea (OSA) diagnosed during the recovery phase of acute coronary syndrome (ACS). MethodsPatients presenting with ACS and treated with percutaneous coronary intervention were recruited prospectively for a home-based sleep study within 30days of hospital discharge. Major adverse cardiac and cerebrovascular events (MACCEs) assessed included cardiac death, myocardial infarction, stroke, unplanned revascularization, and hospitalization for heart failure. ResultsOf the 85 patients recruited, 68 successfully completed the study. The median time from percutaneous coronary intervention to sleep study was 14days (interquartile range: 7.5–27days). OSA was diagnosed in 24 patients (35.3%) (apnea–hypopnea index ⩾15). A drug-eluting stent was implanted into the target lesion in 45 patients (66.2%). None of the study patients had received treatment for OSA. At 24-month follow-up, the MACCE incidence was 34.9% in the OSA group and 5.1% in the non-OSA group (P=0.008, log-rank test). After adjusting for the possible confounding effect of age, gender, coronary intervention indications, hypertension, smoking, and body mass index, OSA remained an independent predictor of MACCEs (adjusted hazard ratio, 6.95; 95% confidence interval, 1.17–41.4; P=0.033). ConclusionOSA diagnosed in patients treated with percutaneous coronary intervention for ACS by post-discharge sleep studies conducted 2weeks after percutaneous coronary intervention was independently associated with MACCEs at 24-month follow-up.

Effect of increasing depth of dexmedetomidine and propofol anesthesia on upper airway morphology in children and adolescents with obstructive sleep apnea

Study ObjectiveTo examine the dose–response effects of dexmedetomidine (DEX) and propofol (PROP) on airway morphology in children and adolescents with a history of obstructive sleep apnea (OSA). DesignProspective, single-blinded, controlled comparative study. SettingUniversity-affiliated teaching hospital. Patients60 patients with a history of OSA who presented for a magnetic resonance imaging (MRI) sleep study. InterventionsPatients were randomized to two equal groups (DEX or PROP). Magnetic resonance images of the airway were obtained during low (1 μg/kg/hr) and high (3 μg/kg/hr) doses of DEX, or low (100 μg/kg/m) and high (200 μg/kg/m) doses of PROP, based on group assignment. MeasurementsThe airway anteroposterior (AP) diameter, transverse diameter, and sectional areas were measured at the level of the nasopharyngeal airway and retroglossal airway. The influence of the two drugs and OSA severity, as determined by polysomnography, on airway dimensions was examined using mixed-effects analysis of covariance models. Main ResultsUpper airway morphology was completed in 45 patients. Most airway measurements showed statistically nonsignificant associations with increasing doses of PROP and DEX. As the dosage increased, average airway dimensions were typically unchanged or slightly increased with DEX compared with airway dimensions that were unchanged or slightly decreased with PROP. An airway intervention was required in three children (11%) in the DEX group and 7 children (23%) in the PROP group (P = NS). ConclusionsBoth agents provided an acceptable level of anesthesia for MRI sleep studies in patients with OSA, with statistically nonsignificant changes in airway dimensions.

Reduced orexin-A levels in frontotemporal dementia: possible association with sleep disturbance.

Sleep disturbances including excessive daytime sleepiness (EDS) are encountered in frontotemporal dementia (FTD). To investigate the relationship between the plasma orexin-A levels and sleep disturbance patterns, we measured the plasma orexin-A levels and performed sleep studies in patients with FTD. The orexin-A levels were measured in 10 consecutive patients with FTD and controls by enzyme-linked immunosorbent assay. Nocturnal polysomnography (PSG) and Multiple Sleep Latency Test (MSLT) were performed in 2 patients with FTD. The orexin-A levels were significantly lower in patients with FTD compared to controls. The PSG revealed increased rapid eye movement (REM) latency in patients, whether or not they reported EDS. Mean sleep latency in MSLT was less than 10 minutes in both the patients, being shorter in patient without EDS, but none of them had REM sleep onset. Some patients with FTD may develop narcolepsy-like involuntary sleep attacks, even without complaining of EDS. Involvement of hypothalamus and a subsequent alteration in the orexin levels might be one of the determining factors in this sleep disturbance.