Prevalence Of Snoring Research Articles

Gender-specific association between snoring and total sleep duration with type 2 diabetes mellitus in rural adults.

To investigate the separate and joint association between snoring and total sleep duration with the risk of type 2 diabetes mellitus (T2DM) in both genders within Chinese rural community. The Henan Rural Cohort Study included a total of 28093 participants. Data on snoring and total sleep duration were obtained through the Pittsburgh Sleep Quality Index (PSQI). Binary logistic regression was employed to assess the correlation between snoring and total sleep duration with T2DM. The prevalences of T2DM were 8.53% in males and 9.27% in females. Males exhibited a higher prevalence of snoring (34.90%) compared to females (22.42%), and the median of total sleep duration was also longer in males (8.83h) than in females (8.67h), respectively (P < 0.001). Females who snored had an adjusted odds ratio (OR) and 95% confidence interval (CI) for T2DM of 1.19 (1.06, 1.35) when contrasted with non-snorers. Compared with optimal total sleep duration (6-8h), longer total sleep duration (≥ 8h) increased the prevalence of T2DM by 17% (95%CI: 3%, 32%) in females. Additionally, the participants with shorter total sleep duration (< 6h) and snoring have the highest risk of T2DM, with an increase of 91% (95%CI: 20%, 204%) than those with optimal total sleep duration and non-snorers in females. These significant associations were not found in males. Snoring and longer total sleep duration independently elevated the prevalence of T2DM. Meantime, a synergistic relationship was observed between snoring and total sleep duration with a higher prevalence of T2DM. These associations exhibited gender-specific differences.

A genome-wide association study based on the China Kadoorie Biobank identifies genetic associations between snoring and cardiometabolic traits

Despite the high prevalence of snoring in Asia, little is known about the genetic etiology of snoring and its causal relationships with cardiometabolic traits. Based on 100,626 Chinese individuals, a genome-wide association study on snoring was conducted. Four novel loci were identified for snoring traits mapped on SLC25A21, the intergenic region of WDR11 and FGFR, NAA25, ALDH2, and VTI1A, respectively. The novel loci highlighted the roles of structural abnormality of the upper airway and craniofacial region and dysfunction of metabolic and transport systems in the development of snoring. In the two-sample bi-directional Mendelian randomization analysis, higher body mass index, weight, and elevated blood pressure were causal for snoring, and a reverse causal effect was observed between snoring and diastolic blood pressure. Altogether, our results revealed the possible etiology of snoring in China and indicated that managing cardiometabolic health was essential to snoring prevention, and hypertension should be considered among snorers.

Regular snoring is associated with uncontrolled hypertension

Snoring may be a risk factor for cardiovascular disease independent of other co-morbidities. However, most prior studies have relied on subjective, self-report, snoring evaluation. This study assessed snoring prevalence objectively over multiple months using in-home monitoring technology, and its association with hypertension prevalence. In this study, 12,287 participants were monitored nightly for approximately six months using under-the-mattress sensor technology to estimate the average percentage of sleep time spent snoring per night and the estimated apnea-hypopnea index (eAHI). Blood pressure cuff measurements from multiple daytime assessments were averaged to define uncontrolled hypertension based on mean systolic blood pressure≥140 mmHg and/or a mean diastolic blood pressure ≥90 mmHg. Associations between snoring and uncontrolled hypertension were examined using logistic regressions controlled for age, body mass index, sex, and eAHI. Participants were middle-aged (mean ± SD; 50 ± 12 y) and most were male (88%). There were 2467 cases (20%) with uncontrolled hypertension. Approximately 29, 14 and 7% of the study population snored for an average of >10, 20, and 30% per night, respectively. A higher proportion of time spent snoring (75th vs. 5th; 12% vs. 0.04%) was associated with a ~1.9-fold increase (OR [95%CI]; 1.87 [1.63, 2.15]) in uncontrolled hypertension independent of sleep apnea. Multi-night objective snoring assessments and repeat daytime blood pressure recordings in a large global consumer sample, indicate that snoring is common and positively associated with hypertension. These findings highlight the potential clinical utility of simple, objective, and noninvasive methods to detect snoring and its potential adverse health consequences.

Prevalence of Snoring in Pregnancy and Its Maternal-Fetal Outcomes at Vajira Hospital

Background: Snoring is an important symptom that is associated with obstructive sleep apnea and increases the risk of adverse pregnancy outcomes. In Thailand, the prevalence of snoring during pregnancy is uncertain. Determining the prevalence and characteristics may reduce the prevalence of snoring and improve pregnancy outcomes. Objective: The primary outcome was to determine the prevalence of snoring in Thai pregnant women in the third trimester, including pregnancy and chronic onset. The secondary outcome was to investigate the associations between pregnancy outcome and habitual snorer or those identified as high risk by the Thai Berlin Questionnaire. Materials and Methods: Three hundred eighty-two singleton pregnant women aged at least 18 years and at least 33 weeks of gestational age were recruited from the antenatal care clinic at Vajira Hospital, Navamindradhiraj University, between November 2021 and September 2022 and filled out the Thai Berlin Questionnaire. The 382 pregnant women were identified the presence of snoring or high risk of OSA in the previous month. Medical records, including demographic information and pregnancy outcomes, were collected, and analyzed. Results: The prevalence of snoring was 31.4% in the third trimester of pregnancy of which 27% were pregnancy onset snoring and 4.4% were chronic onset snoring. Habitual snoring was significantly different from non-snoring in regard to the requirement for positive-pressure ventilation in newborns (aOR 6.67, 95% CI 1.2 to 35.54). The high risk group had significantly more pregnancy induced hypertension than the low risk group (aOR 5.96, 95% CI 2.15 to 16.5), gestational hypertension (aOR 13.6, 95% CI 2.1 to 86.8), preeclampsia (aOR 4.07, 95% CI 1.09 to 15.2), severe preeclampsia (aOR 4.9, 95% CI 1.15 to 20.93), preterm birth (aOR 6.21, 95% CI 1.58 to 24.42), and low birth weight of newborn (aOR 6.09, 95% CI 2.5 to 14.87). Conclusion: The prevalence of snoring among Thai pregnant women was comparable to previous Western studies. Screening pregnant women at risk of the symptom may provide an early chance to lower the prevalence of snoring and adverse pregnancy outcomes. Keywords: Snoring; Snoring in pregnancy; Pregnancy outcomes

0802 Quantifying Screening Efficacy and Referral Patterns in Well Child Visits

Abstract Introduction Sleep-disordered breathing (SDB) can have profound impacts on pediatric physical, psychological and behavioral health. However, proactive history taking is needed to identify the signs of SDB, such as snoring. The American Academy of Pediatrics (AAP) therefore recommends that primary care providers actively screen for snoring at routine health maintenance visits. This study aims to assess the use of a snoring screening tool in our institution’s Electronic Medical Record (EMR) well child visit templates and subsequent rate of screening for sleep disordered breathing during routine pediatric visits. Methods We queried our institution’s electronic medical record for all patients ages 0-17 years who were presenting for their Well Child Visit (WCV) from January 1, 2019 through September 30, 2022. The query yielded a convenience sample of 428,632 children. The question “does your child snore” was embedded into the WCV template for all primary care providers. Results Before the pandemic only 12.3% of WCVs (52,695 patients) had a completed screening question. The snoring prevalence was 6.4% (4,034 patients) with 15% (594 patients) of those who screened positive for snoring receiving a referral to ENT or sleep medicine (65% to ENT). During the COVID pandemic (2020-2021) the screening rate was 13.4%. The snoring prevalence was 5.2% with 19% being referred to ENT or sleep medicine. There was also an increase in screening during the COVID pandemic, but screening usage reverted to pre-COVID levels when pandemic restrictions eased in 2022. Conclusion The introduction of a snoring screening tool in generic WCV note templates did not significantly improve the rate of screening for sleep disordered breathing at routine pediatric visits. However, this embedded tool was used more often during the SARS-CoV2 pandemic, when many visits were performed using telemedicine. Our data collection also highlighted a high prevalence of snoring within our institution and a referral pattern that largely routes these children directly to Otolaryngology versus Pediatric Sleep Medicine. This makes it imperative to continue brainstorming ways to support primary providers' abilities to screen for SDB and empower them with management options. Support (if any) None

Obstructive sleep apnea and orofacial myofunctional aspects in obesity.

This study aimed to evaluate the quality of sleep, presence of obstructive sleep apnea (OSA), and its relationship with the presence of snoring, cephalometric characteristics, degree of collapse of the upper airways, and orofacial myofunctional profile in obese and overweight individuals. All participants completed polysomnography, as well assleep and snoring questionnaires. We further performed orofacial, otorhinolaryngological, and anthropometric evaluations on all participants. A total of 102 adults, comprising 29 obese, 21 overweight, and 52 eutrophic individuals of both sexes participated in this study. We observed a high prevalence of snoring in both obese and overweight (100%), and in 65% of eutrophic individuals. Among the obese subjects58% had a severe degree of OSA, whereas 4% of eutrophic subjects presented a risk for OSA development. Sleep quality was related to body mass index (BMI) and cervical and abdominal circumference. All obese and overweight individuals presented with orofacial myofunctional alterations such as facial asymmetry, alteration of the maxilla-jaw relationship, inadequate tongue posture, changes in masticatory pattern and swallowing, and inadequate general orofacial myofunctional condition. Airway obstructions at the retropalatal and retrolingual levels > 75% were observed in at least 48% of the individuals. Obese and overweight individuals presented a higher risk for the development of OSA compared with eutrophic patients, and obese individuals presented a greater severity of OSA. The higher the BMI and greater the cervical and abdominal circumferences, the higher the prevalence of OSA, worse the quality of sleep, and more serious orofacial myofunctional characteristics in this population.

Association of self-reported snoring with decreased retinal thickness and vessel density.

Purpose: Self-reported snoring has been reported to influence nerves and vessels. However, there are few direct evidences of snoring related to nerves and microvessels defects. Therefore, we evaluated the association of self-reported snoring with retinal structure and microcirculation. Methods: A total of 2,622 participants were recruited from the Jidong eye cohort study (JECS). Physical examinations, laboratory tests, and questionnaires were recorded. We also used optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) to assess the retinal structure and microvascular network. Snoring was defined as “never,” “occasionally,” and “frequently or more severe” according to self-reported frequency. Results: The prevalence of snoring were 84.6% (n = 983) and 45.0% (n = 657) in males and females, respectively. Compared with never snoring group, the retinal thickness increased in “occasionally” (p < 0.001) and “frequently or more severe” groups (p = 0.001), while no difference was found between snoring groups (p = 0.14). Superficial retinal capillary plexus (RCP) vessel density was lower in “frequently or more severe” group than in “never” (p < 0.001) and “occasionally” snoring groups (p < 0.001). After adjusting for confounders, “frequently or more severe” snoring was significantly associated with thinner total retinal thickness [β = −2.79 (95% CI: −5.27, −0.30)] and lower superficial RCP vessel density [β = −0.71 (95% CI: −1.19, −0.23)]. Conclusion: Our research showed self-reported snoring was associated with thinner retinal thickness and lower superficial RCP vessel density. The findings of our study emphasize the need for self-reported snoring assessments in determining retinal structure and microcirculation impairment.

Risk factors for habitual snoring among children aged 2-14years in Chengdu, Sichuan.

Habitual snoring (HS) is a prominent symptom of sleep-disordered breathing; thus, it isalso important to consider the associated, multidimensional risk factors for HS in children. This study was aimed to identify risk factors for HS in children. A cross-sectional survey was performed in Chengdu. Children aged 2-14years from four districts were randomly chosen to participate. Questionnaires were voluntarily completed by the children's guardians. The survey included 926 boys and 622 girls, who were an average of 6.4 ± 3.0years old. The sample included 463 habitual snorers (30.4%), 683 occasional snorers (44.8%), and 402 nonsnorers (26.4%). HS was found in 51.8% of children under 7years old and 26.6% of children aged 7years old or older. The prevalence of pregnancy complications was significantly lower in mothers who bore children with HS (p = .006). Among the HS group, 86.6% had an immediate family member who snores. Breastfeeding duration among the HS group was significantly less than among the occasional snoring and nonsnoring groups. History of symptoms of allergic rhinitis, rhinosinusitis, tonsillitis, and pneumonia/bronchitis in the past 6months was associated with HS. Likewise, maternal smoking during pregnancy, maternal exposure to secondhand smoke during pregnancy, and child exposure to secondhand smoke were also associated with HS. The prevalence of HS was higher in children under 7years old. Having a mother with more education, a family history of snoring, a shorter period of breastfeeding, upper respiratory tract inflammation, and passive smoking are important risk factors for HS. Pregnancy complications may be associated with lower prevalence of snoring in childhood.

Sleep disordered breathing and oral health-related quality of life in children with different skeletal malocclusions

ABSTRACT Objective To evaluate the relationship among different skeletal malocclusion patterns, sleep-disordered breathing (SDB) and children’s oral health-related quality of life (OHRQoL). Methods Two hundred-five patients were divided into three groups, considering skeletal malocclusion. Parents completed the Pediatric Sleep Questionnaire (PSQ) on behalf of the patients, who completed the 14-question version of the Oral Health Impact Profile (OHIP-14). Results SDB was observed in 10.7% of children. The overall prevalence of snoring, difficulty breathing during sleeping, mouth breathing, and dry mouth on awakening was 8.78%, 7.31%, 36.09%, and 37.07%, respectively. However, there was no significant difference in OHIP-14 parameters among the skeletal groups. A positive correlation was found between OHIP-14 and PSQ and was significant in Class I and III. Conclusion Although there was no significant difference, SDB risk and sleep quality were found as most to least problematic, in the following sequential order: Class II > Class III > Class I.

Sleep Apnea Screening in Children With Sickle Cell Anemia

Screening for obstructive sleep apnea (OSA) is recommended by current guidelines in children with sickle cell anemia (SCA), but no specific approach is described. The Pediatric Sleep Questionnaire (PSQ) is a validated detection tool for OSA in children. We assessed the utility of PSQ to screen for OSA in children with concomitant SCA and snoring. A prospective study, in children 4 to 18 years old with SCA. Subjects were assessed for snoring and PSQ administered at the same visit. All children with snoring were then referred for polysomnography. A total of 106 subjects were screened. Habitual snoring prevalence was 51/106 (48.1%). In the snoring group, OSA was detected in 83.9% (apnea-hypopnea index [AHI] ≥1.0/h) and 22.6% (AHI ≥5.0/h), respectively. Sensitivity and specificity of PSQ in children with snoring was 46.2% and 20.0% (AHI ≥1.0/h), and 57.1% and 50.0% (AHI ≥5.0/h), respectively. Physician assessment for snoring had a high sensitivity of 70.3% but low specificity of 58.4% (AHI ≥1.0/h), and 87.5% and 41.5% (AHI ≥5.0/h), respectively. PSQ is a poor screening tool for detection of OSA in those children with SCA who snore. Physician assessment for snoring could however be an initial approach before polysomnography.

Snoring increases the development of coronary artery disease: a systematic review with meta-analysis of observational studies.

Snoring is one of the cardinal presentations of obstructive sleep apnea (OSA) and is more common than OSA. Abundant evidence has suggested a robust association between OSA and coronary artery disease (CAD). However, whether or not snoring alone is related to a higher risk of CAD is unknown. This study systematically reviewed observational studies with meta-analysis to evaluate the linkage between snoring and CAD. We searched PubMed and Embase and retrieved 13 articles focusing on the relationship between snoring and CAD. These articlesincluded a total of 151,366 participants and 9099 CAD patients. Quantitative analysis indicated that snoring was associated with a 28% (RR: 1.28, 95% CI: 1.13 to 1.45, P < 0.001) increase in the risk of developing CAD. Snorers are exposed to a 28%increased risk for CAD. Although the association may be partly mediated through OSA, most snorers are not affected by apnea. Given the high prevalence of snoring and thedisease burden of CAD in the general population, screening for snoring may be worthwhile for the early prevention of CAD.

Relationship between Snoring and Lifestyle-related Diseases among a Japanese Occupational Population.

Objective Snoring is a common physical condition in active workers. However, the link between snoring and health problems is poorly understood. Therefore, the prevalence of snoring in Japanese workers and the relationships between snoring and lifestyle-related diseases were investigated. Methods This was a retrospective, single-center, cross-sectional study. The results of a single year's medical examinations were investigated for 25,141 Japanese active office workers 20 to 59 years old. The presence and duration of snoring were investigated using a personal computer at a medical interview before the medical checkup. The snoring frequency was investigated for each gender. In addition, the relationships between snoring and hypertension, diabetes, and dyslipidemia were also analyzed. Results Men (21,774) were a mean 46±6 years old with a snoring prevalence of 43%. Women (3,367) were a mean 46±6 years old with a snoring prevalence of 20%. In men, snoring was an independent comorbid factor of hypertension and dyslipidemia. In particular, a long snoring vintage (multiple years) was an independent comorbid factor for hypertension [odds ratio (OR), 1.14; 95% confidence interval (CI), 1.05-1.24; p=0.002; and OR, 1.20; 95% CI, 1.07-1.34; p=0.001]. In women, snoring was not an independent comorbid factor for lifestyle-related diseases when adjusted for the age and body mass index. Conclusion Snoring was shown to be a frequent pathophysiology in active workers. It was a health indicator for active workers, and especially in men, intervention for snoring may reduce the risk of developing lifestyle-related diseases.

Pediatric sleep-disordered breathing in the orthodontic population: Prevalence of positive risk and associations

Pediatric sleep-disordered breathing (SDB) describes a spectrum of disease ranging from snoring to upper airway resistance syndrome and obstructive sleep apnea (OSA). Anatomical features assessed during orthodontic exams are often associated with symptoms of SDB in children. Hence, we need to determine the prevalence of positive risk for SDB in the pediatric orthodontic population compared with a general pediatric population and understand comorbidities associated with SDB risk among orthodontic patients. Responses from Pediatric Sleep Questionnaires were collected from 390 patients between the ages of 5 and 16years, seeking orthodontic treatment. Prevalence of overall SDB risk, habitual snoring, and sleepiness were determined in the orthodontic population and compared with those previously reported by identical methods in the general pediatric population. Additional health history information was used to assess comorbidities associated with SDB risk in 130 of the patients. At 10.8%, the prevalence of positive SDB risk was found to be significantly higher in the general pediatric orthodontic population than in a healthy pediatric population (5%). The prevalence of snoring and sleepiness in the orthodontic population was 13.3% and 17.9%, respectively. Among the comorbidities, nocturnal enuresis (13.6%), overweight (18.2%), and attention deficit hyperactivity disorder (31.8%) had a higher prevalence in orthodontic patients with higher SDB risk (P<0.05). There is a higher pediatric SDB risk prevalence in the orthodontic population compared with a healthy pediatric population. Orthodontic practitioners should make SDB screening a routine part of their clinical practice.

The prevalence of snoring and its related family factors of children from 3 to 14 years old in Beijing

Objective: To investigate the snoring status and related family factors of children from 3 to 14 years old in Beijing. Methods: From May to July, 2015, data of children from 3 to 14 years old were obtained from a status survey from 7 districts(Xicheng, Chaoyang, Changping, Shunyi, Fangshan, Huairou and Mentougou) in Beijing. A total of 11 420 children from 25 primary and middle schools were randomly selected. Pediatric Sleep Questionnaire (PSQ) and a self-administered questionnaire were carried out for the adopted children. Self-administered questionnaire included the snoring related family factors. Logistic regression was used to estimate the odd ratio(OR) with 95% confidence intervals for variables. Results: A total of 9 198 children meet the inclusion criteria and are analyzed in the study, of whom 901 (9.80%) were found with snoring behavior. The incidence of boys is higher than girls. Obese children take higher risk of snoring. Compared with younger children (≤6 years old), older children (≥12 years old) have a significantly lower risk of snoring (OR=0.464, 95%CI 0.368-0.585). There is no statistical association between full-term infants, infant feeding pattern, parental cigarette smoking and child snoring.The children with family history of snoring have a significantly higher risk of snoring occurrence. The educational background of mother is statistically related to children snoring (OR=1.241, 95%CI 1.058-1.457). Conclusions: The incidence of children snoring in Beijing is 9.80%, male gender, obesity, and young age are all risk factors for children snoring. There is a significantly statistical relationship between snoring and related family factors, such as family snoring history and education experience.

Parental reports showed that snoring in infants at three and eight months associated with snoring parents and smoking mothers.

This prospective study examined the prevalence of snoring during infancy and the prenatal and postnatal risk factors for this condition. The study population comprised 1388 infants from the CHILD-SLEEP birth cohort, who were recruited in the Pirkanmaa Hospital District, Finland, between 2011 and 2013. Sleep and background factor questionnaires were filled out prenatally by parents and when the infant was three and eight months old. The prevalence of habitual snoring was 3.2% at the age of three months and 3.0% at eight months, and snoring infants had more sleeping difficulties at those ages, with odds ratios (ORs) of 3.11 and 4.63, respectively. At three months, snoring infants slept for a shorter length of time (p=0.001) and their sleep was more restless (p=0.004). In ordinal logistic regression models, parental snoring (adjusted OR=1.65 and 2.60) and maternal smoking (adjusted OR=2.21 and 2.17) were significantly associated with infant snoring at three and eight months, while formula feeding and dummy use (adjusted OR=1.48 and 1.56) were only associated with infant snoring at three months. Parental snoring and maternal smoking increased the risk of snoring. Infants who snored also seemed to suffer more from other sleep difficulties.

Prevalence of sleep-disordered breathing and associations with orofacial symptoms among Saudi primary school children

BackgroundThis study aimed to determine the prevalence of sleep-disordered breathing among primary school children in Riyadh, Saudi Arabia, and to evaluate associations between sleep-disordered breathing and respiratory conditions/orofacial symptoms.MethodsIn this cross-sectional study, 1600 questionnaires were distributed to Saudi boys and girls aged 6–12 years from 16 primary schools in Riyadh. The questionnaire covered relevant demographic and personal characteristics, presence of respiratory conditions and orofacial symptoms, and the Pediatric Sleep Questionnaire. The latter was used to assess the prevalence of symptoms of sleep-disordered breathing and was completed by the participating children’s parents.ResultsIn total, 1350 completed questionnaires were returned (85% response rate). The children’ mean age was 9.2 ± 1.8 years; 733 (54.3%) were boys and 617 (45.7%) girls. Overall, 21% of children were at high risk of sleep-disordered breathing. The prevalence of snoring was 14.4% and that of sleep apnea 3.4%. Boys were at higher risk of sleep-disordered breathing than girls (P = 0.040). Children with respiratory conditions or orofacial symptoms were at higher risk of sleep-disordered breathing (P < 0.0001) than children without these conditions/symptoms.ConclusionsAround 21% of Saudi children are at risk of sleep-disordered breathing. There is a strong association between sleep-disordered breathing symptoms and the presence of respiratory conditions or orofacial symptoms.

Assessment of the risk of obstructive sleep apnoea syndrome among healthcare workers.

Sleep deprivation is known to increase the risks for workplace accidents, neuro-behavioural symptoms and reduced quality of life. Shift work leads to sleep related problems, such as sleep deprivation, poor sleep quality and daytime sleepiness. The purpose of our study is to assess snoring prevalence and obstructive sleep apnoea risk among healthcare workers (HCWs) by using the Berlin Questionnaire. HCWs employed at different centres that agreed to take part in this study were enrolled. Employing the Berlin Questionnaire, demographic characteristics, smoking histories, comorbidities, on-call shifts, number of on-call shifts and sleep durations of the participants were surveyed. 604 HCWs including specialist, nurse, junior doctor, medical student, clinical academic, health technician and hospital staff were enrolled in this study. In terms of sleep apnoea, 92 (15.1%) participants were identified as high-risk and 512 (84.8%) as low-risk according to the findings of the questionnaire. When the two groups identified as high and low risk for sleep apnoea according to the Berlin Questionnaire were compared, significant differences were found between the two groups in terms of age, sex, height, weight, BMI value and hypertension (p< 0.001 for all variables). Multivariate logistic regression analysis has shown that on-call shifts (OR= 0.199, CI= 0.053-0.747, p= 0.017) are negative associated with sleep apnoea risk. With extended working hours and on-call shifts increasing the risk of sleep disorders among HCWs, surveys designed for screening can be used to identify the prospective cases in this population for further examination.

Pulse transit time in pregnancy: a new way to diagnose and classify sleep disordered breathing?

There are significant discrepancies between the prevalence of snoring and that of objectively defined sleep disordered breathing among pregnant women, suggesting subtle airflow limitations that may not be captured by conventional scoring. This study examined the performance of pulse transit time, an indirect measure of arterial stiffness and sympathetic activation, in pregnancy. Pregnant women with obesity and snoring and a group of controls without symptoms of sleep disordered breathing were recruited in the first trimester. Women underwent a level III in-laboratory sleep monitoring study including an electrocardiogram and pulse oximetry, and pulse transit time was measured. Sleep disordered breathing was defined as an apnea-hypopnea index at least five events per hour of sleep. Statistical analysis was performed using Spearman correlation, Fisher's exact t-test, and univariate analysis. Of the 222 women, 38 met criteria for sleep disordered breathing. Pulse transit time drops were very prevalent (95% of participants with snoring had > 5 drops per hour). Median apnea-hypopnea index was 0.7 (interquartile range [IQR]: 2.6) events per hour whereas median pulse transit time drop index was 20.70 (IQR: 35.90) events per hour. Pulse transit time index was significantly higher in snorers with apnea-hypopnea index less than five events per hours and participants with apnea-hypopnea index greater than five events per hour compared to controls. Examination of random epochs with pulse transit time drops showed that 95% of pulse transit time drops were associated with airflow limitation. Pulse transit time ascertains frequent events of sympathetic activation in at-risk women with and without sleep disordered breathing beyond conventional apneas and hypopneas. Pulse transit time may be an important addition to the identification of clinically significant sleep disordered breathing in pregnant women, and may identify more sleep disordered breathing than apnea-hypopnea index.

Computer Algorithms in Assessment of Obstructive Sleep Apnoea Syndrome and Its Application in Estimating Prevalence of Sleep Related Disorders in Population.

The incorporation of telemedicine and artificial intelligence for early screening and assessment of severity of life-style disorders has a great potential for better assessment in a busy outpatient clinic and thereby curtail down the related morbidities. A computer based algorithm based upon standardized questionnaire (from established assessment tools) is designed to assess the risk of obstructive sleep apnoea syndrome (OSAS). In addition the incorporation of basic screening questions of anamnesis help in suggesting a probable diagnosis of sleep related disorder as well. The overall data at our center has been analyzed to establish the existing pattern of sleep related disorders. Of 850 healthy subjects screened, prevalence of snoring was 20.47% while OSAS was seen in 4.20% (N = 25) in males and 2.64% (N = 8) in females. The parasomnia was most prevalent (14.71%), followed by insomnia (10.24%), periodic leg movement (6.59%), bruxism (1.65%) and narcolepsy (0.59%). Hypertension, laryngopharyngeal reflux and obesity were the common co-morbidities in OSAS while family history of hypertension and diabetes were common in snorers. A significant association with OSA was seen with diabetes mellitus, neck circumference and nasal obstruction, while, obesity and apnoeic episodes were more significantly associated with OSA than snorers. Increased waist to hip ratio was appreciated in both the OSAS and snorers. The algorithm based online assessment is likely to diagnose the occult clinical cases as well as assess the risk of OSAS. In routine outpatient clinic, a clinician may better assess the patient morbidity with a comprehensive availability of symptoms and moreover enhance the post-treatment compliance. In addition a smartphone based computerized assessment for general population may be designed for other lifestyle disorders as well.

Abstract TP215: Clinical Phenotypes of Obstructive Sleep Apnea in Stroke Patients: A Cluster Analysis

Introduction: Obstructive sleep apnea (OSA) is highly prevalent in stroke survivors. Untreated OSA is associated with an increased risk of adverse cardiovascular outcomes and OSA treatment may improve neurological recovery in stroke survivors, yet OSA in stroke patients remains poorly characterized. To our knowledge, this is the first study aiming to identify OSA phenotypes in stroke survivors. Methods: Patients (n=451) with ischemic strokes and OSA (apnea-hypopnea index (AHI) ≥ 10 using a cardiopulmonary screening device (ApneaLink Plus)) were identified from the Brain Attack Surveillance in Corpus Christi (BASIC) project. Latent class analysis was performed based on the following variables: age, sex, race/ethnicity, AHI, pre-stroke snoring, pre-stroke tiredness/fatigue, pre-stroke sleep duration, prior stroke history, initial NIHSS, BMI, hypertension, diabetes, atrial fibrillation, coronary artery disease, and congestive heart failure. Results: A model with 3 phenotype clusters provided the best fit. Cluster 1 (n=55, 12%) was defined by higher NIHSS scores and high prevalence of snoring. Patients in cluster 2 (n=253, 56%) were younger and had relatively low NIHSS scores. Cluster 3 (n=143, 32%) included patients with severe OSA and higher prevalence of medical comorbidities. Conclusion: Ischemic stroke survivors with OSA can be categorized into three clinical phenotype clusters characterized by differences in stroke severity, OSA severity, patient age and medical comorbidities. This highlights the heterogeneity of post-stroke OSA. Awareness of the different faces of OSA in patients with ischemic stroke may help clinicians identify OSA in their patients, and informs research concerning the pathophysiology and prognostication of post-stroke OSA.