STOP-Bang Score Research Articles

Exploratory Study on Impact of Comorbid Sleep Apnea Treatment in Patients with Polycythemia Vera and Essential Thrombocythemia

Background: Systemic inflammation has been implicated in the progression of myeloproliferative neoplasms (MPNs), polycythemia vera (PV) and essential thrombocythemia (ET). Obstructive sleep apnea (OSA) is a highly prevalent disorder that can lead to TNF-driven systemic inflammation. OSA leads to oxidative stress and NF-kB driven inflammatory gene expression through the mechanistic pathways of intermittent hypoxia and autonomic activation. We therefore sought to understand the prevalence of OSA in patients with MPNs and the feasibility of understanding the impact of treating comorbid sleep apnea in patients with PV and ET. Methods: Patients with PV and ET diagnosed using the 2008 or 2016 WHO criteria underwent STOP-BANG questionnaires to evaluate for the likelihood of OSA. Based on the finding of 3 or more positive responses on STOP-BANG questionnaire (PLoS One 2015;10:e0143697), patients underwent further evaluation with polysomnography or home sleep apnea test to diagnose OSA at an American Academy of Sleep Medicine-certified sleep laboratory (Figure 1). Patients with apnea-hypopnea index (AHI) of 5 or more events per hour and Eastern Cooperative Oncology Group scale score of 0-2 underwent continuous positive airway pressure therapy (CPAP). Effects of CPAP therapy on MPN-symptom assessment form total symptom scores (MPN-SAF TSS), JAK2V617F, MPL and CALR allelic burden, and exploratory endpoints of changes in inflammatory and thrombotic markers were ascertained (Figure 1). Comparisons with observational cohorts were planned to ascertain changes in the above endpoints at 0-, 3- and 6-months intervals (Figure 1). Based on a 40% reduction in allele burden (SD of 25%) and correlation of 0.5 between paired measurements, it was estimated that using a paired t-test with 27 evaluable patients will provide a 95% power to detect a 20% change in JAK2V617F burden from 40% to 20%. Similarly, assuming a 50% correlation (SD of 16) between pre- and post-therapy MPN-SAF TSS scores, 27 evaluable patients will provide a 80% power to detect a change of 10 at the two-sided 0.025 significance level. Results: Screening for OSA in patients with ET and PV revealed a high prevalence of OSA risk based on STOP-BANG scores. 26/29 males (mean age 63.6±11.8 years; BMI 29±3.3) and 16/26 females (mean age 61.5±12.8 years; BMI 28.2±6.5) had STOP-BANG scores of 3 or more. 8 patients with PV and ET have so far been enrolled into this study. 6/8 patients (age ranges from 41-74 years; 4 females and 2 males) with OSA (AHI 5-56 events/hr; 4% oxygen desaturation index 4.7-30/hr) underwent CPAP therapy. 1/6 patients in the CPAP arm did not tolerate CPAP and was excluded. 5/6 patients completed study procedures as did 2 additional patients without OSA in the observational study arm. Of 5/6 patients undertaking CPAP, 3/5 had the JAK2V617F mutations whereas 2/5 had the CALR mutation. JAK2V617F allele burdens at baseline in 2/5 patients were 80.7% and 4% at baseline and reduced to 73% and 1% at 6 months respectively whereas the third patient had undetectable JAK2V617F burdens throughout the study. All except one patient experienced improvement in MPN-SAF TSS scores after 6 months of CPAP therapy. While all 5 patients treated with CPAP showed improvements in C-reactive protein levels, analysis of NFkB1, TNF and IL-6 transcript levels showed mixed results. Similar mixed results were found with hypoxia-inducible factor (HIF) target gene expression ( SLC2A1, VEGF-A, EDN1) and markers of iron turnover (% transferrin saturation, transferrin, iron and ferritin levels) despite reduction in erythropoietin values in 4/5 patients with CPAP therapy at 6 months. Conclusions: Given the significant likelihood of OSA in patients with PV and ET (as based on STOP-BANG scores of 3 or more), there is need to evaluate and treat for OSA. Preliminary results show abnormalities in inflammatory markers with reductions in C-reactive protein and erythropoietin levels following CPAP therapy even though mixed results were noted in inflammatory and HIF-target gene transcripts, and markers of iron turnover. Larger studies and longer follow-up are required to understand the impact of OSA on not only the thrombotic and inflammatory milieu in patients with MPNs, but also the benefit of treating on prevention of disease progression and thrombotic manifestations common in MPNs. Funding: Huntsman Interventional Trial Grant CTO #HCI-17-HEM 28.

Health Screening Among a Rural, Hourly Workforce: North Carolina SERVIRE Project

This study demonstrates the feasibility of a novel, business-partnered, and worksite-based approach to healthcare access to facilitate chronic disease screening and diagnosis among rural hourly workers. The prevalence of undiagnosed and untreated diabetes and hypertension among screening participants was determined. From February 2021 to June 2023, investigators partnered with 29 businesses to screen 1,114 workers. Health screenings included a demographic questionnaire, A1c testing for prediabetes (A1c of 5.7-6.4) and diabetes (A1c≥6.5), hypertension (Stage 1: systolic blood pressure of 130-139 mmHg; Stage 2: systolic blood pressure ≥140 mmHg), kidney disease (estimated glomerular filtration rate <60; urine protein ≥1+), and questionnaire assessment of stroke (CHA2DS2-VASc) and sleep apnea (STOP-bang) risk. Of the 1,114 individuals screened (n=632, 56.7% male; n=497, 44.6% Black)), 388 (36%) screened positive for prediabetes or diabetes. Diabetes was previously undiagnosed in 273 (70.4%) of these participants. More than half of the participants (n=680, 62.4%) had an elevated blood pressure reading during the screening, and the majority of these participants (n=445, 65.4%) had not been previously diagnosed with hypertension. In addition, 241 (21.6%) participants were at an increased risk of stroke (CHA2DS2-VASc≥2), and 182 (23.7%) had a STOP-Bang score ≥4, indicating an increased risk of obstructive sleep apnea. By partnering with local businesses to deliver worksite-based health screenings, high rates of undiagnosed and uncontrolled diabetes and hypertension were identified among the rural, hourly workforce. This worksite-based approach to healthcare access could facilitate early detection of chronic disease, improve patient engagement in the healthcare system, and ultimately yield better long-term public health outcomes.

O037 Diagnostic Accuracy of OSA Screening Tools for Acute Coronary Syndrome

Abstract Obstructive sleep apnoea(OSA) is associated with cardiovascular diseases including acute coronary syndrome(ACS). Current estimates suggest some 70% of patients with ACS have OSA. OSA in this population remains under-recognised. This high prevalence calls for effective OSA screening tools for this high-risk population. We aimed to assess the diagnostic accuracy of the Epworth Sleepiness Scale (ESS), Berlin and STOP-BANG questionnaire in screening for OSA in patients with ACS. 70 patients with ACS (age IQR: 58[52,63] years, BMI: 27[24,30]kg/m2) were recruited from the cardiology department following an admission for ACS. Patients were administered with the ESS, Berlin and STOP-BANG questionnaires within 6 months of ACS admission. A level 2 polysomnogram was conducted to confirm the presence and severity of OSA (AHI≥5). The diagnostic accuracy of ESS&amp;gt;10, Berlin questionnaire (high-risk category), STOP-BANG score ≥3 (intermediate-high risk) and STOP-BANG score ≥5 (high-risk) was compared to a level 2 polysomnogram for different OSA severity. OSA (AHI≥5 events/h) was diagnosed in 94% of patients with ACS. 67% of patients had moderate-severe OSA (AHI≥15 events/h). ESS, Berlin and STOP-BANG questionnaires have poor diagnostic accuracy across all severity of OSA (ESS&amp;gt;10, AUC:0.60 (95%CI: 0.42-0.79); Berlin, high risk, AUC:0.54 (95%CI: 0.39-0.68); STOP-BANG ≥3, AUC:0.69 (95%CI: 0.56-0.82); STOP-BANG ≥5, AUC: 0.66 (95%CI: 0.53-0.79)). This study confirms a very high prevalence of OSA in patients with ACS. The Berlin and STOP-BANG questionnaires alone are inadequate to identify OSA in this high-risk cohort. Simplified objective measures to screen for OSA may be better suited for this patient population.

STUDY ON SOME ANTHROPOMETRIC CHARACTERISTICS AND LEARNING OUTCOMES OF THE SECOND YEAR MEDICAL STUDENTS WITH OBSTRUCTIVE SLEEP APNEA RISK AT CAN THO UNIVERSITY OF MEDICINE AND PHARMACY

Background: Obstructive sleep apnea (OSA) is a condition characterized by repeated pauses in breathing during sleep, which is frequently accompanied by snoring, daytime sleepiness, and decreased concentration. Several scales, including the STOP-BANG and EPWORTH scores, have been developed to screen people at high risk for OSA. There have been few studies on both OSA risk and anthropometric characteristics, academic performance in student populations, particularly medical students. Objectives: (1) Determine the proportion of medical students at risk of OSA based on STOP-BANG score, EPWORTH score, and their academic performance; and (2) Survey the association between some anthropometric characteristics, STOP-BANG score, daytime sleepiness, and poor academic performance of second-year medical students. Materials and method: A descriptive cross-sectional study was conducted on 565 second-year medical students at Can Tho University of Medicine and Pharmacy. Results: Our study included 565 students, 44.4% of whom were male. The average BMI was 21.0 kg/m2, the mean neck circumference was 32.9 cm, the mean waist circumference was 73.2 cm, the mean waist/hip ratio was 0.80, the mean systolic blood pressure was 116.2 mmHg, the mean diastolic blood pressure was 67.8 mmHg. The percentage of students at risk of OSA based on STOP-BANG scores was 13.5%, and 58.4% based on EPWORTH scores. Smoking affects 0.9% of students, hypertension affects 2.7%, snoring affects 16.6%, average sleep time is 6.59 hours, and poor academic performance affects 4.4%. According to the STOP-BANG transcript, the percentage of students with poor academic performance (&lt;2.5) in the group at risk of OSA was higher than in the group without the risk of OSA (10.5% versus 3.5%, χ2=7.730, p=0.012). According to the EPWORTH score, the proportion of students with poor academic performance (&lt;2.5) in the group at risk of OSA was lower than in the group without the risk of OSA (χ2=5.406, p=0.02). In multivariable logistic regression analysis, BMI ≥ 23kg/m2 was a risk factor for poor academic results (OR=2.5, p=0.043), while daytime sleepiness was a protective factor for poor academic results (OR = 0.384, p = 0.024). Conclusions: The percentage of students at risk of OSA based on STOP-BANG scores was 13.5%, and 58.4% based on EPWORTH scores. Second-year medical students at Can Tho University of Medicine and Pharmacy who are at risk of OSA according to STOP-BANG score have lower academic performance. Poor academic results were associated with BMI ≥ 23kg/m2.

A - 76 Association between Sleep Apnea Risk and Cognitive Performance in Individuals with Type 1 Diabetes (T1D): Evidence from the Glucog Study.

Evidence suggests that individuals with type 1 diabetes (T1D) experience higher rates of sleep apnea compared to the general population, which may contribute to higher rates of cognitive dysfunction in T1D. 206 participants with T1D (mean [range] age = 45.48 [18-84] years, 53.40% female, 60.20% college degree or higher, mean [range] HbA1c = 7.5 [5.1-12.3] %) were recruited from four diabetes centers. Measures included 10 self-administered online cognitive tasks (testmybrain.org) that assessed nonverbal reasoning, visual working memory, cognitive flexibility, processing speed, visual memory, sustained attention, and basic psychomotor speed, as well as the STOP-BANG inventory to assess obstructive sleep apnea (OSA) risk. Correlation coefficients and partial correlations were used to examine the relationship between OSA risk and cognitive performance. 20.39% of the sample was at high risk for OSA. Higher STOP-BANG scores were significantly correlated with poorer performance on digit symbol coding, flicker change detection, matrix reasoning, multiple object tracking, visual paired associates, gradCPT, letter-number switching, and choice reaction time r(204) = -0.15 to -0.42, p < 0.01. After controlling for age, OSA risk was associated with poorer performance on matrix reasoning, pr(203) = -0.16, p = 0.02, and visual paired associates pr(203) = - 0.14, p = 0.04. Findings revealed an association between OSA risk and poorer performance on measures of nonverbal reasoning and visual memory that persisted after controlling for age. Future research is needed to better understand the mechanisms by which OSA risk impacts cognitive performance in this population.

High risk of obstructive sleep apnea among hypertensive patients in two tertiary centers in Nigeria

Objectives: The prevalence of obstructive sleep apnea (OSA) is rising globally with its associated morbidity and mortality. Although OSA is associated with hypertension and is the leading cause of secondary and resistant hypertension, its presence is usually not actively sought during clinical evaluation of hypertensive patients resulting in a missed opportunity to treat the condition. This study assessed the prevalence of high risk of OSA and excessive daytime sleepiness (EDS) among hypertensive patients. It also assessed the pattern of symptoms of OSA among the participants. Materials and Methods: We used a structured questionnaire to collect data from hypertensive patients aged 18 years and above, who were attending the outpatient clinics of two tertiary hospitals in Enugu state. Data collected include frequency of symptoms of OSA, Epworth sleepiness scale (ESS) score, snoring, tiredness, observed apnea or choking, blood pressure, body mass index, age, neck circumference, and gender (STOPBANG) score, number of comorbidities present, and demography of participants. STOPBANG score of 5–8 classified participants as having high risk of OSA, and ESS &gt;10 as having excessive daytime sleepiness (EDS.). Results: Three hundred and twenty hypertensive patients were recruited (mean age: 56.0 ± 9.5 years; female: 58.8%). The prevalence of high-risk OSA was 13.8% and that of EDS was 6.3%. Snoring, nocturia, tiredness, and observed apnea were significantly present in 90.9%, 90.9%, 81.8%, and 22.7% of those with high risk of OSA (n = 44), respectively, compared with intermediate (60.6%, 91.5%, 53.2%, and 1.6%) and low risk (12.5%, 77.3%, 19.3%, and 1.1%) groups (P &lt; 0.001, P = 0.003, P &lt; 0.001, and P &lt; 0.001, respectively). Gasping, (χ2 [2] = 8.4, P = 0.015); memory loss, (χ2 [2] = 6, P = 0.04); and sleep fragmentation, (χ2 [2] = 9.9, P = 0.007) also showed significant difference between high-, intermediate-, and low-risk OSA groups. Conclusion: The prevalence of the high risk of OSA among hypertensive patients presenting to our tertiary hospitals are modest. Snoring and nocturia are their most common symptoms. We recommend screening hypertensive patients for OSA to identify those at high risk, as they will likely benefit from sleep study and treatment if confirmed.

Comorbid association of obstructive sleep apnea (OSA) and thrombotic primary antiphospholipid syndrome (tPAPS): A more severe phenotype?

ObjectiveWe aimed to evaluate the frequency of obstructive sleep apnea (OSA) in patients with thrombotic primary antiphospholipid syndrome (tPAPS), to investigate the performance of screening tools for OSA in this scenario and to compare clinical/laboratorial differences in tPAPS patients with and without OSA. MethodsWe consecutively enrolled patients with tPAPS to undergo sleep studies using a portable monitor. OSA was defined as apnea-hypopnea index ≥15 events/h. Frequency of OSA in tPAPS was evaluated and compared with age-, gender-, and BMI-matched controls (1:3 ratio) from the Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil). Next, we tested the performance of three different screening tools for assessing OSA in patients with tPAPS. Finally, patients with tPAPS were stratified according to OSA status comparing their clinical and laboratory characteristics (including damage burden measured by Damage Index for Antiphospholipid Syndrome [DIAPS] and biomarkers associated with thrombosis) using standard statistical procedures. ResultsFifty-two patients were included for analysis (females: 82.7%; mean age: 48 ± 14 years; body-mass index: 31.1 ± 6.5 Kg/m2; 25% with moderate-severe OSA). When compared to matched controls from ELSA-Brasil (n = 115), there was no significant differences in the frequencies of OSA (tPAPS: 12/42 [28.6%] vs. controls: 35/115 [30.4%], p = 0.821). Among screening tools, NoSAS had the highest area under ROC curve (AUC 0.806, CI 95% 0.672–0.939, p = 0.001), followed by STOP-Bang (AUC 0.772, CI 95% 0.607–0.938, p = 0.004). Patients with comorbid tPAPS and OSA presented higher levels of von Willebrand factor (vWF) (median 38.9 vs. 32.6, p = 0.038) and DIAPS (median 5 vs. 2, p = 0.020), when compared to those without OSA. OSA remained statistically associated with higher DIAPS, even after controlling for age, disease duration and BMI. ConclusionOSA is common in patients with tPAPS, with rates comparable to a non-referred population. Both NoSAS and STOP-Bang scores seems to be useful for screening OSA in these patients. Patients with tPAPS+OSA had higher damage burden and higher levels of vWF, which might suggest a more severe phenotype of tPAPS in this scenario.

Association of dual use of cigarettes with obstructive sleep apnea assessed by the STOP-Bang score.

Although previous studies have addressed the association between smoking and obstructive sleep apnea (OSA), there are few studies on the association between electronic cigarette use and OSA. Thus, we aimed to evaluate the association between the dual use of electronic and conventional cigarettes and OSA. Data from 7350 participants of the 2019-2021 Korean National Health and Nutrition Examination Survey were analyzed in this population-based study. The STOP-Bang score was calculated using eight items: snoring, tiredness, observed apnea, high blood pressure, body mass index, age, neck circumference, and sex. The main independent variable was smoking behavior. A multiple logistic regression analysis was performed. Subgroup analysis was conducted to analyze the association between smoking behavior in detail and OSA, and stratified analyses were additionally performed. Of the 7350 participants, 417 (5.7%) had a high risk of OSA, according to the STOP-Bang score. Compared to the non-smoker group, the dual user group had a 2.46-fold increase in the odds of OSA (adjusted odds ratio, AOR = 2.45; 95% CI: 1.04-5.79). Current non-smokers who were dual users in the past had increased odds of having OSA (AOR=3.61; 95% CI: 1.32-9.92). In the stratified analyses, dual cigarette use was significantly associated with OSA in females and those with a low physical activity level. Dual users and cigarette-only users had an increased probability of developing OSA. Even if they are not currently smoking or vaping, individuals who were dual users in the past were associated with a higher risk of OSA. The association between dual cigarette use and OSA was more pronounced in females and those with a low physical activity level. While intervening for obstructive sleep apnea or investigating risk factors, new smoking methods such as vaping and dual use should be considered along with conventional smoking.

Sleep parameters in patients with chronic hypersensitivity pneumonitis: a case-control study.

To compare patients with chronic hypersensitivity pneumonitis (cHP) and controls with normal spirometry in terms of their sleep characteristics, as well as to establish the prevalence of obstructive sleep apnea (OSA) and nocturnal hypoxemia. Secondary objectives were to identify factors associated with OSA and nocturnal hypoxemia; to correlate nocturnal hypoxemia with the apnea-hypopnea index (AHI) and lung function, as well as with resting SpO2, awake SpO2, and SpO2 during exercise; and to evaluate the discriminatory power of sleep questionnaires to predict OSA. A total of 40 patients with cHP (cases) were matched for sex, age, and BMI with 80 controls, the ratio of controls to cases therefore being = 2:1. The STOP-Bang questionnaire, the Epworth Sleepiness Scale (ESS), the Pittsburgh Sleep Quality Index, the Berlin questionnaire and the Neck circumference, obesity, Snoring, Age, and Sex (NoSAS) score were applied to all cases, and both groups underwent full-night polysomnography. The patients with cHP had longer sleep latency, lower sleep efficiency, a lower AHI, a lower respiratory disturbance index, fewer central apneas, fewer mixed apneas, and fewer hypopneas than did the controls. The patients with cHP had significantly lower nocturnal SpO2 values, the percentage of total sleep time spent below an SpO2 of 90% being higher than in controls (median = 4.2; IQR, 0.4-32.1 vs. median = 1.0; IQR, 0.1-5.8; p = 0.01). There were no significant differences between cases with and without OSA regarding the STOP-Bang questionnaire, NoSAS, and ESS scores. The prevalence of OSA in cHP patients (cases) was high, although not higher than that in controls with normal spirometry. In addition, cases had more hypoxemia during sleep than did controls. Our results suggest that sleep questionnaires do not have sufficient discriminatory power to identify OSA in cHP patients.

To Evaluate Usefulness of Stop-Bang Questionnaire in Predicting Difficult Bag Mask Ventilation and Difficult Intubation in Adult Patients for Elective Surgery: Important Guide for Obstructive Sleep Apnea Patients

Introduction: Obstructive sleep apnea (OSA) is a condition with repetitive interruptions to breathing due to obstruction of the airway in sleep. We evaluated STOP-BANG score outcome. Aim and Objective: To evaluate the usefulness of stop-bang questionnaire in predicting difficult bag mask ventilation and difficult intubation (DIT) with comparison. Materials and Methods: A prospective, simple randomized, comparative study was on 100 patients. Results: O group had male preponderance, higher American Society of Anesthesiologists grades along with comorbidities, higher mallampati grades, lower sternomental distance and thyromental distance, and higher neck circumference. Mean time in study group was 31.7 s and in control group was 18.68 s. Conclusion: We conclude that patients with STOP-BANG score ≥3 are at higher risk of unanticipated difficult mask ventilation and DIT in undiagnosed cases of OSA.

Poster (Health Services, Economics and Policy Change) ID 1969166

Background We studied the feasibility of a home-based screening sleep test (HBSST), the validity of four questionnaires used to screen for sleep-related breathing disorders (SRBDs), and the potential association between SRBD and clinical features in individuals with spinal cord injury (SCI). Methods Adults with subacute/chronic (&amp;gt;1 month post-injury) SCI were recruited for the cross-sectional study and qualitative analysis. Feasibility of the HBSST was objectively evaluated and participants shared their experience. We also examined the validity of the Berlin, STOP, Medical Outcomes Study Sleep Scale [MOS-SS], and STOP-Bang screening questionnaires. We investigated the association between the degree of SRBD and three features (i.e., neck circumference, body mass index [BMI] and oropharynx opening as assessed using the Modified Mallampati classification [MMC]). Results There were 13 females and 18 males with ages varying from 20 to 86 years (mean age: 54.7 years) with motor complete (n=8) or incomplete SCI at cervical (n=21) or thoraco-lumbar levels. Time since SCI varied from 1.5 to 474 months. Overall, 28 individuals completed the HBSST and endorsed its feasibility. Mean apnea-hypopnea index (AHI) was 17.3 events/hour (range: 0.5-83.7). AHI was significantly correlated with Berlin (p=0.036) and STOP-Bang scores (p=0.009). There was no significant correlation between AHI and MOS-SS (p=0.348) or STOP (p=0.165). AHI was not associated with neck circumference (p=0.614), BMI (p=0.958), or MMC (p=0.335). Conclusions Our results suggest that HBSST is a feasible screening method, and Berlin and STOP-Bang are valid screening questionnaires for the SCI population. AHI was not correlated with BMI, neck circumference, or MMC.

Sleep quality in women with diabetes in pregnancy: a single-center retrospective study

PurposeSleep quality is an important indicator of individual quality of life, which not only affects people’s mental health but is also closely related to the occurrence of many diseases. Sleep disorders associated with diabetes in pregnancy can greatly endanger the health of both mothers and babies, and their hazards are strongly associated with blood glucose levels. This study explored the quality of sleep and sleep disorders in pregnant women with diabetes.MethodsFrom June 2020 to July 2021, a total of 693 patients diagnosed with diabetes during pregnancy in Gansu Provincial Maternal and Child Health Hospital were used as the experiment group, including 626 patients with gestational diabetes mellitus (GDM) and 67 patients with pregestational diabetes mellitus (PGDM). At the same time, 709 women not having diabetes were randomly selected as the control group. To obtain the general situation of the participants, the participants were surveyed using the Pittsburgh Sleep Quality Index (PSQI) and the STOP-BANG (S, Snoring; T, Tiredness; O, Observed apnea; P, high blood Pressure; B, Body mass index > 35 kg/ m2; A, Age > 50 years; N, Neck circumference > 40 cm; G, male Gender) questionnaire. The differences in sleep quality and obstructive sleep apnea-hypopnea syndrome (OSAHS) were analyzed between the experiment group and the control group by using chi-square and t-test, and the clinical features and related factors of sleep disorder were analyzed.ResultsCompared with the control group, the age, pre-pregnancy weight, body mass index (BMI), and neck circumference were larger in the experimental group (P < 0.05). The experimental group had higher PSQI scores for sleep quality, time to fall asleep score, sleep duration, sleep efficiency, sleep disorder, and daytime dysfunction than the control group (all P < 0.001). Specific analysis of the clinical features of sleep disorders indicated that the experimental group scored higher than the control group (P < 0.05). The analysis of the types of daytime dysfunction showed that the experiment group scored higher in terms of frequently feeling sleepy and lack of energy to do things than the control group (P < 0.05). Analysis of STOP-BANG scores indicated that the proportion of patients with GDM or PGDM having fatigue, hypertension, BMI > 35 kg/m2, and neck circumference > 40 cm was higher than that in the control group (P < 0.05). According to regression analysis, sleep quality of patients with GDM was significantly impacted by the increases in age (OR: 1.243, CI:1.197–1.290), neck circumference (OR: 1.350, CI: 1.234–1.476), PSQI score (OR: 2.124, CI:1.656–2.724), and sleep efficiency score (OR: 3.083, CI:1.534–6.195), whereas that of patients with PGDM was impacted by age (OR: 1.191, CI:1.086–1.305), neck circumference (OR: 1.981, CI: 1.469–2.673), and PSQI score (OR: 7.835, CI: 2.383–25.761).ConclusionsPregnant women with diabetes had poorer sleep quality and a higher risk of developing OSAHS than those without diabetes. There may be some link between sleep quality and the onset of diabetic.

BASET scoring: A novel simple biometric score for screening and grading obstructive sleep apnea

BackgroundPolysomnography (PSG) is the gold-standard diagnostic tool for Obstructive Sleep Apnea (OSA). However, the availability of PSG is limited, and OSA is widely underdiagnosed; more than 80% of most developed nations undiagnosed. There is no diagnostic validated simple tool with clear cutoff point for predicting and roll out patient with OSA in primary care clinics significantly alters clinical outcomes. ObjectivesOur study aimed to assess the validity of BASET scoring as a new potential tool for screening and grading the severity of OSA patients. MethodsAfter institution review board approval and formal patient consent, 144 subjects for suspected OSA and their relatives were enrolled. All subjects were subjected to a full night PSG study after history taking, sleep questionnaires, and physical examination, including BASET score components: B= Body Mass Index (BMI), A= Abdominal circumference (AC), S = Snoring, E= Epworth Sleepiness Scale, and T= Tongue teeth imprint. ROC analysis that used to assess the optimal cutoff point of the BASET score and to compare its accuracy for predicting OSA with Berlin and STOP-Bang scores. ResultsThis study included 63 OSAS patients, 33 (52.38%) males and 30 (47.62%) females, and 81 controls; 22 (27.16%) males and 50 (72.84%) females. The Cronbach's alpha for the 5 BASET score components was 0.846, indicating the internal consistency reliability of the scale. Moreover, BASET score has a moderately strong positive significant correlation (r = 0.778, p<0.001) with AHI. By ROC analysis, the accuracy of the three measures was generally high, with BASET score predicting OSA most accurately (AUC=0.984, 95%CI: 0.956–0.999), followed by STOP-Bang (AUC=0.939, 95%CI: (0.887–0.972) and Berlin (AUC=0.901, 95%CI: 0.841–0.945). The AUC of BASET score was significantly higher compared to the Berlin score (difference= 0.0825, 95%CI: 0.039–0.125) and STOP-Bang score (difference= 0.0447, 95%CI: 0.011–0.078). On the other hand, there was no difference between the AUC of Berlin and STOP-Bang scores (difference=0.0378, 95%CI: 0.006 - 0.081 4). BASET score was significantly (p<0.001) associated with OSA grades, ConclusionBASET score is a convenient, reliable, and valid tool for diagnosing OSA. BASET score is more accurate for predicting OSA than Berlin and STOP-Bang scores, while there is no difference between Berlin and STOP-Bang scores. BASET score indicates OSA grades. Registration of clinical trials by numberNCT05511974. Name of the registryClinicalTrials.gov URL: https://clinicaltrials.gov/

Prevalence of obstructive sleep apnea risk and quality of sleep in chronic liver cell disease patients admitted to a tertiary care centre

Introduction: Cirrhosis and associated complications result in significant morbidity and mortality. In the absence of a liver transplant, the prognosis, and the quality of life of decompensated cirrhosis patients are dismal. Hepatic encephalopathy, a complication of cirrhosis; defined as potentially reversible neuropsychiatric abnormalities seen in patients with liver dysfunction, has sleep disturbances as an integral part. But cirrhosis patients also suffer from various other sleep disorders including obstructive sleep apnea (OSA) which are independent of hepatic encephalopathy manifestations. But diagnosing OSA is challenging in this patient population. But when diagnosed early OSA can be treated successfully preventing further complications and improving the quality of life of cirrhotic patients. Methods: A cross-sectional study was conducted among cirrhosis patients admitted to Colombo South Teaching Hospital using investigator administered questionnaires to assess the risk of OSA. Internationally validated STOP­Bang and Pittsburgh Sleep Quality Index (PSQI) were used to screen for OSA and sleep quality respectively.Results: Out of 42 participants, two-thirds were males, and the mean age of the study population was 58 years. Most of the patients were in Child-Pugh class C (76.2%) Of the study population, 38.1 % were having high STOP­Bang scores (&gt;5) and were in the high-risk group for obstructive sleep apnea. The percentage of poor sleepers with PSQI scores of more than 5 was as high as 85.7%. Higher severity of cirrhosis was associated with high PSQI scores and high-risk STOPBANG scores. Having ascites conferred a high risk for OSA. Conclusions: Higher severity of cirrhosis is associated with poorer sleep quality as well as increased risk for OSA.

Evaluation of the relationship between the STOP-Bang score with oxygen reserve index and difficult airway: a prospective observational study

BackgroundPatients diagnosed with Obstructive Sleep Apnea (OSA) syndrome have a tendency towards hypoventilation, hypoxia, and hypercarbia in the perioperative period. This study hypothesized that the Oxygen Reserve Index (ORi) could predict possible hypoxia and determine difficult airways in patients at risk for OSA, as determined by the STOP-Bang questionnaire. MethodsThis prospective study included adult patients undergoing elective surgery under general anesthesia with endotracheal intubation, divided into two groups: low risk (0–2 points) and high risk (3–8 points) based on their STOP-Bang questionnaire results. The primary outcome measure was the highest ORi value reached during preoxygenation and the time to reach this value. Data were recorded at four time points: before preoxygenation (T1), end of preoxygenation (T2), end of mask ventilation (T3), and end of intubation (T4), as well as partial oxygen pressure values in T1, T2, and T4. The secondary outcome measures were the grading scale for mask ventilation, Cormack-Lehane score, tonsil dimensions, use of a stylet, and application of the burp maneuver during intubation. ResultsIn the high-risk group, preoperative peripheral oxygen saturation values, the highest ORi value reached in preoxygenation, and ORi values at T3 and T4 times were lower, and the time to reach the highest ORi value was longer (p < 0.05). ConclusionUsing ORi in patients with OSA may be useful in evaluating oxygenation, and since difficult airway is more common, ORi monitoring will better manage possible hypoxic conditions.

Association between Obstructive Sleep Apnea and Chronic Kidney Disease According to Sex, Long Working Hours: The Korean National Health and Nutrition Examination Survey (2019-2020).

This study aimed to investigate whether obstructive sleep apnea (OSA) is associated with an increased risk of chronic kidney disease (CKD) and to perform subgroup analysis by sex and working hours. This cross-sectional study was conducted on 8157 subjects who participated in the Korea National Health and Nutrition Examination Survey (KNHANES). The adults completed the STOP-BANG score to measure their risk of OSA, and blood and urine samples were collected to ascertain the severity of CKD based on the estimated glomerular filtration rate and urine albumin-to-creatinine ratio. Multivariate logistic regression was used for complex sample analysis. After fully adjusting for the confounding variables, the high-risk OSA group showed a significantly higher risk of developing albuminuria and CKD than the low-risk group, particularly among men. Odds ratio (OR) 1.72, 95% confidence interval (CI) 1.13-2.6 and (OR 1.67, 95% CI 1.14-2.45), respectively. Additionally, men who worked for 40 h/week showed a significant association between OSA, CKD, and albuminuria. This study supports the link between OSA and the risk of kidney disease, especially among men and those who work long hours. Screening and treating OSA may be a crucial strategy for preventing kidney disease, particularly in high-risk populations.

Assessment of Leptin Levels and Their Correlation With the Severity of Obstructive Sleep Apnea Syndrome: A Case-Control Study.

Background Obstructive sleep apnea (OSA) is characterized by a combination of structural issues in the upper airway and imbalances in the respiratory control system. While numerous studies have linked OSA with obesity, it remains uncertain whether leptin, a hormone associated with fat, plays a role in the functional and anatomical defects that lead to OSA. Therefore, the aim of this study was to investigate whether leptin levels could be used as a predictor of OSA syndrome (OSAS). Methodology A case-control observational study was conducted, enrolling study participants who reported obesity (BMI > 30) within the range of >30 to <35 kg/m2, along with a short neck and a history of snoring, excessive daytime drowsiness, fatigue, or insomnia. Leptin levels and fasting blood sugar (FBS) were measured in all individuals. Additionally, the study evaluated the severity of OSAS using indicators such as the STOP BANG scores, apnea-hypopnea index, uvula grade score, and Epworth Sleepiness Scale scores. Results A total of 80 participants (40 cases and 40 controls) were included in the study. The mean leptin and FBS levels were significantly higher in cases compared to controls. Moreover, leptin levels exhibited a significant correlation with the severity indices of OSAS. Conclusion The study findings indicate that individuals with higher leptin levels tend to exhibit more severe OSAS symptoms. Furthermore, these elevated leptin levels contribute to the worsening of various OSA symptoms. Larger controlled studies have suggested that pharmacologically restoring the altered leptin levels may serve as a beneficial adjunct to treatment for alleviating OSAS symptoms.

Role of sleep questionnaires in predicting obstructive sleep apnea amongst interstitial lung diseases patients.

The co-existence of obstructive sleep apnea (OSA) and interstitial lung diseases (ILD) results in significant morbidity and mortality. So screening for OSA is important for its early diagnosis among ILD patients. The commonly used questionnaires for screening of OSA are Epworth sleep score (ESS) and STOP-BANG. However, the validity of these questionnaires among ILD patients is not well studied. The aim of this study was to assess the utility of these sleep questionnaires in detection of OSA among ILD patients. It was a prospective observational study of one year in a tertiary chest centre in India. We enrolled 41 stable cases of ILD who were subjected to self-reported questionnaires (ESS, STOP-BANG, and Berlin questionnaire). The diagnosis of OSA was done by Level 1 polysomnography. The correlation analysis was done between the sleep questionnaires and AHI. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for all the questionnaires. The cutoff values of STOPBANG and ESS questionnaire were calculated from the ROC analyses. P value of <0.05 was considered to be significant. OSA was diagnosed in 32 (78%) patients with mean AHI of 21.8 ± 17.6.The mean age was 54.8 ± 8.9 years with majority being female (78%) and mean body mass index (BMI) was 29.7 ± 6.4 kg/m2. The mean ESS and STOPBANG score were 9.2 ± 5.4 and 4.3 ± 1.8, respectively, and 41% patients showed high risk for OSA with Berlin questionnaire. The sensitivity for detection of OSA was highest (96.1%) with ESS and lowest with Berlin questionnaire (40.6%). The receiver operating characteristics (ROC) area under curve for ESS was 0.929 with optimum cutoff point of 4, sensitivity of 96.9%, and specificity of 55.6%, while ROC area under curve for STOPBANG was 0.918 with optimum cutoff point of 3, sensitivity of 81.2% and specificity of 88.9%.The combination of two questionnaires showed sensitivity of >90%. The sensitivity also increased with the increasing severity of OSA. AHI showed positive correlation with ESS (r = 0.618, P < 0.001) and STOPBANG (r = 0.770, P < 0.001). The ESS and STOPBANG showed high sensitivity with positive correlation for prediction of OSA in ILD patients. These questionnaires can be used to prioritize the patients for polysomnography (PSG) among ILD patients with suspicion of OSA.

STOP-Bang Questionnaire Is Associated With Aortic Remodeling in Patients With Acute Type B Aortic Dissection Undergoing Standard Thoracic Endovascular Aortic Repair.

To determine whether the STOP-Bang questionnaire, which is a tool for evaluating obstructive sleep apnea, is associated with aortic remodeling after thoracic endovascular aortic repair (TEVAR) in patients with type B aortic dissection (TBAD). Patients with TBAD who underwent standard TEVAR at our center from January 2015 to December 2020 were enrolled. For the included patients, we recorded baseline characteristics, comorbidities, preoperative computed tomographic angiography findings, procedure details, and complications. The STOP-Bang questionnaire was administered to each patient. Total scores comprised points for 4 yes/no questions and 4 clinical measurements. STOP-Bang ≥5 and STOP-Bang <5 groups were then created using the STOP-Bang total scores. We evaluated aortic remodeling 1 year after discharge and the reintervention rate, as well as false lumen complete thrombosis (FLCT) and non-FLCT length. Fifty-five patients were enrolled in the study; STOP-Bang <5, n=36, and STOP-Bang ≥5, n=19. Compared with the STOP-Bang ≥5 group, the STOP-Bang <5 group achieved statistically significantly higher descending aorta positive aortic remodeling (PAR) rates in zones 3 to 5 (zone 3: p=0.002; zone 4: p=0.039; zone 5: p=0.023), higher total descending aorta-PAR rate (66.7% vs 36.8%, respectively; p=0.004), and lower reintervention rate (8.1% vs 38.9%, respectively; p=0.005). In the logistic regression analysis, STOP-Bang ≥5 had an odds ratio of 0.12 (95% confidence interval: 0.03-0.58; p=0.008). There was no significant difference in overall survival between the groups. STOP-Bang questionnaire scores were associated with aortic remodeling after TEVAR in patients with TBAD. Increasing the frequency of surveillance after TEVAR might be beneficial in these patients. We analysed aortic remodelling 1 year after thoracic endovascular aortic repair (TEVAR) in acute type B aortic dissection (TBAD) patients with STOP-Bang < 5 and STOP-Bang ≥ 5. Aortic remodelling was better, and the reintervention rate was higher in patients with STOP-Bang < 5 compared with patients with STOP-Bang ≥ 5. In patients with STOP-Bang ≥ 5, aortic remodelling was worse in zones 3-5 compared with zones 6-9. This study suggests that the STOP-Bang questionnaire results is associated with aortic remodelling after TEVAR in patients with TBAD.

Self-helped detection of obstructive sleep apnea based on automated facial recognition and machine learning.

The diagnosis of obstructive sleep apnea (OSA) relies on time-consuming and complicated procedures which are not always readily available and may delay diagnosis. With the widespread use of artificial intelligence, we presumed that the combination of simple clinical information and imaging recognition based on facial photos may be a useful toolto screen for OSA. We recruited consecutivesubjects suspected of OSA who had received sleep examination and photographing. Sixty-eight points from 2-dimensional facial photos were labelled by automated identification. An optimized model with facial features and basic clinical information was established and tenfold cross-validation was performed. Area under the receiver operating characteristic curve (AUC) indicated the model's performance using sleep monitoring as the reference standard. A total of 653 subjects (77.2% males, 55.3% OSA) were analyzed. CATBOOST was the most suitable algorithm for OSA classification with a sensitivity, specificity, accuracy, and AUC of 0.75, 0.66, 0.71, and 0.76 respectively (P < 0.05), which was better than STOP-Bang questionnaire, NoSAS scores, and Epworth scale. Witnessed apnea by sleep partner was the most powerful variable, followed by body mass index, neck circumference, facial parameters, and hypertension. The model's performance became more robust with a sensitivity of 0.94, for patients with frequent supine sleep apnea. Thefindings suggest that craniofacial features extracted from 2-dimensional frontal photos, especially in the mandibular segment, have the potential to become predictors of OSA in the Chinese population. Machine learning-derived automatic recognition may facilitate the self-help screening for OSA in a quick, radiation-free, and repeatable manner.