Suspicion Of Obstructive Sleep Apnea Research Articles

Obstructive sleep apnea in patients with fibrotic interstitial lung disease (non-idiopathic pulmonary fibrosis): what should be offered?

Objective: The frequency of obstructive sleep apnea (OSA) in patients with idiopathic pulmonary fibrosis (IPF) is high. The clinical course of non-IPF interstitial lung disease (ILD) can be similar to that of IPF. We sought to assess the frequency and predictors of OSA in patients with non-IPF fibrotic ILD, as well as the impact of positive airway pressure (PAP) therapy on the quality of life of such patients. Methods: This was a prospective study in which non-IPF fibrotic ILD patients underwent a home sleep apnea test. The patients with and without OSA were compared, and a multivariate logistic regression model was used to identify independent predictors of OSA. At 3 months after initiation of PAP therapy, we evaluated the participating patients for respiratory events, nocturnal hypoxemia, and changes in quality of life. Results: Of a total of 50 patients, 50% were male, and 76% were diagnosed with OSA. The mean age was 67.8 ± 8.3 years. The patients with OSA had significantly lower TLC (p = 0.033) and awake SpO2 (p = 0.023) than did those without OSA. In the multivariate logistic regression model, SpO2 (OR = 0.46; p = 0.016) and TLC (OR = 0.95; p = 0.026) remained significantly associated with OSA risk. A total of 12 patients received PAP therapy. At 3 months after initiation of PAP therapy, 91.7% were well controlled, Epworth Sleepiness Scale scores decreased significantly (p = 0.006), and emotional well-being tended to improve (p = 0.068). PAP therapy corrected nocturnal hypoxemia in all patients. Conclusions: We found a high frequency of OSA in patients with non-IPF fibrotic ILD. A low TLC was an independent predictor of a higher risk of OSA. PAP therapy can correct nocturnal hypoxemia. There should be a low threshold for suspicion of OSA and initiation of PAP therapy in patients with non-IPF fibrotic ILD.

Ambulatory polygraphy as a screening tool for obstructive sleep apnea in combination with semi-continuous rhythm monitoring in patients with atrial fibrillation: a pilot study

Abstract Background Obstructive sleep apnea (OSA) is a common, yet underdiagnosed risk factor in atrial fibrillation (AF) patients. Polysomnography (PSG) is the gold standard for OSA diagnosis but is also costly, time-consuming, and labor-intensive. (Cardio)-respiratory polygraphy (PG) offers an ambulatory screening for OSA detection. Studying the impact of OSA diagnosis and treatment on AF recurrence will require scalable tools for semi-continuous heart rhythm monitoring. Purpose The NOXFib-AF pilot study assessed the feasibility of PG as an OSA screening tool in patients with AF. The study monitored AF recurrences using a Fitbit smartwatch for heart rhythm monitoring with the FibriCheck algorithm. This pilot assessed the feasibility and patient compliance. Methods Overnight OSA testing was performed with the Noxturnal T3 (NOX-T3s) PG device used at home by AF patients, followed by four weeks of heart rhythm monitoring. Both semi-continuous monitoring with the Fitbit Versa 2 smartwatch with FibriCheck algorithm, and spot-check measurements on a smartphone (twice daily and in case of symptoms) were used. Patients with OSA suspicion on PG (Apnea-Hypopnea Index (AHI) cut-off ≥ 11.1 based on previous studies) were referred for PSG confirmation. Patient satisfaction with the PG and Fitbit smartwatch was evaluated through questionnaires. Results Thirty symptomatic AF patients underwent an overnight PG-based OSA screening, achieving an overall success rate of 96.7% (29/30). Interim analysis of 19 patients who underwent PSG evaluation upon referral showed that 12 (63.2%) were correctly diagnosed with at least moderate OSA (i.e., AHI ≥ 15) and were eligible for reimbursed CPAP treatment. PG and PSG agreement for OSA classification was fair (Cohen’s kappa = 0.230), with 68.4% (13/19) correctly classified (normal-mild, moderate-severe). There was high patient adherence to wearing the smartwatch for four weeks, with median compliance (i.e., adherence to the expected number of measurements) of 96.9% (IQR: 94.3% – 97.6%). A median of 150 (IQR: 145 – 151) daily automatic measurements were performed. Spot-check measurements via the smartphone also showed high compliance (110%, IQR: 100.0% – 135.5%) and high patient motivation (i.e., consistency of performing measurements; 90.3%, IQR: 67.7% – 96.8%). Patients were positive for both PG screening (Figure 1A) and Fitbit-based FibriCheck monitoring (Figure 1B). Conclusions PG is a feasible approach as a home screening tool for OSA, positively perceived by patients. Also, the acceptance of semi-continuous Fitbit-based FibriCheck monitoring was high. In a follow-up study, both tools will be used to evaluate the impact of a structured OSA screening and treatment trajectory on AF burden.

P121 ROLE OF AMBULATORY BLOOD PRESSURE MONITORING (ABPM) IN THE EVALUATION OF PATIENTS WITH SUSPECTED SLEEP APNEA

Background and Objective: Obstructive sleep apnea (OSA) often coexists with hypertension. Ambulatory blood pressure monitoring (ABPM) is essential for detecting significant blood pressure fluctuations, especially during nighttime. This study seeks to assess the role of ABPM in identifying OSA. Methods: We analyzed a database of patients with suspected OSA using the STOP-BANG questionnaire at a cardiology center from July 2020 to April 2024. Anthropometric characteristics, blood pressure behavior through ABPM, and sleep patterns via polysomnography were evaluated. The influence of risk predictors on OSA development was assessed using multinomial logistic regression. Results: The study included 38 men (50.6%) and 37 women (49.3%); 48 hypertensive patients (64%) and 27 without hypertension (27%). The average STOP-BANG score was 3.8. Of these, 92% had some degree of OSA. The mean age was 60±13.2 years. Neck circumference (NC) and total apnea-hypopnea index were 37.5 cm and 19.7 events/hour, respectively, with a predominance of REM OSA. Only NC and nocturnal diastolic pressure were significant variables. For the development of moderate OSA, NC showed significant relative risk ratios (RRR) (p=0.045). Severe OSA development was influenced by mean nocturnal diastolic blood pressure (MNDAP) and NC, with significant RRRs (p=0.007 and p=0.041, respectively). This means that for each mmHg increase in nocturnal diastolic pressure, the risk of severe OSA increases by 1.3 times compared to healthy patients, predominantly during REM sleep. Conversely, increased daytime diastolic pressure decreases this risk by 25%. Conclusions: An increase in mean nocturnal diastolic pressure measured by ABPM is a significant predictor of severe OSA development. This underscores ABPM's importance in evaluating patients with suspected OSA. While the STOP-BANG questionnaire is useful for initial OSA suspicion, it has limitations in identifying the most severe cases, necessitating tools like ABPM for more accurate assessment. The use of ABPM improves accuracy in detecting severe OSA and enhances understanding of hypertension phenotypes’ pathophysiology. Table 1. Obstructive Sleep Apnea (OSA) Severity Classification and Its Correlation with Mean Nocturnal Diastolic Blood Pressure (MNDAP), Mean Daytime Diastolic Blood Pressure (MDDAP), and Neck Circumference (NC)

Prevalence of obstructive sleep apnea and its associated factors in primary health care in Morocco.

Obstructive sleep apnea is a common respiratory disorder that is still underdiagnosed in Morocco. This study aims to determine the prevalence of obstructive sleep apnea and its associated factors in primary healthcare. In this cross-sectional study, 815 adults aged 18 years and older consulting in the primary health care services in Marrakech, Morocco, were included. We evaluated the risk of obstructive sleep apnea syndrome using the modified STOP-BANG questionnaire. The prevalence of the high risk of obstructive sleep apnea in our sample is 24.8% (CI 95%: 21.7 - 27.6%). The variables independently associated with the high suspicion of obstructive sleep apnea were: gender male (p = 0.001), age ≥ 45 years (p = 0.001), high blood pressure (p = 0.005), hyperlipidemia (p = 0.042), daytime sleepiness (p = 0.003), snoring (p = 0.001), tiredness (p = 0.001) and mandibular retrognathia (p = 0.025). This survey revealed a significant prevalence of obstructive sleep apnea in Morocco. Therefore, we propose to generalize the screening of obstructive sleep apnea in hypertensive patients who report symptoms including daytime sleepiness, snoring, nocturnal choking, and tiredness that are unexplained by other known factors.

Cluster Headache Characteristics and the Severity of Obstructive Sleep Apnea: Insights from Polysomnography Analysis

Purpose: Cluster headache (CH) is characterized by circadian rhythmicity of the attacks, and it is known to respond exceptionally well to oxygen therapy. Furthermore, obstructive sleep apnea (OSA) frequently co-occurs with CH, and both conditions may be parallel outcomes of hypothalamic dysfunction rather than being causally related. The aim of this study was to analyze the association between CH characteristics and polysomnographic factors stratified by the severity of OSA in patients diagnosed with CH and OSA.Methods: We retrospectively analyzed the data of OSA patients with CH who were enrolled in the Korean Cluster Headache Registry and underwent polysomnography due to clinical suspicion of OSA. Basic demographic data, headache-related parameters, and polysomnographic parameters were analyzed according to the severity of OSA (apnea-hypopnea index: <15 or ≥15 per hour).Results: Twelve CH patients with OSA were evaluated. The onset age of CH was higher (38.5 years vs. 19.0 years, p=0.010), and the maximal duration of cluster bouts was longer (156.5 days vs. 47.0 days, p=0.037) in the moderate-to-severe OSA group than in the mild OSA group. Unlike other polysomnographic parameters, the apnea-hypopnea index and respiratory arousal index during rapid eye movement (REM) sleep were comparable across different OSA severity levels.Conclusion: The onset age and duration of cluster bouts were associated with the severity of OSA in CH patients. Additionally, the relatively high susceptibility to hypoxia during REM sleep in patients with mild OSA implies that interventions may be potentially advantageous, even in CH patients with mild OSA.

Cardiac autonomic dysfunction and structural remodeling: the potential mechanism to mediate the relationship between obstructive sleep apnea and cardiac arrhythmias.

Cardiac arrhythmias are very common in patients with obstructive sleep apnea (OSA), especially atrial fibrillation (AF) and nonsustained ventricular tachycardia (NVST). Cardiac autonomic dysfunction and structural remodeling caused by OSA provide the milieu for cardiac arrhythmia development. This study aimed to determine whether OSA is associated with various cardiac arrhythmias and investigate potential pathophysiologic pathways between them. The analysis covered 600 patients with clinical suspicion of OSA hospitalized in Renmin Hospital of Wuhan University between January 2020 and May 2023. After undergoing sleep apnea monitor, all subjects received laboratory tests, Holter electrocardiography, and Echocardiography. Compared with those without OSA and adjusting for potential confounders, subjects with moderate OSA had three times the odds of AF (odds ratio [OR] 3.055; 95% confidence interval [CI], 1.002-9.316; p = 0.048). Subjects with severe OSA had three times the odds of AF (OR 3.881; 95% CI, 1.306-11.534; p = 0.015) and NSVT (OR 3.690; 95% CI, 0.809-16.036; p = 0.046). There were significant linear trends for the association between OSA severity with AF and NVST (p < 0.05). And this association was mediated by cardiac structural changes including left atrial diameter, left ventricular diastolic diameter, right atrial diameter and right ventricular diameter. In addition, the ratio of low-frequency and high-frequency individually mediated the association between severe OSA and NVST. This study demonstrated that severe OSA was independently associated with AF and NSVT, and this association was mediated by autonomic nervous system changes and cardiac structural remodeling.

Validation of a Wearable Medical Device for Automatic Diagnosis of OSA against Standard PSG.

The objective of this study was to assess the accuracy of automatic diagnosis of obstructive sleep apnea (OSA) with a new, small, acoustic-based, wearable technology (AcuPebble SA100), by comparing it with standard type 1 polysomnography (PSG) diagnosis. This observational, prospective study was carried out in a Spanish hospital sleep apnea center. Consecutive subjects who had been referred to the hospital following primary care suspicion of OSA were recruited and underwent in-laboratory attended PSG, together with the AcuPebble SA100 device simultaneously overnight from January to December 2022. A total of 80 patients were recruited for the trial. The patients had a median Epworth scoring of 10, a mean of 10.4, and a range of 0-24. The mean AHI obtained with PSG plus sleep clinician marking was 23.2, median 14.3 and range 0-108. The study demonstrated a diagnostic accuracy (based on AHI) of 95.24%, sensitivity of 92.86%, specificity of 97.14%, positive predictive value of 96.30%, negative predictive value of 94.44%, positive likelihood ratio of 32.50 and negative likelihood ratio of 0.07. The AcuPebble SA100 (EU) device has demonstrated an accurate automated diagnosis of OSA in patients undergoing in-clinic sleep testing when compared against the gold-standard reference of in-clinic PSG.

A Case of Intractable REM Sleep Behavior Disorder Improved With Nasal Continuous Positive Airway Pressure Therapy

Rapid eye movement (REM) sleep behavior disorder (RBD) is characterized by dream enactment behavior and REM sleep without atonia and is traumatic for the patient and/or bedpartner. Obstructive sleep apnea (OSA) is a common comorbidity of RBD, and several reports have suggested that severe OSA may aggravate RBD symptoms. This case report discusses a patient with medically intractable RBD combined with OSA, confirmed by 10-year follow-up polysomnography (PSG) data, which improved with nasal continuous positive airway pressure (CPAP) therapy. The clinical symptoms of RBD markedly improved after CPAP treatment. Clinicians should raise the clinical suspicion of OSA in patients with intractable RBD and consider follow-up PSG and OSA treatments.

Obesity and Its Relation to Excessive Daytime Sleepiness in Civilian Pilots.

INTRODUCTION: Excessive daytime sleepiness (EDS) is often associated with decreased work performance and fatigue in civil pilots. However, aeromedical recommendations for the evaluation of EDS are associated with suspicion of obstructive sleep apnea (OSA). Currently, many studies have found an association between obesity and EDS, regardless of OSA. This study aims to determine whether there is a relationship between obesity and EDS in Indonesian civilian pilots, as well as its risks for developing OSA.METHODS: This study used a cross-sectional design and was carried out at the Directorate General Civil Aviation Medical. Subjects were asked to fill out questionnaires, including the Epworth Sleepiness Scale to measure EDS and STOP-Bang to assess OSA risk, followed by anthropometric measurements for body mass index (BMI) and waist circumference as obesity indicators.RESULTS: A total of 156 subjects were obtained, with an EDS prevalence of 16.7%. There was no significant relationship between obesity and EDS, but the prevalence of EDS was higher in obese subjects based on waist circumference than based on BMI (17.8% vs. 15.6%). Most obese pilots with EDS had a low risk of OSA (83.3% and 80%).CONCLUSION: The prevalence of EDS was found to be higher in pilots with central obesity compared to BMI-categorized obesity. The incidence of EDS was not correlated with the risk of OSA.Brahmanti RS, Sampurna B, Ibrahim N, Adi NP, Siagian M, Werdhani RA. Obesity and its relation to excessive daytime sleepiness in civilian pilots. Aerosp Med Hum Perform. 2023; 94(11):815-820.

Refining the diagnostic suspicion of obstructive sleep apnea.

Refining the diagnostic suspicion of obstructive sleep apnea.

A Case Series of Sleep Bruxism Treated With Nasal Continuous Positive Airway Pressure: Craniofacial Feature and Polysomnographic Findings

Sleep bruxism (SB) is a common disorder that presents as repetitive jaw muscle activity with clenching or grinding of teeth and/or bracing or thrusting of the mandible. Several studies have suggested that SB is associated with obstructive sleep apnea (OSA). However, the effect of treatment with continuous positive airway pressure (CPAP) on SB concomitant with OSA has not been well recognized, except in a few reported cases. Herein, we present three cases of SB with various OSA severities that were successfully treated with CPAP, as indicated by the improvement in their clinical symptoms and bruxism index on polysomnography. Our results suggest that clinicians should raise suspicion of OSA in patients with SB and be aware that patients with SB and concomitant moderate-to-severe OSA can be successfully treated with CPAP.

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.

Rastreio de Síndrome de Apneia Obstrutiva do Sono em motoristas

Professional drivers show a higher prevalence of obstructive sleep apnea (OSA) compared with the general population. OSA has been widely associated with an increased risk of traffic accidents. This article aims to investigate the presence of risk factors for OSA, its prevalence and the value of screening tools in a truck drivers' cohort. Descriptive and analytical prospective study. Demographic, anthropometric, Epworth Sleepiness Scale, STOP-Bang and Berlin Questionnaire were used to select subjects with suspicion of OSA. Polysomnography (PSG) was performed in individuals with positive screening. Mean age was 44.6±7 years, mean body mass index was 28.7±4 kg/m². Of the 281 truck drivers screened, 88 were positive for potential OSA. Of these, 63 completed PSG study and the diagnosis was confirmed in 85.7% (prevalence of 19.2%). The following variables showed a positive correlation with the apnea-hypopnea index: neck circumference and STOP-Bang. The combination of a predominantly male population, obesity, age distribution and lifestyle could account for the high prevalence of OSA in this specific population. Questionnaires proved to be a valuable screening tool. Screening, treatment, and management of OSA should be a priority as a public safety policy.

0846 Prevalence of Obstructive Sleep Apnea Among Medical ICU Patients

Abstract Introduction The prevalence of Obstructive Sleep Apnea (OSA) among medical intensive care unit (MICU) patients is unknown. However, OSA prevalence in the general population and in conditions that are frequently comorbid in ICU populations (e.g., diabetes and cardiovascular disease) suggests that OSA may be common among MICU patients. Our objective is to prospectively examine the prevalence and severity of OSA in patients admitted to a tertiary academic MICU. Methods This was a prospective observational study that included patients admitted to the MICU from July to December 2022. Patient charts were reviewed for patient demographics, clinical characteristics, and evidence of pre-existing OSA. Pre-existing OSA was assessed via in depth review of the electronic medical record and included data fields such as the past medical history, documentation of OSA treatment, description of OSA diagnosis in outpatient provider notes, and/or sleep study records. Based on chart review, we also assigned confidence ratings for the OSA diagnosis (high versus low) and noted patients for whom outpatient providers had a high clinical suspicion for OSA in the absence of definitive sleep evaluation. Results Herein, we present preliminary analysis of 345 MICU patients. Mean age (SD) was 64 (18) years; 49% were female, 23% were Black, and 67% were White. Acute respiratory failure (36%) and septic shock (24%) were the leading reasons for admission. Mean (SD) APACHE II severity of illness score was 19.6 (8.8) and body mass index was 27.5 (8.5). Pre-existing OSA was identified in 19% of patients; 63% of pre-existing OSA patients were characterized as “high confidence” in OSA diagnosis. An additional 6% of patients had high clinical suspicion of OSA. Severity data was sparse in the chart with only 17% of OSA patients having severity data available; OSA severity distribution was as follows: mild 9%, moderate 27%, and severe 64%. Conclusion Our preliminary analysis indicates that OSA is notably prevalent among MICU patients. We hypothesize that OSA is under-recognized and consequently undertreated in MICU patients. With this in mind, future directions include investigation of the recognition, treatment, and outcomes related to pre-existing OSA in critically ill patients. Support (if any) NHLBI, NIH T35HL007649

0470 Factors Associated with Discordant Initial Home Sleep Apnea Testing and Polysomnography

Abstract Introduction Nocturnal polysomnography (PSG) is the gold standard for diagnosing obstructive sleep apnea (OSA). Home sleep apnea tests (HSAT) have been incorporated in the diagnostic algorithm in patients with a high pre-test suspicion of OSA. While many studies have compared HSATs with PSGs, it is not well understood what factors may be responsible for inconclusive HSAT results. Methods We performed a retrospective chart review of adult patients who underwent a non-diagnostic HSAT evaluation, who subsequently tested positive for OSA (on PSG) between 1/1/2022 and 11/1/2022. We collected demographic and sleep study data. Patients who did not have a follow up PSG were excluded. Results A total of 20 patients were reviewed. 80% had a negative HSAT with a positive subsequent PSG. The average age was 33.9 years (SD +/- 11.3 years). 43% were male and 50% were Caucasian. The average BMI was 29 kg/m2 (SD +/- 5.3 kg/m2). The average Epworth Sleepiness Scale score (ESS) was 8 (median 6.5) with only 31% reporting an ESS &amp;gt;10. The average HSAT recording time was 449.1 minutes. The average respiratory disturbance index (RDI) on the follow up PSG was 17.7 events/hour of sleep (SD +/- 12). Only 1 patient was diagnosed with severe OSA. 38% were diagnosed with anxiety in this cohort. Other co-morbidities were insignificant. Of all the HSATs performed, 40% were denied for an initial PSG evaluation and converted to an HSAT evaluation. Conclusion HSATs are validated in patients with a high pretest probability of OSA. Anxiety was found in one third of patients included (possibly contributing to a negative initial HSAT). Patient demographics however were also not remarkable for a high risk of OSA in this group (e.g. non-obese, &amp;lt; 55 years, female). The subsequent diagnosis for OSA was also only mild or moderate (93.8%) in this lower risk cohort. Hence, another explanation for the initial negative HSAT evaluation may have been the insurance denial of the initial PSG request (40%). Denials of low risk patients for PSG may contribute to a misuse of resources. We also need to educate referring physicians to follow appropriate HSAT ordering criteria (based on high OSA risk factors). Support (if any)

Continuous positive airway pressure treatment reduces renal tubular damage in patients with obstructive sleep apnea: A retrospective single-center cohort study

BackgroundChronic intermittent hypoxia (IH) plays a significant role in the pathogenesis of obstructive sleep apnea (OSA) comorbidities. The prevalence of chronic kidney disease is higher in patients with OSA than the general population, and renal function decline is well correlated with renal tubular injury. However, little is known about the impact of OSA-induced chronic IH on the renal tubules. MethodsWe conducted a retrospective survey of clinical records performing multiple regression analysis and cluster analysis with particular attention to the 3% oxygen desaturation index (ODI) and urinary N-acetyl-β-d-glucosaminidase (NAG). ResultsIn patients with suspicion of OSA, urinary NAG creatinine ratio (UNCR) was elevated as their 3% ODI increased (n = 197, p < 0.001), and the elevated UNCR decreased following CPAP treatment in patients with OSA (n = 46, p = 0.014). Multiple regression analysis showed that 3% ODI was associated with UNCR. Cluster analysis identified three clusters of patients with OSA, including two younger age clusters, one of which was characterized by high BMI, high 3% ODI, and high prevalence of major comorbidities. In a comparative analysis of younger age cases (age ≤ 55, n = 82), the UNCR level was higher in patients with severe 3% ODI (3% ODI > 40 events/h, n = 24) (p = 0.014). ConclusionsOur results indicate that even at younger ages, OSA patients with severe chronic IH and major comorbidities are susceptible to renal tubular damage. Early treatment with CPAP may attenuate renal tubular injury and progression toward end-stage renal disease.

Power spectral analysis of the sleep electroencephalogram in positional obstructive sleep apnea

Objective/BackgroundPrevious studies have shown that obstructive sleep apnoea (OSA) is associated with reduced delta EEG and increased beta EEG power and increased EEG slowing ratio. There are however no studies that explore differences in sleep EEG between positional obstructive sleep apnoea (pOSA) and non-positional obstructive sleep apnoea (non-pOSA) patients. Patients/methods556 of 1036 consecutive patients (246 of 556 were female) undertaking polysomnography (PSG) for the suspicion of OSA met the inclusion criteria for this study. We calculated power spectra of each sleep epoch using Welch's method with ten, 4-s overlapping windows. Outcome measures such as Epworth Sleepiness Scale, SF-36 Quality of Life, Functional Outcomes of Sleep Questionnaire and Pyschomotor Vigilance Task were compared between the groups. ResultsPatients with pOSA had greater delta EEG power in NREM and greater N3 proportions compared to their non-pOSA counterparts. There were no differences in theta (4–8Hz), alpha (8–12Hz), sigma (12–15Hz) or beta (15–25Hz) EEG power or EEG slowing ratio between the two groups. There were also no differences in the outcome measures between these two groups. The division of pOSA into spOSA and siOSA groups showed better sleep parameters in siOSA but with no difference in sleep power spectra. ConclusionsThis study partially supports our hypothesis in showing that pOSA, compared to non-pOSA, is associated with increased delta EEG power but did not show any variation to beta EEG power or EEG slowing ratio. This limited improvement in sleep quality did not translate to measurable changes to outcomes, suggesting beta EEG power or EEG slowing ratio may be key factors.

Adult-onset obstructive sleep apnea and pediatric pharyngoplasty in 22q11.2 deletion syndrome

Objective/backgroundWe aimed to evaluate adult-onset obstructive sleep apnea (OSA) and related risk factors, including history of pediatric palatal/pharyngeal surgery to remediate velopharyngeal dysfunction, in 22q11.2 deletion syndrome (22q11.2DS). Patients/methodsUsing a retrospective cohort design and standard sleep study-based criteria, we determined presence of adult-onset OSA (age ≥16 years) and relevant variables through comprehensive chart review in a well-characterized cohort of 387 adults with typical 22q11.2 microdeletions (51.4% female, median age 32.3, interquartile range 25.0–42.5, years). We used multivariate logistic regression to identify independent risk factors for OSA. ResultsOf the 73 adults with sleep study data, 39 (53.4%) met criteria for OSA at median age 33.6 (interquartile range 24.0–40.7) years, indicating a minimum OSA prevalence of 10.1% in this 22q11.2DS cohort. History of pediatric pharyngoplasty (odds ratio 2.56, 95% confidence interval 1.15–5.70) was a significant independent predictor of adult-onset OSA, while accounting for other significant independent predictors (asthma, higher body mass index, older age), and for male sex. An estimated 65.5% of those prescribed continuous positive airway pressure therapy were reported as adherent. ConclusionsIn addition to factors of known importance in the general population, delayed effects of pediatric pharyngoplasty may contribute to risk of adult-onset OSA in individuals with 22q11.2DS. The results support increased index of suspicion for OSA in adults with a 22q11.2 microdeletion. Future research with this and other homogeneous genetic models may help to improve outcomes and to better understand genetic and modifiable risk factors for OSA.

Evaluation of patients with suspected obstructive sleep apnea in a low-middle income country: Lagos experience

Obstructive sleep apnea (OSA) is a common chronic disorder that decreases the quality of life of patients. It is an underdiagnosed medical condition in Nigeria. This study aimed to describe the clinical presentations and validate the sleep apnea screening questionnaires with a home sleep study for the diagnosis of patients with suspected OSA seen in Lagos. This was a descriptive cross sectional study carried out on adult patients with suspicion of OSA referred to the Respiratory Clinic of Lagos State University Teaching Hospital. A proforma was used to obtain information and also data from home polysomnography was obtained for each patient. We selected 22 patients. The commonest presentations include snoring (20 or 90.9%), daytime somnolence (16 or 72.7%) and choking while sleeping (12 or 54.5%). The commonest comorbidities were hypertension (16 or 72.7%) and obesity (6 or 27.3%). The STOP-Bang score identified more patients with a high clinical probability for OSA than the Epworth score (20 and 12 patients respectively). Polysomnography showed evidence of sleep apnea in most suspected patients with severity ranging from mild, to moderate to severe disease (3 or 13.6%, 3 or 13.6%, and 10 or 45.5% respectively). The use of combined Epworth and STOP-Bang questionnaires combination is great tool in identifying patients with suspected cases of OSA based on clinical presentations that will eventually benefit in a resource-limited environment like Lagos. There should be increased awareness of the use of this readily available and cheap questionnaire among physicians in Lagos for ease of OSAS diagnosis for many patients.

The Burden of Respiratory Alterations during Sleep on Comorbidities in Obstructive Sleep Apnoea (OSA).

Background: Obstructive sleep apnoea (OSA) has an important impact on the risk of morbidity and mortality, so we have designed the present study to understand which factor is most involved in the risk of developing a comorbidity between OSA severity and nocturnal hypoxemia. Methods: A retrospective study was conducted on 617 adult subjects who were referred to our unit for a suspicion of OSA between January 2018 and January 2020. Results: Sleep investigations performed by participants (72% male and obese in 70% of cases) reported an overall mean apnoea–hypopnoea index (AHI) of 44.0 ± 24.8 events·h−1. Overall, 66% were classified as severe OSA and 76% experienced nocturnal hypoxemia. By analysing the burden of OSA severity and nocturnal hypoxemia on the comorbidities risk, multivariate analysis highlighted the predominant role of age and obesity. Accordingly, after the exclusion of the older and obese participants from the analyses, we noticed that severe OSA was related to the risk of hypertension (odds ratio (OR) = 3.0 [95% confidence interval [CI] 1.4–6.2], p = 0.004) as well as nocturnal hypoxemia (OR = 2.6 [95% CI 1.2–5.4], p = 0.01). Conclusions: The study seems to suggest that in young, non-obese subjects, OSA is a predisposing factor for the risk of developing hypertension.