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European Respiratory Review : An... Jun 2021Obstructive sleep apnoea (OSA) is a common sleep disorder with a high social and economic burden. Thus, early prediction and diagnosis of OSA are important. Changes in... (Review)
Review
INTRODUCTION
Obstructive sleep apnoea (OSA) is a common sleep disorder with a high social and economic burden. Thus, early prediction and diagnosis of OSA are important. Changes in metabolism and the microbiome may serve as biomarkers for OSA. Herein, we review the literature on the metabolomic and microbiome changes associated with OSA, and identify the metabolites and microorganisms involved.
METHODS
We searched the PUBMED and EMBASE electronic databases using the following terms: "obstructive sleep apnea", "OSA", "sleep disordered breathing", "SDB", "intermittent hypoxia", "sleep fragmentation", and either "metabolomics" or "microbiome". In total, 273 papers were identified, of which 28 were included in our study.
RESULTS
Changes in the levels of certain metabolites related to fatty acid, carbohydrate and amino acid metabolism were associated with the incidence of OSA. The diversity and abundance of microflora, particularly Firmicutes and Bacteroidetes, were altered in humans and rodents with OSA.
CONCLUSIONS
Certain changes in metabolism and the microbiota play an integral role in the pathophysiology of OSA and OSA-induced cardiovascular complications. Metabolomic and microbiome biomarkers shed light on the pathogenesis of OSA, and facilitate early diagnosis and treatment.
Topics: Biomarkers; Humans; Metabolomics; Microbiota; Sleep Apnea Syndromes; Sleep Apnea, Obstructive
PubMed: 33980666
DOI: 10.1183/16000617.0220-2020 -
Respirology (Carlton, Vic.) Jul 2020One-seventh of the world's adult population, or approximately one billion people, are estimated to have OSA. Over the past four decades, obesity, the main risk factor... (Review)
Review
One-seventh of the world's adult population, or approximately one billion people, are estimated to have OSA. Over the past four decades, obesity, the main risk factor for OSA, has risen in striking proportion worldwide. In the past 5 years, the WHO estimates global obesity to affect almost two billion adults. A second major risk factor for OSA is advanced age. As the prevalence of the ageing population and obesity increases, the vulnerability towards having OSA increases. In addition to these traditional OSA risk factors, studies of the global population reveal select contributing features and phenotypes, including extreme phenotypes and symptom clusters that deserve further examination. Untreated OSA is associated with significant comorbidities and mortality. These represent a tremendous threat to the individual and global health. Beyond the personal toll, the economic costs of OSA are far-reaching, affecting the individual, family and society directly and indirectly, in terms of productivity and public safety. A better understanding of the pathophysiology, individual and ethnic similarities and differences is needed to better facilitate management of this chronic disease. In some countries, measures of the OSA disease burden are sparse. As the global burden of OSA and its associated comorbidities are projected to further increase, the infrastructure to diagnose and manage OSA will need to adapt. The use of novel approaches (electronic health records and artificial intelligence) to stratify risk, diagnose and affect treatment are necessary. Together, a unified multi-disciplinary, multi-organizational, global approach will be needed to manage this disease.
Topics: Age Factors; Artificial Intelligence; Comorbidity; Ethnicity; Global Burden of Disease; Global Health; Humans; Obesity; Prevalence; Risk Factors; Sleep Apnea Syndromes; Sleep Apnea, Obstructive
PubMed: 32436658
DOI: 10.1111/resp.13838 -
Acta Otorhinolaryngologica Italica :... Oct 2019
Review
Topics: Child; Databases, Factual; Endoscopy; Humans; Needs Assessment; Polysomnography; Risk Factors; Sleep Apnea, Obstructive
PubMed: 31708576
DOI: 10.14639/0392-100X-N0262 -
Paediatric Anaesthesia Feb 2022Various developmental aspects of respiratory physiology put infants and young children at an increased risk of respiratory failure, which is associated with a higher... (Review)
Review
Various developmental aspects of respiratory physiology put infants and young children at an increased risk of respiratory failure, which is associated with a higher rate of critical incidents during anesthesia. The immaturity of control of breathing in infants is reflected by prolonged central apneas and periodic breathing, and an increased risk of apneas after anesthesia. The physiology of the pediatric upper and lower airways is characterized by a higher flow resistance and airway collapsibility. The increased chest wall compliance and reduced gas exchange surface of the lungs reduce the pulmonary oxygen reserve vis-à-vis a higher metabolic oxygen demand, which causes more rapid oxygen desaturation when ventilation is compromised. This review describes the various developmental aspects of respiratory physiology and summarizes anesthetic implications.
Topics: Anesthesia; Apnea; Child; Child, Preschool; Humans; Infant; Oxygen; Respiration; Sleep Apnea, Central
PubMed: 34877744
DOI: 10.1111/pan.14362 -
Journal of Clinical Sleep Medicine :... Feb 2022Opioids are widely prescribed for pain management, and it is estimated that 40% of adults in the United States use prescription opioids every year. Opioid misuse leads... (Review)
Review
UNLABELLED
Opioids are widely prescribed for pain management, and it is estimated that 40% of adults in the United States use prescription opioids every year. Opioid misuse leads to high mortality, with respiratory depression as the main cause of death. Animal and human studies indicate that opioid use may lead to sleep-disordered breathing. Opioids affect control of breathing and impair upper airway function, causing central apneas, upper airway obstruction, and hypoxemia during sleep. The presence of obstructive sleep apnea (OSA) increases the risk of opioid-induced respiratory depression. However, even if the relationship between opioids and central sleep apnea is firmly established, the question of whether opioids can aggravate OSA remains unanswered. While several reports have shown a high prevalence of OSA and nocturnal hypoxemia in patients receiving a high dose of opioids, other studies did not find a correlation between opioid use and obstructive events. These differences can be attributed to considerable interindividual variability, divergent effects of opioids on different phenotypic traits of OSA, and wide-ranging methodology. This review will discuss mechanistic insights into the effects of opioids on the upper airway and hypoglossal motor activity and the association of opioid use and obstructive sleep apnea.
CITATION
Freire C, Sennes LU, Polotsky VY. Opioids and obstructive sleep apnea. . 2022;18(2):647-652.
Topics: Analgesics, Opioid; Animals; Humans; Opioid-Related Disorders; Respiration; Sleep Apnea Syndromes; Sleep Apnea, Obstructive
PubMed: 34672945
DOI: 10.5664/jcsm.9730 -
Seminars in Fetal & Neonatal Medicine Oct 2023This chapter focuses on the pharmacological management of newborn infants in the peri-extubation period to reduce the risk of re-intubation and prolonged mechanical... (Review)
Review
This chapter focuses on the pharmacological management of newborn infants in the peri-extubation period to reduce the risk of re-intubation and prolonged mechanical ventilation. Drugs used to promote respiratory drive, reduce the risk of apnoea, reduce lung inflammation and avoid bronchospasm are critically assessed. When available, Cochrane reviews and randomised trials are used as the primary sources of evidence. Methylxanthines, particularly caffeine, are well studied and there is accumulating evidence to guide clinicians on the timing and dosage that may be used. Efficacy and safety for doxapram, steroids, adrenaline and salbutamol are summarised. Management of term infants, extubation following surgery, accidental and complicated extubation and the use of cuffed endotracheal tubes are presented. Overall, caffeine is the only drug with a substantial evidence base, proven to increase the likelihood of successful extubation in preterm infants; no drugs are needed to facilitate extubation in most term infants. Future studies might further define the role of caffeine in late preterm infants and evaluate medications for post-extubation stridor, bronchospasm or apnoea not responsive to methylxanthines.
Topics: Infant, Newborn; Humans; Infant, Premature; Caffeine; Apnea; Ventilator Weaning; Bronchial Spasm; Intermittent Positive-Pressure Ventilation; Airway Extubation
PubMed: 38030435
DOI: 10.1016/j.siny.2023.101490 -
The Lancet. Respiratory Medicine Feb 2024In patients with heart failure and reduced ejection fraction, sleep-disordered breathing, comprising obstructive sleep apnoea (OSA) and central sleep apnoea (CSA), is... (Randomized Controlled Trial)
Randomized Controlled Trial
Adaptive servo-ventilation for sleep-disordered breathing in patients with heart failure with reduced ejection fraction (ADVENT-HF): a multicentre, multinational, parallel-group, open-label, phase 3 randomised controlled trial.
BACKGROUND
In patients with heart failure and reduced ejection fraction, sleep-disordered breathing, comprising obstructive sleep apnoea (OSA) and central sleep apnoea (CSA), is associated with increased morbidity, mortality, and sleep disruption. We hypothesised that treating sleep-disordered breathing with a peak-flow triggered adaptive servo-ventilation (ASV) device would improve cardiovascular outcomes in patients with heart failure and reduced ejection fraction.
METHODS
We conducted a multicentre, multinational, parallel-group, open-label, phase 3 randomised controlled trial of peak-flow triggered ASV in patients aged 18 years or older with heart failure and reduced ejection fraction (left ventricular ejection fraction ≤45%) who were stabilised on optimal medical therapy with co-existing sleep-disordered breathing (apnoea-hypopnoea index [AHI] ≥15 events/h of sleep), with concealed allocation and blinded outcome assessments. The trial was carried out at 49 hospitals in nine countries. Sleep-disordered breathing was stratified into predominantly OSA with an Epworth Sleepiness Scale score of 10 or lower or predominantly CSA. Participants were randomly assigned to standard optimal treatment alone or standard optimal treatment with the addition of ASV (1:1), stratified by study site and sleep apnoea type (ie, CSA or OSA), with permuted blocks of sizes 4 and 6 in random order. Clinical evaluations were performed and Minnesota Living with Heart Failure Questionnaire, Epworth Sleepiness Scale, and New York Heart Association class were assessed at months 1, 3, and 6 following randomisation and every 6 months thereafter to a maximum of 5 years. The primary endpoint was the cumulative incidence of the composite of all-cause mortality, first admission to hospital for a cardiovascular reason, new onset atrial fibrillation or flutter, and delivery of an appropriate cardioverter-defibrillator shock. All-cause mortality was a secondary endpoint. Analysis for the primary outcome was done in the intention-to-treat population. This trial is registered with ClinicalTrials.gov (NCT01128816) and the International Standard Randomised Controlled Trial Number Register (ISRCTN67500535), and the trial is complete.
FINDINGS
The first and last enrolments were Sept 22, 2010, and March 20, 2021. Enrolments terminated prematurely due to COVID-19-related restrictions. 1127 patients were screened, of whom 731 (65%) patients were randomly assigned to receive standard care (n=375; mean AHI 42·8 events per h of sleep [SD 20·9]) or standard care plus ASV (n=356; 43·3 events per h of sleep [20·5]). Follow-up of all patients ended at the latest on June 15, 2021, when the trial was terminated prematurely due to a recall of the ASV device due to potential disintegration of the motor sound-abatement material. Over the course of the trial, 41 (6%) of participants withdrew consent and 34 (5%) were lost to follow-up. In the ASV group, the mean AHI decreased to 2·8-3·7 events per h over the course of the trial, with associated improvements in sleep quality assessed 1 month following randomisation. Over a mean follow-up period of 3·6 years (SD 1·6), ASV had no effect on the primary composite outcome (180 events in the control group vs 166 in the ASV group; hazard ratio [HR] 0·95, 95% CI 0·77-1·18; p=0·67) or the secondary endpoint of all-cause mortality (88 deaths in the control group vs. 76 in the ASV group; 0·89, 0·66-1·21; p=0·47). For patients with OSA, the HR for all-cause mortality was 1·00 (0·68-1·46; p=0·98) and for CSA was 0·74 (0·44-1·23; p=0·25). No safety issue related to ASV use was identified.
INTERPRETATION
In patients with heart failure and reduced ejection fraction and sleep-disordered breathing, ASV had no effect on the primary composite outcome or mortality but eliminated sleep-disordered breathing safely.
FUNDING
Canadian Institutes of Health Research and Philips RS North America.
Topics: Humans; Stroke Volume; Sleepiness; Ventricular Function, Left; Canada; Sleep Apnea Syndromes; Heart Failure; Sleep Apnea, Central; Sleep Apnea, Obstructive; Treatment Outcome
PubMed: 38142697
DOI: 10.1016/S2213-2600(23)00374-0 -
The European Respiratory Journal Jan 2023The impact of sex on the association of obstructive sleep apnoea (OSA) with recurrent cardiovascular events following acute coronary syndrome (ACS) remains uncertain....
BACKGROUND
The impact of sex on the association of obstructive sleep apnoea (OSA) with recurrent cardiovascular events following acute coronary syndrome (ACS) remains uncertain. This study sought to examine the association between OSA and long-term cardiovascular outcomes in women and men with ACS.
METHODS
In this prospective cohort study, we recruited 2160 ACS patients undergoing portable sleep monitoring between June 2015 and January 2020. The primary end-point was major adverse cardiovascular and cerebrovascular event (MACCE), including cardiovascular death, myocardial infarction, stroke, ischaemia-driven revascularisation or hospitalisation for unstable angina or heart failure.
RESULTS
After exclusion of patients with failed sleep studies, central sleep apnoea, regular continuous positive airway pressure therapy and loss of follow-up, 1927 patients were enrolled. Among them, 298 (15.5%) were women and 1014 (52.6%) had OSA (apnoea-hypopnoea index ≥15 events·h). The prevalence of OSA was 43.0% and 54.4% in women and men, respectively. In 4339 person-years (median 2.9 years, interquartile range 1.5-3.6 years), the cumulative incidence of MACCE was significantly higher in OSA non-OSA groups in the overall population (22.4% 17.7%; adjusted hazard ratio (HR) 1.29, 95% CI 1.04-1.59; p=0.018). OSA was associated with greater risk of MACCE in women (28.1% 18.8%; adjusted HR 1.68, 95% CI 1.02-2.78; p=0.042), but not in men (21.6% 17.5%; adjusted HR 1.22, 95% CI 0.96-1.54; p=0.10). No significant interaction was noted between sex and OSA for MACCE (interaction p=0.32). The incremental risk in women was attributable to higher rates of hospitalisation for unstable angina and ischaemia-driven revascularisation.
CONCLUSIONS
In hospitalised ACS patients, OSA was associated with increased risk of subsequent events, particularly among women. Female patients with ACS should not be neglected for OSA screening and dedicated intervention studies focusing on women with ACS and comorbid OSA should be prioritised.
Topics: Male; Humans; Female; Acute Coronary Syndrome; Prospective Studies; Risk Factors; Sleep Apnea, Obstructive; Angina, Unstable
PubMed: 36104289
DOI: 10.1183/13993003.01110-2022 -
Ugeskrift For Laeger Jun 2023Diagnosis of a sleep disorders is multimodal. An overview is presented in this review. The medical history leads to a tentative diagnosis supported by questionnaires,... (Review)
Review
Diagnosis of a sleep disorders is multimodal. An overview is presented in this review. The medical history leads to a tentative diagnosis supported by questionnaires, sleep diary and objective methods. Examination may reveal upper airway problems in a patient suspected to have obstructive sleep apnoea or rigidity in an elderly patient with shouting during sleep, suggestive of rapid eye movement sleep behaviour disorder. The choice of diagnostic sleep test is based on the tentative diagnosis. Other tests (e.g., lumbar puncture, brain scan) may be indicated. Wearables pose the advantage of documenting the patients' habitual sleep and circadian rhythm.
Topics: Aged; Humans; Sleep; Chronobiology Disorders; Circadian Rhythm; Sleep Apnea, Obstructive; Neuroimaging
PubMed: 37381870
DOI: No ID Found -
Neuro Endocrinology Letters Apr 2023Both panic disorder (PD) and obstructive sleep apnea (OSA) are frequent conditions that can be comorbid. This article reviews the current state of knowledge about the... (Review)
Review
OBJECTIVE
Both panic disorder (PD) and obstructive sleep apnea (OSA) are frequent conditions that can be comorbid. This article reviews the current state of knowledge about the comorbidity of PD and OSA and the effectiveness of therapy in patients with this comorbidity.
METHOD
Articles obtained via PubMed and Web of Science search were selected; the publishing date was between January 1990 and December 2022. The applied search terms were: obstructive sleep apnea; panic disorder; CPAP; antidepressants; anxiolytics; antipsychotics. Eighty-one articles were chosen by primary search via keywords. After a complete assessment of the full texts, 60 papers were chosen. Secondary papers from the references of the primary documents were investigated, evaluated for suitability, and included in the list of documents (n = 18). Thus, seventy-eight papers were incorporated into the review article.
RESULTS
Studies describe a greater prevalence of panic disorder in OSA patients. So far, there is no data on the prevalence of OSA in PD patients. Limited evidence is found regarding the influence of CPAP treatment on PD, and this evidence suggests that CPAP can partially alleviate PD symptoms. Medication used in PD treatment can significantly impact comorbid OSA, as explored in several studies.
CONCLUSIONS
The relationship between the two conditions seems bidirectional, and it is necessary to assess OSA patients for comorbid panic disorder and vice versa. Both disorders can worsen the other and must be treated with a complex approach to ensure improvement in patients' physical health and psychological well-being.
Topics: Humans; Panic Disorder; Sleep Apnea, Obstructive; Comorbidity; Continuous Positive Airway Pressure; Anti-Anxiety Agents
PubMed: 37182230
DOI: No ID Found