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The European Respiratory Journal Mar 2023Mechanisms underlying blood pressure changes in obstructive sleep apnoea (OSA) are incompletely understood. Increased respiratory effort is one of the main features of...
BACKGROUND
Mechanisms underlying blood pressure changes in obstructive sleep apnoea (OSA) are incompletely understood. Increased respiratory effort is one of the main features of OSA and is associated with sympathetic overactivity, leading to increased vascular wall stiffness and remodelling. This study investigated associations between a new measure of respiratory effort (percentage of total sleep time spent with increased respiratory effort based on measurement of mandibular jaw movements (MJM): REMOV, %TST) and prevalent hypertension in adults referred for evaluation of suspected OSA.
METHODS
A machine learning model was built to predict hypertension from clinical data, conventional polysomnography (PSG) indices and MJM-derived parameters (including REMOV). The model was evaluated in a training subset and a test subset.
RESULTS
The analysis included 1127 patients: 901 (80%) in the training subset and 226 (20%) in the test subset. The prevalence of hypertension was 31% and 30%, respectively, in the training and test subsets. A risk stratification model based on 18 input features including REMOV had good accuracy for predicting prevalent hypertension (sensitivity 0.75 and specificity 0.83). Using the Shapley additive explanation method, REMOV was the best predictor of hypertension after clinical risk factors (age, sex, body mass index and neck circumference) and time with oxygen saturation <90%, ahead of standard PSG metrics (including the apnoea-hypopnoea index and oxygen desaturation index).
CONCLUSION
The proportion of sleep time spent with increased respiratory effort automatically derived from MJM was identified as a potential new reliable metric to predict prevalent hypertension in patients with OSA.
Topics: Adult; Humans; Sleep; Sleep Apnea, Obstructive; Hypertension; Polysomnography; Risk Factors
PubMed: 36455958
DOI: 10.1183/13993003.01486-2022 -
International Journal of Molecular... Apr 2023Obstructive sleep apnoea (OSA) is a prevalent underdiagnosed disorder whose incidence increases with age and weight. Uniquely characterised by frequent breathing... (Review)
Review
Obstructive sleep apnoea (OSA) is a prevalent underdiagnosed disorder whose incidence increases with age and weight. Uniquely characterised by frequent breathing interruptions during sleep-known as intermittent hypoxia (IH)-OSA disrupts the circadian rhythm. Patients with OSA have repeated episodes of hypoxia and reoxygenation, leading to systemic consequences. OSA consequences range from apparent symptoms like excessive daytime sleepiness, neurocognitive deterioration and decreased quality of life to pathological complications characterised by elevated biomarkers linked to endocrine-metabolic and cardiovascular changes. OSA is a well-recognized risk factor for cardiovascular and cerebrovascular diseases. Furthermore, OSA is linked to other conditions that worsen cardiovascular outcomes, such as obesity. The relationship between OSA and obesity is complex and reciprocal, involving interaction between biological and lifestyle factors. The pathogenesis of both OSA and obesity involve oxidative stress, inflammation and metabolic dysregulation. The current medical practice uses continuous positive airway pressure (CPAP) as the gold standard tool to manage OSA. It has been shown to improve symptoms and cardiac function, reduce cardiovascular risk and normalise biomarkers. Nonetheless, a full understanding of the factors involved in the deleterious effects of OSA and the best methods to eliminate their occurrence are still poorly understood. In this review, we present the factors and evidence linking OSA to increased risk of cardiovascular conditions.
Topics: Humans; Quality of Life; Sleep Apnea, Obstructive; Obesity; Cardiovascular Diseases; Inflammation; Metabolic Diseases; Hypoxia
PubMed: 37047780
DOI: 10.3390/ijms24076807 -
Australian Journal of General Practice Sep 2023Insomnia and obstructive sleep apnoea are the two most common sleep disorders and frequently co-exist. Patients with comorbid insomnia and sleep apnoea experience worse... (Review)
Review
BACKGROUND
Insomnia and obstructive sleep apnoea are the two most common sleep disorders and frequently co-exist. Patients with comorbid insomnia and sleep apnoea experience worse daytime function, mental health and physical health than patients with either disorder alone. General practitioners may face unique challenges in the assessment and management of this prevalent and debilitating condition.
OBJECTIVE
This article aims to provide an overview of the prevalence, consequences, assessment and management of patients with comorbid insomnia and sleep apnoea in Australian general practice.
DISCUSSION
Patients with either insomnia or sleep apnoea should be assessed for both conditions. Treatments for both disorders should be offered to patients with both conditions. The recommended treatment for insomnia is cognitive behavioural therapy, whereas the recommended first-line treatment for moderate and severe obstructive sleep apnoea is lifestyle/weight management advice (where relevant) and continuous positive airway pressure therapy.
Topics: Humans; Australia; General Practitioners; Sleep Apnea Syndromes; Sleep Apnea, Obstructive; Sleep Initiation and Maintenance Disorders
PubMed: 37666781
DOI: 10.31128/AJGP-12-22-6648 -
IEEE Journal of Translational... 2023Obstructive Sleep Apnea (OSA) and Central Sleep Apnea (CSA) are two types of Sleep Apnea (SA) with different etiologies and treatment options. Home sleep apnea testing...
UNLABELLED
Obstructive Sleep Apnea (OSA) and Central Sleep Apnea (CSA) are two types of Sleep Apnea (SA) with different etiologies and treatment options. Home sleep apnea testing based on photoplethysmography-derived peripheral arterial tonometry (PAT HSAT) has become the most widely deployed outpatient SA diagnostic method. Being able to differentiate between CSA and OSA based solely on photoplethysmography-data would further increase PAT HSAT's clinical utility. The present work proposes a method to detect CSA using finger photoplethysmography (PPG) data and evaluates the proposed method against simultaneous in-lab polysomnography (PSG).
METHODS
For 266 patients with a suspicion of SA, concurrent in-lab PSG and PPG data were acquired. The respiratory information embedded in the PPG data was extracted and used to train an ensemble of trees classifiers that predicts the central or obstructive nature of each respiratory event. The classifier performance was evaluated using patient-wise leave-one-out cross-validation where an expert analysis of the PSG served as ground truth. A second, independent analysis of the PSG was also evaluated against the ground truth to allow benchmarking of the PPG-based method.
RESULTS
The method achieved a sensitivity of 81%, a specificity of 99%, a positive predictive value of 90%, and a negative predictive value of 98% at the central apnea-hypopnea index cutoff of 10 events per hour of sleep.
CONCLUSION AND SIGNIFICANCE
The present study aimed to evaluate a method to detect CSA in SA patients using only PPG data which could be used to flag CSA which in turn may aid in more optimal therapy decision making.
Topics: Humans; Sleep Apnea, Central; Photoplethysmography; Sleep Apnea, Obstructive; Sleep; Sleep Apnea Syndromes
PubMed: 36704242
DOI: 10.1109/JTEHM.2023.3236393 -
The European Respiratory Journal Apr 2022Due in part to overall improvements in health, the population of elderly individuals is increasing rapidly. Similarly, obstructive sleep apnoea (OSA) is both gaining... (Review)
Review
Due in part to overall improvements in health, the population of elderly individuals is increasing rapidly. Similarly, obstructive sleep apnoea (OSA) is both gaining increased recognition and also increasing due to the worldwide obesity epidemic. The overlap of OSA and ageing is large, but there is strong plausibility for causation in both directions: OSA is associated with pathological processes that may accelerate ageing and ageing-related processes; ageing may cause physical and neurological changes that predispose to obstructive (and central) apnoea. In addition, the common symptoms ( excessive daytime sleepiness, and defects in memory and cognition), possible physiological consequences of OSA ( accelerated cardiovascular and cerebrovascular atherosclerosis), and changes in metabolic and inflammatory markers overlap with the symptoms and associated conditions seen in ageing. There is also the possibility of synergy in the effects of these symptoms and conditions on quality of life, as well as a need to separate treatable consequences of OSA from age-related complaints. Taken together, the aforementioned considerations make it essential to review the interaction of OSA and ageing, both proven and suspected. The present review examines some aspects of what is known and points to the need for further investigation of the relationships, given the large number of potentially affected subjects.
Topics: Aged; Disorders of Excessive Somnolence; Humans; Obesity; Quality of Life; Sleep Apnea Syndromes; Sleep Apnea, Obstructive
PubMed: 34561285
DOI: 10.1183/13993003.01649-2021 -
Acta Otorhinolaryngologica Italica :... Feb 2022The aim of our study was to investigate the presence of dysphagia in patients with Obstructive Sleep Apnoea (OSA) and to correlate swallowing impairment with hypnologic...
OBJECTIVE
The aim of our study was to investigate the presence of dysphagia in patients with Obstructive Sleep Apnoea (OSA) and to correlate swallowing impairment with hypnologic and anatomic parameters.
METHODS
The study population includes 36 patients suffering from OSA. Patients were divided into two groups using the presence of dysphagia as a distinctive parameter. Group 1 included 27 OSA patients without signs of dysphagia and Group 2 included 9 OSA patients with signs of dysphagia.
RESULTS
The age of patients in Group 2 was higher compared with the age of patients in Group 1. Analysis of Continuous Positive Airway Pressure (CPAP), obtained in the titration phase, showed that OSA patients with signs of dysphagia required a higher level of CPAP pressure than those who were not affected by swallowing abnormalities (12.6 ± 1 10.5 ± 1.9 p = 0.003). No other differences in anthropometric, hypnologic, or arterial blood gas values were found between the two groups.
CONCLUSIONS
In clinical practice, all OSA patients should undergo a complete ENT exam, including assessment of swallowing, before CPAP therapy is started. This may predict the need for higher CPAP pressure settings to resolve apnoea episodes in the presence of dysphagia as well as guide the choice of CPAP interfaces (orofacial vs. nasal) in these patients.
Topics: Continuous Positive Airway Pressure; Deglutition; Deglutition Disorders; Humans; Nose; Sleep Apnea, Obstructive
PubMed: 35129539
DOI: 10.14639/0392-100X-N1578 -
Respirology (Carlton, Vic.) Oct 2022
Topics: Humans; Sleep; Sleep Apnea, Obstructive
PubMed: 35871771
DOI: 10.1111/resp.14332 -
Sleep Medicine Dec 2023Excessive daytime sleepiness is common with obstructive sleep apnoea and can persist despite efforts to optimise primary airway therapy. The literature lacks... (Review)
Review
STUDY OBJECTIVE
Excessive daytime sleepiness is common with obstructive sleep apnoea and can persist despite efforts to optimise primary airway therapy. The literature lacks recommendations regarding differential diagnosis and management of excessive daytime sleepiness in obstructive sleep apnoea. This study sought to develop expert consensus statements to bridge the gap between existing literature/guidelines and clinical practice.
METHODS
A panel of 10 international experts was convened to undertake a modified Delphi process. Statements were developed based on available evidence identified through a scoping literature review, and expert opinion. Consensus was achieved through 3 rounds of iterative, blinded survey voting and revision to statements until a predetermined level of agreement was met (≥80 % voting "strongly agree" or "agree with reservation").
RESULTS
Consensus was achieved for 32 final statements. The panel agreed excessive daytime sleepiness is a patient-reported symptom. The importance of subjective/objective evaluation of excessive daytime sleepiness in the initial evaluation and serial management of obstructive sleep apnoea was recognised. The differential diagnosis of residual excessive daytime sleepiness in obstructive sleep apnoea was discussed. Optimizing airway therapy (eg, troubleshooting issues affecting effectiveness) was addressed. The panel recognised occurrence of residual excessive daytime sleepiness in obstructive sleep apnoea despite optimal airway therapy and the need to evaluate patients for underlying causes.
CONCLUSIONS
Excessive daytime sleepiness in patients with obstructive sleep apnoea is a public health issue requiring increased awareness, recognition, and attention. Implementation of these statements may improve patient care, long-term management, and clinical outcomes in patients with obstructive sleep apnoea.
Topics: Humans; Delphi Technique; Sleep Apnea, Obstructive; Disorders of Excessive Somnolence; Continuous Positive Airway Pressure; Surveys and Questionnaires
PubMed: 37839271
DOI: 10.1016/j.sleep.2023.10.001 -
European Respiratory Review : An... Jun 2022Excessive daytime sleepiness (EDS) is a major symptom of obstructive sleep apnoea (OSA), defined as the inability to stay awake during the day. Its clinical descriptors... (Review)
Review
Excessive daytime sleepiness (EDS) is a major symptom of obstructive sleep apnoea (OSA), defined as the inability to stay awake during the day. Its clinical descriptors remain elusive, and the pathogenesis is complex, with disorders such as insufficient sleep and depression commonly associated. Subjective EDS can be evaluated using the Epworth Sleepiness Scale, in which the patient reports the probability of dozing in certain situations; however, its reliability has been challenged. Objective tests such as the multiple sleep latency test or the maintenance of wakefulness test are not commonly used in patients with OSA, since they require nocturnal polysomnography, daytime testing and are expensive. Drugs for EDS are available in the United States but were discontinued in Europe some time ago. For European respiratory physicians, treatment of EDS with medication is new and they may lack experience in pharmacological treatment of EDS, while novel wake-promoting drugs have been recently developed and approved for clinical use in OSA patients in the USA and Europe. This review will discuss 1) the potential prognostic significance of EDS in OSA patients at diagnosis, 2) the prevalence and predictors of residual EDS in treated OSA patients, and 3) the evolution of therapy for EDS specifically for Europe.
Topics: Disorders of Excessive Somnolence; Humans; Reproducibility of Results; Sleep Apnea, Obstructive; Sleepiness; Wakefulness
PubMed: 35613742
DOI: 10.1183/16000617.0230-2021 -
European Respiratory Review : An... Jun 2023There is now widespread recognition within the world of sleep medicine of the increasing importance of dental sleep medicine and, in particular, the role of oral... (Review)
Review
There is now widespread recognition within the world of sleep medicine of the increasing importance of dental sleep medicine and, in particular, the role of oral appliance therapy (OAT) in the management of adults with obstructive sleep apnoea (OSA). For the purpose of this review, the term OAT refers to a custom-made intra-oral appliance, which acts to posture the mandible in a forward and downward direction, away from its natural resting position. Whilst nasally applied continuous positive airway pressure remains the "gold standard" in nonsurgical OSA management, OAT remains the recognised alternative treatment.This review of OAT aims to provide an evidence-based update on our current understanding of their mode of action, exploring the potential anatomical and physiological impact of their use in preventing collapse of the upper airway; the current clinical practice guidelines, including the recently published National Institute of Clinical Excellence 2021 guidance, in conjunction with the American Academy of Sleep Medicine and American Academy of Dental Sleep Medicine; optimal design features, comparing the role of custom-made noncustom OAT devices and the importance of titration in achieving a dose-dependent effect; patient predictors, preference and adherence to OAT; its impact on a range of both patient- and clinician-centred health outcomes, with a comparison with CPAP; the limitations and side-effects of providing OAT; and, finally, a look at future considerations to help optimise the delivery and outcomes of OAT.
Topics: Adult; Humans; Continuous Positive Airway Pressure; Sleep Apnea, Obstructive
PubMed: 37343962
DOI: 10.1183/16000617.0257-2022