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European Journal of Medical Research Jul 2023Polysomnography (PSG) is the gold standard for the diagnosis of obstructive sleep apnoea (OSA). Home sleep apnoea testing with peripheral arterial tonometry (PAT) is a...
BACKGROUND
Polysomnography (PSG) is the gold standard for the diagnosis of obstructive sleep apnoea (OSA). Home sleep apnoea testing with peripheral arterial tonometry (PAT) is a recommended diagnostic alternative for patients with an increased risk for OSA. In a large clinical cohort, we investigated concordance and predictors for discordance in diagnosing OSA using PAT and PSG, and three-year cardiovascular risk in patients with discordant OSA diagnosis.
METHODS
Retrospective monocentric cohort study. Patients with a PAT AHI ≥ 5/h followed by an in-hospital PSG within three months were included. All patients with a PAT AHI ≥ 5/h but a PSG AHI < 5/h were classified as discordant. Patients with PAT and PSG AHI ≥ 5/h were classified as concordant. To ascertain cardiovascular risk, major adverse cardiovascular events (MACE) were analyzed in discordant patients and sex, age, body mass index (BMI) and cardiovascular disease-matched concordant patients over a follow-up time of 3.1 ± 0.06 years.
RESULTS
A total of 940 patients, 66% male with an average age of 55 ± 0.4 years and BMI of 31 ± 0.2 kg/m were included. Agreement in OSA diagnosis was observed in 80% of patients (55% in mild and 86% in moderate and severe OSA). Factors significantly associated with a discordant diagnosis were female sex, younger age and lower BMI, but not comorbidities. There was no significant difference in MACE (p = 0.920) between discordant patients (n = 155) and matched concordant patients (n = 274) with or without therapy.
CONCLUSIONS
Concordance between PAT and PSG diagnosis of sleep apnoea is good, particularly in moderate and severe OSA. Predictors for discordant results between PAT and PSG were age, sex and BMI. MACE risk is similar in those with OSA diagnosed by PAT or PSG.
Topics: Humans; Female; Male; Middle Aged; Polysomnography; Cohort Studies; Retrospective Studies; Sleep Apnea, Obstructive; Sleep Apnea Syndromes
PubMed: 37481575
DOI: 10.1186/s40001-023-01164-w -
Intermittent Hypoxia Mediates Cancer Development and Progression Through HIF-1 and miRNA Regulation.Archivos de Bronconeumologia Oct 2023There is still a debate for the link between obstructive sleep apnoea (OSA) and cancer. The mechanisms underlying this causality are poorly understood. Several miRNAs...
INTRODUCTION
There is still a debate for the link between obstructive sleep apnoea (OSA) and cancer. The mechanisms underlying this causality are poorly understood. Several miRNAs are involved in cancer development and progression with expression being influenced by hypoxia. The aims of this work were (i) to compare miRNAs expression in controls versus patients affected by OSA without or with cancer (ONCO-OSA) and (ii) in colorectal cancer cells exposed to intermittent hypoxia (IH), to evaluate miRNAs impact on tumor progression in vitro.
METHODS
We detected miRNAs by qRT-PCR in patients' sera and in CaCo2 cells exposed to 2-32h of IH with or without acriflavine (ACF), a HIF-1 inhibitor. Viability and transwell invasion test were applied to investigate the proliferation and migration of CaCo2 exposed to IH and treated with miRNA inhibitors or acriflavine. HIF-1α activity was evaluated in CaCo2 cells after IH.
RESULTS
The levels of miR-21, miR-26a and miR-210 increased in OSA and ONCO-OSA patients compared to controls. MiR-23b increased in ONCO-OSA patients, and miR-27b and miR-145 increased in OSA but not ONCO-OSA patients. MiR-21, miR-26a, miR-23b and miR-210 increased in cells after IH. IH stimulated cell proliferation and migration. This effect was reduced after either miRNA inhibition or acriflavine treatment. MiRNA inhibition reduces HIF-1α gene expression. Conversely, acriflavine reduced the expression of these miRNAs.
CONCLUSIONS
We identified a signature of miRNAs, induced by the IH environment. They could be implicated in cancer development and progression through a regulatory loop involving HIF-1.
Topics: Humans; MicroRNAs; Caco-2 Cells; Acriflavine; Hypoxia; Sleep Apnea, Obstructive; Neoplasms
PubMed: 37517933
DOI: 10.1016/j.arbres.2023.07.001 -
Sleep Medicine Nov 2020Sleep-disordered breathing (SDB) is highly prevalent after stroke and is associated with poor outcomes. Currently, after stroke, objective testing must be used to...
OBJECTIVE/BACKGROUND
Sleep-disordered breathing (SDB) is highly prevalent after stroke and is associated with poor outcomes. Currently, after stroke, objective testing must be used to differentiate patients with and without SDB. Within a large, population-based study, we evaluated the usefulness of a flexible statistical model based on baseline characteristics to predict post-stroke SDB.
PATIENTS/METHODS
Within a population-based study, participants (2010-2018) underwent SDB screening, shortly after ischemic stroke, with a home sleep apnea test. The respiratory event index (REI) was calculated as the number of apneas and hypopneas per hour of recording; values ≥10 defined SDB. The distributed random forest classifier (a machine learning technique) was applied to predict SDB with the following as predictors: demographics, stroke risk factors, stroke severity (NIHSS), neck and waist circumference, palate position, and pre-stroke symptoms of snoring, apneas, and sleepiness.
RESULTS
Within the total sample (n = 1330), median age was 65 years; 47% were women; 32% non-Hispanic white, 62% Mexican American, and 6% African American. SDB was found in 891 (67%). The area under the receiver operating characteristic curve, a measure of predictive ability, applied to the validation sample was 0.75 for the random forest model. Random forest correctly classified 72.5% of validation samples.
CONCLUSIONS
In this large, ethnically diverse, population-based sample of ischemic stroke patients, prediction models based on baseline characteristics and clinical measures showed fair rather than clinically reliable performance, even with use of advanced machine learning techniques. Results suggest that objective tests are still needed to differentiate ischemic stroke patients with and without SDB.
Topics: Aged; Female; Humans; Male; Polysomnography; Risk Factors; Sleep Apnea Syndromes; Snoring; Stroke
PubMed: 32835899
DOI: 10.1016/j.sleep.2020.05.004 -
Australian Journal of General Practice Sep 2023The cardiovascular outcomes of obstructive sleep apnoea (OSA) are well understood. The effects of OSA on the urological system are emerging and they have the potential... (Review)
Review
BACKGROUND
The cardiovascular outcomes of obstructive sleep apnoea (OSA) are well understood. The effects of OSA on the urological system are emerging and they have the potential to impact quality of life and patient outcomes.
OBJECTIVE
This article aims to strengthen the connection between OSA and urological complaints, summarise their response to CPAP treatment and discuss their clinical utility in OSA.
DISCUSSION
Common urological complaints associated with OSA are nocturnal polyuria, overactive bladder symptoms and erectile dysfunction. Urinary symptoms are thought to be related to recurrent hypoxic episodes and have a significant impact on quality of life. Multiple studies report that urological symptoms and quality of life improve with CPAP treatment. However, current OSA screening questionnaires rely heavily on cardiorespiratory symptoms and specific risk factors that are not present in all OSA population subgroups. We review data that support clinicians incorporating urological symptoms when screening for OSA.
Topics: Male; Humans; Quality of Life; Urological Manifestations; Continuous Positive Airway Pressure; Risk Factors; Sleep Apnea, Obstructive
PubMed: 37666780
DOI: 10.31128/AJGP-01-23-6666 -
Journal of Clinical Sleep Medicine :... Apr 2020Simonson J, Greenberg H, Talwar A. Pulmonary artery dilatation and obstructive sleep apnea. . 2020;16(4):647.
Simonson J, Greenberg H, Talwar A. Pulmonary artery dilatation and obstructive sleep apnea. . 2020;16(4):647.
Topics: Dilatation; Heart Defects, Congenital; Humans; Pulmonary Artery; Sleep Apnea Syndromes; Sleep Apnea, Obstructive
PubMed: 32022665
DOI: 10.5664/jcsm.8300 -
The European Respiratory Journal May 2021
Topics: Humans; Sleep Apnea Syndromes; Sleep Apnea, Obstructive
PubMed: 33958377
DOI: 10.1183/13993003.04644-2020 -
Lin Chuang Er Bi Yan Hou Tou Jing Wai... Feb 2022REM-related obstructive sleep apnea (REM-OSA) refers to apneas and hypopneas in which most respiratory events occur during REM. The total AHI of REM-OSA is low... (Review)
Review
REM-related obstructive sleep apnea (REM-OSA) refers to apneas and hypopneas in which most respiratory events occur during REM. The total AHI of REM-OSA is low compared to NREM-OSA, but the duration of apnea hypopnea events is longer and the oxygen saturation is lower. Only focusing on the total AHI value will miss the diagnosis of REM-OSA, and even some patients with severe hypoxemia cannot be effectively treated.REM-OSA may be an early manifestation of OSA, and active early recognition and intervention may benefit patients.The pathophysiology and mechanism of REM-OSA are still unclear. In this article, we reviewed the existing REM-OSA related research.
Topics: Humans; Hypoxia; Sleep Apnea, Obstructive; Sleep, REM
PubMed: 35172555
DOI: 10.13201/j.issn.2096-7993.2022.02.015 -
Australian Journal of General Practice Jun 2024Obstructive sleep apnoea (OSA) and insomnia are the two most common sleep disorders and are frequent reasons for presentation in Australian general practice.
BACKGROUND
Obstructive sleep apnoea (OSA) and insomnia are the two most common sleep disorders and are frequent reasons for presentation in Australian general practice.
OBJECTIVE
This article describes the development, content and suggested uses of the online sleep health primary care clinical resource, which provides general practitioners and other primary healthcare professionals with evidence-based information on the aetiology, assessment, management, referral and ongoing care for OSA and chronic insomnia.
DISCUSSION
The Royal Australian College of General Practitioners-accepted clinical resource for the management of OSA and chronic insomnia in primary care was developed by the Australian National Centre for Sleep Health Services Research. The resource is designed to be used during consultations (eg following the steps in assessment and management and the use of online questionnaires for the assessment of OSA [Epworth Sleepiness Scale/OSA50/STOP-Bang] and insomnia [Sleep Condition Indicator/and Insomnia Severity Index]) and as an education/training tool (eg evidence on the role of continuous positive airway pressure/mandibular advancement splints for management of OSA and brief behavioural therapy for insomnia/cognitive behavioural therapy for insomnia for the management of insomnia).
Topics: Humans; Primary Health Care; Sleep Apnea, Obstructive; Sleep Initiation and Maintenance Disorders; Surveys and Questionnaires; Australia; Continuous Positive Airway Pressure
PubMed: 38840372
DOI: 10.31128/AJGP-03-23-6779 -
The Lancet. Respiratory Medicine Sep 2022
Topics: Humans; Obesity; Patient Outcome Assessment; Sleep Apnea, Obstructive
PubMed: 35461571
DOI: 10.1016/S2213-2600(22)00137-0 -
The Cochrane Database of Systematic... Oct 2022Central sleep apnoea (CSA) is characterised by abnormal patterns of ventilation during sleep due to a dysfunctional drive to breathe. Consequently, people with CSA may... (Review)
Review
BACKGROUND
Central sleep apnoea (CSA) is characterised by abnormal patterns of ventilation during sleep due to a dysfunctional drive to breathe. Consequently, people with CSA may present poor sleep quality, sleep fragmentation, inattention, fatigue, daytime sleepiness, and reduced quality of life.
OBJECTIVES
To assess the effectiveness and safety of non-invasive positive pressure ventilation (NIPV) for the treatment of adults with CSA.
SEARCH METHODS
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and Scopus on 6 September 2021. We applied no restrictions on language of publication. We also searched clinical trials registries for ongoing and unpublished studies, and scanned the reference lists of included studies to identify additional studies.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) reported in full text, those published as abstract only, and unpublished data.
DATA COLLECTION AND ANALYSIS
Two review authors independently selected studies for inclusion, extracted data, and assessed risk of bias of the included studies using the Cochrane risk of bias tool version 1.0, and the certainty of the evidence using the GRADE approach. In the case of disagreement, a third review author was consulted.
MAIN RESULTS
We included 15 RCTs with a total of 1936 participants, ranging from 10 to 1325 participants. All studies had important methodological limitations. We assessed most studies (11 studies) as at high risk of bias for at least one domain, and all studies as at unclear risk of bias for at least two domains. The trials included participants aged > 18 years old, of which 70% to 100% were men, who were followed from one week to 60 months. The included studies assessed the effects of different modes of NIPV and CSA. Most participants had CSA associated with chronic heart failure. Because CSA encompasses a variety of causes and underlying clinical conditions, data were carefully analysed, and different conditions and populations were not pooled. The findings for the primary outcomes for the seven evaluated comparisons are presented below. Continuous positive airway pressure (CPAP) plus best supportive care versus best supportive care in CSA associated with chronic heart failure In the short term, CPAP plus best supportive care may reduce central apnoea hypopnoea index (AHI) (mean difference (MD) -14.60, 95% confidence interval (CI) -20.11 to -9.09; 1 study; 205 participants). However, CPAP plus best supportive care may result in little to no difference in cardiovascular mortality compared to best supportive care alone. The evidence for the effect of CPAP plus best supportive care on all-cause mortality is very uncertain. No adverse effects were observed with CPAP, and the results for adverse events in the best supportive care group were not reported. Adaptive servo ventilation (ASV) versus CPAP in CSA associated with chronic heart failure The evidence is very uncertain about the effect of ASV versus CPAP on quality of life evaluated in both the short and medium term. Data on adverse events were not reported, and it is not clear whether data were sought but not found. ASV versus bilevel ventilation in CSA associated with chronic heart failure In the short term, ASV may result in little to no difference in central AHI. No adverse events were detected with ASV, and the results for adverse events in the bilevel ventilation group were not reported. ASV plus best supportive care versus best supportive care in CSA associated with chronic heart failure In the medium term, ASV plus best supportive care may reduce AHI compared to best supportive care alone (MD -20.30, 95% CI -28.75 to -11.85; 1 study; 30 participants). In the long term, ASV plus best supportive care likely increases cardiovascular mortality compared to best supportive care (risk ratio (RR) 1.25, 95% CI 1.04, 1.49; 1 study; 1325 participants). The evidence suggests that ASV plus best supportive care may result in little to no difference in quality of life in the short, medium, and long term, and in all-cause mortality in the medium and long term. Data on adverse events were evaluated but not reported. ASV plus best supportive care versus best supportive care in CSA with acute heart failure with preserved ejection fraction Only adverse events were reported for this comparison, and no adverse events were recorded in either group. ASV versus CPAP maintenance in CPAP-induced CSA In the short term, ASV may slightly reduce central AHI (MD -4.10, 95% CI -6.67 to -1.53; 1 study; 60 participants), but may result in little to no difference in quality of life. Data on adverse events were not reported, and it is not clear whether data were sought but not found. ASV versus bilevel ventilation in CPAP-induced CSA In the short term, ASV may slightly reduce central AHI (MD -8.70, 95% CI -11.42 to -5.98; 1 study; 30 participants) compared to bilevel ventilation. Data on adverse events were not reported, and it is not clear whether data were sought but not found.
AUTHORS' CONCLUSIONS
CPAP plus best supportive care may reduce central AHI in people with CSA associated with chronic heart failure compared to best supportive care alone. Although ASV plus best supportive care may reduce AHI in people with CSA associated with chronic heart failure, it likely increases cardiovascular mortality in these individuals. In people with CPAP-induced CSA, ASV may slightly reduce central AHI compared to bilevel ventilation and to CPAP. In the absence of data showing a favourable impact on meaningful patient-centred outcomes and defining clinically important differences in outcomes in CSA patients, these findings need to be interpreted with caution. Considering the level of certainty of the available evidence and the heterogeneity of participants with CSA, we could draw no definitive conclusions, and further high-quality trials focusing on patient-centred outcomes, such as quality of life, quality of sleep, and longer-term survival, are needed to determine whether one mode of NIPV is better than another or than best supportive care for any particular CSA patient group.
Topics: Adult; Male; Humans; Adolescent; Female; Sleep Apnea, Central; Sleep Apnea, Obstructive; Continuous Positive Airway Pressure; Disorders of Excessive Somnolence; Heart Failure
PubMed: 36278514
DOI: 10.1002/14651858.CD012889.pub2