-
Nature and Science of Sleep 2024The prevalence of obstructive sleep apnea (OSA) among the bariatric surgery population is estimated to be 45-70%. However, weight loss obtained by bariatric surgery is... (Review)
Review
The prevalence of obstructive sleep apnea (OSA) among the bariatric surgery population is estimated to be 45-70%. However, weight loss obtained by bariatric surgery is not always associated with full remission of OSA, suggesting that other confounding factors are present. This article aims to review the current literature, focusing on factors that could predict the persistence of OSA after bariatric surgery. For this purpose, relevant studies of more than 50 patients that assessed pre- and post-operative presence and severity of OSA detected by poly(somno)graphy (PG/PSG) in bariatric populations were collected. Six retrospective and prospective studies were evaluated that included 1302 OSA patients, with a BMI range of 42.6 to 56 kg/m, age range of 44.8 to 50.7 years, and percentage of women ranging from 45% to 91%. The studies were very heterogeneous regarding type of bariatric surgery, diagnostic criteria for OSA and OSA remission, and delay of OSA reassessment. OSA remission was observed in 26% to 76% of patients at 11-12 months post-surgery. Loss to follow-up was high in all studies, leading to a potential underestimation of OSA remission. Based on this limited sample of bariatric patients, age, pre-operative OSA severity, proportion of weight loss, and type 2 diabetes (T2D) were identified as factors associated with OSA persistence but the results were inconsistent between studies regarding the impact of age and the magnitude of weight loss. Several other factors may potentially lead to OSA persistence in the bariatric surgery population, such as fat distribution, ethnicity, anatomical predisposition, pathophysiological traits, supine position, and REM-predominant hypopnea and apnea. Further well-conducted multicentric prospective studies are needed to document the importance of these factors to achieve a better understanding of OSA persistence after bariatric surgery in obese patients.
PubMed: 38348054
DOI: 10.2147/NSS.S448346 -
Sleep Medicine Mar 2024Obstructive sleep disordered breathing (SDB) is prevalent in patients with Spinal Muscular Atrophy (SMA) and possibly reduced by disease modifying treatment (DMT) such...
BACKGROUND
Obstructive sleep disordered breathing (SDB) is prevalent in patients with Spinal Muscular Atrophy (SMA) and possibly reduced by disease modifying treatment (DMT) such as nusinersen. We hypothesized that some obstructive events may in fact be pseudo-obstructive, reflecting the imbalance of chest wall weakness with preserved diaphragmatic function, rather than true upper airway obstruction. If confirmed, these events could represent SMA-specific outcome measures. We aimed to report on the pattern observed in respiratory polygraphies (PG) in paediatric patients with SMA type 2 resembling obstructive SDB. We defined pseudo-obstructive SDB and assessed its changes throughout disease progression.
METHODS
Retrospective review of 18 PG of 6 SMA type 2 patients naïve from DMT across 3 timepoints (first study, one-year follow-up, latest study).
RESULTS
At first study patients aged 3-13 years. Four patients were self-ventilating in room air and one of them required non-invasive ventilation (NIV) after the 1-year study. Two patients were on NIV since the first study. The features of pseudo-obstructive SDB included a. paradoxical breathing before, after, and throughout the event, b. the absence of increased respiratory rate during the event, c. the absence of compensatory breath after the event with a return to baseline breathing. Pseudo-obstructive events were progressively more prevalent over time. The derived pseudo-obstructive AHI increased at each timepoint in all patients self-ventilating, whilst it dropped after NIV initiation/adjustments.
CONCLUSIONS
Pseudo-obstructive SDB is prevalent in SMA type 2. Its number progresses along with the disease and is treatable with NIV. Prospective studies in larger SMA cohorts are planned.
Topics: Humans; Child; Sleep Apnea Syndromes; Prospective Studies; Sleep Apnea, Obstructive; Muscular Atrophy, Spinal; Respiration; Spinal Muscular Atrophies of Childhood
PubMed: 38330697
DOI: 10.1016/j.sleep.2024.02.005 -
Annals of the American Thoracic Society May 2024Oral appliances are second-line treatments after continuous positive airway pressure for obstructive sleep apnea (OSA) management. However, the need for oral appliance... (Observational Study)
Observational Study
Oral appliances are second-line treatments after continuous positive airway pressure for obstructive sleep apnea (OSA) management. However, the need for oral appliance titration limits their use as a result of monitoring challenges to assess the treatment effect on OSA. To assess the validity of mandibular jaw movement (MJM) automated analysis compared with polysomnography (PSG) and polygraphy (PG) in evaluating the effect of oral appliance treatment and the effectiveness of MJM monitoring for oral appliance titration at home in patients with OSA. This observational, prospective study included 135 patients with OSA eligible for oral appliance therapy. The primary outcome was the apnea-hypopnea index (AHI), measured through in-laboratory PSG/PG and MJM-based technology. Additionally, MJM monitoring at home was conducted at regular intervals during the titration process. The agreement between PSG/PG and MJM automated analysis was revaluated using Bland-Altman analysis. Changes in AHI during the home-based oral appliance titration process were evaluated using a generalized linear mixed model and a generalized estimating equation model. The automated MJM analysis demonstrated strong agreement with PG in assessing AHI at the end of titration, with a median bias of 0.24/h (limits of agreement, -11.2 to 12.8/h). The improvement of AHI from baseline in response to oral appliance treatment was consistent across three evaluation conditions: in-laboratory PG (-59.6%; 95% confidence interval, -59.8% to -59.5%), in-laboratory automated MJM analysis (-59.2%; -65.2% to -52.2%), and at-home automated MJM analysis (-59.7%; -67.4% to -50.2%). Incorporating MJM automated analysis into the oral appliance titration process has the potential to optimize oral appliance therapy outcomes for OSA.
Topics: Humans; Sleep Apnea, Obstructive; Prospective Studies; Male; Polysomnography; Female; Middle Aged; Adult; Mandible; Aged; Continuous Positive Airway Pressure; Movement; Monitoring, Physiologic
PubMed: 38330168
DOI: 10.1513/AnnalsATS.202312-1077OC -
Addiction & Health Oct 2023This study aimed to assess the association of sleep apnea syndrome (SAS) with methadone dose and timing of administration in patients receiving methadone maintenance...
BACKGROUND
This study aimed to assess the association of sleep apnea syndrome (SAS) with methadone dose and timing of administration in patients receiving methadone maintenance treatment (MMT) for opioid use disorder (OUD).
METHODS
This retrospective cross-sectional study was conducted on adult patients receiving MMT who had a nocturnal respiratory polygraphy between November 2015 and December 2021. Data on methadone treatment and polygraph recording, including the apnea-hypopnea index (AHI) were collected.
FINDINGS
A total of 40 patients, mostly male (72.5%), with a mean age of 35±6.7 years and a mean body mass index (BMI) of 25.1±4.5 kg/m were included. The daily dose of methadone was significantly associated with an AHI≥15 events/h as well as an AHI≥30 events/h, even after adjustment for age, gender, BMI, and benzodiazepine use. However, these associations were not preserved when the time of administration (day vs evening) was considered, while the evening administration was significantly associated with an AHI≥15 events/h. The best sensitivity and specificity for the prediction of AHI≥15 events/h and AHI≥30 events/h were obtained with daily methadone doses of≥72.5 mg and 77.5 mg, respectively.
CONCLUSION
In this sample of MMT patients, methadone doses of 72.5 mg and 77.5 mg were the best cut-off values for predicting AHI≥15 and≥30 events/h, respectively, especially when taken in the evening. These results should draw clinicians' attention to the importance of SAS screening, and further studies are needed, notably comparisons with buprenorphine.
PubMed: 38322484
DOI: 10.34172/ahj.2023.1455 -
Archivos de Cardiologia de Mexico Feb 2024To determine the clinical-epidemiological characteristics, diagnostic feasibility of home respiratory polygraphy and treatment of patients with suspected obstructive...
OBJECTIVE
To determine the clinical-epidemiological characteristics, diagnostic feasibility of home respiratory polygraphy and treatment of patients with suspected obstructive sleep apnea (OSA) at cardiovascular risk.
METHODS
An observational, cross-sectional, descriptive study was conducted in patients seen in a cardiology outpatient service with suspected OSA, from January 2015 to December 2019. The information was obtained from medical records, and a descriptive statistical analysis was applied to this information.
RESULTS
138 files were reviewed; only 8% of the home respiratory polygraphs were discarded, because they did not meet the required quality standards. It was demonstrated that 89% suffered from OSA, 60% moderate to severe; in men after 50 years of age. The main cardiovascular risk factors was hypertension (89%). The most prevalent heart disease was hypertension (52%). Cardiovascular pharmacological treatment was improved in 82% of the cases. Cardiac rehabilitation in 30%, noninvasive mechanical ventilation 41%, fixed modality 33%, and self-adjustable 9%, all with telemetry.
CONCLUSIONS
The prevalence and severity of OSA is higher in the presence of risk or established cardiovascular disease. In the presence of clinical suspicion, it is feasible to confirm the diagnosis with home respiratory poligrafy due to the level of precision and the lower infrastructure required. Greater involvement of the cardiologist in the diagnosis and treatment of this disorder is necessary due to the significant risk of cardiovascular disease it represents.
PubMed: 38306451
DOI: 10.24875/ACM.23000078 -
Stroke Mar 2024Sleep-disordered breathing (SDB) and atrial fibrillation (AF) are highly prevalent in patients with stroke and are recognized as independent risk factors for stroke....
BACKGROUND
Sleep-disordered breathing (SDB) and atrial fibrillation (AF) are highly prevalent in patients with stroke and are recognized as independent risk factors for stroke. Little is known about the impact of comorbid SDB and AF on long-term outcomes after stroke.
METHODS
In this prospective cohort study, 353 patients with acute ischemic stroke or transient ischemic attacks were analyzed. Patients were screened for SDB by respiratory polygraphy during acute hospitalization. Screening for AF was performed using a 7-day ECG up to 3× in the first 6 months. Follow-up visits were scheduled at 1, 3, 12, 24, and 36 months poststroke. Cox regression models adjusted for various factors (age, sex, body mass index, hypertension, diabetes, dyslipidemia, and heart failure) were used to assess the impact of comorbid SDB and AF on subsequent death or cerebro-cardiovascular events.
RESULTS
Among 353 patients (299 ischemic stroke and 54 transient ischemic attacks), median age, 67 (interquartile range, 57-74) years with 63% males. Moderate-to-severe SDB (apnea-hypopnea index score, ≥15/h) was present in 118 (33.4%) patients. Among the 56 (15.9%) patients with AF, 28 had comorbid moderate-to-severe SDB and AF. Over 36 months, there were 12 deaths and 67 recurrent cerebro-cardiovascular events. Patients with comorbid moderate-to-severe SDB and AF had a higher risk of subsequent death or cerebro-cardiovascular events compared with those with only moderate-to-severe SDB without AF (hazard ratio, 2.49 [95% CI, 1.18-5.24]) and to those without moderate-to-severe SDB or AF (hazard ratio, 2.25 [95% CI, 1.12-4.50]). However, no significant difference was found between the comorbid moderate-to-severe SDB and AF group and the group with only AF without moderate-to-severe SDB (hazard ratio, 1.64 [95% CI, 0.62-4.36]).
CONCLUSIONS
Comorbid moderate-to-severe SDB and AF significantly increase the risk of long-term mortality or recurrent cerebro-cardiovascular events after acute ischemic stroke. Considering both conditions as cumulative and modifiable cerebro-cardiovascular risk factors is of interest for the management of acute stroke.
REGISTRATION
URL: https://www.clinicaltrials.gov; Unique identifier: NCT02559739.
Topics: Male; Humans; Aged; Female; Ischemic Attack, Transient; Atrial Fibrillation; Ischemic Stroke; Prospective Studies; Stroke; Sleep Apnea Syndromes; Risk Factors
PubMed: 38275115
DOI: 10.1161/STROKEAHA.123.042856 -
Sleep Advances : a Journal of the Sleep... 2024Polygraphy (PG) is often used to diagnose obstructive sleep apnea (OSA). However, it does not use electroencephalography, and therefore cannot estimate sleep time or...
Polygraphy (PG) is often used to diagnose obstructive sleep apnea (OSA). However, it does not use electroencephalography, and therefore cannot estimate sleep time or score arousals and related hypopneas. Consequently, the PG-derived respiratory event index (REI) differs from the polysomnography (PSG)-derived apnea-hypopnea index (AHI). In this study, we comprehensively analyzed the differences between AHI and REI. Conventional AHI and REI were calculated based on total sleep time (TST) and total analyzed time (TAT), respectively, from two different PSG datasets ( = 1561). Moreover, TAT-based AHI (AHI) and TST-based REI (REI) were calculated. These indices were compared keeping AHI as the gold standard. The REI, AHI, and REI were significantly lower than AHI ( < 0.0001, ≤ 0.002, and ≤ 0.01, respectively). The total classification accuracy of OSA severity based on REI was 42.1% and 72.8% for two datasets. Based on AHI, the accuracies were 68.4% and 85.9%, and based on REI, they were 65.9% and 88.5% compared to AHI. AHI was most correlated with REI ( = 0.98 and = 0.99 for the datasets) and least with REI ( = 0.92 and = 0.97). Compared to AHI, REI had the largest mean absolute errors (13.9 and 6.7) and REI the lowest (5.9 and 1.9). REI had the lowest sensitivities (42.1% and 72.8%) and specificities (80.7% and 90.9%) in both datasets. Based on these present results, REI underestimates AHI. Furthermore, these results indicate that arousal-related hypopneas are an important measure for accurately classifying OSA severity.
PubMed: 38264141
DOI: 10.1093/sleepadvances/zpad054 -
Journal of Clinical Medicine Jan 2024Obstructive sleep apnea (OSA) is common in professional truck drivers. It is important that OSA is recognized since undiagnosed and/or untreated sleep apnea is a risk...
Obstructive sleep apnea (OSA) is common in professional truck drivers. It is important that OSA is recognized since undiagnosed and/or untreated sleep apnea is a risk factor for sleepiness-related traffic accidents. In this study, we developed a new simple tool to screen for obstructive sleep apnea (OSA) in this population. Altogether, 2066 professional truck drivers received a structured questionnaire. A total of 175 drivers had a clinical examination and were invited to participate in sleep laboratory studies, including cardiorespiratory polygraphy. We studied associations of different risk factors with the presence of sleep apnea. We established a new simple screening tool for obstructive sleep apnea (OSA) that was compared to other existing screening tools. A total of 1095 drivers completed the questionnaire. Successful cardiorespiratory polygraphy was obtained for 172 drivers. Full data were available for 160 male drivers included in the analyses. The following five risk factors for sleep apnea formed the BAMSA score (0 to 5): BMI > 30 kgm, age > 50 years, male gender, snoring at least one night per week, and the presence of apnea at least sometimes. BAMSA showed a sensitivity of 85.7% and a specificity of 78.8% in detecting AHI ≥ 15 when using a cut-off point of 4, and the ROC area was 0.823. BAMSA is a sensitive and easy-to-use tool in predicting obstructive sleep apnea in male professional drivers.
PubMed: 38256656
DOI: 10.3390/jcm13020522 -
Archives of Disease in Childhood Mar 2024Cardiorespiratory polygraphy (CRP) is the predominant technology used to diagnose obstructive sleep apnoea (OSA) in tertiary centres in the UK. Nocturnal pulse oximetry...
BACKGROUND AND OBJECTIVE
Cardiorespiratory polygraphy (CRP) is the predominant technology used to diagnose obstructive sleep apnoea (OSA) in tertiary centres in the UK. Nocturnal pulse oximetry (NPO) is, however, cheaper and more accessible. This study evaluated the ability of NPO indices to predict OSA in typically developing (TD) children.
METHODS
Indices from simultaneous NPO and CRP recordings were compared in TD children (aged 1-16 years) referred to evaluate OSA in three tertiary centres. OSA was defined as an obstructive apnoea-hypopnoea index (OAHI) ≥1 event/hour. Receiver operating characteristic curves assessed the diagnostic accuracy of NPO indices including ODI3 (3% Oxygen Desaturation Index, ODI4 (4% Oxygen Desaturation Index), delta 12 s index and minimum oxygen saturation. Two-by-two tables were generated to determine the sensitivities and specificities of whole number cut-off values for predicting OAHIs ≥1, 5 and 10 events/hour.
RESULTS
Recordings from 322 TD children, 197 male (61.2%), median age 4.9 years (range 1.1-15.6), were reviewed. OAHI was ≥1/hour in 144 (44.7%), ≥5/hour in 61 (18.9%) and ≥10/hour in 28 (8.7%) cases. ODI3 and ODI4 had the best diagnostic accuracy. ODI3 ≥7/hour and ODI4 ≥4/hour predicted OSA in TD children with sensitivities/specificities of 57.6%/85.4% and 46.2%/91.6%, respectively. ODI3 ≥8/hour was the best predictor of OAHI ≥5/hour (sensitivity 82.0%, specificity 84.3%).
CONCLUSION
Raised ODI3 and ODI4 predict OSA in TD children with high specificity but variable sensitivity. NPO may be an alternative to diagnose moderate-severe OSA if access to CRP is limited. Low sensitivities to detect mild OSA mean that confirmatory CRP is needed if NPO is normal.
Topics: Child; Humans; Male; Infant; Child, Preschool; Adolescent; Polysomnography; Sleep Apnea, Obstructive; Oximetry; Oxygen; Sensitivity and Specificity
PubMed: 38253431
DOI: 10.1136/archdischild-2023-326191 -
Sleep Medicine Feb 2024Sleep-disordered breathing (SDB) is common in patients with neuromuscular diseases (NMD). Focusing on hypercapnia may lead to the neglect of other SDB such as...
BACKGROUND
Sleep-disordered breathing (SDB) is common in patients with neuromuscular diseases (NMD). Focusing on hypercapnia may lead to the neglect of other SDB such as obstructive and/or central sleep apnea syndrome (SAS). Our objectives were to assess the risk of inappropriate SDB management according to different screening strategies and to evaluate the prevalence and determinants of isolated and overlapping sleep apnea in patients with slowly progressive NMD.
METHODS
This monocentric, cross-sectional, retrospective study analyzed medical records of adult NMD patients referred to a sleep department. Diagnostic strategies, including respiratory polygraphy (RP), nocturnal transcutaneous capnography (tcCO2), and blood gases (BG), were assessed for their performance in diagnosing SDB. Demographics and pulmonary function test results were compared between patients with or without SDB to identify predictors.
RESULTS
Among the 149 patients who underwent a full diagnostic panel (RP + tcCO2 + BG), 109 were diagnosed with SDB. Of these, 33% had isolated SAS, and central apneas were predominant. Using single diagnostic strategies would lead to inappropriate SDB management in two thirds of patients. A combination of 2 diagnostic tools resulted respectively in 21.1, 22.9 and 42.2 % of inappropriate SDB management for RP + tcCO2, RP + BG and tcCO2 + BG.
CONCLUSION
The significant prevalence of sleep apnea syndrome in patients with slowly progressive NMD highlights the need for increased awareness among clinicians. Improved diagnostics involve a systematic approach addressing both sleep apnea and diurnal and nocturnal alveolar hypoventilation to avoid inappropriate management and limit the consequences of SDB.
Topics: Adult; Humans; Retrospective Studies; Cross-Sectional Studies; Sleep Apnea Syndromes; Neuromuscular Diseases; Sleep Apnea, Central; Blood Gas Monitoring, Transcutaneous
PubMed: 38237410
DOI: 10.1016/j.sleep.2024.01.009