Sleep-Disordered Breathing in Recipients of Implantable Defibrillators

Study Objectives: To examine the prevalence and clinical significance of sleep-disordered breathing in patients with implantable cardioverter defibrillators (ICD).
Methods and Results: Overnight sleep studies were performed in 129 ICD recipients who had no history of sleep apnea. The mean left ventricular ejection fraction (LVEF) was 29 ± 11%. Mild, moderate, and severe sleep apnea was diagnosed in the presence of an apnea/hypopnea index (AHI) of 5–15/h, 15.1–30/h, and >30/h, respectively. No sleep apnea was present in 49 patients (38%), 57 (44%) had central sleep apnea (CSA), and 23 patients (18%) had obstructive sleep apnea (OSA). Mild, moderate, and severe sleep apnea were present in 25%, 31%, and 44% of patients with CSA, compared with 52%, 22%, and 26% of patients with OSA (P < 0.05). LVEF was similar in patients with versus without OSA or CSA. Patients with CSA were significantly older and had a higher prevalence of ischemic cardiomyopathy than patients without sleep apnea.
Conclusions: Previously undiagnosed CSA is common in ICD recipients. Severely disordered breathing during sleep was more prevalent among patients with CSA than patients with OSA. This prospective, observational study will examine the long-term clinical significance of sleep-disordered breathing in ICD recipients.     

Association Between Obstructive Sleep Apnea and Pulmonary Embolism

ObjectivesTo compare the prevalence of obstructive sleep apnea (OSA) in patients with pulmonary embolism (PE) with a sex-, age-, and body mass index (BMI)–matched, population-based control group and to assess the association between OSA and PE.MethodsWe performed a case-control study from October 1, 2006, through November 30, 2009. We included 107 patients with PE and a control group (n=102) without PE in University Hospitals Son Espases and La Paz in Spain. Variables included in the analysis were medical history, anthropometric variables (weight, height, BMI, and neck circumference), Epworth Sleepiness Scale score, home respiratory polygraphy, basic biochemical profile and hemogram, spirometry, and physical activity.ResultsThe mean ± SD apnea-hypopnea index (AHI) was significantly higher in patients with PE than population controls (21.2±20.6 vs 11.5±15.9 h^?1; P<.001). The presence of an AHI greater than 5 h^?1 and hypersomnolence (Epworth Sleepiness Scale score ≥11) was more frequent in PE patients than in controls (14.0% vs 4.9%; P=.0002). A crude model analysis by several cutoffs revealed that the AHI was significantly associated with PE. After adjustment for age, sex, smoking, BMI, lung function, and all known PE risk factors, the odds ratio for PE was 3.7 (95% CI, 1.3-10.5; P=.01).ConclusionA higher prevalence of OSA was detected in patients diagnosed as having acute PE than controls. This study identified a significant and independent association between OSA and PE.     

Development of the University Postoperative Obstructive Sleep Apnea Protocol (UPOP)

PurposeThe purpose of this project was to retrospectively analyze medical records to determine the relationship between surgical patients with obstructive sleep apnea (OSA) risk factors and the occurrence of a critical respiratory event (CRE) in the postanesthesia care unit (PACU), and to subsequently develop a protocol for postoperative care. Although OSA is prevalent among the surgical population, research has primarily focused on preoperative identification and tailored perioperative care with limited application of standardized postoperative OSA management.DesignSurgical charts were retrospectively reviewed between April 1, 2019 and June 31, 2019. Medical records were reviewed to identify surgical patients who had a diagnosis of OSA or two or more OSA risk factors. For patients who met initial inclusion, PACU charts were reviewed for the occurrence of a CRE while in PACU. Data analysis involved use of both Microsoft Excel 2011 and IBM SPSS Statistics Base, version 26.MethodsMedical records were reviewed to identify patients in PACU who had two or more documented OSA risk factors (body mass index >35, snoring, alcohol use, diabetes mellitus [DM], hypertension [HTN], or male) or a diagnosis of OSA (n = 1,361). This sample was further refined to determine the patients who had a CRE (oxygen saturation less than 92%; respiratory rate less than 10, Modified Aldrete Respiratory Score of 1 and/or lesser) while in the PACU (n = 200).FindingsThere was a statistically significant relationship between one CRE in the PACU and a pre-existing diagnosis of HTN, DM, snoring, alcohol use, and male gender (P < .001 for each variable). There was a statistically significant difference in body mass index between patients who experienced a CRE and those who did not (P = .004). HTN and DM (n = 16) were associated with the highest occurrence of a CRE.ConclusionsThe University Postoperative Obstructive Sleep Apnea Protocol was designed based on results and current evidence-based practice. Development of a postoperative OSA protocol will positively impact patient outcomes and may reduce health care expenditures. Next steps include protocol implementation and analysis.     

Obstructive Sleep Apnea,Glucose Tolerance,and β-Cell Function in Adults With Prediabetes or Untreated Type 2 Diabetes in the Restoring Insulin Secretion (RISE) Study

OBJECTIVEObstructive sleep apnea (OSA) is associated with insulin resistance and has been described as a risk factor for type 2 diabetes. Whether OSA adversely impacts pancreatic islet β-cell function remains unclear. We aimed to investigate the association of OSA and short sleep duration with β-cell function in overweight/obese adults with prediabetes or recently diagnosed, treatment-naive type 2 diabetes.RESEARCH DESIGN AND METHODSTwo hundred twenty-one adults (57.5% men, age 54.5 ± 8.7 years, BMI 35.1 ± 5.5 kg/m²) completed 1 week of wrist actigraphy and 1 night of polysomnography before undergoing a 3-h oral glucose tolerance test (OGTT) and a two-step hyperglycemic clamp. Associations of measures of OSA and actigraphy-derived sleep duration with HbA_1c, OGTT-derived outcomes, and clamp-derived outcomes were evaluated with adjusted regression models.RESULTSMean ± SD objective sleep duration by actigraphy was 6.6 ± 1.0 h/night. OSA, defined as an apnea-hypopnea index (AHI) of five or more events per hour, was present in 89% of the participants (20% mild, 28% moderate, 41% severe). Higher AHI was associated with higher HbA_1c (P = 0.007). However, OSA severity, measured either by AHI as a continuous variable or by categories of OSA severity, and sleep duration (continuous or <6 vs. ≥6 h) were not associated with fasting glucose, 2-h glucose, insulin sensitivity, or β-cell responses.CONCLUSIONSIn this baseline cross-sectional analysis of the RISE clinical trial of adults with prediabetes or recently diagnosed, untreated type 2 diabetes, the prevalence of OSA was high. Although some measures of OSA severity were associated with HbA_1c, OSA severity and sleep duration were not associated with measures of insulin sensitivity or β-cell responses.     

Evaluating the clinical value of the hypoxia burden index in patients with obstructive sleep apnea

Purpose: We aimed to develop a novel index, the hypoxia burden index (HBI), that reflects the degree and duration of oxygen desaturation, and to determine whether this index is better than the apnea hypopnea-index (AHI) for evaluating obstructive sleep apnea (OSA) and cardiovascular diseases morbidities.

Methods: We retrospectively analyzed 459 adult subjects who underwent overnight polysomnography (PSG) in this study. The HBI was calculated by dividing the total desaturation area of SpO₂ below 90% by the TST measured in seconds. Correlations between the HBI and PSG parameters and the cardiovascular diseases (CVDs) of inpatients were explored.

Results: For the 459 participants, the HBI was highly correlated with the AHI (r = 0.690), lowest oxygen saturation (SpO₂min) (r = ?0.733), and proportion of cumulative sleep time with SpO₂ below 90% in total sleep time (TST) (CT90%) (r = 0.801). The HBI was mildly correlated with Epworth sleepiness scale score, morning systolic blood pressure, diastolic blood pressure, and mean arterial pressure. Among the significantly different parameters in the CVD and non-CVD groups in 202 inpatients (age, sex, the longest time of apnea, AHI, and HBI), only age, sex, and HBI [OR 1.006 (1.001–1.011), p = 0.021] were independently correlated with CVDs.

Conclusions: The HBI considers both hypoxia duration and severity during sleep. It may have potential value in predicting the clinical outcomes of OSA based on its correlation with ESS scores and morning blood pressure as well as its independent association with the prevalence of CVDs, whereas the AHI is not significantly associated with CVD prevalence.     

Obstructive Sleep Apnea Among Obese Patients With Type 2 Diabetes

OBJECTIVE

To assess the risk factors for the presence and severity of obstructive sleep apnea (OSA) among obese patients with type 2 diabetes.

RESEARCH DESIGN AND METHODS

Unattended polysomnography was performed in 306 participants.

RESULTS

Over 86% of participants had OSA with an apnea-hypopnea index (AHI) ≥5 events/h. The mean AHI was 20.5 ± 16.8 events/h. A total of 30.5% of the participants had moderate OSA (15 ≤ AHI <30), and 22.6% had severe OSA (AHI ≥30). Waist circumference (odds ratio 1.1; 95% CI 1.0–1.1; P = 0.03) was significantly related to the presence of OSA. Severe OSA was most likely in individuals with a higher BMI (odds ratio 1.1; 95% CI 1.0–1.2; P = 0.03).

CONCLUSIONS

Physicians should be particularly cognizant of the likelihood of OSA in obese patients with type 2 diabetes, especially among individuals with higher waist circumference and BMI.We report the prevalence of obstructive sleep apnea (OSA) and the factors that increase the risk and severity of OSA among 306 obese patients with type 2 diabetes enrolled in Sleep AHEAD, a four-site ancillary study of the Look AHEAD Trial (Action for Health in Diabetes).     

Sleep disruption in chronic rhinosinusitis

Introduction: Chronic rhinosinusitis (CRS) is a common disease of the upper airways and paranasal sinuses with a marked decline in quality of life (QOL). CRS patients suffer from sleep disruption at a significantly higher proportion (60 to 75%) than in the general population (8–18 %). Sleep disruption in CRS causes decreased QOL and is linked to poor functional outcomes such as impaired cognitive function and depression.

Areas covered: A systematic PubMed/Medline search was done to assess the results of studies that have investigated sleep and sleep disturbances in CRS.

Expert commentary: These studies reported sleep disruption in most CRS patients. The main risk factors for sleep disruption in CRS include allergic rhinitis, smoking, and high SNOT-22 total scores. The literature is inconsistent with regard to the prevalence of sleep-related disordered breathing (e.g. obstructive sleep apnea) in CRS patients. Although nasal obstruction is linked to sleep disruption, the extent of sleep disruption in CRS seems to expand beyond that expected from physical blockage of the upper airways alone. Despite the high prevalence of sleep disruption in CRS, and its detrimental effects on QOL, the literature contains a paucity of studies that have investigated the mechanisms underlying this major problem in CRS.     

冠状动脉血管狭窄程度与睡眠呼吸暂停的相关性研究

目的 阻塞性睡眠呼吸暂停（OSA）被认为是冠心病（CHD）的风险因素,本研究拟探讨OSA与冠状动脉血管狭窄程度之间的关系。方法 入选疑似CHD患者420例,所有受试者行冠状动脉造影并计算Gensini评分判断冠状动脉血管狭窄程度、多导联睡眠呼吸监测测定呼吸暂停低通气指数（AHI）,分析冠状动脉血管狭窄程度与OSA的相关性。结果 Gensini评分≥80患者的年龄、AHI及高血压、糖尿病、OSA患病率高于Gensini评分<80患者组（P<0.01）。与无OSA患者和轻度OSA患者比较,中度、重度OSA患者Gensini评分均明显增高（P=0.007,0.037）。Logistic回归分析：总体人群中,年龄、男性、AHI、高血压、糖尿病是Gensini评分≥80的风险因素。在年龄≥55岁组,校正性别和年龄后,AHI升高增加 Gensini评分≥80的风险(OR=1.03,95%CI:1.00~1.05,P<0.05）。在年龄<55岁患者中,合并糖尿病较无糖尿病患者Gensini评分≥80风险增加1.77倍（OR=2.77,95%CI:1.29~5.94,P<0.05）。结论 冠状动脉血管狭窄程度是与AHI具有相关性,中度、重度OSA患者Gensini评分更高,年龄≥55岁的患者Gensini评分与AHI独立相关。     

Obstructive sleep apnea risk and psychological health among non-Hispanic blacks in the Metabolic Syndrome Outcome (MetSO) cohort study

Abstract

Introduction This study assessed associations of depression and anxiety with risk of obstructive sleep apnea (OSA) among non-Hispanic blacks in the Metabolic Syndrome Outcome (MetSO) study.

Method A total of 1,035 patients participated. ARES^TM score?≥6 defined high OSA risk. Moderate depression was defined by a CES-D score?≥16. Moderate anxiety was measured by a BAI score?≥16.

Results The mean age was 62?±?14 years; 70% were female. A total of 93% were diagnosed with hypertension; 61%, diabetes; and 72%, dyslipidemia; 90% were overweight/obese; 33% had a history of heart disease; and 10% had a stroke. Logistic regression analysis, adjusting for age and gender, showed that patients with depression had nearly two-fold increased odds of being at risk for OSA (OR 1.75, 95% CI 1.02–2.98, p?< 0.05). Patients with anxiety had three-fold increased odds of being at risk for OSA (OR 3.30, 95% CI 2.11–5.15, p?< 0.01). After adjusting for marital status and income, patients with anxiety had a 6% increase in OSA risk (OR 1.06, 95% CI 1.04–1.09, p?< 0.05), but depression was no longer significant.

Conclusion Our results suggest that non-Hispanic blacks with metabolic syndrome who experience anxiety and/or depression should be screened for OSA.

• Key messages

• This study assessed associations of moderate to severe depression and anxiety with risk of obstructive sleep apnea (OSA) among non-Hispanic blacks with metabolic syndrome.

• Patients with depression had nearly two-fold increased odds of being at risk for OSA.

• Patients with anxiety had three-fold increased odds of being at risk for OSA.

     

Selection of Screening Tool for Sleep-Disordered Breathing or Obstructive Sleep Apnea in Pediatric Patients in the Perianesthesia Setting

PurposeThis study was undertaken to select an appropriate tool to predict risk of obstructive sleep apnea (OSA) among pediatric patients in the preoperative setting.Design/MethodsA retrospective chart review and a survey of nursing staff to compare two tools that were determined to be valid in assessing risk of OSA and postanesthesia complications in pediatric patients aged 6 months to 18 years was conducted. About 300 pediatric patients presenting for elective surgery were screened for OSA using STBUR (Snoring, Trouble Breathing during sleep, struggling to Breathe during Sleep, and waking UnRefreshed) and ST(1)OP-BANG (Snoring, Tonsillar hypertrophy, sleep Obstruction, BMI, Age, Neuromuscular disorders, and Genetic/congenital deformities) concurrently. Six preoperative nurses were then surveyed to compare ease of use and time to complete the screening tools.FindingsThe STBUR tool was found to predict complications in 37.5% patients versus 22.7% patients with the pediatric ST(1)OP-BANG. Nursing staff found that although both tools were quick and easy to use, the STBUR tool was easier for parents to answer.ConclusionsUse of a screening tool to help predict risk of OSA and postanesthetic complications also helps to dictate anesthesia technique, nursing staffing requirements, and plans of care for postoperative management of pediatric patients.     

Implementation Science: Incorporating Obstructive Sleep Apnea Screening and Capnography Into Everyday Practice

PurposeThis article describes the implementation and maintenance of obstructive sleep apnea (OSA) screening and capnography monitoring.DesignA quality improvement project.MethodsA multidisciplinary team provided staff education to three perianesthesia care units. Using the STOP-Bang screening tool, five or more positive responses indicated high risk for OSA. A postanesthesia care unit audit tool tracked STOP-Bang scores, capnography use, hypoventilation events, nursing interventions, and respiratory complications.FindingsAmong 314 patients with OSA, 36% were identified as high risk. Nurses used capnography on 76% of OSA patients and were able to readily identify hypoventilation and intervene. Respiratory complications occurred in 10.8% (n = 34) requiring a higher level of care. Postimplementation, all six postanesthesia care units employ this best practice.ConclusionsPerianesthesia nurses found OSA screening and capnography easy to incorporate into nursing practice. This process can reduce respiratory complications in the surgical patient with OSA. An Evidence-Based Practice Fellowship Program facilitated this practice change.     

STOP-Bang Screening for Obstructive Sleep Apnea in Preoperative Patients: A Quality Improvement Project

PurposeUndiagnosed obstructive sleep apnea (OSA) results in increased morbidity and mortality. It is important to screen preoperative patients for OSA risks in order to plan for adverse events during operations. This project implemented OSA screening and education with preoperative patients and referred them for further evaluation and diagnosis.DesignQuality improvement project.MethodsSTOP-Bang was implemented with 32 preoperative patients at an ambulatory surgery center to screen and educate patients about OSA risks and refer them for further evaluation.FindingsAt follow-up, 46.9% out of the 32 patients reported further consultation with their primary care providers, among whom, 60% further consulted a sleep medicine practitioner and completed a sleep study. Screening and education, support from significant others, and collaboration between healthcare professionals are facilitators to seeking OSA evaluation.ConclusionsImplementing OSA screening and education for preoperative patients is beneficial for further evaluation and diagnosis.     

Impact of Opioid Therapy on Sleep and Respiratory Patterns in Adults With Advanced Cancer Receiving Palliative Care

Context

In advanced cancer, abnormal sleep patterns may contribute to poor quality of life, but the impact of opioid-related sleep disorders has not been explored in detail in these patients.

Submental Ultrasound Measurement of Dynamic Tongue Base Thickness in Patients with Obstructive Sleep Apnea

Dynamic tongue base thickness (TBT) may be an important anatomic factor in airway narrowing in patients with obstructive sleep apnea (OSA). The development of an accurate clinical assessment of the retroglossal airway in patients with OSA is still evolving. Submental ultrasound was used to investigate the association between measurements of TBT in response to negative airway pressure and the existence of OSA. Twenty OSA patients and 20 control participants underwent ultrasound measurement of TBT on eupneic breathing and with the Mueller maneuver, as well as clinical and polysomnographic assessments. Logistic regression analyses indicated that after adjustment for confounding factors, independent predictors of OSA included TBT in response to negative airway pressure, as measured by submental ultrasound with the Mueller maneuver (odds ratio: 2.11, 95% confidence interval: 1.15–3.87, p < 0.05), and the difference between TBT with the Muller maneuver and that without the Mueller maneuver (odds ratio: 2.47, 95% confidence interval: 1.09–5.58, p < 0.05). Ultrasound measurement of TBT during the Mueller maneuver provides a quantitative assessment of the retroglossal airway in OSA patients with minimal invasiveness and easy accessibility.     

Improving Provider AASM Guideline Adherence for Adult Obstructive Sleep Apnea

With an estimated 10% of the United States adult population impacted by obstructive sleep apnea (OSA), a protocol was created to increase clinical provider adherence to the American Academy of Sleep Medicine’s Clinical Guidelines for OSA. Clinic provider responsibilities included screening patients ≥ 18 years old using the Epworth Sleepiness Scale (ESS), referring patients scoring > 9 for a sleep study, educating patients diagnosed with OSA regarding disease and treatment options, prescribing treatment and short-term follow-up. After providing education and resources, 72% of patients ≥ 18 years of age were screened and 19 patients with a positive screen and OSA diagnosis had reduced OSA severity after treatment.     

Safety of a Novel Obstructive Sleep Apnea Triage Tool for Postoperative Orthopedic Surgery Patients

PurposeThe purpose of this quality improvement project is to provide a tool for effective and safe triage of postoperative patients in the postanesthesia care unit with known or suspected obstructive sleep apnea (OSA) at an academic orthopedic hospital in New York City.DesignThe structure of this project was observational after implementation of a novel OSA triage tool.MethodsResults were reported from a single center experience in a hospital where there was no existing standard assessment tool consistently used to triage patients with either known or suspected OSA in the postoperative period. Adult patients who underwent orthopedic surgery between October 2018 and February 2020 and who had a known or suspected history of OSA were included. After admission to the postanesthesia care unit (PACU) and upon meeting their modified Aldrete criteria or after 2 hours had elapsed, the PACU primary provider used the OSA triage tool to assess whether the patient had a high or low risk of respiratory deterioration after discharge from the PACU related to OSA. Patients without high-risk criteria were discharged from the PACU to a medical/surgical unit. For patients with high-risk criteria, the PACU provider requested critical care consultation to determine each patient's appropriate hospital disposition upon PACU discharge.FindingsOver the course of the study period, 216 patients were evaluated using the OSA triage tool: 53.2% of the cohort was male, median BMI was 36.3 kg/m², and 80.1% had a prior diagnosis of obstructive sleep apnea. Patients underwent a variety of orthopedic surgeries with 23.6% having undergone hip surgery, 51.4% knee surgery, 13.4% spine surgery, 9.7% shoulder surgery, and 1.9% foot or ankle surgery. Notably, with the use of this tool, only 12.5% of patients met criteria for critical care consult and 91.7% were admitted to the floor from the PACU. Rapid response for respiratory complications were not observed in any of the patients. There were only three patients who required critical care evaluation after PACU discharge. An anonymous survey completed by PACU nurse practitioners and anesthesiologists revealed a 96.8% self-reported satisfaction with OSA triage tool.ConclusionWe demonstrated that use of a OSA triage tool in the single-center orthopedic PACU at NYULH is potentially a safe and effective method of triaging patients with known or suspected OSA to acute care beds versus higher levels of care.     

Obstructive Sleep Apnea and Type 2 Diabetes: A Screening Approach

Obstructive sleep apnea (OSA) is a sleep disorder common among patients with type 2 diabetes (T2D). The aim of this quality improvement project was to increase identification and referral for sleep study for individuals with T2D at moderate to high risk for OSA. Pre- and post-intervention patient samples were analyzed to compare the number of referrals for sleep study. Results demonstrated that none of the patients pre-intervention were referred for sleep study compared with 77% of patients post-intervention. This project demonstrated implementing an evidence-based tool to screen patients with T2D for OSA leads to higher rates of detection and referral.     

阻塞性睡眠呼吸暂停患者血脂及脂蛋白(a)的测定

【目的】测定阻塞性睡眠呼吸暂停(OSA)患者血脂及脂蛋白(a)[Lp(a)]的水平,了解OSA对血脂及LP(a)水平的影响及其意义。【方法】采用多导睡眠(PSG)检查的方法,对62例患者,按照呼吸紊乱指数(AHI)分为正常对照组、轻度OSA和中重度OSA三组,检测三组患者血脂及LP(a)的水平。【结果】OSA组的总胆固醇(TC)、甘油三脂(TG)、低密度脂蛋白(LDL-C)及LP(a)的水平高于正常对照组,并且OSA越重,以上指标水平越高,中重度OSA组的高密度脂蛋白(HDL-C)明显低于正常对照组。各组TC、TG、LDL-C及Lp(a)与AHI、最长呼吸暂停时间呈正相关、与最低血氧饱和度(minSaO2)、平均血氧饱和度(meanSaO2)呈负相关。【结论】OSA患者存在脂代谢异常,OSA越严重的患者其发生心血管事件的可能性越大。     

EB病毒与儿童睡眠呼吸暂停综合征相关性分析

目的:探究EB病毒与儿童睡眠呼吸暂停综合征的相关性.方法:选取2018年1 月至2019年1 月重庆市开州区人民医院收治的儿童睡眠呼吸暂停综合征患者250例作为研究对象,随机分成观察组和对照组,每组125 例.2组患者均实施手术治疗,术后观察组患者实施抗病毒治疗,对照组患者不实施抗病毒治疗,对2 组患者术后病情发展情况进行调查.结果:观察组经抗病毒治疗,仅26例患者最终发展为儿童睡眠呼吸暂停综合征,复发率为20.80%,对照组当中未实施抗病毒治疗,79例患者最终发展为儿童睡眠呼吸暂停综合征,复发率为63.20%,2 组比较差异有统计学意义(χ2 =12.87,P<0.05).讨论:EB病毒与儿童睡眠呼吸暂停综合征具有一定的相关性,EB病毒阳性患者更容易引起患者发病,但EB病毒阴性患者依然有发病几率,针对患者病情为其实施对症治疗,对于确保患者正常身体发育具有重要意义.