Journal articles on the topic 'Sleep disordered breathing (SDB)'
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Izci Balserak, Bilgay. "Sleep disordered breathing in pregnancy." Breathe 11, no. 4 (December 2015): 268–77. http://dx.doi.org/10.1183/20734735.009215.
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Key pointsSleep disordered breathing (SDB) is common and the severity increases as pregnancy progresses.Frequent snoring, older age and high pre-pregnancy body mass index (>25 kg⋅m−2) could be reliable indicators for SDB in early pregnancy.SDB screening tools, including questionnaires, used in the nonpregnant population have poor predictive ability in pregnancy.Accumulating evidence suggests that SDB during pregnancy may be associated with increased risk of adverse pregnancy outcomes, including gestational diabetes and pre-eclampsia. However, the results should be interpreted cautiously because several studies failed to adjust for potential maternal confounders and have other study limitations.There are no pregnancy-specific practice guidelines for SDB treatment. Many clinicians and practices follow recommendations for the treatment in the general population. Women with pre-existing SDB might need to be reassessed, particularly after the sixth month of pregnancy, because symptoms can worsen with nasal congestion and weight gain.Educational aimsTo highlight the prevalence and severity of sleep disordered breathing (SDB) in the pregnant population.To inform readers about risk factors for SDB in pregnancy.To explore the impact of SDB on adverse maternal and fetal outcomes, and biological pathways for associated adverse maternal and fetal outcomes.To introduce current management options for SDB in pregnancy, including medical and behavioural approaches.Sleep disordered breathing (SDB) is very common during pregnancy, and is most likely explained by hormonal, physiological and physical changes. Maternal obesity, one of the major risk factors for SDB, together with physiological changes in pregnancy may predispose women to develop SDB. SDB has been associated with poor maternal and fetal outcomes. Thus, early identification, diagnosis and treatment of SDB are important in pregnancy. This article reviews the pregnancy-related changes affecting the severity of SDB, the epidemiology and the risk factors of SDB in pregnancy, the association of SDB with adverse pregnancy outcomes, and screening and management options specific for this population.
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Yang, Yeonmi. "Sleep Disordered Breathing in Children." JOURNAL OF THE KOREAN ACADEMY OF PEDTATRIC DENTISTRY 49, no. 4 (November 30, 2022): 357–67. http://dx.doi.org/10.5933/jkapd.2022.49.4.357.
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Sleep disordered breathing (SDB) is a disease characterized by repeated hypopnea and apnea during sleep due to complete or partial obstruction of upper airway. The prevalence of pediatric SDB is approximately 12 - 15%, and the most common age group is preschool children aged 3 - 5 years. Children show more varied presentations, from snoring and frequent arousals to enuresis and hyperactivity. The main cause of pediatric SDB is obstruction of the upper airway related to enlarged tonsils and adenoids. If SDB is left untreated, it can cause complications such as learning difficulties, cognitive impairment, behavioral problems, cardiovascular disease, metabolic syndrome, and poor growth. Pediatric dentists are in a special position to identify children at risk for SDB. Pediatric dentists recognize clinical features related to SDB, and they should screen for SDB by using the pediatric sleep questionnaire (PSQ), lateral cephalometry radiograph, and portable sleep monitoring test and refer to sleep specialists. As a therapeutic approach, maxillary arch expansion treatment, mandible advancement device, and lingual frenectomy can be performed. Pediatric dentists should recognize that prolonged mouth breathing, lower tongue posture, and ankyloglossia can cause abnormal facial skeletal growth patterns and sleep problems. Pediatric dentists should be able to prevent these problems through early intervention.
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Gokdemir, Yasemin, and Refika Ersu. "Sleep disordered breathing in childhood." European Respiratory Review 25, no. 139 (February 29, 2016): 48–53. http://dx.doi.org/10.1183/16000617.0081-2015.
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Sleep disordered breathing (SDB) in childhood is linked with significant end-organ dysfunction across various systems, particularly with cardiovascular, neurocognitive and metabolic consequences. If we understand the pathophysiology of SDB, diagnose it promptly and treat appropriately, we may be able to prevent morbidity associated with SDB and also save health resources around the world. In this article, we highlight articles on this topic published in medical journals in the past year.
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Young, Terry, Paul E. Peppard, and Shahrad Taheri. "Excess weight and sleep-disordered breathing." Journal of Applied Physiology 99, no. 4 (October 2005): 1592–99. http://dx.doi.org/10.1152/japplphysiol.00587.2005.
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Excess weight is a well-established predictor of sleep-disordered breathing (SDB). Clinical observations and population studies throughout the United States, Europe, Asia, and Australia have consistently shown a graded increase in the prevalence of SDB as body mass index, neck girth, or other measures of body habitus increases. Clinical studies of weight loss and longitudinal population studies provide strong support for a causal association. The role of excess body weight, a modifiable risk factor, with SDB raises many questions relevant to clinical practice and public health. The topic takes on added importance with the alarming rate of weight gain in children as well as adults in industrialized nations. Among adults ages 30–69 yr, averaging over the estimated United States 2003 age, sex, and BMI distributions, we estimate that ∼17% of adults have mild or worse SDB (apnea-hypopnea index ≥ 5) and that 41% of those adults have SDB “attributable” to having a body mass index of ≥25 kg/m2. Similarly, we estimate that ∼5.7% of adults have moderate or worse SDB (apnea-hypopnea index ≥ 15) and that 58% of those adults have SDB attributable to excess weight. Clearly, if the expanding epidemic of obesity seen in the United States continues, the prevalence of SDB will almost certainly increase, along with the proportion of SDB attributable to obesity.
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McMillan, Alison, and Mary J. Morrell. "Sleep disordered breathing at the extremes of age: the elderly." Breathe 12, no. 1 (March 2016): 50–60. http://dx.doi.org/10.1183/20734735.003216.
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Key pointsSleep disordered breathing (SDB) is common and its prevalence increases with age. Despite this high prevalence, SDB is frequently unrecognised and undiagnosed in older people.There is accumulating evidence that SDB in older people is associated with worsening cardio- cerebrovascular, cognitive and functional outcomes.There is now good evidence to support the use of continuous positive airway pressure therapy in older patients with symptomatic SDB.Educational aimsTo highlight the prevalence and presentation of sleep disordered breathing (SDB) in older people.To inform readers about the risk factors for SDB in older people.To explore the impact of SDB in older people.To introduce current evidence based treatment options for SDB in older people.Sleep disordered breathing (SBD) increases in prevalence as we age, most likely due to physiological and physical changes that occur with ageing. Additionally, SDB is associated with comorbidity and its subsequent polypharmacy, which may increase with increasing age. Finally, the increased prevalence of SDB is intrinsically linked to the obesity epidemic. SDB is associated with serious outcomes in younger people and, likewise, older people. Thus, identification, diagnosis and treatment of SDB is important irrelevant of age. This article reviews the age-related changes contributing to SDB, the epidemiology and the risk factors for SDB in older people, the association of SDB with adverse outcomes, and diagnostic and treatment options for this population.
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Carrijo, Fanny Cavalcante, Winicius Arildo Ferreira Araujo, Iorrana Morais de Oliveira, Crystina Alcântara Carvalho, Marcelo Costa Rodrigues, Maria Tereza de Oliveira e. Souza, Glauco Issamu Miyahara, and Grace Kelly Martins Carneiro. "Prevalence of sleep-disordered breathing related to malocclusion in children." Research, Society and Development 10, no. 16 (December 19, 2021): e598101623984. http://dx.doi.org/10.33448/rsd-v10i16.23984.
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Sleep-disordered breathing is characterized by airway dysfunction that can occur in any age, but most prevalent in children, caused by the occurrence of respiratory effort, snoring or even by apnea during sleep. Therefore, the aim of this study was to survey the prevalence of sleep disorders associated with malocclusion in children aged 3 to 12 years in Mineiros, State of Goiás, Brazil. Material and Methods: this is a field research with a sample of 99 children affected by some type of sleep-disordered breathing and malocclusions. Data were collected through a questionnaire about sleep-disordered breathing and a clinical record carried out through intraoral clinical examination. Results: among the 24 children with SDB, 17 had SDB and Malocclusion, which is 70.8% of the children had SDB associated with malocclusion. Of the 75 children without SDB, 11 (14.7%) had malocclusion. Conclusion: No significant differences were found between sleep-disordered breathing and sex-related malocclusions.
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Clark, Christine M., Dale S. DiSalvo, Jansie Prozesky, and Michele M. Carr. "Sleep Disordered Breathing May Signal Laryngomalacia." Open Anesthesiology Journal 11, no. 1 (August 21, 2017): 68–74. http://dx.doi.org/10.2174/1874321801711010068.
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Background: Pediatric anesthesiologists are often confronted with children with sleep-disordered breathing (SDB) presenting for tonsillectomy and/or anesthesia. The typical patient has symptoms of obstructive sleep apnea (OSA) with enlarged tonsils; however, a subset of patients may have underlying laryngomalacia (LM) without tonsillar hypertrophy. Both OSA and LM significantly increase the risk of intra- and postoperative airway obstruction and sensitivity to narcotics. The prevalence of LM may be underestimated, because direct laryngoscopy (DL) is not routinely performed in the diagnostic evaluation of patients with SDB who lack tonsillar hypertrophy. Aim: To identify the prevalence and DL findings in pediatric patients with SDB without tonsillar hypertrophy. Methods: Retrospective chart review of 108 patients with SDB who underwent general anesthesia for adenotonsillectomy (TA) or adenoidectomy with concomitant DL. The following data were collected: demographic information, medical comorbidities, polysomnography results, anesthetic techniques, and postoperative complications. Results: 94.5% of children had DL findings consistent with LM, including a retropositioned epiglottis and short aryepiglottic folds. Postglottic edema was observed in 42.2%, and these patients were significantly more likely to have a diagnosis of gastroesophageal reflux (P=0.023). 57.8% had vocal cord edema. 75.3% of children who received routine postoperative follow-up care experienced complete symptom resolution. Postoperative complications following discharge from hospital occurred in 12.4% of patients, and 15.7% underwent supraglottoplasty for continued SDB symptoms after TA or adenoidectomy. Conclusion: A substantial proportion of patients with SDB who lacked tonsillar hypertrophy had findings consistent with LM, suggesting that the larynx may be the primary site of upper airway obstruction in these patients. This has significant implications in terms of perioperative management. The majority of patients with SDB had symptomatic improvement following TA or adenoidectomy; however, a subset required further surgical intervention with supraglottoplasty.
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Abazi, Yllka, Fabian Cenko, Marianna Cardella, Gjergji Tafa, and Giuseppina Laganà. "Sleep Disordered Breathing: An Epidemiological Study among Albanian Children and Adolescents." International Journal of Environmental Research and Public Health 17, no. 22 (November 19, 2020): 8586. http://dx.doi.org/10.3390/ijerph17228586.
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Sleep Disordered Breathing (SDB) comprises a group of diseases characterized by alterations in the frequency and/or depth of breathing during sleep. The aim of this study was to investigate the frequency of SDB in a group of Albanian children and adolescents and to describe its social, physiological, psychological, sleep-related, and anthropometric risk factors, in relation to the sociodemographic situation. A total of 6087 participants (mean age: 10.42 years, range: 6 to 15 years, 52.3% females and 47.7% males) attending public schools all over Albania took part in the cross-sectional study. On a sample of 6087 questionnaires distributed, 4702 (77.25% of the original sample) were returned and included in the study. High risk status for SDB was assessed using the Paediatric Sleep Questionnaire (PSQ). The prevalence of SDB was 7.9%. No statistically significant difference was found for gender at high risk for SBD. Compared to participants living in urban aeras (7.3%), participants living in rural areas (10.4%) reported significantly higher SDB prevalence rates. No other significant correlations were detected between the high-risk subjects and the age. The prevalence of the subjects at high risk of SBD obese participants (20.8%) was statistically higher than among nonobese ones (6.3%). SDB is highly prevalent in Albanian growing population and further prevalence studies are recommended.
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Mosquera, Ricardo A., Mary Kay Koenig, Rahmat B. Adejumo, Justyna Chevallier, S. Shahrukh Hashmi, Sarah E. Mitchell, Susan E. Pacheco, and Cindy Jon. "Sleep Disordered Breathing in Children with Mitochondrial Disease." Pulmonary Medicine 2014 (2014): 1–8. http://dx.doi.org/10.1155/2014/467576.
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A retrospective chart review study was performed to determine the presence of sleep disordered breathing (SDB) in children with primary mitochondrial disease (MD). The symptoms, sleep-related breathing, and movement abnormalities are described for 18 subjects (ages 1.5 to 18 years, 61% male) with MD who underwent polysomnography in our pediatric sleep center from 2007 to 2012. Of the 18 subjects with MD, the common indications for polysomnography were excessive somnolence or fatigue (61%,N= 11), snoring (44%,N= 8), and sleep movement complaints (17%,N= 3). Polysomnographic measurements showed SDB in 56% (N= 10) (obstructive sleep apnea in 60% (N= 6), hypoxemia in 40% (N= 4), and sleep hypoventilation in 20% (N= 2)). There was a significant association between decreased muscle tone and SDB (P: 0.043) as well as obese and overweight status with SDB (P=0.036). SDB is common in subjects with MD. Early detection of SDB, utilizing polysomnography, should be considered to assist in identification of MD patients who may benefit from sleep-related interventions.
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Garde, Alison J. B., Neil A. Gibson, Martin P. Samuels, and Hazel J. Evans. "Recent advances in paediatric sleep disordered breathing." Breathe 18, no. 3 (September 2022): 220151. http://dx.doi.org/10.1183/20734735.0151-2022.
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This article reviews the latest evidence pertaining to childhood sleep disordered breathing (SDB), which is associated with negative neurobehavioural, cardiovascular and growth outcomes. Polysomnography is the accepted gold standard for diagnosing SDB but is expensive and limited to specialist centres. Simpler tests such as cardiorespiratory polygraphy and pulse oximetry are probably sufficient for diagnosing obstructive sleep apnoea (OSA) in typically developing children, and new data-processing techniques may improve their accuracy. Adenotonsillectomy is the first-line treatment for OSA, with recent evidence showing that intracapsular tonsillectomy results in lower rates of adverse events than traditional techniques. Anti-inflammatory medication and positive airway pressure respiratory support are not always suitable or successful, although weight loss and hypoglossal nerve stimulation may help in select comorbid conditions.Educational aimsTo understand the clinical impact of childhood sleep disordered breathing (SDB).To understand that, while sleep laboratory polysomnography has been the gold standard for diagnosis of SDB, other diagnostic techniques exist with their own benefits and limitations.To recognise that adenotonsillectomy and positive pressure respiratory support are the mainstays of treating childhood SDB, but different approaches may be indicated in certain patient groups.
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Eimar, H., M. A. Q. Al-Saleh, A. R. G. Cortes, D. Gozal, D. Graf, and C. Flores-Mir. "Sleep-Disordered Breathing Is Associated with Reduced Mandibular Cortical Width in Children." JDR Clinical & Translational Research 4, no. 1 (May 22, 2018): 58–67. http://dx.doi.org/10.1177/2380084418776906.
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Introduction: Evidence from the adult population suggests that sleep-disordered breathing (SDB) (i.e., obstructive sleep apnea [OSA]) is negatively associated with bone mineral density. Whether a similar association exists in children with SDB has not been investigated. Using the mandibular cortical width (MCW) as a proxy for skeletal bone density, we investigated if children at risk of SDB or diagnosed with OSA have a reduced mandibular cortical width compared to children without SDB. Methods: Two retrospective cross-sectional studies were performed. The first study included comparison of MCW between 24 children with polysomnographically (PSG) diagnosed OSA and 72 age- and sex-matched control children. The second study included a cohort of children in which SDB was suggested by the Pediatric Sleep Questionnaire (PSQ) ( n = 101). MCW was measured from panoramic radiographs. Results: Multiple-predictors regression analysis from the first study indicated that in children with a severe form of SDB, as induced by OSA severity, there was a negative association with MCW (β = –0.290, P = 0.049). Moreover, PSG-diagnosed OSA children had thinner MCW (2.9. ± 0.6mm) compared to healthy children (3.5 ± 0.6 mm; P = 0.002). These findings were further supported by the second study illustrating that PSQ total scores were negatively associated with MCW (β = –0.391, P < 0.001). Conclusions: Findings suggest that children at risk for or diagnosed with SDB exhibit reduced mandibular cortical width that purportedly may reflect alterations in bone homeostasis. Knowledge Transfer Statement: We report that sleep-disordered breathing (including its severe form, obstructive sleep apnea) in children is associated with reduced mandibular cortical width. This association might be a direct consequence of reduced bone health to sleep-disordered breathing or a reflection that reduced bone formation underlies the development of sleep-disordered breathing. Our findings suggest that mandibular cortical width can be used as an adjunct diagnostic parameter for the diagnosis of sleep-disordered breathing.
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Patel, Salma, Wojciech Zareba, Jean-Philippe Couderc, Xiaojuan Xia, Raymond Woosley, Imran Patel, Daniel Combs, Saif Mashaqi, and Sairam Parthasarathy. "479 The association of QTc and QT Variability with Severity of Sleep Disordered Breathing." Sleep 44, Supplement_2 (May 1, 2021): A189. http://dx.doi.org/10.1093/sleep/zsab072.478.
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Abstract Introduction The apneas and hypopneas that characterize sleep-disordered breathing (SDB) are associated with QTc prolongation and increased QT variability. There have been mixed results as to whether QTc and QT variability increase with increasing SDB severity. This study assesses whether QTc prolongation and QT variability are likely to increase with increasing severity of SDB in a large multi-center cohort. Methods 200 subjects with no SDB and approximately 600 with three levels of SDB (mild, moderate, severe) were randomly selected from the Sleep Heart Health study and matched by age, gender and BMI. SDB was defined as an apnea/hypopnea index ≥5. Respiratory and electrocardiograms (ECG) signals from polysomnography studies were analyzed. Bazett’s heart rate correction was used to calculate QTc. QT variability was measured as standard deviation of QT intervals (SDQT) and short-term interval QT variability (STVQT), at 5-minute intervals. Subjects were excluded if there were missing data or low-quality ECG. Results Seven hundred and seventy-one subjects (age 68±10 years, 51% female, 92% Caucasian) were included. One hundred and sixty-five subjects had no SDB, 235 mild, 195 moderate and 176 had severe SDB. The mean (SD) QTc was 422(29), 411(26), 419 (34) and 418 (36) ms for the no SDB, mild, moderate, and severe SDB groups, respectively (p=0.017). The mean (SD) STVQT was 7 (9), 11 (16), 8 (9) and 9 (11) for the no SDB, mild, moderate severe SDB groups, respectively (p=<0.001). The mean (SD) STVQT was 3 (2), 4 (4), 4 (3) and 4(4) for the no SDB, mild, moderate severe SDB groups, respectively (p=<0.001). There was no statistically linear relationship between QT prolongation or QT variability and SBD severity. Conclusion QTc duration and QT variability were not increased with SDB severity. Support (if any) American Academy of Sleep Medicine Foundation (203-JF-18), National Institutes of Health (HL126140), University of Arizona Health Sciences Career Development Award (5299903), and University of Arizona Faculty Seed Grant (5833261)
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Noone, A., Y. Lao, T. Crawford, D. Kennedy, J. Martin, A. Ferrante, D. Wabnitz, and A. Kontos. "O035 Elevated liver enzymes in paediatric sleep disordered breathing." SLEEP Advances 3, Supplement_1 (October 1, 2022): A14. http://dx.doi.org/10.1093/sleepadvances/zpac029.034.
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Abstract Introduction Paediatric sleep disordered breathing (SDB) is associated with adverse cardiovascular outcomes. Non-alcoholic fatty liver disease (NAFLD) and dyslipidaemia are potential modifiable risk factors for cardiovascular disease, often coexisting in adults with SDB. Increases in lipid outputs from the liver have been identified in obese adults and children with SDB. Whether children with SDB compared to healthy non-snoring controls have evidence of elevated serum lipids and associated liver enzyme changes were assessed. Methods Seventy-five children (SDB=49, controls=26) between the ages of 6-17 years matched for age, gender and BMI underwent overnight polysomnography to measure SDB severity and provided a fasting blood sample to assess lipid and liver panels. Results OAHI was significantly increased in children with SDB compared to healthy non-snoring controls (p < 0.05). Serum potassium, alanine aminotransferase and lactate dehydrogenase were significantly increased in children with SDB, while albumin was significantly decreased (p < 0.05). No differences were found between serum lipid levels. Conclusion The presence of paediatric SDB may increase the risk of developing NAFLD. Further investigation is required to determine whether routine assessment of liver enzymes should be implemented in paediatric SDB. Whether surgical removal of the adenoids and tonsils to treat paediatric SDB can stabilise liver enzyme levels requires further research.
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Friedman, Michael, Hani Ibrahim, and Lee Bass. "Clinical Staging for Sleep-Disordered Breathing." Otolaryngology–Head and Neck Surgery 127, no. 1 (July 2002): 13–21. http://dx.doi.org/10.1067/mhn.2002.126477.
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OBJECTIVE: The purpose of this study was to identify prognostic indicators that would lead to stratification of patients likely to have successful surgery for sleep-disordered breathing (SDB) versus those destined to fail. STUDY DESIGN: We retrospectively reviewed 134 patients to correlate palate position and tonsil size to the success of the UPPP as based on postoperative polysomnography results. Similar to our previously published data on the Friedman Score as a predictor of the presence and severity of SDB, the palate position was determined on physical examination of the oral cavity and was graded for each patient. This grade combined with tonsil size was used to stage the patients. Stage I was defined as having palate position 1 or 2 combined with tonsil size 3 or 4. Stage II was defined as having palate position 3 or 4 and tonsil size 3 or 4. Stage III patients had palate position 3 or 4 and tonsil size 0, 1, or 2. Any patient with body mass index of greater than 40 was placed in the stage III group. The results of uvulopalatopharyngoplasty (UPPP) were then graded as success or failure and success rates were compared by stage. SETTING: Academically affiliated tertiary care referral center. RESULTS: Stage I patients who underwent UPPP had a success rate of 80.6%, stage II patients had a success rate of 37.9%, and stage III patients had a success rate of 8.1%. CONCLUSION: A clinical staging system for SDB based on palate position, tonsil size, and body mass index is presented. It appears to be a valuable predictor of the success of UPPP. Additional studies and wider use of the staging system will ultimately define its role in the treatment of SDB.
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Moon, Soyeon, Daewoo Lee, Jaegon Kim, and Yeonmi Yang. "Assessment of Predicting Factors for Pediatric Sleep Disordered Breathing." JOURNAL OF THE KOREAN ACADEMY OF PEDTATRIC DENTISTRY 47, no. 4 (November 30, 2020): 377–88. http://dx.doi.org/10.5933/jkapd.2020.47.4.377.
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The aim of this study was to evaluate the association between various predicting tools and Apnea-Hypopnea Index (AHI) to identify children with sleep disordered breathing (SDB). From 5 to 10 years old who came for orthodontic counseling, 61 children, whom had lateral cephalograms, pediatric sleep questionnaire (PSQ) records, and portable sleep monitoring results, were included in this study. A total of 17 measurements (11 distances and 6 angles) were made on lateral cephalograms. The measurements of lateral cephalograms, PSQ scales and portable sleep monitoring results were statistically analyzed. 49 of 61 (80%) patients showed AHI > 1, which suspected to have SDB and their mean AHI was 2.75. In this study, adenoid size (A/N ratio), position of the hyoid bone from mandibular plane, gonial angle, and PSQ scale were related to a higher risk of pediatric SDB. Also, oxygen desaturation index (ODI) and snoring time from sleep monitoring results were statistically significant in children with SDB using Mann-Whitney test (<i>p</i> ＜ 0.05).<br/>In conclusion, evaluation of hyoid bone position, adenoidal hypertrophy, gonial angle in lateral cephalogram, and PSQ scale was important to screen out potential SDB, especially in children with frequent snoring.
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Seiler, Andrea, Millene Camilo, Lyudmila Korostovtseva, Alan G. Haynes, Anne-Kathrin Brill, Thomas Horvath, Matthias Egger, and Claudio L. Bassetti. "Prevalence of sleep-disordered breathing after stroke and TIA." Neurology 92, no. 7 (January 11, 2019): e648-e654. http://dx.doi.org/10.1212/wnl.0000000000006904.
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ObjectiveTo perform a systematic review and meta-analysis on the prevalence of sleep-disordered breathing (SDB) after stroke.MethodsWe searched PubMed, Embase (Ovid), the Cochrane Library, and CINAHL (from their commencements to April 7, 2017) for clinical studies reporting prevalence and/or severity of SDB after stroke or TIA. Only sleep apnea tests performed with full polysomnography and diagnostic devices of the American Academy of Sleep Medicine categories I–IV were included. We conducted random-effects meta-analysis. PROSPERO registration number: CRD42017072339.ResultsThe initial search identified 5,211 publications. Eighty-nine studies (including 7,096 patients) met inclusion criteria. Fifty-four studies were performed in the acute phase after stroke (after less than 1 month), 23 studies in the subacute phase (after 1–3 months), and 12 studies in the chronic phase (after more than 3 months). Mean apnea-hypopnea index was 26.0/h (SD 21.7–31.2). Prevalence of SDB with apnea-hypopnea index greater than 5/h and greater than 30/h was found in 71% (95% confidence interval 66.6%–74.8%) and 30% (95% confidence interval 24.4%–35.5%) of patients, respectively. Severity and prevalence of SDB were similar in all examined phases after stroke, irrespective of the type of sleep apnea test performed. Heterogeneity between studies (I2) was mostly high.ConclusionThe high prevalence of SDB after stroke and TIA, which persists over time, is important in light of recent studies reporting the (1) feasibility and (2) efficacy of SDB treatment in this clinical setting.
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Gavidia, Ronald, Galit Levi Dunietz, Lisa Matlen, Shelley Hershner, Daphna Stroumsa, Neeraj Kaplish, and Louise O’Brien. "417 Transgender Hormone Therapy and Sleep-Disordered Breathing." Sleep 44, Supplement_2 (May 1, 2021): A165. http://dx.doi.org/10.1093/sleep/zsab072.416.
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Abstract Introduction Sex hormones may affect human respiration during wakefulness and sleep. Testosterone has been associated with increased obstructive respiratory events contributing to sleep-disordered breathing (SDB) in men, whereas a protective effect against SDB has been attributed to estrogen in women. These associations, primarily observed in cisgender populations, have been rarely examined in transgender individuals on hormone replacement therapy (HRT). The present study investigated associations between HRT and SDB in transgender adults. Methods A chart review of medical records from transgender patients was conducted in a large academic sleep medicine center. Individuals were included if they were at least 18 years old, had one or more sleep complaints, and SDB testing results available. Participants were then stratified by affirmed gender (transmasculine and transfeminine) and by HRT status. We used descriptive statistics procedures to examine differences between gender and HRT groups. Associations between HRT and the apnea-hypopnea index (AHI) were estimated with age-adjusted linear regression models. Results Of the 194 individuals identified, 89 satisfied the inclusion criteria. Nearly half of participants were transmasculine (52%). The mean age was 38±13 years, and mean body mass index was 34.7±9.0 Kg/m2. Approximately 60% of participants were on HRT at the time of SDB evaluation. Transmasculine people who were prescribed testosterone had a significantly increased AHI and lower oxygen nadir in comparison to transmasculine individuals not on testosterone (AHI 36.8±37.8/hour vs.15.3±16.6/hour, p=0.01; oxygen nadir 83.4±8.3% vs. 89.1±2.4%, p=0.001). In contrast, differences between transfeminine people with and without feminizing HRT (androgen blocker + estrogen) were not statistically significant (AHI 21.4±27.7/hour vs. 27.7±26.0/hour, p=0.45; oxygen nadir 86.5±6.7% vs. 84.1±7.7%, p=0.29). Linear regression models adjusted for age found an association between HRT and AHI for transmasculine (β=16.7, 95% CI 2.7, 30.8), but not for transfeminine participants (β=-2.5, 95% CI -17.9, 12.9). Conclusion These findings suggest differential associations between HRT and AHI among transgender individuals, with transmasculine on testosterone having a significant increase in AHI. Prospective studies with large sample sizes are warranted to evaluate these associations. Support (if any) Dr. Gavidia’s work was supported by an NIH/NINDS T32-NS007222 grant
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Coats, Andrew J. Stewart. "Monitoring for sleep-disordered breathing in heart failure." European Heart Journal Supplements 21, Supplement_M (December 1, 2019): M36—M39. http://dx.doi.org/10.1093/eurheartj/suz233.
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Abstract Sleep-disordered breathing (SDB) is extremely common in heart failure (HF) and it carries with it adverse symptoms and impaired survival. Sleep-disordered breathing has two main types; obstructive sleep apnoea (OSA) and central sleep apnoea (CSA), which can overlap. The differentiation between CSA and OSA is important and is recommended in recent HF guidelines, by recommending a formal sleep study. The reason is that for OSA the main therapy is a positive pressure airway mask, whereas for patients with HFrEF and CSA this mask therapy actually increases cardiovascular mortality, and therefore alternative therapies are required, such as implantable phrenic nerve stimulation to improve sleep and related daytime symptoms attributable to the CSA. This article discusses the detection, screening, and monitoring of SDB in HF patients.
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Alshaarawy, Omayma, Srinivas Teppala, and Anoop Shankar. "Markers of Sleep-Disordered Breathing and Prediabetes in US Adults." International Journal of Endocrinology 2012 (2012): 1–8. http://dx.doi.org/10.1155/2012/902324.
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Background. Prediabetes is a preclinical stage in the hyperglycemia continuum where subjects are at increased risk of developing diabetes. Several studies reported a positive association between markers of sleep-disordered breathing (SDB) and diabetes. However, few studies investigated the relationship between SDB markers and prediabetes.Methods. We examined 5,685 participants ≥20 years from the National Health and Nutrition Examination Survey (NHANES) 2005–2008. The exposure of interest was SDB markers including sleep duration, snoring, snorting, and daytime sleepiness. The outcome was prediabetes (n=2058), among subjects free of diabetes.Results. SDB markers were associated with prediabetes. Compared to those without any sleep disturbance, the multivariable odds ratio (OR) (95% confidence interval (CI)) of prediabetes among those with three or more SDB markers was 1.69 (1.28–2.22). In subgroup analyses, the association between SDB markers and prediabetes was stronger among women (OR (95% CI) = 2.09 (1.36–3.23) when compared to men (1.52 (1.00–2.35)) and was present among non-Hispanic whites (2.66 (1.92–3.69)) and Mexican Americans (1.99 (1.13–3.48)), but not among non-Hispanic blacks (1.10 (0.70–1.73)).Conclusion. SDB markers were associated with prediabetes. This association was stronger in women and was present mainly in non-Hispanic whites and Mexican Americans.
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Immanuel, Sarah A., Yvonne Pamula, Mark Kohler, James Martin, Declan Kennedy, Muammar M. Kabir, David A. Saint, and Mathias Baumert. "Respiratory timing and variability during sleep in children with sleep-disordered breathing." Journal of Applied Physiology 113, no. 10 (November 15, 2012): 1635–42. http://dx.doi.org/10.1152/japplphysiol.00756.2012.
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Sleep-disordered breathing (SDB) in children is assessed by quantification of hypopnea and apnea events. Little is known, however, about respiratory timing and breath-to-breath variability during sleep. The aim of this study was to investigate respiratory parameters across sleep stages in children with SDB before and after treatment compared with healthy children. Overnight polysomnography (PSG) was conducted in 40 children with SDB prior to and 6 mo following adenotonsillectomy. For comparison, a control group of 40 healthy sex- and age-matched children underwent two PSGs at equivalent time points but without intervention. The following variables were measured breath by breath during obstruction-free periods in stage 2 nonrapid eye movement (NREM), stage 4 NREM, and REM sleep: inspiratory time (Ti), expiratory time (Te), total time (Ttotal), inspiratory duty cycle (DC; =Ti/Ttotal), respiratory frequency (fR), and SD of the parameters Ti, Te, fR, and DC. Variability in waveform morphology was also computed using the residue of respiratory patterns. The severity of SDB was relatively mild in the study cohort (obstructive apnea hypopnea index: baseline, 5.1 ± 9.4 vs. 0.1 ± 0.2, P < 0.001; follow-up, 0.3 ± 0.3 vs. 0.8 ± 1.0, P < 0.01). Compared with healthy controls, children with SDB showed significantly longer Ti and Te and a lower fR at the baseline study. These differences were not significant after adenotonsillectomy. Sleep stages were associated with significant differences in all of the respiratory measures in both groups of children. In conclusion, children with relatively mild SDB showed prolonged inspiration and expiration indicative of chronic narrowing of the upper airway. Treatment of SDB normalizes respiratory timing. Documentation of these parameters may aid in both understanding and management of children with SDB.
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Khokhrina, Anna, Elena Andreeva, and Jean-Marie Degryse. "The prevalence of sleep-disordered breathing in Northwest Russia: The ARKHsleep study." Chronic Respiratory Disease 17 (January 1, 2020): 147997312092810. http://dx.doi.org/10.1177/1479973120928103.
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Sleep-disordered breathing (SDB) is a chronic condition characterized by repeated breathing pauses during sleep. The reported prevalence of SDB in the general population has increased over time. Furthermore, in the literature, a distinction is made between SDB, obstructive sleep apnea (OSA), and “OSA syndrome” (OSAS). Patients with SDB are at increased risk of comorbid cardiovascular diseases (CVDs). The aim of the ARKHsleep study was to assess the prevalence of SDB in general and of OSA and OSAS in particular. A total of 1050 participants aged 30–70 years, who were randomly selected from a population register, were evaluated for the probability of SDB using the Epworth Sleepiness Scale score and body mass index. Sleep was recorded for one night via home sleep apnea testing (Somnolter®). Medical conditions were determined from medical records. Additional data included background characteristics, anthropometric variables, blood pressure, and scores from four questionnaires. The survey sample consisted of 41.2% males and had a mean age of 53.1 ± 11.3 years. The prevalence of mild-to-severe, moderate-to-severe, and severe SDB was 48.9% [45.8–51.9], 18.1% [15.9–20.6], and 4.5% [3.2–5.8], respectively. Individuals reporting snoring or breathing pauses had a higher severity of SDB than individuals free of symptoms. The ARKHsleep study revealed a high burden of both SDB and CVD; however, more large-scale cohort studies and intervention studies are needed to better understand whether the early recognition and treatment of mild SDB with or without symptoms will improve cardiovascular prognosis and/or quality of life.
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Wada, Hiroo, Kazumasa Nagata, Ryutaro Shirahama, Tomokazu Tajima, Manami Kimura, Ai Ikeda, Koutatsu Maruyama, Masahiro Tamura, Keiji Suzuki, and Takeshi Tanigawa. "Impact of sleep disordered breathing on performance in judo players." BMJ Open Sport & Exercise Medicine 5, no. 1 (April 2019): e000418. http://dx.doi.org/10.1136/bmjsem-2018-000418.
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ObjectivePrevious studies have suggested that young sports players may suffer from sleep disordered breathing (SDB). It was hypothesised that SDB in heavy-class judo players was far more prevalent than expected and that it could reduce judo performance, which could be improved by appropriate therapies. To address this, the present study estimated the percentage of heavy-class judo players with SDB and investigated the effect of SDB treatment on judo performance.MethodsWe enrolled 19 young judo players from a university judo team with body weight >100 kg and/or body mass index >30 kg/m2. Both excessive daytime sleepiness (EDS) and respiratory disturbance index (RDI) were evaluated using the Epworth Sleepiness Scale (ESS) and an overnight type 3 sleep monitor.ResultsThe percentages of young heavyweight-class judo players with EDS (ESS ≥11) and those with SDB (RDI ≥5) were both 63%, which was unexpectedly high for the age class. Seven of the participants underwent continuous positive airway pressure therapy, which improved both RDI and ESS scores (p<0.05 for each) and subsequently the sleep quality and judo performance of the participants.ConclusionsOur study indicates that young judo players might silently suffer from SDB, leading to poorer judo performance and to future cardiovascular diseases. Clinicians should be aware of the possible presence of SDB in young sports players and consider the application of diagnostic and therapeutic remedies.
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Tagaito, Y., V. Y. Polotsky, M. J. Campen, J. A. Wilson, A. Balbir, P. L. Smith, A. R. Schwartz, and C. P. O'Donnell. "A model of sleep-disordered breathing in the C57BL/6J mouse." Journal of Applied Physiology 91, no. 6 (December 1, 2001): 2758–66. http://dx.doi.org/10.1152/jappl.2001.91.6.2758.
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To investigate the pathophysiological sequelae of sleep-disordered breathing (SDB), we have developed a mouse model in which hypoxia was induced during periods of sleep and was removed in response to arousal or wakefulness. An on-line sleep-wake detection system, based on the frequency and amplitude of electroencephalograph and electromyograph recordings, served to trigger intermittent hypoxia during periods of sleep. In adult male C57BL/6J mice ( n= 5), the sleep-wake detection system accurately assessed wakefulness (97.2 ± 1.1%), non-rapid eye movement (NREM) sleep (96.0 ± 0.9%) and rapid eye movement (REM) sleep (85.6 ± 5.0%). After 5 consecutive days of SDB, 554 ± 29 (SE) hypoxic events were recorded over a 24-h period at a rate of 63.6 ± 2.6 events/h of sleep and with a duration of 28.2 ± 0.7 s. The mean nadir of fraction of inspired O2 (Fi O2 ) on day 5 was 13.2 ± 0.1%, and 137.1 ± 13.2 of the events had a nadir Fi O2 <10% O2. Arterial blood gases confirmed that hypoxia of this magnitude lead to a significant degree of hypoxemia. Furthermore, 5 days of SDB were associated with decreases in both NREM and REM sleep during the light phase compared with the 24-h postintervention period. We conclude that our murine model of SDB mimics the rate and magnitude of sleep-induced hypoxia, sleep fragmentation, and reduction in total sleep time found in patients with moderate to severe SDB in the clinical setting.
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Kishan, Sajit, Mugula Sudhakar Rao, Padmakumar Ramachandran, Tom Devasia, and Jyothi Samanth. "Prevalence and Patterns of Sleep-Disordered Breathing in Indian Heart Failure Population." Pulmonary Medicine 2021 (July 3, 2021): 1–8. http://dx.doi.org/10.1155/2021/9978906.
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Background. Sleep-disordered breathing (SDB) is a common yet a largely underdiagnosed entity in developing countries. It is one treatable condition that is known to adversely affect the mortality and morbidity in heart failure (HF). This study is one of the first attempts aimed at studying SDB in chronic HF patients from an Indian subcontinent. Objectives. The aim of this study was to study the prevalence, type, and characteristics of SDB in chronic HF patients and their association with HF severity and left ventricular (LV) systolic function and also to determine the relevance of SDB symptoms and screening questionnaires such as the Epworth Sleepiness Scale (ESS), Berlins questionnaire, and STOP-BANG score in predicting SDB in chronic HF patients. Methods. We enrolled 103 chronic heart failure patients aged more than 18 years. Patients with a history of SDB and recent acute coronary syndrome within 3 months were excluded. Relevant clinical data, anthropometric measures, echocardiographic parameters, and sleep apnea questionnaires were collected, and all patients underwent the overnight type 3 sleep study. Results. The overall prevalence of SDB in our study was high at 81.55% (84/103), with a predominant type of SDB being obstructive sleep apnea (59.2%). The occurrence of SDB was significantly associated with the male gender ( p = 0.002 ) and higher body mass index (BMI) values ( p = 0.01 ). SDB symptoms and questionnaires like ESS, STOP-BANG, and Berlins also did not have a significant association with the occurrence of SDB in HF patients. Conclusions. Our study showed a high prevalence of occult SDB predominantly OSA, in chronic HF patients. We advocate routine screening for occult SDB in HF patients.
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Zhang, Xinyan, Marcel Smits, Leopold Curfs, and Karen Spruyt. "Sleep Respiratory Disturbances in Girls with Rett Syndrome." International Journal of Environmental Research and Public Health 19, no. 20 (October 12, 2022): 13082. http://dx.doi.org/10.3390/ijerph192013082.
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Individuals with Rett Syndrome (RTT), a rare neurodevelopmental disorder, present disordered breathing during wakefulness. Whilst findings on breathing during sleep are contradictory, the relation between sleep breathing and their clinical features, genetic characteristics, age, and sleep phase is rarely investigated, which is the objective of this study. Overnight polysomnography (PSG) was performed. Sleep macrostructure parameters were compared between the RTT subjects with and without sleep-disordered breathing (SDB). The association between the apnea–hypopnea index (AHI) with age at PSG was tested. Particularly for RTT subjects with SDB, the respiratory indexes in REM and NREM sleep were compared. Stratified analyses per clinical characteristics, genetic characteristics, and clinical features’ severity were performed. Non-parametric statistics were applied. A sample of 11 female RTT subjects, aged 8.69 ± 5.29 years with ten confirmed with MECP2 mutations, were studied. The average AHI was 3.94 ± 1.19/h TST, of which eight (72.73%) had obstructive sleep apnea, i.e., six in 1/h TST ≤ AHI ≤ 5/h TST, and two in AHI > 5/h TST. The mean SpO2% was 81.00 ± 35.15%. The AHI was not significantly correlated with their age at PSG (rs = −0.15, p = 0.67). Sleep macrostructure in SDB-absent and SDB-present groups was not different. Respiratory indexes in those with obstructive sleep apnea showed no difference between REM and NREM sleep nor any of the strata. In our clinical sample, more than half of the RTT subjects with MECP2 mutations had obstructive sleep apnea in both NREM and REM sleep which was unrelated to their clinical features. Our results also indicated hypoxemia throughout nocturnal sleep in RTT. To conclude, our results suggest that disordered breathing during sleep is prevalently present in RTT as an independent clinical feature.
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Väyrynen, Kirsi, Kati Kortelainen, Heikki Numminen, Katja Miettinen, Anna Keso, Mirja Tenhunen, Heini Huhtala, and Sari-Leena Himanen. "Screening Sleep Disordered Breathing in Stroke Unit." Sleep Disorders 2014 (2014): 1–7. http://dx.doi.org/10.1155/2014/317615.
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In acute stroke, OSA has been found to impair rehabilitation and increase mortality but the effect of central apnea is more unclear. The aim of the present study was to evaluate the feasibility of using limited ambulatory recording system (sleep mattress to evaluate nocturnal breathing and EOG-electrodes for sleep staging) in sleep disordered breathing (SDB) diagnostics in mild acute cerebral ischemia patients and to discover the prevalence of various SDB-patterns among these patients. 42 patients with mild ischemic stroke or transient ischemic attack were studied. OSA was found in 22 patients (52.4%). Central apnea was found in two patients (4.8%) and sustained partial obstruction in only one patient (2.4%). Sleep staging with EOG-electrodes only yielded a similar outcome as scoring with standard rules. OSA was found to be common even after mild stroke. Its early diagnosis and treatment would be favourable in order to improve recovery and reduce mortality. Our results suggest that OSA can be assessed by a limited recording setting with EOG-electrodes, sleep mattress, and pulse oximetry.
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Izci Balserak, Bilgay. "Special Issue: The Diagnosis and Management of OSA." Diagnostics 12, no. 8 (August 8, 2022): 1919. http://dx.doi.org/10.3390/diagnostics12081919.
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Keenan, Sean P., Kathleen A. Ferguson, Moira Chan-Yeung, and John A. Fleetham. "Prevalence of Sleep Disordered Breathing in a Population of Canadian Grainworkers." Canadian Respiratory Journal 5, no. 3 (1998): 184–90. http://dx.doi.org/10.1155/1998/403649.
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OBJECTIVES: To determine the prevalence of sleep disordered breathing (SDB) in a Canadian population of industrial workers (grainworkers). To determine the clinical features that are predictive of SDB and the validity of self-reported snoring.DESIGN: Cross-sectional, interviewer-administered questionnaire with selective recruitment of subjects for home sleep monitoring.SETTING: Community setting, Vancouver, British Columbia.PARTICIPANTS: All male grainworkers at grain elevators in Vancouver were approached for completion of a questionnaire. Eighty-three per cent of 524 subjects completed the questionnaire and were divided by presumed risk for SDB into four groups. All subjects in the highest risk group (group 1- frequent snoring and witnessed apneas) and a random sample of 40 subjects in the other three groups (group 2 - frequent snoring without witnessed apneas; group 3 - infrequent snoring rare; group 4 - nonsnoring) were approached for home sleep monitoring and 42% consented.INTERVENTIONS: Interviewer-administered questionnaire and home sleep monitoring.RESULTS: The overall prevalence of SDB in this relatively overweight group was estimated to be 25%, with a stepwise increase from group 4 to group 1 (7%, 29%, 40%, 60%). Presence of snoring and witnessed apneas, a greater body-mass index and a larger neck circumference were associated with SDB. Self-reported snoring was not found to be predictive.CONCLUSIONS: This first study of the prevalence of SDB in Canada suggests that SDB is at least as prevalent in Canada as in other industrialized nations and may actually be more common than previously thought. Further studies are required to determine the morbidity, mortality and economic loss associated with SDB in industrial workers.
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Padmanabhan, Vivek, PR Kavitha, and Amitha Hegde. "Sleep Disordered Breathing in Children – A Review and the Role of a Pediatric Dentist." Journal of Clinical Pediatric Dentistry 35, no. 1 (September 1, 2010): 15–21. http://dx.doi.org/10.17796/jcpd.35.1.u2010g22480145u4.
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Among the many factors important in children's development is sleep. Sleep disorders can impair children's sleep and lead to negative consequences. The most common sleep disordered breathing (SDB) in children is obstructive sleep apnea (OSA). One of the main causes of childhood SDB is enlargement of the tonsil tissues and, in most cases, their removal serves as an ultimate treatment of SDB. However, it remains unclear what proportion of children with enlarged tonsil tissue suffer from SDB. Dentists are becoming increasingly aware of the issue of SDB as they are sometimes involved in treatment of this condition using oral appliances. Moreover, as dentists often look into children's mouths, they can play an active role in identifying those with enlarged tonsils and referring them for sleep assessment. This review focuses on the diagnosis and treatment of SDB and also on the utility of oral appliances in the management of this disorder.
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Kim, Nawoon, Daewoo Lee, Jaegon Kim, Changkeun Lee, and Yeonmi Yang. "A Study on Factors Related to Sleep Disordered Breathing in Children." JOURNAL OF THE KOREAN ACADEMY OF PEDTATRIC DENTISTRY 49, no. 2 (May 31, 2022): 180–87. http://dx.doi.org/10.5933/jkapd.2022.49.2.180.
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The aim of this study was to investigate the risk factors associated with sleep disordered breathing (SDB) by comparing intraoral factors, body mass index (BMI), and medical history with pediatric sleep questionnaire (PSQ) findings.Seven hundred eighty-seven subjects aged between 7 to 11 years old were included. Their caregivers were asked to complete questionnaires. Oral manifestations including Angle’s classification, overjet, and Brodsky tonsil grade were examined. Children with PSQ scores of more than 0.33 points were classified into the SDB high-risk group.Among the 787 subjects, 34 (4.3%) were classified into the SDB high-risk group. Children with allergic rhinitis, atopic dermatitis, excessive overjet, or large tonsil size had a significantly higher risk for SDB versus those without. Also, there was a significant difference in SDB risk according to BMI status. Gender, gestational age, breastfeeding, and Angle’s classification were not associated with SDB.Children at high risk for SDB were predisposed to tonsillar hypertrophy, allergic rhinitis, obesity, and atopic dermatitis. Children with these factors could be candidates for early intervention to prevent the progression of SDB.
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Ardissino, Maddalena, Rohin K. Reddy, Eric A. W. Slob, Kiran H. K. Patel, David K. Ryan, Dipender Gill, and Fu Siong Ng. "Sleep Disordered Breathing, Obesity and Atrial Fibrillation: A Mendelian Randomisation Study." Genes 13, no. 1 (January 2, 2022): 104. http://dx.doi.org/10.3390/genes13010104.
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It remains unclear whether the association between obstructive sleep apnoea (OSA), a form of sleep-disordered breathing (SDB), and atrial fibrillation (AF) is causal or mediated by shared co-morbidities such as obesity. Existing observational studies are conflicting and limited by confounding and reverse causality. We performed Mendelian randomisation (MR) to investigate the causal relationships between SDB, body mass index (BMI) and AF. Single-nucleotide polymorphisms associated with SDB (n = 29) and BMI (n = 453) were selected as instrumental variables to investigate the effects of SDB and BMI on AF, using genetic association data on 55,114 AF cases and 482,295 controls. Primary analysis was conducted using inverse-variance weighted MR. Higher genetically predicted SDB and BMI were associated with increased risk of AF (OR per log OR increase in snoring liability 2.09 (95% CI 1.10–3.98), p = 0.03; OR per 1-SD increase in BMI 1.33 (95% CI 1.24–1.42), p < 0.001). The association between SDB and AF was not observed in sensitivity analyses, whilst associations between BMI and AF remained consistent. Similarly, in multivariable MR, SDB was not associated with AF after adjusting for BMI (OR 0.68 (95% CI 0.42–1.10), p = 0.12). Higher BMI remained associated with increased risk of AF after adjusting for OSA (OR 1.40 (95% CI 1.30–1.51), p < 0.001). Elevated BMI appears causal for AF, independent of SDB. Our data suggest that the association between SDB, in general, and AF is attributable to mediation or confounding from obesity, though we cannot exclude that more severe SDB phenotypes (i.e., OSA) are causal for AF.
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Fregosi, R. F., S. F. Quan, W. L. Morgan, J. L. Goodwin, R. Cabrera, I. Shareif, K. W. Fridel, and R. R. Bootzin. "Pharyngeal critical pressure in children with mild sleep-disordered breathing." Journal of Applied Physiology 101, no. 3 (September 2006): 734–39. http://dx.doi.org/10.1152/japplphysiol.01444.2005.
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There is evidence that narrowing or collapse of the pharynx can contribute to obstructive sleep-disordered breathing (SDB) in adults and children. However, studies in children have focused on those with relatively severe SDB who generally were recruited from sleep clinics. It is unclear whether children with mild SDB who primarily have hypopneas, and not frank apnea, also have more collapsible airways. We estimated airway collapsibility in 10 control subjects (9.4 ± 0.5 yr old; 1.9 ± 0.2 hypopneas/h) and 7 children with mild SDB (10.6 ± 0.5 yr old; 11.5 ± 0.1 hypopneas/h) during stable, non-rapid eye movement sleep. None of the subjects had clinically significant enlargement of the tonsils or adenoids, nor had any undergone previous tonsillectomy or adenoidectomy. Airway collapsibility was measured by brief (2-breath duration) and sudden reductions in pharyngeal pressure by connecting the breathing mask to a negative pressure source. Negative pressure applications ranging from −1 to −20 cmH2O were randomly applied in each subject while respiratory airflow and mask pressure were measured. Flow-pressure curves were constructed for each subject, and the x-intercept gave the pressure at zero flow, the so-called critical pressure of the upper airway (Pcrit). Pcrit was significantly higher in children with SDB than in controls (−10.8 ± 2.8 vs. −15.7 ± 1.2 cmH2O; P < 0.05). There were no significant differences in the slopes of the pressure-flow relations or in baseline airflow resistance. These data support the concept that intrinsic pharyngeal collapsibility contributes to mild SDB in children.
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Mietchen, Jonathan J., David P. Bennett, Trevor Huff, Dawson W. Hedges, and Shawn D. Gale. "Executive Function in Pediatric Sleep-Disordered Breathing: A Meta-analysis." Journal of the International Neuropsychological Society 22, no. 8 (August 2, 2016): 839–50. http://dx.doi.org/10.1017/s1355617716000643.
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AbstractObjectives:Evaluate the association between pediatric sleep-disordered breathing (SDB) and executive functioning.Methods:We searched multiple electronic databases for peer-reviewed journal articles related to pediatric SDB and executive functioning. We included studies that assessed SDBviapolysomnography, included objective or questionnaire measures of executive function, and had an age-matched control group. Fourteen articles met inclusion criteria with a total sample of 1697 children ages 5 to 17 years (M=9.81 years;SD=0.34). We calculated an overall effect size for each of the five executive domains (vigilance, inhibition, working memory, shifting, and generativity) as well as effect sizes according to SDB severity: mild, moderate, severe. We also calculated effect sizes separately for objective and subjective questionnaires of executive functioning.Results:We found a medium effect size (−0.427) for just one of five executive function domains on objective neuropsychological measures (generativity). In contrast, effect sizes on all three executive domains measuredviaquestionnaire data were significant, with effect sizes ranging from medium (−0.64) to large (−1.06). We found no difference between executive domains by severity of SDB.Conclusions:This meta-analysis of executive function separated into five domains in pediatric SDB suggested lower performance in generativity on objective neuropsychological measures. There were no differences associated with SDB severity. Questionnaire data suggested dysfunction across the three executive domains measured (inhibition, working memory, shifting). Overall, limited evidence suggested poorer performance in executive function in children with SDB according to objective testing, and subjective ratings of executive function suggested additional worsened performance. (JINS, 2016,22, 839–850)
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Brown, Devin L., Chengwei Li, Ronald D. Chervin, Erin Case, Nelda M. Garcia, Susan D. Tower, and Lynda D. Lisabeth. "Wake-up stroke is not associated with sleep-disordered breathing in women." Neurology: Clinical Practice 8, no. 1 (January 18, 2018): 8–14. http://dx.doi.org/10.1212/cpj.0000000000000412.
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BackgroundWe sought to investigate the frequency of wake-up stroke (WUS) and its association with sleep-disordered breathing (SDB) in women.MethodsWithin a population-based study, women with acute ischemic stroke were asked about their stroke symptom onset time. SDB screening was performed with the well-validated ApneaLink Plus device; SDB was defined by a respiratory event index ≥10. Logistic regression was used to test the association between SDB presence and severity and WUS unadjusted and adjusted for potential confounders including prestroke depression and sleep duration.ResultsAmong 466 participants, the median age was 67.0 years (interquartile range [IQR] 58.0, 77.0), 55% were Mexican American, and the median initial NIH Stroke Scale score was 3.0 (IQR 1.0, 6.0). Stroke symptom onset occurred during nocturnal sleep (25.3%), during a nap (3.9%), during wakefulness (65.9%), or unknown (4.9%). In those with SDB screening performed (n = 259), a median of 11 days (IQR 5, 17) poststroke, WUS was not associated with the presence or severity (respiratory event index) of SDB in unadjusted or adjusted analysis.ConclusionsIn this population-based study, WUS represented about 30% of all generally mild severity ischemic strokes in women and was not associated with SDB.
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Brockmann, Pablo E., and David Gozal. "Neurocognitive Consequences in Children with Sleep Disordered Breathing: Who Is at Risk?" Children 9, no. 9 (August 25, 2022): 1278. http://dx.doi.org/10.3390/children9091278.
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Sleep-disordered breathing (SDB) is a prevalent disease in children characterized by snoring and narrowing of the upper airway leading to gas exchange abnormalities during sleep as well as sleep fragmentation. SDB has been consistently associated with problematic behaviors and adverse neurocognitive consequences in children but causality and determinants of susceptibility remain incompletely defined. Since the 1990s several studies have enlightened these associations and consistently reported poorer academic performance, lower scores on neurocognitive tests, and behavioral abnormalities in children suffering from SDB. However, not all children with SDB develop such consequences, and severity of SDB based on standard diagnostic indices has often failed to discriminate among those children with or without neurocognitive risk. Accordingly, a search for discovery of markers and clinically useful tools that can detect those children at risk for developing cognitive and behavioral deficits has been ongoing. Here, we review the advances in this field and the search for possible detection approaches and unique phenotypes of children with SDB who are at greater risk of developing neurocognitive consequences.
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Patel, Salma, Wojciech Zareba, Bonnie LaFleur, Jean-Philippe Couderc, Xiaojuan Xia, Raymond Woosley, Daniel Combs, et al. "478 The Relationship between Sleep Disordered Breathing, Markers of Ventricular Repolarization and Cardiovascular Mortality." Sleep 44, Supplement_2 (May 1, 2021): A188—A189. http://dx.doi.org/10.1093/sleep/zsab072.477.
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Abstract Introduction Sleep disordered breathing (SDB) is associated with increased mortality. Obstructive apneas/hypopneas have been associated with an increase in both QTc duration and QT variability. These markers of ventricular repolarization are associated with arrhythmias and death. It is unknown whether SDB-related QTc changes are responsible for the relationship between QTc/QT variability and cardiovascular death (CVD). Methods From the Sleep Heart Health Study, we randomly selected 200 subjects in each of four groups based on overall apnea/hypopnea index: those with no SDB and those in either, mild, moderate or severe SDB at baseline, matched for gender, age and BMI. Respiratory-related channels and electrocardiograms (ECG) from each polysomnography were analyzed. QTc was calculated using Bazett’s heart rate correction. The following measures of QT variability were obtained: i) standard deviation of QT intervals (SDQT) at 1- and 5-minute intervals and ii) short-term interval QT variability (STVQT) at 5-minute intervals. Cox proportional hazards regression models were used to evaluate potential predictors of CVD. Results Twenty-nine subjects were excluded either due to missing data or low quality ECG. The 771 subjects included were 68±10 years of age, half were female. During follow-up, 220 subjects (28.5%) died of CVD among whom, 67 (30.5%) had comorbid severe SDB, 45 (20.5%) had no SDB, and the remaining CVD deaths had mild (47, 21.4%) and moderate 61 (27.7%) SDB. The CVD patients were more likely to be older(p<0.001), hypertensive (p<0.001), diabetic(p<0.001), and had increased SDQT(p<0.001), STVQT(p<0.001) and QTc (0.017). After adjusting for covariates, the presence of mild (p=0.562), moderate(p=0.439) and severe SDB (p=0.912) did not moderate the association between QTc prolongation and CVD. Additionally, mild (p=0.486), moderate(p=0.478) and severe SDB (p=0.849) did not moderate the association between SDQT and CVD. Similarly, mild (p=0.144), moderate(p=0.594) and severe SDB (p=0.508) did not moderate the association between STVQT and CVD. However, QTc, SDQT, STVQT, mild and severe SDB were individually associated with CVD (p=0.004, 0.000, 0.000, 0.014, 0.022, respectively). Conclusion SDB was not a factor in the relationship between QTc prolongation/QT variability and CVD. Support (if any) American Academy of Sleep Medicine Foundation (203-JF-18), National Institutes of Health (HL126140), University of Arizona Health Sciences Career and Development Award (5299903)
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Bauer, Peter, Patricia Arand, Dragana Radovanovic, Franco Muggli, Andreas W. Schoenenberger, Renate Schoenenberger-Berzins, Augusto Gallino, Georg Ehret, and Paul Erne. "Assessment of Cardiac Function and Prevalence of Sleep Disordered Breathing using Ambulatory Monitoring with Acoustic Cardiography – Initial Results from SWICOS." Journal Of Hypertension And Cardiology 2, no. 3 (February 5, 2018): 32–46. http://dx.doi.org/10.14302/issn.2329-9487.jhc-18-1932.
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The aim of this study was to assess the use of ambulatory acoustic cardiography during the initial data collection of the longitudinal study of a rural population in Switzerland (n=297, mean age 48.9 ±16.5 years, 57% female). Ambulatory acoustic cardiography non-invasively can assess sleep disordered breathing (SDB) and provides markers of left ventricular systolic and diastolic dysfunction. The percentage of the third heart sound detected during sleep decreased significantly across age groups (age < 40 years, 40-60 years, > 60 years) for both genders (males, p=0.04; females, p=0.02). The percentage of a fourth heart sound detected exhibited an increasing trend for both genders with age suggesting increased diastolic dysfunction with aging. Mean electromechanical activation time (EMAT) during sleep was within the normal range across age groups and both genders (male 93.7 ± 11.6 ms, female 94.6 ± 13.0 ms), and did not vary significantly with age. A large proportion of subjects had a high likelihood of sleep disordered breathing (17.6%). Baseline characteristics categorized by SDB severity indicate increasing age, male gender and being overweight (BMI ≥ 25) to be associated with greater SDB severity. Acoustic cardiography findings categorized by SDB severity reveal increased nocturnal non-dipping heart rate, presence of atrial fibrillation, prolonged QRS duration and QTc interval, increased percentage of fourth heart sound detected, and longer EMAT to be significantly associated with greater SDB severity. Overall, acoustic cardiography detected a very low prevalence of systolic dysfunction, age-related increases in diastolic dysfunction and a moderate prevalence of sleep disordered breathing.
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Peck, Bailey, Timothy Renzi, Hannah Peach, Jane Gaultney, and Joseph S. Marino. "Examination of Risk for Sleep-Disordered Breathing Among College Football Players." Journal of Sport Rehabilitation 28, no. 2 (February 1, 2019): 126–32. http://dx.doi.org/10.1123/jsr.2017-0127.
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Context: Professional football linemen are at risk for sleep-disordered breathing (SDB) compared with other types of athletes. It is currently unknown whether college football linemen display a similar risk profile. Objective: (1) To determine for the first time whether college football linemen show risk for SDB and (2) test the hypothesis that SDB risk is higher in college football linemen compared with an athletic comparison group. Design: Descriptive laboratory study. Setting: The Health Risk Assessment Laboratory. Participants: Male football linemen (n = 21) and track (n = 19) Division I athletes between the ages of 18 and 22 years. Interventions: Participants completed the Multivariable Apnea Prediction Index and Epworth Sleepiness Scale surveys, validated measures of symptoms of sleep apnea and daytime sleepiness, respectively. Neck and waist circumferences, blood pressure, Modified Mallampati Index (MMPI), and tonsil size were determined, followed by body composition assessment using dual-energy X-ray absorptiometry. Main Outcome Measures: Scores from surveys, anthropometric data, MMPI, and body composition. Results: Survey data demonstrated a deficiency in sleep quality and efficiency, coinciding with increased self-reported symptoms of apnea (Multivariable Apnea Prediction Index = 0.78) in college linemen relative to track athletes. Neck circumference (44.36 cm), waist circumference (107.07 cm), body mass index (35.87 kg/m2), and percent body fat (29.20%), all of which exceeded the clinical predictors of risk for obstructive sleep apnea, were significantly greater in linemen compared with track athletes. Multivariable Apnea Prediction variables were significantly correlated with MMPI, neck circumference, percent body fat, body mass index, and systolic blood pressure (r ≥ .31, P < .05), indicating that college football linemen are at increased risk for SDB. Conclusions: Risk factors for SDB recognized in professional football linemen are also present at the college level. Screening may minimize present or future risk for SDB, as well as the downstream risk of SDB-associated metabolic and cardiovascular disease.
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Agudelo, Christian, Alberto Ramos, Xiaoyan Sun, Sonya Kaur, Dylan Del Papa, Josefina Kather, and Douglas Wallace. "Sleep-Disordered Breathing Risk with Comorbid Insomnia Is Associated with Mild Cognitive Impairment." Applied Sciences 12, no. 5 (February 25, 2022): 2414. http://dx.doi.org/10.3390/app12052414.
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Introduction: Few studies have evaluated the combined association between SDB with comorbid insomnia and mild cognitive impairment (MCI). To test the hypothesis that SDB with comorbid insomnia is associated with greater odds of MCI than either sleep disorder independently, we used ADNI data to evaluate cross-sectional associations between SDB risk with comorbid insomnia status and MCI. Methods: Participants with normal cognition or MCI were included. Insomnia was defined by self-report. SDB risk was assessed by modified STOP-BANG. Logistic regression models evaluated associations between four sleep disorder subgroups (low risk for SDB alone, low risk for SDB with insomnia, high risk for SDB alone, and high risk for SDB with insomnia) and MCI. Models adjusted for age, sex, BMI, APOE4 genotype, race, ethnicity, education, marital status, hypertension, cardiovascular disease, stroke, alcohol abuse, and smoking. Results: The sample (n = 1391) had a mean age of 73.5 ± 7.0 years, 44.9% were female, 72.0% were at low risk for SDB alone, 13.8% at low risk for SDB with insomnia, 10.1% at high risk for SDB alone, and 4.1% at high risk for SDB with insomnia. Only high risk for SDB with comorbid insomnia was associated with higher odds of MCI (OR 3.22, 95% CI 1.57–6.60). Conclusion: Studies are needed to evaluate SDB with comorbid insomnia as a modifiable risk factor for MCI.
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Csábi, E., P. Benedek, and V. Gaál. "Increased externalizing and internalizing problems in children with sleep-disordered breathing." European Psychiatry 64, S1 (April 2021): S632. http://dx.doi.org/10.1192/j.eurpsy.2021.1681.
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IntroductionSleep-disordered Breathing (SDB) is a spectrum disorder ranging from primary snoring to obstructive sleep apnea (OSA). One of the most common sleep-disorder in childhood, however remarkably little is known of the effect of SDB on behavioral functions.ObjectivesThe aim of our study to investigate the behavioral consequences of SDB compared to children with no history of sleep disorders.MethodsTwo hundred thirty-four children aged 4-10 years participated in the study. The SDB group consists seventy-eight children, sixty-one of the them with OSA and seventeen with primary snoring (average age: 6,7 (SD = 1,83), 32 female/46 male), One hundred fifty-six children participated in the control group (average age: 6,57 years (SD = 1,46), 80 female/76 male). The two groups were matched by age and gender. We used the Attention Deficit Hyperactivity Disorder Rating Scale, Strength and Difficulty Questionnaire, and Child Behavior Checklist to assess the behavioral functions. Furthermore, the OSA-18 Questionnaire was administrated to support the diagnosis of SDB.ResultsAccording to our results, children with SDB showed a significantly higher level of anxiety and depression and demonstrated significantly higher externalizing (such as attentional problems, hyperactivity, or social problems) and internalizing behavior problems (aggression, rule-breaking behavior).ConclusionsDue to the neurobehavioral consequences, our finding underlines the importance of the early diagnosis and treatment of sleep-disorder breathing.DisclosureNo significant relationships.
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Seetho, Ian W., and John PH Wilding. "Sleep-disordered breathing, type 2 diabetes and the metabolic syndrome." Chronic Respiratory Disease 11, no. 4 (October 3, 2014): 257–75. http://dx.doi.org/10.1177/1479972314552806.
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Sleep-disordered breathing (SDB) encompasses a spectrum of conditions that can lead to altered sleep homeostasis. In particular, obstructive sleep apnoea (OSA) is the most common form of SDB and is associated with adverse cardiometabolic manifestations including hypertension, metabolic syndrome and type 2 diabetes, ultimately increasing the risk of cardiovascular disease. The pathophysiological basis of these associations may relate to repeated intermittent hypoxia and fragmented sleep episodes that characterize OSA which drive further mechanisms with adverse metabolic and cardiovascular consequences. The associations of OSA with type 2 diabetes and the metabolic syndrome have been described in studies ranging from epidemiological and observational studies to controlled trials investigating the effects of OSA therapy with continuous positive airway pressure (CPAP). In recent years, there have been rising prevalence rates of diabetes and obesity worldwide. Given the established links between SDB (in particular OSA) with both conditions, understanding the potential influence of OSA on the components of the metabolic syndrome and diabetes and the underlying mechanisms by which such interactions may contribute to metabolic dysregulation are important in order to effectively and holistically manage patients with SDB, type 2 diabetes or the metabolic syndrome. In this article, we review the literature describing the associations, the possible underlying pathophysiological mechanisms linking these conditions and the effects of interventions including CPAP treatment and weight loss.
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Archbold, Kristen Hedger, Bruno Giordani, Deborah L. Ruzicka, and Ronald D. Chervin. "Cognitive Executive Dysfunction in Children with Mild Sleep-Disordered Breathing." Biological Research For Nursing 5, no. 3 (January 2004): 168–76. http://dx.doi.org/10.1177/1099800403260261.
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In children, moderate or severe sleep-disordered breathing (SDB) may impair cognitive executive functions (EFs), including working memory, attention, and mental flexibility. The main objective of this study was to assess EFs in children with mild levels of SDB. Subjects for this descriptive study were 12 children (5 girls, 7 boys) aged 8.0 to 11.9 years (M = 9.0 ± 0.85) participating in an ongoing study of the effects of adenotonsillectomy on behavior. Each subject had a nocturnal polysomnogram (PSG) and multiple sleep latency test (MSLT). Mild SDB was considered present if the child’s apnea/hypopnea index (AHI) was ≥ 1 and < 10. Between MSLT nap attempts, each child completed standardized tests of EFs. The sample showed significant impairment of sustained attention and vigilance on a computerized continuous performance test. Children with low mental flexibility scores on the Children’s Category Test (CCT) spent more time in stage 1 sleep (12.2% v. 9.5%, P = 0.028 on PSG) and showed a marginally higher arousal index (9.7 v. 6.5, P = 0.06 on PSG) than children with average or above-average CCT scores. AHI accounted for significant proportion of the variance in CCT scores when 1 outlier was removed (N = 11, Rsq = 0.67, P = 0.002). Mild levels of SDB and associated sleep architecture disruptions may be associated with impairment of EFs in children.
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Chen, S., U. Eden, and M. Prerau. "0732 Quantitative Characterization Of Sleep Disordered Breathing Dynamics." Sleep 43, Supplement_1 (April 2020): A278—A279. http://dx.doi.org/10.1093/sleep/zsaa056.728.
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Abstract Introduction Sleep-disordered breathing (SDB) is a dynamic process in which the rate of respiratory events is highly influenced by numerous covariates, such as sleep stage, body position dominance, time of night, and overall instability of sleep architecture. Additionally, respiratory event rate likely has history dependence, such that the likelihood of a respiratory event is influenced by the timing of previous events. Despite its dynamic nature, clinical diagnosis collapses the complex process of SDB to a single number measuring the average rate of respiratory event occurrence— the apnea-hypopnea index (AHI). Thus, potentially valuable information is being lost by ignoring SDB temporal dynamics and history dependence. Methods We apply a general point process framework to sleep apnea events to develop parametric models of a time-varying instantaneous apnea rate given clinical covariates (e.g. EEG power, sleep stage, body position). Develop models of apnea history dependence, describing the likelihood of events given past event times. In doing so, we are able to compute an “instantaneous AHI”, which measures the moment-by-moment event rate, which evolves temporally as a function of other clinical observations as well as event history. We apply our model to data from the MESA cohort (include number of subjects, male/female here). We then applied dimensionality-reduction methods to assess any population phenotypes. Results For every subject, we computed a time-varying AHI for each time point in their polysomnogram and estimated the influence of each of the measured covariates on the instantaneous rate. Results showed that the greatest predictor of apnea events were related to history dependence. Clustering analysis showed no distinct clusters, but rather a constant gradient of changes in history dependence. Conclusion These results suggest that the greatest predictor of an apnea event onset is the timing previous event. Moreover, the way in which previous events influence subsequent events can be used as a means of phenotyping, paving the way towards identifying optimal personalized treatment. Support National Institute of Neurological Disorders and Stroke Grant R01 NS-096177
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Kim, Lenise, Chloe Alexandre, Huy Pho, Alban Latremoliere, Vsevolod Polotsky, and Luu Pham. "0167 Obesity-Induced Breathing Variability During Sleep Is Not Entirely Attributed to Apneas and Sleep Fragmentation." Sleep 45, Supplement_1 (May 25, 2022): A77—A78. http://dx.doi.org/10.1093/sleep/zsac079.165.
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Abstract Introduction Obesity is a major cause of sleep-disordered breathing (SDB). Conventional metrics of SDB can be confounded by the effects of obesity on oxygenation and lack of standard definitions. Sleep fragmentation is frequently observed in obese individuals, but whether it occurs independently of SDB remains unknown. Quantitative analysis of ventilation may delineate the effects of obesity on breathing patterns and sleep fragmentation. We aimed to examine the effects of obesity on respiratory patterns during sleep and the relationship between obesity-related respiratory variability and sleep fragmentation. Methods Sleep recordings were performed in 15 lean C57BL/6J and 17 diet-induced obese (DIO) mice on the same genetic background. We applied Poincaré analysis of minute ventilation (VE) during sleep to estimate the breathing variability. Arousals were classified as respiratory when associated with ≥30% drops in VE from baseline. Results Breathing variability was significantly higher in DIO mice during NREM sleep, but not during REM sleep. Obesity-induced breathing variability could not be entirely attributed to apneas or arousals. Sleep fragmentation was 45% greater in DIO mice. Respiratory arousals comprised 15% of the arousals in both strains. Breathing variability was inversely associated with sleep fragmentation regardless of obesity. Conclusion Obesity increased respiratory variability during NREM sleep, which was not fully attributed to apneas and macro-sleep architecture. Obesity caused sleep fragmentation that was not entirely explained by SDB severity. Our quantitative analysis of VE identified differences in breathing variability in obesity that were not captured by traditional SDB metrics, which may be applicable for human SDB. Support (If Any) NHLBI NIH R01 HL135483, 2R01 HL133100-05, R01 HL128970, and R01 HL13892; NINDS NIH R01 NS112266; American Academy of Sleep Medicine Foundation 238-BS-20; American Thoracic Society Unrestricted Award; Johns Hopkins Blaustein Pain Research Grant; American Heart Association Postdoctoral Fellowship Award 828142.
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Kelly, Monica, Isabel Moghtaderi, Sarah Kate McGowan, Gwendolyn Carlson, Karen Josephson, Michael Mitchell, Dominika Swistun, et al. "400 Utility of the STOP Questionnaire in Predicting Sleep Disordered Breathing in Older Women Veterans." Sleep 44, Supplement_2 (May 1, 2021): A159. http://dx.doi.org/10.1093/sleep/zsab072.399.
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Abstract Introduction Sleep disordered breathing (SDB) is underdiagnosed in older women, despite a significant increase in SDB prevalence post-menopause. Few studies have assessed the diagnostic accuracy of SDB screening questionnaires in older women, particularly older Women Veterans (WV). WV have higher rates of SDB compared to non-Veteran women and are particularly vulnerable to sleep disorders in general. We examined the diagnostic accuracy of the STOP questionnaire compared to home sleep apnea testing (HSAT) that includes sleep time estimation (i.e., WatchPAT) in older WV. Methods Cross-sectional baseline data obtained from chart review were combined from two behavioral sleep intervention studies targeting WV with sleep difficulties (i.e., insomnia symptoms) or SDB risk factors (e.g., hypertension, obesity). A total of 136 older WV (50-91y; age=60.0±7.8y) completed the STOP questionnaire (yes/no: snoring, tiredness, observed breathing pauses, and high blood pressure [BP]) and had an apnea-hypopnea index (AHI) available from their baseline HSAT (WatchPAT). Sensitivity, specificity, and positive and negative likelihood ratios (+LR/-LR) were calculated to characterize the diagnostic accuracy of STOP≥2 for AHI≥5 (mild SDB) or AHI≥15 (moderate SDB). Results 70.6% (n=96) of participants endorsed a STOP≥2, 83.8% (n=114) demonstrated an AHI≥5 and 46.3% (n=63) demonstrated an AHI≥15. For AHI≥5, sensitivity was 73.7% (95% CI=64.6,81.5%), specificity was 45.5% (95% CI=24.4,67.8%), +LR was 1.35 (95% CI=0.91, 2.01), and -LR was 0.58 (95% CI=0.33,1.00). For AHI≥15, sensitivity was 76.2% (95% CI=63.8,86%), specificity was 34.2% (95% CI=23.5,46.3%), +LR was 1.16 (95% CI=0.93,1.44), and -LR was 0.70 (95% CI=0.30,1.20). Conclusion The likelihood ratios for STOP≥2 limited the utility of the STOP vs. an HSAT system with sleep scoring in determining AHI. While the STOP correctly identified 3/4 of older WV with SDB on WatchPAT, it correctly identified <50% of older WV without SDB. Screening measures that better capture predictors of moderate SDB in women at risk for SDB are needed, especially in older women who may not present clinically with the common SDB symptoms (i.e. snoring, tiredness, observed breathing pauses, and high BP). STOP compared to polysomnography studies are also needed. Support (if any) VA HSR&D IIR-13–058, IIR 16–244 and RCS 20–191; NIH/NHLBI K24 HL143055, VAGLAHS GRECC, VA Office of Academic Affiliations, and AASM Foundation.
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Kaplan, Alyson, and Seckin O. Ulualp. "Assessment of Central Sleep Apnea Events in Children with Sleep-Disordered Breathing." Sleep Disorders 2022 (May 17, 2022): 1–7. http://dx.doi.org/10.1155/2022/2590337.
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Purpose. To determine the prevalence of central apnea (CA) events and central sleep apnea (CSA) in children with sleep-disordered breathing (SDB) and to assess the effect of tonsillectomy and adenoidectomy (TA) on CSA in children with obstructive sleep apnea (OSA). Material and Methods. The medical charts of children with SDB were reviewed to obtain information on past medical history, polysomnography (PSG) findings, and surgical management. Counts and indexes of obstructive apnea, obstructive hypopnea, and central apnea were evaluated before and after TA. The prevalence of CSA and the effect of age, gender, obesity, and comorbid conditions on CSA were assessed in children with SDB as well as in children with PSG proven OSA. Results. Seven hundred twelve children with SDB (age range: 1 to 18 yrs, mean: 5.8 ± 3.4 ) were identified. CA events occurred in 640 of 712 (89.5%) patients. Of the 712 patients, 315 (44.2%) met the criteria for the diagnosis of CSA. CSA was more prevalent in toddlers and preschoolers ( p < 0.001 ). Obese children had a higher prevalence of CSA compared to nonobese children ( p < 0.001 ). The prevalence of CSA in patients with OSA was 45.4%. The number of CA events, CAI, and OAHI after TA was less than that of before TA ( p < 0.001 ). Residual CSA after TA occurred in 20 children (26%). Conclusion. Central apnea events and central sleep apnea occur in children who present to a pediatric otolaryngology clinic for evaluation of sleep disordered breathing. Central sleep apnea and obstructive sleep apnea both improve after tonsillectomy and adenoidectomy.
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Venkataraman, Shreyas, Shahid Karim, Aiswarya Rajendran, C. Anwar A. Chahal, and Virend K. Somers. "Sleep Disordered Breathing in Hypertrophic Cardiomyopathy—Current State and Future Directions." Journal of Clinical Medicine 9, no. 4 (March 25, 2020): 901. http://dx.doi.org/10.3390/jcm9040901.
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Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiomyopathy and sleep disordered breathing (SDB) is a treatable risk factor that has been seen to occur concurrently, and is known to propagate mortality and morbidity in a number of cardiovascular disease states including heart failure, and indeed hypertrophic cardiomyopathy. In this review, we summarize past studies that explored the simultaneous occurrence of HCM and SDB, and the pathophysiology of SDB in relation to heart failure, arrhythmias, cardiac ischemia and pulmonary hypertension in HCM. The current therapeutic modalities, with the effect of obstructive sleep apnea (OSA) treatment on HCM, are then discussed along with potential future directions.
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Hirunwiwatkul, Prakobkiat, and Patnarin Mahattanasakul. "Sleep-disordered breathing and self-reported general health status in Thai patients." Asian Biomedicine 4, no. 6 (December 1, 2010): 861–68. http://dx.doi.org/10.2478/abm-2010-0113.
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Abstract Background: Sleep-disordered breathing (SDB) has been a rapidly increasing health problem in Thai. Its effect on quality of life of Thai patients has not been adequately addressed. Objective: Determine the relationship between SDB and self-reported general health status in Thai patients. Materials and methods: A descriptive and cross-sectional study was used. Two hundred and sixtyeight patients (195 men and 73 women, age: 16-82 years) are recruited from King Chulalongkorn Memorial Hospital between January 2006 and December 2007. A health profile was obtained by self-administered questionnaire. SDB severity was assessed using an attended single-night comprehensive polysomnography. Results: SDB was not directly associated with the general health status. Presence of excessive daytime sleepiness, which was the major symptom of obstructive sleep apnea, was associated with a decrease in all domains of Short Form 36. Age, sex, and body mass index were also related to a lower physical function. Hypertension and excessive daytime sleepiness were associated with the severity of SDB. Conclusion: SDB is indirectly related to a lower general health status, and this relationship is of clinical significance.
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Davis, MD, FCCP, FAAHPM, Mellar P., Bertrand Behm, MD, and Diwakar Balachandran, MD. "Looking both ways before crossing the street: Assessing the benefits and risk of opioids in treating patients at risk of sleep disordered breathing for pain and dyspnea." Journal of Opioid Management 13, no. 3 (May 1, 2017): 183. http://dx.doi.org/10.5055/jom.2017.0385.
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Opioids adversely influence respiration in five distinct ways. Opioids reduce the respiratory rate, tidal volume, amplitude, reflex responses to hypercapnia and hypoxia, and arousability related necessary for respiratory adaptive responses. Opioids cause impairment of upper pharyngeal dilator muscles leading to obstructive apnea. Opioids cause complex sleep disordered breathing (SDB) consisting of central sleep apnea and obstructive sleep apnea. Clinically opioids worsen preexisting SDB. Recent studies have shown increased morbidity and mortality in patients receiving opioids for chronic noncancer pain and chronic obstructive pulmonary disease, which appear to be related to cardiovascular events, not overdose. Both patient populations are at risk for sleep disordered breathing and increased risk for adverse cardiovascular events on opioids for dyspnea or pain. This review discusses the influence of opioids on respiration and SDB and will review the adverse respiratory and cardiovascular effects of opioid use in at risk populations. Recommendations regarding management will follow as a summary.
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Sivathamboo, Shobi, Sarah Farrand, Zhibin Chen, Elise J. White, Andrew (Andreas) Pattichis, Callum Hollis, John Carino, et al. "Sleep-disordered breathing among patients admitted for inpatient video-EEG monitoring." Neurology 92, no. 3 (December 14, 2018): e194-e204. http://dx.doi.org/10.1212/wnl.0000000000006776.
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ObjectiveTo examine the prevalence and risk factors of sleep-disordered breathing (SDB) in individuals with epilepsy and psychogenic nonepileptic seizures (PNES).MethodsWe conducted a cross-sectional study of consecutive patients admitted for inpatient video-EEG monitoring at The Royal Melbourne Hospital, Australia, between December 1, 2011, and July 31, 2017. Participants underwent routine clinical investigations during their monitoring period including polysomnography, neurocognitive testing, and screening instruments of daytime somnolence, sleep quality, and quality of life.ResultsOur study population consisted of 370 participants who received a diagnosis of epilepsy (n = 255), PNES (n = 93), or both disorders (n = 22). Moderate to severe SDB (defined by an apnea-hypopnea index ≥15) was observed in 26.5% (98/370) of individuals, and did not differ across subgroups: epilepsy 26.3% (67/255), PNES 29.0% (27/93), or both disorders 18.2% (4/22; p = 0.610). Following adjustment for confounders, pathologic daytime sleepiness predicted moderate to severe SDB in epilepsy (odds ratio [OR] 10.35, 95% confidence interval [CI] 2.09–51.39; p = 0.004). In multivariable analysis, independent predictors for moderate to severe SDB in epilepsy were older age (OR 1.07, 95% CI 1.04–1.10; p < 0.001) and higher body mass index (OR 1.06, 95% CI 1.01–1.11; p = 0.029), and in PNES older age (OR 1.10, 95% CI 1.03–1.16; p = 0.002).ConclusionPolysomnography during inpatient video-EEG monitoring identified a substantial number of patients with undiagnosed SDB. This was remarkable in the subgroup with PNES, who were often female and obese. Identification of risk factors may improve management of SDB in these populations. The association with pathologic daytime sleepiness suggests that SDB may be an important contributor to these common and disabling symptoms in patients with epilepsy.