The effect of sleep #apnea on all-cause mortality in nondialyzed chronic #kidney disease patients
http://www.sleep-journal.com/article/S1389-9457(16)30205-2/abstract
In nondialyzed patients, CKD was each associated with central sleep apnea (CSA) and severe SDB. CSA was an independent risk factor for all-cause mortality, and was a more evident mortality risk in CKD patients than in non-CKD participants. Rapid decline of renal function may play a role in the mortality of CKD patients associated with SA.
http://www.sleep-journal.com/article/S1389-9457(16)30205-2/abstract
In nondialyzed patients, CKD was each associated with central sleep apnea (CSA) and severe SDB. CSA was an independent risk factor for all-cause mortality, and was a more evident mortality risk in CKD patients than in non-CKD participants. Rapid decline of renal function may play a role in the mortality of CKD patients associated with SA.
Screening for #Obstructive Sleep #Apnea in Adults
http://jamanetwork.com/journals/jama/fullarticle/2598778
The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for OSA in asymptomatic adults. (I statement)
http://jamanetwork.com/journals/jama/fullarticle/2598778
The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for OSA in asymptomatic adults. (I statement)
Jamanetwork
USPSTF Recommendation: Screening for Obstructive Sleep Apnea in Adults
This Recommendation Statement from the US Preventive Services Task Force concludes that current evidence is insufficient to assess the balance of benefits and harms of screening for obstructive sleep apnea in asymptomatic adults (I statement).
Clinical Practice Guideline for #Diagnostic Testing for Adult Obstructive Sleep #Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline
http://www.aasmnet.org/jcsm/ViewAbstract.aspx?pid=30972
We recommend that clinical tools, questionnaires and prediction algorithms not be used to diagnose OSA in adults, in the absence of polysomnography or home sleep apnea testing. (STRONG)
We recommend that polysomnography, or home sleep apnea testing with a technically adequate device, be used for the diagnosis of OSA in uncomplicated adult patients presenting with signs and symptoms that indicate an increased risk of moderate to severe OSA. (STRONG)
We recommend that if a single home sleep apnea test is negative, inconclusive, or technically inadequate, polysomnography be performed for the diagnosis of OSA. (STRONG)
We recommend that polysomnography, rather than home sleep apnea testing, be used for the diagnosis of OSA in patients with significant cardiorespiratory disease, potential respiratory muscle weakness due to neuromuscular condition, awake hypoventilation or suspicion of sleep related hypoventilation, chronic opioid medication use, history of stroke or severe insomnia. (STRONG)
We suggest that, if clinically appropriate, a split-night diagnostic protocol, rather than a full-night diagnostic protocol for polysomnography be used for the diagnosis of OSA. (WEAK)
We suggest that when the initial polysomnogram is negative and clinical suspicion for OSA remains, a second polysomnogram be considered for the diagnosis of OSA. (WEAK)
http://www.aasmnet.org/jcsm/ViewAbstract.aspx?pid=30972
We recommend that clinical tools, questionnaires and prediction algorithms not be used to diagnose OSA in adults, in the absence of polysomnography or home sleep apnea testing. (STRONG)
We recommend that polysomnography, or home sleep apnea testing with a technically adequate device, be used for the diagnosis of OSA in uncomplicated adult patients presenting with signs and symptoms that indicate an increased risk of moderate to severe OSA. (STRONG)
We recommend that if a single home sleep apnea test is negative, inconclusive, or technically inadequate, polysomnography be performed for the diagnosis of OSA. (STRONG)
We recommend that polysomnography, rather than home sleep apnea testing, be used for the diagnosis of OSA in patients with significant cardiorespiratory disease, potential respiratory muscle weakness due to neuromuscular condition, awake hypoventilation or suspicion of sleep related hypoventilation, chronic opioid medication use, history of stroke or severe insomnia. (STRONG)
We suggest that, if clinically appropriate, a split-night diagnostic protocol, rather than a full-night diagnostic protocol for polysomnography be used for the diagnosis of OSA. (WEAK)
We suggest that when the initial polysomnogram is negative and clinical suspicion for OSA remains, a second polysomnogram be considered for the diagnosis of OSA. (WEAK)
Association of Positive Airway #Pressure With #Cardiovascular Events and Death in Adults With Sleep #Apnea
A Systematic Review and Meta-analysis
http://jamanetwork.com/journals/jama/article-abstract/2643307
Among 356 major adverse cardiovascular events and 613 deaths recorded, there was no significant association of PAP with major adverse cardiovascular events (RR, 0.77 [95% CI, 0.53 to 1.13]; P = .19 and RD, −0.01 [95% CI, −0.03 to 0.01]; P = .23), cardiovascular death (RR, 1.15 [95% CI, 0.88 to 1.50]; P = .30 and RD −0.00 [95% CI, −0.02 to 0.02]; P = .87), or all-cause death (RR, 1.13 [95% CI, 0.99 to 1.29]; P = .08 and RD, 0.00 [95% CI, −0.01 to 0.01]; P = .51). The same was true for ACS, stroke, and heart failure.
The use of PAP, compared with no treatment or sham, was not associated with reduced risks of cardiovascular outcomes or death for patients with sleep apnea. Although there are other benefits of treatment with PAP for sleep apnea, these findings do not support treatment with PAP with a goal of prevention of these outcomes.
A Systematic Review and Meta-analysis
http://jamanetwork.com/journals/jama/article-abstract/2643307
Among 356 major adverse cardiovascular events and 613 deaths recorded, there was no significant association of PAP with major adverse cardiovascular events (RR, 0.77 [95% CI, 0.53 to 1.13]; P = .19 and RD, −0.01 [95% CI, −0.03 to 0.01]; P = .23), cardiovascular death (RR, 1.15 [95% CI, 0.88 to 1.50]; P = .30 and RD −0.00 [95% CI, −0.02 to 0.02]; P = .87), or all-cause death (RR, 1.13 [95% CI, 0.99 to 1.29]; P = .08 and RD, 0.00 [95% CI, −0.01 to 0.01]; P = .51). The same was true for ACS, stroke, and heart failure.
The use of PAP, compared with no treatment or sham, was not associated with reduced risks of cardiovascular outcomes or death for patients with sleep apnea. Although there are other benefits of treatment with PAP for sleep apnea, these findings do not support treatment with PAP with a goal of prevention of these outcomes.
Jamanetwork
Positive Airway Pressure, Cardiovascular Events, and Death in Sleep Apnea
This systematic review analyzes 10 randomized clinical trials comparing the effects of positive airway pressure (PAP) vs sham PAP in reducing cardiovascular outcomes or death among patients with sleep apnea.
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Symptom Subtypes of Obstructive Sleep #Apnea Predict Incidence of #Cardiovascular Outcomes
https://www.atsjournals.org/doi/abs/10.1164/rccm.201808-1509OC
Associations between subtypes and prevalence of overall cardiovascular disease (CVD), as well as its components (coronary heart disease [CHD]), heart failure [HF] and stroke) were assessed using logistic regression..
Measurements and Main Results: Four symptom subtypes were identified (Disturbed Sleep [12.2%], Minimally Symptomatic [32.6%], Excessively Sleepy [16.7%], and Moderately Sleepy [38.5%]), similar to prior studies. In adjusted models, while no significant associations with prevalent CVD were found, the Excessively Sleepy subtype was associated with over 3-fold increased risk of prevalent HF compared to each of the other subtypes.
Symptom subtype was also associated with incident CVD (p<0.001), CHD (p=0.015) and HF (p=0.018), with the Excessively Sleepy again demonstrating increased risk (hazard ratios of 1.7-2.4) compared to other subtypes. When compared to individuals without OSA (AHI<5), significantly increased risk for prevalent and incident cardiovascular events were observed mostly for patients in the Excessively Sleepy subtype.
Conclusions: OSA symptom subtypes are reproducible and associated with cardiovascular risk, providing important evidence of their clinical relevance.
Symptom Subtypes of Obstructive Sleep #Apnea Predict Incidence of #Cardiovascular Outcomes
https://www.atsjournals.org/doi/abs/10.1164/rccm.201808-1509OC
Associations between subtypes and prevalence of overall cardiovascular disease (CVD), as well as its components (coronary heart disease [CHD]), heart failure [HF] and stroke) were assessed using logistic regression..
Measurements and Main Results: Four symptom subtypes were identified (Disturbed Sleep [12.2%], Minimally Symptomatic [32.6%], Excessively Sleepy [16.7%], and Moderately Sleepy [38.5%]), similar to prior studies. In adjusted models, while no significant associations with prevalent CVD were found, the Excessively Sleepy subtype was associated with over 3-fold increased risk of prevalent HF compared to each of the other subtypes.
Symptom subtype was also associated with incident CVD (p<0.001), CHD (p=0.015) and HF (p=0.018), with the Excessively Sleepy again demonstrating increased risk (hazard ratios of 1.7-2.4) compared to other subtypes. When compared to individuals without OSA (AHI<5), significantly increased risk for prevalent and incident cardiovascular events were observed mostly for patients in the Excessively Sleepy subtype.
Conclusions: OSA symptom subtypes are reproducible and associated with cardiovascular risk, providing important evidence of their clinical relevance.
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Association of Obstructive Sleep #Apnea With the Risk of Affective Disorders
https://jamanetwork.com/journals/jamaotolaryngology/article-abstract/2749521
..In a subgroup analysis, the adjusted HRs for patients with OSA who developed #depressive and #anxiety disorders were 2.90 (95% CI, 1.98–4.24) and 1.75 (95% CI, 1.26–2.44), respectively. Moreover, female patients with OSA had a significant likelihood of prospective development of depression and anxiety (adjusted HR for depression, 3.97 [95% CI, 1.54-10.19]; adjusted HR for anxiety, 2.42 [95% CI, 1.17-5.02]) compared with male patients with OSA (adjusted HR for depression, 2.74 [95% CI, 1.80-4.17]; adjusted HR for anxiety, 1.64 [95% CI, 1.13-2.39]).
Conclusions and Relevance This observational study using nationwide data suggests that OSA is associated with an increased incidence of affective disorder, such as depression and anxiety. Further studies appear to be needed to confirm our findings and, if validated, then studies are needed to explore the nature of the observed association, including potential causality, between OSA and affective symptoms.
Association of Obstructive Sleep #Apnea With the Risk of Affective Disorders
https://jamanetwork.com/journals/jamaotolaryngology/article-abstract/2749521
..In a subgroup analysis, the adjusted HRs for patients with OSA who developed #depressive and #anxiety disorders were 2.90 (95% CI, 1.98–4.24) and 1.75 (95% CI, 1.26–2.44), respectively. Moreover, female patients with OSA had a significant likelihood of prospective development of depression and anxiety (adjusted HR for depression, 3.97 [95% CI, 1.54-10.19]; adjusted HR for anxiety, 2.42 [95% CI, 1.17-5.02]) compared with male patients with OSA (adjusted HR for depression, 2.74 [95% CI, 1.80-4.17]; adjusted HR for anxiety, 1.64 [95% CI, 1.13-2.39]).
Conclusions and Relevance This observational study using nationwide data suggests that OSA is associated with an increased incidence of affective disorder, such as depression and anxiety. Further studies appear to be needed to confirm our findings and, if validated, then studies are needed to explore the nature of the observed association, including potential causality, between OSA and affective symptoms.
Jamanetwork
Association of Obstructive Sleep Apnea With the Risk of Affective Disorders
This cohort study uses a Korean nationwide database to investigate whether obstructive sleep apnea is associated with the development of depression and anxiety.
A Screening Algorithm for Obstructive Sleep #Apnea in #Pregnancy
Obstructive sleep apnea (#OSA) is common in pregnancy and associated with maternal and fetal complications. Early detection of OSA may have important implications for maternal-fetal well-being. A screening tool combining several methods of assessment may better predict OSA among pregnant women compared with tools that rely solely on self-reported information..
Participants’ mean age was 27.4 ± 7.0 years. The prevalence of OSA during the first and third trimester was 10.7% and 24.1%, respectively. The final model predicting OSA risk consisted of body mass index, age, and presence of tongue enlargement. During the first trimester, the AUC was 0.86 (95% confidence interval [CI], 0.76–0.96). During the third trimester, the AUC was 0.87 (95% CI, 0.77–0.96). When the first-trimester data were used to predict third-trimester OSA risk, the AUC was 0.87 (95% CI, 0.77–0.97). This model had high sensitivity and specificity when used during both trimesters. The negative posttest probabilities (probability of OSA given a negative test result) ranged from 0.03 to 0.07.
Conclusions: A new model consisting of body mass index, age, and presence of tongue enlargement provided accurate screening of OSA in pregnant women, particularly African-Americans. This tool can be easily and rapidly administered in busy clinical practices without depending on patients’ awareness of experiencing apnea symptoms.
https://www.atsjournals.org/doi/10.1513/AnnalsATS.201902-131OC
Obstructive sleep apnea (#OSA) is common in pregnancy and associated with maternal and fetal complications. Early detection of OSA may have important implications for maternal-fetal well-being. A screening tool combining several methods of assessment may better predict OSA among pregnant women compared with tools that rely solely on self-reported information..
Participants’ mean age was 27.4 ± 7.0 years. The prevalence of OSA during the first and third trimester was 10.7% and 24.1%, respectively. The final model predicting OSA risk consisted of body mass index, age, and presence of tongue enlargement. During the first trimester, the AUC was 0.86 (95% confidence interval [CI], 0.76–0.96). During the third trimester, the AUC was 0.87 (95% CI, 0.77–0.96). When the first-trimester data were used to predict third-trimester OSA risk, the AUC was 0.87 (95% CI, 0.77–0.97). This model had high sensitivity and specificity when used during both trimesters. The negative posttest probabilities (probability of OSA given a negative test result) ranged from 0.03 to 0.07.
Conclusions: A new model consisting of body mass index, age, and presence of tongue enlargement provided accurate screening of OSA in pregnant women, particularly African-Americans. This tool can be easily and rapidly administered in busy clinical practices without depending on patients’ awareness of experiencing apnea symptoms.
https://www.atsjournals.org/doi/10.1513/AnnalsATS.201902-131OC
www.atsjournals.org
A Screening Algorithm for Obstructive Sleep Apnea in Pregnancy | Annals of the American Thoracic Society
Rationale: Obstructive sleep apnea (OSA) is common in pregnancy and associated with maternal and fetal complications. Early detection of OSA may have important implications for maternal-fetal well-...
Effect of Multilevel Upper Airway Surgery vs Medical Management on the Apnea-Hypopnea Index and Patient-Reported Daytime Sleepiness Among Patients With Moderate or Severe Obstructive #Sleep #Apnea
https://2medical.news/2020/09/10/effect-of-multilevel-upper-airway-surgery-vs-medical-management-on-the-apnea-hypopnea-index-and-patient-reported-daytime-sleepiness-among-patients-with-moderate-or-severe-obstructive-sleep-apnea/
Many adults with obstructive sleep apnea (OSA) use device treatments inadequately and remain untreated.. ..Among 102 participants who were randomized (mean [SD] age, 44.6 [12.8] years; 18 [18%] women), 91 (89%) completed the trial. The mean AHI was 47.9 at baseline and 20.8 at 6 months for the surgery group and 45.3 at baseline and 34.5 at 6 months for the medical management group (mean …
https://2medical.news/2020/09/10/effect-of-multilevel-upper-airway-surgery-vs-medical-management-on-the-apnea-hypopnea-index-and-patient-reported-daytime-sleepiness-among-patients-with-moderate-or-severe-obstructive-sleep-apnea/
Many adults with obstructive sleep apnea (OSA) use device treatments inadequately and remain untreated.. ..Among 102 participants who were randomized (mean [SD] age, 44.6 [12.8] years; 18 [18%] women), 91 (89%) completed the trial. The mean AHI was 47.9 at baseline and 20.8 at 6 months for the surgery group and 45.3 at baseline and 34.5 at 6 months for the medical management group (mean …
Nocturnal #Arrhythmias and Heart‐Rate Swings in Patients With Obstructive Sleep #Apnea Syndrome Treated With Beta Blockers
https://2medical.news/2020/10/31/nocturnal-arrhythmias-and-heart%E2%80%90rate-swings-in-patients-with-obstructive-sleep-apnea-syndrome-treated-with-beta-blockers/
The higher cardiovascular variability and the increased prevalence of arrhythmias in patients with obstructive sleep apneas may contribute to their higher rate of fatal events during sleep. In this regard, the use of beta blockers (BB) is debated because they may induce bradyarrhythmias and alter the pattern of heart rate changes induced by apneas. Thus, the aim of our study is to quantify peri‐apneic heart‐rate …
https://2medical.news/2020/10/31/nocturnal-arrhythmias-and-heart%E2%80%90rate-swings-in-patients-with-obstructive-sleep-apnea-syndrome-treated-with-beta-blockers/
The higher cardiovascular variability and the increased prevalence of arrhythmias in patients with obstructive sleep apneas may contribute to their higher rate of fatal events during sleep. In this regard, the use of beta blockers (BB) is debated because they may induce bradyarrhythmias and alter the pattern of heart rate changes induced by apneas. Thus, the aim of our study is to quantify peri‐apneic heart‐rate …
Obstructive Sleep #Apnea as a Risk Factor for Intracerebral #Hemorrhage
https://2medical.news/2021/04/14/obstructive-sleep-apnea-as-a-risk-factor-for-intracerebral-hemorrhage/
To determine whether obstructive sleep apnea (OSA) is associated with intracerebral hemorrhage (ICH) risk, we assessed premorbid OSA exposure of patients with nontraumatic ICH and matched controls. Methods: Ethnic/Racial Variations of Intracerebral Hemorrhage is a multicenter, case-control study evaluating risk factors for ICH that recruited 3000 cases with ICH and 3000 controls. OSA status was ascertained using the Berlin Questionnaire as a surrogate for premorbid …
https://2medical.news/2021/04/14/obstructive-sleep-apnea-as-a-risk-factor-for-intracerebral-hemorrhage/
To determine whether obstructive sleep apnea (OSA) is associated with intracerebral hemorrhage (ICH) risk, we assessed premorbid OSA exposure of patients with nontraumatic ICH and matched controls. Methods: Ethnic/Racial Variations of Intracerebral Hemorrhage is a multicenter, case-control study evaluating risk factors for ICH that recruited 3000 cases with ICH and 3000 controls. OSA status was ascertained using the Berlin Questionnaire as a surrogate for premorbid …
Sleep #Apnea and Incident #Stroke in a National Cohort of Black and White Adults
https://2medical.news/2024/03/19/sleep-apnea-and-incident-stroke-in-a-national-cohort-of-black-and-white-adults/
https://2medical.news/2024/03/19/sleep-apnea-and-incident-stroke-in-a-national-cohort-of-black-and-white-adults/
2Medical.News
Sleep #Apnea and Incident #Stroke in a National Cohort of Black and White Adults
Background and ObjectivesRacial/ethnic differences have been documented in the relationship between obstructive sleep apnea (OSA) and stroke incidence, yet racial differences in OSA symptoms or tre…
Older adults at greater risk for #Alzheimer’s disease show stronger associations between sleep #apnea severity in #REM sleep and verbal memory
https://2medical.news/2024/05/25/older-adults-at-greater-risk-for-alzheimers-disease-show-stronger-associations-between-sleep-apnea-severity-in-rem-sleep-and-verbal-memory/
https://2medical.news/2024/05/25/older-adults-at-greater-risk-for-alzheimers-disease-show-stronger-associations-between-sleep-apnea-severity-in-rem-sleep-and-verbal-memory/
2Medical.News
Older adults at greater risk for #Alzheimer’s disease show stronger associations between sleep #apnea severity in #REM sleep and…
Obstructive sleep apnea (OSA) increases risk for cognitive decline and Alzheimer’s disease (AD). While the underlying mechanisms remain unclear, hypoxemia during OSA has been implicated in cognitiv…