Gender differences in association between expiratory dynamic airway collapse and severity of obstructive sleep apnea.

OBJECTIVES: Repetitive unbalances and tensions generated by inspiratory efforts against an obstructive upper airway during sleep predispose the development of expiratory central airway collapse. In addition, structures of the upper airway between men and women have differences and could be the reasons for differences in obstructive sleep apnea (OSA) prevalence between genders. The present study aimed to evaluate the association between parameters of expiratory dynamic tracheal collapse measured using chest multidetector CT and objectively measured OSA severity between men and women. MATERIALS AND METHODS: A total of 901 participants who underwent chest CT and overnight in-home polysomnography from the Korean Genome and Epidemiology Study were cross-sectionally analyzed (women: 46.2%). The participants were divided into three groups based on OSA severity by apnea-hypopnea index (AHI). Multivariate linear regression analysis was performed to determine the effects of central airway collapse after adjustment for cardiovascular-related covariates. RESULTS: In a multivariate analysis, percentages of expiratory lumen structure reductions involving area, diameter, and perimeter were associated with AHI (all p values < 0.05) and with OSA severity (moderate-to-severe OSA than no OSA: ß = 3.30%, p = 0.03; ß = 2.05%, p = 0.02; ß = 1.97%, p = 0.02, respectively) in women, whereas men had only a greater percentage of expiratory wall thickness reduction in moderate-to-severe OSA than no OSA (ß = 0.72%, p = 0.003). In addition, women with both mild OSA and moderate-to-severe OSA had higher expiratory tracheal collapse than men without OSA, and a moderate effect of sex was observed (p for interaction = 0.007). CONCLUSION: The expiratory dynamic tracheal collapse was independently associated with severity of OSA in women than in men. CLINICAL RELEVANCE STATEMENT: Differences of pharyngeal structures and inherent features of airways by genders may affect the dissimilarities in vulnerability to sleep apnea between men and women. KEY POINTS: • The expiratory dynamic tracheal collapse was independently associated with severity of OSA in women than in men. • Women with over mild OSA had higher expiratory tracheal collapse than men without OSA, and moderate effect of sex was observed. • Structural differences of airway may affect differences in susceptibility of sleep apnea between genders.

All-cause and major-cause mortality associated with sleep latency in the Korean Genome and Epidemiology Study (KoGES): a population-based prospective cohort study.

BACKGROUND: The all-cause and cause-specific mortality risk associated with sleep latencies in the general adult population is unknown. We aimed to investigate the association of habitual prolonged sleep latency with long-term all-cause and cause-specific mortality in adults. METHODS: The Korean Genome and Epidemiology Study (KoGES) is a population-based prospective cohort study comprising community-dwelling men and women aged 40-69 years from Ansan, South Korea. The cohort was studied bi-annually from April 17, 2003, to Dec 15, 2020, and the current analysis included all individuals who completed the Pittsburgh Sleep Quality Index (PSQI) questionnaire between April 17, 2003, and Feb 23, 2005. The final study population comprised 3757 participants. Data were analysed from Aug 1, 2021, to May 31, 2022. The main exposure was sleep latency groups based on the PSQI questionnaire: fell asleep in 15 min or less, fell asleep in 16-30 min, occasional prolonged sleep latency (fell asleep in >30 min once or twice a week in the past month) and habitual prolonged sleep latency (fell asleep in >60 min more than once a week or fell asleep in >30 min ≥3 times a week, or both) in the past month at baseline. Outcomes were all-cause and cause-specific (cancer, cardiovascular disease, and other causes) mortality reported during the 18-year study period. Cox proportional hazards regression models were used to examine the prospective relationship between sleep latency and all-cause mortality, and competing risk analyses were done to investigate the association of sleep latency with cause-specific mortality. FINDINGS: During a median follow-up of 16·7 years (IQR 16·3-17·4), 226 deaths were reported. After adjusting for demographic characteristics, physical characteristics, lifestyle factors, chronic conditions, and sleep variables, self-reported habitual prolonged sleep latency was associated with an increased risk of all-cause mortality (hazard ratio [HR] 2·22, 95% CI 1·38-3·57) compared to the reference group (those who fell asleep in 16-30 min). In the fully adjusted model, habitual prolonged sleep latency was associated with a more than doubled risk of dying from cancer compared to the reference group (HR 2·74, 95% CI 1·29-5·82). No significant association was observed between habitual prolonged sleep latency and deaths from cardiovascular disease and other causes. INTERPRETATION: In this population-based prospective cohort study, habitual prolonged sleep latency was independently associated with an increased risk of all-cause and cancer-specific mortality in adults (independently of demographic characteristics, lifestyle factors, chronic morbidities, and other sleep variables). Although further studies are warranted to investigate the causality of the relationship, strategies or interventions to prevent habitual prolonged sleep latencies might enhance longevity in the general adult population. FUNDING: Korea Centers for Disease Control and Prevention.

Alcohol consumption and cognitive function in elderly Japanese men.

Although heavy alcohol consumption has been identified as a risk factor for adverse cognitive functioning, it currently remains unclear whether moderate alcohol consumption exerts similar effects. Observational studies previously reported the potential benefits of moderate alcohol consumption on cognition, particularly in the elderly; however, these effects have not yet been demonstrated in Asian populations. The aim of the present study was to investigate the relationship between alcohol consumption levels and global and domain-specific cognitive functions in cognitively intact elderly Japanese men. Cross-sectional data from the Shiga Epidemiological Study of Subclinical Atherosclerosis (SESSA), an ongoing prospective, population-based study in Shiga, Japan, were used to examine the relationship between alcohol consumption and cognitive function. Men (n = 585) aged ≥65 years provided information on their weekly consumption of alcohol, and the data obtained were used to construct categories of never, ex- (quit before interview), very light (<14 g/day), light (14-23 g/day), moderate (>23-46 g/day), and heavy (>46 g/day) drinkers. Cognitive function was measured using the Cognitive Abilities Screening Instrument (CASI). A fractional logistic regression model adjusted for age, education, body mass index, smoking, exercise, hypertension, diabetes, and dyslipidemia showed that the CASI scores for global and domain-specific cognitive functions were not significantly different between all subgroups of current drinkers and never-drinkers. However, the CASI score of ex-drinkers (multivariable adjusted mean CASI score [SD]) was significantly lower than that of never-drinkers in the global [never vs. ex: 90.16 (2.21) vs. 88.26 (2.58)] and abstraction and judgment domain [never vs. ex: 9.48 (0.46) vs. 8.61 (0.57)]). The present results do not suggest any beneficial or adverse relationship between current alcohol consumption levels and cognitive functioning (both global and domain specific) in elderly Japanese men; however, low cognitive function among ex-drinkers warrants future investigations to identify the factors causing drinkers to quit.

Influence of height on blood pressure and hypertension among Bangladeshi adults.

BACKGROUND: Recent studies have reported that height is inversely associated with blood pressure and hypertension. However, there is lack of comprehensive findings from Bangladesh in this regard. OBJECTIVE: The purpose of this study was to explore the association between height and blood pressure in a Bangladeshi population. SETTING: Rural and urban sites from seven divisions of Bangladesh. PARTICIPANTS: Participants were 7932 males and females (aged ≥35 years) evaluated in the 2011 Bangladesh Demographic Health Survey. Participants (n = 7647) who had complete height, weight, systolic and diastolic blood pressure (SBP and DBP) measurements and non-missing medication history, were included in the analysis. METHODS: Hypertension was defined as an SBP over 140 mmHg or/and a DBP over 90 mmHg, or current use of antihypertensive medication. Difference between SBP and DBP was calculated to get pulse pressure (PP). Multivariate linear and logistic regression models were used. RESULTS: PP decreased linearly with increasing height among males (-0.11, P < 0.05) and females (-0.19, P < 0.05) after adjusting for age, BMI, living region, type of occupation, wealth index, and highest level of education. SBP decreased linearly with increasing height among only females (-0.14, P < 0.05), after adjusting for age, BMI, living region, type of occupation, wealth index, and highest level of education. No association was found between quartiles of height and prevalence of hypertension. CONCLUSIONS: Height was found to be inversely associated with pulse pressure in both sexes. Studies with longitudinal design are needed to investigate the association between shortness with blood pressure and hypertension.

Prevalence and correlates of cardiometabolic multimorbidity among hypertensive individuals: a cross-sectional study in rural South Asia-Bangladesh, Pakistan and Sri Lanka.

OBJECTIVE: To determinate the prevalence and correlates of cardiometabolic multimorbidity (CMM), and their cross-country variation among individuals with hypertension residing in rural communities in South Asia. DESIGN: A cross-sectional study. SETTING: Rural communities in Bangladesh, Pakistan and Sri Lanka. PARTICIPANTS: A total of 2288 individuals with hypertension aged ≥40 years from the ongoing Control of Blood Pressure and Risk Attenuation- Bangladesh, Pakistan and Sri Lanka clinical trial. MAIN OUTCOME MEASURES: CMM was defined as the presence of ≥2 of the conditions: diabetes, chronic kidney disease, heart disease and stroke. Logistic regression was done to evaluate the correlates of CMM. RESULTS: About 25.4% (95% CI 23.6% to 27.2%) of the hypertensive individuals had CMM. Factors positively associated with CMM included residing in Bangladesh (OR 3.42, 95% CI 2.52 to 4.65) or Sri Lankan (3.73, 95% CI 2.48 to 5.61) versus in Pakistan, advancing age (2.33, 95% CI 1.59 to 3.40 for 70 years and over vs 40-49 years), higher waist circumference (2.15, 95% CI 1.42 to 3.25) for Q2-Q3 and 2.14, 95% CI 1.50 to 3.06 for Q3 and above), statin use (2.43, 95% CI 1.84 to 3.22), and higher levels of triglyceride (1.01, 95% CI 1.01 to 1.02 per 5 mg/dL increase). A lower odds of CMM was associated with being physically active (0.75, 95% CI 0.57 to 0.97). A weak inverted J-shaped association between International Wealth Index and CMM was found (p for non-linear=0.058), suggesting higher risk in the middle than higher or lower socioeconomic strata. CONCLUSIONS: CMM is highly prevalent in rural South Asians affecting one in four individuals with hypertension. There is an urgent need for strategies to concomitantly manage hypertension, cardiometabolic comorbid conditions and associated determinants in South Asia.

Obesity and its Relation With Diabetes and Hypertension: A Cross-Sectional Study Across 4 Geographical Regions.

BACKGROUND: The implications of rising obesity for cardiovascular health in middle-income countries has generated interest, in part because associations between obesity and cardiovascular health seem to vary across ethnic groups. OBJECTIVE: We assessed general and central obesity in Africa, East Asia, South America, and South Asia. We further investigated whether body mass index (BMI) and waist circumference differentially relate to cardiovascular health; and associations between obesity metrics and adverse cardiovascular health vary by region. METHODS: Using baseline anthropometric data collected between 2008 and 2012 from 7 cohorts in 9 countries, we estimated the proportion of participants with general and central obesity using BMI and waist circumference classifications, respectively, by study site. We used Poisson regression to examine the associations (prevalence ratios) of continuously measured BMI and waist circumference with prevalent diabetes and hypertension by sex. Pooled estimates across studies were computed by sex and age. RESULTS: This study analyzed data from 31,118 participants aged 20 to 79 years. General obesity was highest in South Asian cities and central obesity was highest in South America. The proportion classified with general obesity (range 11% to 50%) tended to be lower than the proportion classified as centrally obese (range 19% to 79%). Every standard deviation higher of BMI was associated with 1.65 and 1.60 times higher probability of diabetes and 1.42 and 1.28 times higher probability of hypertension, for men and women, respectively, aged 40 to 69 years. Every standard deviation higher of waist circumference was associated with 1.48 and 1.74 times higher probability of diabetes and 1.34 and 1.31 times higher probability of hypertension, for men and women, respectively, aged 40 to 69 years. Associations of obesity measures with diabetes were strongest in South Africa among men and in South America among women. Associations with hypertension were weakest in South Africa among both sexes. CONCLUSIONS: BMI and waist circumference were both reasonable predictors of prevalent diabetes and hypertension. Across diverse ethnicities and settings, BMI and waist circumference remain salient metrics of obesity that can identify those with increased cardiovascular risk.

Overweight and abdominal obesity as determinants of undiagnosed diabetes and pre-diabetes in Bangladesh.

BACKGROUND: Type 2 diabetes and pre-diabetes are an increasing pandemic globally and often remain undiagnosed long after onset in low-income settings. The objective of this study is to assess the determinants and prevalence of undiagnosed diabetes and pre-diabetes among adults in Bangladesh. METHODS: In an exploratory study, we performed oral glucose tolerance test on 1243 adults ≥20 years of age from urban Mirpur, Dhaka (n = 518) and rural Matlab, Chandpur (n = 725) who had never been diagnosed with diabetes or pre-diabetes. We collected data on socioeconomic, demographic, past medical history, physical activity, and measured weight, height, waist and hip circumferences, and blood pressure. Risk factors associated with undiagnosed diabetes and pre-diabetes were examined using a multiple logistic regression model. RESULTS: Overall prevalence of diabetes and pre-diabetes was 6.6 % (95 % CI 5.3, 8.1) and 16.6 % (14.5, 18.7) respectively, with both being significantly higher in urban than rural populations (diabetes 12.2 % vs 2.6 % respectively, p < 0.000; pre-diabetes 21.2 % vs 13.2 %, p < 0.001). After adjustment the variables, urban residence (OR 2.5 [95 % CI 1.02, 5.9]), age group 40-59 y (2.9 [1.7-5.2]), ≥60 y (8.1 [2.8-23.8]), overweight (2.2 [1.3-3.9]), abdominal obesity (3.3 [1.8-6.0]) and high WHR 5.6 (2.7-11.9) were all significant predictors of diabetes. Significant predictors of pre-diabetes included age group 40-59 (1.6 [1.1-2.2]), female sex (1.5 [1.0-2.2]), abdominal obesity (1.7 [1.2-2.4]) and high WHR (1.6 [1.2-2.3]). CONCLUSION: Both overweight and abdominal obesity contribute to the hidden public health threat of undiagnosed diabetes and pre-diabetes. Awareness raising and screening of high risk groups combined with a tailored approach are essential for halting the epidemic of diabetes and pre-diabetes in Bangladesh.

Distribution of chronic disease mortality and deterioration in household socioeconomic status in rural Bangladesh: an analysis over a 24-year period.

BACKGROUND: Little is known about long-term changes linking chronic diseases and poverty in low-income countries such as Bangladesh. This study examines how chronic disease mortality rates change across socioeconomic groups over time in Bangladesh, and whether such mortality is associated with households falling into poverty. METHODS: Age-sex standardized chronic diseases mortality rates were estimated across socioeconomic groups in 1982, 1996 and 2005, using data from the health and demographic surveillance system in Matlab, Bangladesh. Changes in households falling below a poverty threshold after a chronic disease death were estimated between 1982-96 and 1996-2005. RESULTS: Age-sex standardized chronic disease mortality rates rose from 646 per 100 000 population in 1982 to 670 in 2005. Mortality rates were higher in wealthier compared with poorer households in 1982 [Concentration Index = 0.037; 95% confidence interval (CI): 0.002, 0.072], but switched direction in 1996 (Concentration Index = -0.007; 95% CI: -0.023, 0.009), with an even higher concentration in the poor by 2005 (Concentration Index = -0.047; 95% CI: -0.061, -0.033). Between 1982-96 and 1996-2005, the highest chronic disease mortality rates were found among those households that fell below the poverty line. Households that had a chronic disease death in 1982 were 1.33 (95% CI: 1.03, 1.70) times more likely to fall below the poverty line in 1996 compared with households that did not. CONCLUSIONS: Chronic disease mortality is a growing proportion of the disease burden in Bangladesh, with poorer households being more affected over time periods, leading to future household poverty.

Awareness and control of hypertension in Bangladesh: follow-up of a hypertensive cohort.

OBJECTIVES: To assess the effect of awareness and advice to seek care on blood pressure (BP) control among patients with hypertension in Bangladesh. DESIGN: Longitudinal study. SETTING: The study was carried out in icddr,b surveillance sites at rural Matlab in Chandpur district and semi-urban Kamalapur in Dhaka, Bangladesh. PARTICIPANTS: Randomly selected men and non-pregnant women aged 20 years or older without any acute illness or history of any vascular events such as stroke or acute myocardial infarction. MAIN OUTCOME MEASURE: Hypertension was defined as systolic BP (SBP) ≥140 and/or diastolic BP (DBP) ≥90 mm Hg or as self-reported hypertension under medication. We advised patients to seek care from a qualified provider and to adopt a healthy lifestyle. We compared changes in BP from baseline to follow-up at around 6 months. RESULTS: Overall, 17.1% (n=287) of participants had hypertension at baseline with significantly higher prevalence in the semi-urban than in the rural population (23.6% vs 10.8%; p<0.001); half were unaware of their condition. At follow-up, 83% (n=204) reported a visit to any healthcare provider. In the semi-urban area, a higher proportion of patients visited medically qualified practitioners than in the rural area (76.7% vs 36.6%, p<0.000). SBP (-3.3±20.7 mm Hg; p<0.01) and DBP (-2.0±13.0 mm Hg; p<0.02) were lower at follow-up. Those who visited medically qualified practitioners had significant SBP (-3.9±22.4 mm Hg; p<0.03) and DBP (-2.7±14.1 mm Hg; p<0.02) reduction. BP reduction did not reach statistical significance among those visiting a pharmacist or their village doctors. Overall, half of the patients with hypertension achieved the BP control goal (BP<140/90 mm Hg). CONCLUSIONS: Awareness and simple health messages increase provider visit, reduce blood pressure and improve BP control in hypertensive Bangladeshis. Longer-term follow-up is required to verify the sustainability.

Adult cardiopulmonary mortality and indoor air pollution: a 10-year retrospective cohort study in a low-income rural setting.

BACKGROUND: Indoor air pollution (IAP) due to solid fuel use is a major risk factor of respiratory and cardiovascular mortality and morbidity. Rural Matlab in Bangladesh has been partly supplied with natural gas since the early 1990s, which offered a natural experiment to investigate the long-term impact of IAP on cardiopulmonary mortality. OBJECTIVE: This study sought to compare adult cardiopulmonary mortality in relation to household fuel type as a surrogate for exposure to indoor air pollution. STUDY DESIGN: This was a retrospective cohort study. We identified all households in 11 villages in Matlab, Bangladesh, and categorized them as either supplied with natural gas or using solid fuel for cooking or heating since January 1, 2001. Cause-specific mortality data including cardiopulmonary deaths were obtained through verbal autopsy as part of a permanent surveillance. Person-years (PYs) of exposure were computed from baseline until the event. Subjects with missing information on cause of death, outward migration, or on fuel type were excluded. Event rates for each fuel category were calculated as well as the relative risk of dying with 95% confidence intervals (CI). SETTING: Rural Matlab, Bangladesh. PATIENTS: Adults 18 years of age or older. OUTCOME MEASURE: Death from cardiopulmonary diseases over a 10-year period. FINDINGS: In total, 946 cardiopulmonary deaths occurred with 884 in the solid-fuel and 62 in the gas-supplied households (n=7,565 and n=508, respectively) over the 10-year period. Cardiopulmonary death rate was 6.2 per 1,000 PYs in the solid-fuel group and 5.3 per 1,000 PYs in people living in households using gas. Mortality due to cardiovascular event was 5.1 and 4.8 per 1,000 PY in people from the solid-fuel and gas-supplied households, respectively, and the incident rate ratio was 1.07 (95% CI: 0.82 to 1.41). Mortality due to respiratory disease was 1.2 and 0.5 per 1,000 PYs in the solid-fuel and gas-supplied groups, respectively, and the incident rate ratio was 2.26 (95% CI: 1.02 to 4.99). INTERPRETATION: Household solid-fuel use is associated with increased respiratory mortality and nonsignificantly increased risk of cardiovascular mortality. Reduction of exposure to pollution due to in-household solid-fuel use is likely to improve survival in Bangladeshi and similar populations.