Obstructive sleep apnoea and adherence to continuous positive airway therapy among Australian women.

BACKGROUND: Clinical characteristics of women with different obstructive sleep apnoea (OSA) severity and adherence to continuous positive airway pressure (CPAP) therapy have not been previously explored. AIMS: To assess OSA prevalence, predictors, clinical and polysomnographic (PSG) characteristics and adherence to CPAP therapy among adult Australian women in a retrospective study. METHODS: All female patients who underwent a diagnostic PSG between 2014 and 2015 were included. CPAP adherence was assessed during the study period between 2018 and 2019 using multiple regression models. RESULTS: Among a total of 591 women included in this study (Aboriginal, n = 86), OSA was diagnosed in 458/591 (78%) patients; mild, moderate and severe OSA was present in 44%, 27% and 29% respectively. Older age, higher BMI and hypertension predicted the presence and severity of OSA. The Epworth Sleepiness Scale (ESS) score was not significantly different with (8 (5, 12)) or without (10 (5, 13)) OSA. PSG showed the rapid eye movement (REM) sleep-associated apnoea-hypopnea index (AHI) was higher with all severity of OSA. Adherence to CPAP therapy was noted in 171 (57%) patients; 47% mild, 57% moderate and 63% with severe OSA respectively. Three multiple regression models (clinical, PSG parameters, OSA severity, combined (clinical and PSG)) showed the combined model had the strongest predictive value and demonstrated that higher ESS and more severe oxygen desaturation were associated with CPAP adherence irrespective of OSA severity. CONCLUSIONS: Older age, higher BMI and the presence of hypertension predicted the presence of OSA. The REM sleep-related AHI was higher. Adherence to CPAP was associated with symptomatic OSA and severe oxygen desaturation.

Bronchiectasis among Australian Aboriginal and non-Aboriginal patients in the regional and remote population of the Northern Territory of Australia.

INTRODUCTION: Chronic respiratory disorders are highly prevalent among Australian Aboriginal people living in the Top End Health Service region in the Northern Territory, Australia. Bronchiectasis is a heterogenous disease that features among these chronic respiratory conditions in this population. However, there are sparse comparative data between Aboriginal and non-Aboriginal patients with bronchiectasis from this region. METHODS: In this retrospective study, demographics, clinical characteristics and relevant laboratory parameters were compared among adult Aboriginal and non-Aboriginal patients diagnosed with bronchiectasis between 2012 and 2017. RESULTS: A total of 388 adults had radiology-confirmed bronchiectasis and 258 (66%) were Aboriginal. Compared to non-Aboriginal patients, Aboriginal patients were significantly younger (mean age 54 v 67 years), the majority lived in rural and remote communities (80% v 9 %), had higher rates of self-reported smoking (52% v 19%), alcohol consumption (29% v 12%) and co-occurrence of chronic obstructive pulmonary disease (65% v 38%) and other chronic co-morbidities. Sputum microbiology was also different between the groups with Haemophilus influenzae, Streptococcus pneumoniae and Moraxella catarrhalis being more common in Aboriginal patients, while Pseudomonas aeruginosa, Aspergillus species and non-tuberculous mycobacteria were higher in non-Aboriginal patients. Further, Aboriginal patients had poorer lung function compared to non-Aboriginal patients (forced expiratory volume after 1 second predicted 33% v 53%, forced vital capacity predicted 49% v 60% respectively), higher exacerbation rates (29% v 18%) and poorer overall outcomes (age at death 60 v 76 years). CONCLUSION: Within a single health service, Aboriginal patients with bronchiectasis have significantly poorer outcomes with differing manifestations and higher comorbidities than non-Aboriginal patients. This warrants further studies to identify feasible interventions to reduce this inequity.

2004 chronic obstructive pulmonary disease with and without bronchiectasis in Aboriginal Australians: a comparative study.

BACKGROUND: Chronic respiratory disorders are highly prevalent in Aboriginal Australian population, including chronic obstructive pulmonary disease (COPD) and bronchiectasis. However, there is paucity of information in the literature among Aboriginal patients with underlying COPD with and without bronchiectasis. AIMS: In this retrospective study we evaluated the demographic and clinical characteristics of adult Aboriginal Australian patients with a clinical diagnosis of COPD with and without bronchiectasis from the remote communities of the Northern Territory of Australia. METHODS: Clinical records were reviewed to extract information on demographics, respiratory and medical comorbid conditions, COPD directed treatment, hospital admission frequency and exacerbations. Chest radiology were reviewed to evaluate the presence or absence of bronchiectasis. Spirometry results, sputum culture and cardiac investigations were also recorded. RESULTS: Of the 767 patients assessed in the remote community respiratory outreach clinics 380 (49%) patients had a clinical diagnosis of COPD. Chest X-ray and computed tomography scan were available to evaluate the presence of bronchiectasis in 258 patients. Of the 258/380 patients, 176/258 (68.2%) were diagnosed to have COPD alone and 82/258 (31.8%) had bronchiectasis along with COPD. The mean age was 56 and 59 years among patients with and without bronchiectasis, respectively, and 57% were males with bronchiectasis. Patients with bronchiectasis had lower body mass index (22 vs 24 kg/m2 ), frequent hospital admissions (2.0 vs 1.5/year) and productive cough (32.1% vs 28.9%). Spirometry showed 77% had forced expiratory volume in 1 s (FEV1 )/forced vital capacity ratio <0.7. In 81% and 75% of patients with and without bronchiectasis the FEV1 /forced vital capacity ratio was <0.7 and the mean FEV1 was 39% and 43% respectively. CONCLUSIONS: About 32% of Aboriginal Australians had co-existent bronchiectasis with COPD. Lower body mass index, productive cough, frequent hospital admission and marginally more severe reduction in lung function were noted among patients with COPD and bronchiectasis compared to those with COPD in isolation.

Gender Differences in the Clinical and Polysomnographic Characteristics Among Australian Aboriginal Patients with Obstructive Sleep Apnea.

BACKGROUND: In this study, we assessed the clinical and polysomnographic (PSG) characteristics according to gender among Australian Aboriginal men and woman diagnosed to have obstructive sleep apnea (OSA). METHODS: In this retrospective study, all adult Aboriginal patients over 18 years of age diagnosed to have OSA with an apnea hypopnea index (AHI) > 5/hour over a 5 year period were included. RESULTS: Of the 337 patients (168 females and 169 males), who underwent a diagnostic PSG, 297 (88%) were diagnosed to have OSA (AHI) >5/hour), 154/297 males (52%) and 143/297 females (48%). Amongst male and female patients with OSA, 63% and 37% were in the severe spectrum (AHI>30/hour). The male cohort had higher stage N1 NREM sleep (P<0.001), reduced N3 NREM sleep (P<0.001), higher AHI severity (P<0.001), higher NREM AHI (P<0.001), and high arousal index (P<0.005). REM sleep-related AHI was higher among female patients with all severity of OSA, along with severe oxygen desaturation during REM sleep. Among patients with severe OSA, the female cohort were younger (age 46 years vs 49 years, P=0.030) and had higher BMI with all severity of OSA, while males had larger neck circumference compared to females. Hypertension increased the odds of severe OSA versus the combined odds of mild and moderate OSA for both genders. CONCLUSION: This study highlights some important differences in the way sleep apnea manifests in Australian Aboriginal males and females and further studies are warranted to explore avenues to look for a physiological basis for these observations and targeted interventions.