Racial Differences in Functional and Sleep Outcomes with Positive Airway Pressure Treatment.

It is unclear if the response to positive airway pressure (PAP) treatment is different between African American (AA) and European Americans (EA). We examined whether race modifies the effects of PAP on sleep and daytime function. We assessed Epworth Sleepiness Scale (ESS), Functional Outcomes of Sleep Questionnaire, Psychomotor Vigilance Task and actigraphy in 185 participants with moderate-to-severe obstructive sleep apnea before and 3-4 months after PAP treatment. The participants were middle-aged (mean, 55.1 years), 83.8% men and 60.5% AA. Linear regression models were used to examine the effect of race on outcomes. The AA had smaller reductions in ESS (mean change (95% confidence interval, CI) AA, -2.30 [-3.35, -1.25] vs. EA, -4.16 [-5.48, -2.84] and frequency of awakenings (AA, -0.73 [-4.92, 3.47] vs. EA, -9.35 [-15.20, -3.51]). A race × PAP usage interaction term was added to the model to examine if the change in outcomes per 1 h increase in PAP usage differed by race. AA exhibited greater improvement in wake after sleep onset (ß (95% CI) AA, -8.89 [-16.40, -1.37] vs. EA, 2.49 [-4.15, 9.12]) and frequency of awakening (ß (95% CI) AA, -2.59 [-4.44, -0.75] vs. EA, 1.71 [-1.08, 4.50]). The results indicate the importance of race in evaluating outcomes following PAP treatment.

Obstructive sleep apnea in pregnancy: performance of a rapid screening tool.

PURPOSE: The Sleep Apnea Symptom Score (SASS) has been commonly used to assess obstructive sleep apnea (OSA). The aim of this study was to examine the psychometric properties of the SASS and the predictive value of SASS incorporating bedpartner-reported information in identifying OSA in pregnant women. METHODS: A cohort of healthy pregnant women completed the SASS and Pittsburgh Sleep Quality Index. Participants underwent overnight laboratory polysomnography (PSG) monitoring. Reliability and validity of the SASS were evaluated. A multivariable predictive model, incorporating the SASS score along with BMI, age, and bedpartner-reported information, was developed to assess the risk for OSA (AHI ≥ 5 events/h). Receiver operating characteristic curves for OSA were constructed to evaluate the sensitivity and specificity of the predictive model. RESULTS: A total of 126 and 105 participants completed the PSG during the first and third trimester, respectively. The SASS demonstrated adequate validity and acceptable reliability (Cronbach's α = 0.72 during the third trimester). When the combined model consisting of SASS, age, BMI, and bedpartner-reported information was used, the area under the curve for AHI ≥ 5 for the first and third trimester was 0.781 (95%CI 0.648, 0.914) and 0.842 (95%CI 0.732, 0.952), respectively; the sensitivity/specificity was 76.9%/72.4% and 82.4%/78.0%, respectively. CONCLUSIONS: The SASS alone has acceptable reliability and validity, but limited predictive values. A new tool, combining the SASS and other patient characteristics (i.e., age, BMI, and bedpartner-reported snoring and breathing pauses), demonstrated improved sensitivity and specificity, and thus may have greater utility in clinical practice for predicting OSA in pregnant women.

Short sleep duration and hyperglycemia in pregnancy: Aggregate and individual patient data meta-analysis.

Short sleep duration has been linked to maternal hyperglycemia. Systematic review and meta-analysis were performed to evaluate the relationship between sleep duration and hyperglycemia in pregnancy or gestational diabetes (GDM). MEDLINE and Scopus were searched until July 2017. Studies that assessed sleep duration and had objective measurements of hyperglycemia during pregnancy were eligible. Aggregate data were available from eight studies, n = 17,308 (seven with self-reported and one with objectively measured sleep duration). Meta-analysis was applied for pooling aggregate data using a random-effects model. Identified authors provided individual patient data (IPD) from four studies with objectively measured sleep duration, n = 287. A one-stage approach with a hierarchical mixed-effect logit model was applied to pool IPD across studies. Aggregate data analysis revealed that women with short sleep duration (<6-7 h) were more likely to have GDM than women without short sleep duration, odds ratio 1.70 (95% CI: 1.24, 2.33). IPD analysis demonstrated that, compared to sleeping >6.25 h, women who slept ≤6.25 h had higher 1-h glucose levels after 50-g oral glucose tolerance testing by 0.65 mmol/L (0.18, 1.13) and an increased risk of GDM, adjusted odds ratio 2.84 (1.25, 6.44). In conclusion, short sleep duration in pregnancy, both self-reported and objectively measured, is associated with hyperglycemia and an increased GDM risk.