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1.
PLoS One ; 16(10): e0256950, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34597324

RESUMO

Continuous positive airway pressure (CPAP) during anaesthesia induction improves oxygen saturation (SpO2) outcomes in adults subjected to airway manipulation, and could similarly support oxygenation in children. We evaluated whether CPAP ventilation and passive CPAP oxygenation in children would defer a SpO2 decrease to 95% after apnoea onset compared to the regular technique in which no positive airway pressure is applied. In this double-blind, parallel, randomised controlled clinical trial, 68 children aged 2-6 years with ASA I-II who underwent surgery under general anaesthesia were divided into CPAP and control groups (n = 34 in each group). The intervention was CPAP ventilation and passive CPAP oxygenation using an anaesthesia workstation. The primary outcome was the elapsed time until SpO2 decreased to 95% during a follow-up period of 300 s from apnoea onset (T1). We also recorded the time required to regain baseline levels from an SpO2 of 95% aided by positive pressure ventilation (T2). The median T1 was 278 s (95% confidence interval [CI]: 188-368) in the CPAP group and 124 s (95% CI: 92-157) in the control group (median difference: 154 s; 95% CI: 58-249; p = 0.002). There were 17 (50%) and 32 (94.1%) primary events in the CPAP and control groups, respectively. The hazard ratio was 0.26 (95% CI: 0.14-0.48; p<0.001). The median for T2 was 21 s (95% CI: 13-29) and 29 s (95% CI: 22-36) in the CPAP and control groups, respectively (median difference: 8 s; 95% CI: -3 to 19; p = 0.142). SpO2 was significantly higher in the CPAP group than in the control group throughout the consecutive measures between 60 and 210 s (with p ranging from 0.047 to <0.001). Thus, in the age groups examined, CPAP ventilation and passive CPAP oxygenation deferred SpO2 decrease after apnoea onset compared to the regular technique with no positive airway pressure.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas/métodos , Oxigênio , Apneia Obstrutiva do Sono/terapia , Criança , Pré-Escolar , Método Duplo-Cego , Feminino , Humanos , Masculino , Apneia Obstrutiva do Sono/fisiopatologia , Resultado do Tratamento
2.
Elife ; 102021 10 14.
Artigo em Inglês | MEDLINE | ID: mdl-34648426

RESUMO

The clinical and societal measurement of human sleep has increased exponentially in recent years. However, unlike other fields of medical analysis that have become highly automated, basic and clinical sleep research still relies on human visual scoring. Such human-based evaluations are time-consuming, tedious, and can be prone to subjective bias. Here, we describe a novel algorithm trained and validated on +30,000 hr of polysomnographic sleep recordings across heterogeneous populations around the world. This tool offers high sleep-staging accuracy that matches human scoring accuracy and interscorer agreement no matter the population kind. The software is designed to be especially easy to use, computationally low-demanding, open source, and free. Our hope is that this software facilitates the broad adoption of an industry-standard automated sleep staging software package.


Assuntos
Algoritmos , Encéfalo/fisiopatologia , Polissonografia , Processamento de Sinais Assistido por Computador , Apneia Obstrutiva do Sono/diagnóstico , Fases do Sono , Design de Software , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Automação , Estudos de Casos e Controles , Criança , Eletroencefalografia , Eletromiografia , Eletroculografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Valor Preditivo dos Testes , Ensaios Clínicos Controlados Aleatórios como Assunto , Reprodutibilidade dos Testes , Apneia Obstrutiva do Sono/fisiopatologia , Adulto Jovem
3.
Int Heart J ; 62(5): 1091-1095, 2021 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-34544988

RESUMO

This is the first study to evaluate directly visceral fat area (VFA) using a visceral fat (VF) meter by the abdominal bioelectrical impedance analysis (A-BIA) method in obstructive sleep apnea (OSA) patients diagnosed with polysomnography (PSG). The purpose of this study is to clarify (1) whether VFA measurement using a VF meter by the A-BIA method is possible even in a private clinic without burdening patients and staff and (2) how much VFA affects OSA compared to body mass index (BMI). Even without a computed tomography scan, which is the gold standard for VFA measurement, a VF meter could analyze patients by the A-BIA method and easily measure VFA. Therefore, it could be used safely even in a private sleep clinic, with very little burden on the patients and the medical staff. We investigated the association between OSA and VFA in 133 OSA patients. Multiple regression analysis revealed that VFA (ß = 0.28; P = 0.020) was a stronger coexisting factor for OSA than age, male gender, or BMI (ß = 0.26; P = 0.032) in all OSA patients. In the OSA patients with VF accumulation, only VFA was a significant component of OSA severity (ß = 0.36; P = 0.006). The A-BIA method instrument could become a useful device for the evaluation of VF accumulation in OSA patients in private sleep clinics. VF accumulation should be recognized as an important risk factor as well as a known risk factor for OSA.


Assuntos
Impedância Elétrica/efeitos adversos , Gordura Intra-Abdominal/diagnóstico por imagem , Polissonografia/métodos , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/fisiopatologia , Adulto , Idoso , Composição Corporal/fisiologia , Índice de Massa Corporal , Feminino , Humanos , Gordura Intra-Abdominal/crescimento & desenvolvimento , Gordura Intra-Abdominal/patologia , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Análise de Regressão , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Apneia Obstrutiva do Sono/diagnóstico
4.
J Laryngol Otol ; 135(10): 892-896, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34372962

RESUMO

OBJECTIVE: Behavioural modification through increasing nutritional awareness, along with customised dietary changes and education about physical inactivity, for obese snorers and mildly sleep apnoeic patients would help improve their quality of life. METHODS: A one-year prospective interventional study enrolled snorers and/or mild obstructive sleep apnoea sufferers, with 36 patients each in the test group and control group. Nutritional information and tailor-made diet charts were given to the 36 test subjects. The severity of snoring and daytime sleepiness after 6 and 12 months was compared using the Epworth Sleepiness Scale and Thornton Snoring Scale as measures of quality of life. RESULTS: Subjective scores on both scales showed highly significant improvement (p ≤ 0.001) in the test group. No significant improvement was seen in the control group. CONCLUSION: Awareness of basic nutrition and customised diet plans help to achieve behavioural modification in the long term, resulting in a better quality of life.


Assuntos
Dieta Redutora/psicologia , Síndromes da Apneia do Sono/psicologia , Apneia Obstrutiva do Sono/psicologia , Ronco/psicologia , Adulto , Idoso , Conscientização , Índice de Massa Corporal , Estudos de Casos e Controles , Ingestão de Alimentos , Exercício Físico/fisiologia , Comportamento Alimentar/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estado Nutricional/fisiologia , Polissonografia/métodos , Estudos Prospectivos , Qualidade de Vida , Comportamento de Redução do Risco , Índice de Gravidade de Doença , Síndromes da Apneia do Sono/fisiopatologia , Apneia Obstrutiva do Sono/fisiopatologia , Ronco/fisiopatologia
5.
Pan Afr Med J ; 38: 359, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34367438

RESUMO

Introduction: obstructive sleep apnea (OSA) is a common chronic pulmonary disease, characterized by repetitive collapse of the upper respiratory airways, leading to oxygen desaturation. This condition is recognized to be associated with cardiovascular disease. Several studies have shown the effects of OSA on both geometry and cardiac function, with conflicting results. We aimed to investigate the relationship between echocardiographic abnormalities and the severity of OSA. Methods: this is a cross-sectional single center study including patients, without any cardiovascular or pulmonary comorbidities, with polygraphy proven OSA. All participants underwent a detailed transthoracic echocardiography (TTE). Results: a total of 93 patients were included in the study, with 62.2% (n=56) females. According to the apnea hypopnea index (AHI), patients were divided into two groups: mild to moderate OSA (5≤ AHI< 30/H) and severe OSA (AHI≥ 30/H). There were no differences in baseline characteristics between the two groups. The assessment of echocardiographic parameters demonstrated that severe OSA have a higher left ventricular end-systolic (LVES) (47.6±7.2 VS 46.2±4.7), left ventricular end-diastolic (LVED) (31.3±6.2 VS 28.9±4.5) diameters and interventricular septum (IVS) thickness (12.7±2.4 VS11.7±2.5) diameters rather than mild to moderate OSA without a significant difference between the two groups. Furthermore, severe OSA patients had lower mean value of left ventricular ejection fraction (LVEF) and fractional shortening (FS) equal to 62.1±9.7 and 32.5±6.3 respectively. The difference between the two groups was not statistically significant. However, a significant association was shown between severity of OSA and left ventricular (LV) diastolic dysfunction, right ventricular internal diameter (RVID) and systolic pulmonary artery pressure (sPAP), with p=0.05, p=0.05 and p= 0.03 respectively. The RVID was also independently associated to the severity of the OSA (aOR 1.33, 95%CI: 0.99-1.79; p=0.05). Conclusion: using bidimensional echocardiography showed a relationship between severe OSA and right ventricular parameters (diastolic dysfunction and RVID) and sPAP.


Assuntos
Ecocardiografia , Ventrículos do Coração/diagnóstico por imagem , Apneia Obstrutiva do Sono/complicações , Disfunção Ventricular Esquerda/diagnóstico por imagem , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Apneia Obstrutiva do Sono/fisiopatologia , Volume Sistólico
7.
Medicine (Baltimore) ; 100(34): e26857, 2021 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-34449455

RESUMO

ABSTRACT: The current global health crisis due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has prompted the medical community to investigate the effects of underlying medical conditions, including sleep-disordered breathing, on inpatient care. Obstructive sleep apnea (OSA) is a common form of sleep-disordered breathing that may complicate numerous acquired conditions, particularly in inpatient and critical care settings. Viral pneumonia is a major contributor to intensive care unit (ICU) admissions and often presents more severely in patients with underlying pulmonary disease, especially those with obesity and OSA. This review summarizes the most recent data regarding complications of both OSA and obesity and highlights their impact on clinical outcomes in hospitalized patients. Additionally, it will highlight pertinent evidence for the complications of OSA in an organ-systems approach. Finally, this review will also discuss impatient treatment approaches for OSA, particularly in relation to the SARS-CoV-2 pandemic.


Assuntos
COVID-19/epidemiologia , Obesidade/epidemiologia , Apneia Obstrutiva do Sono/epidemiologia , Apneia Obstrutiva do Sono/fisiopatologia , COVID-19/fisiopatologia , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/fisiopatologia , Humanos , Unidades de Terapia Intensiva , Obesidade/fisiopatologia , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/fisiopatologia , Fatores de Risco , SARS-CoV-2 , Índice de Gravidade de Doença , Sonolência
8.
Sci Rep ; 11(1): 17178, 2021 08 25.
Artigo em Inglês | MEDLINE | ID: mdl-34433839

RESUMO

Obstructive sleep apnea (OSA) is a common sleep respiratory disease. Previous studies have found that the wakefulness electroencephalogram (EEG) of OSA patients has changed, such as increased EEG power. However, whether the microstates reflecting the transient state of the brain is abnormal is unclear during obstructive hypopnea (OH). We investigated the microstates of sleep EEG in 100 OSA patients. Then correlation analysis was carried out between microstate parameters and EEG markers of sleep disturbance, such as power spectrum, sample entropy and detrended fluctuation analysis (DFA). OSA_OH patients showed that the microstate C increased presence and the microstate D decreased presence compared to OSA_withoutOH patients and controls. The fifth microstate E appeared during N1-OH, but the probability of other microstates transferring to microstate E was small. According to the correlation analysis, OSA_OH patients in N1-OH showed that the microstate D was positively correlated with delta power, and negatively correlated with beta and alpha power; the transition probability of the microstate B → C and E → C was positively correlated with alpha power. In other sleep stages, the microstate parameters were not correlated with power, sample entropy and FDA. We might interpret that the abnormal transition of brain active areas of OSA patients in N1-OH stage leads to abnormal microstates, which might be related to the change of alpha activity in the cortex.


Assuntos
Ritmo alfa , Ritmo beta , Apneia Obstrutiva do Sono/fisiopatologia , Encéfalo/fisiopatologia , Humanos , Fases do Sono
9.
J Am Heart Assoc ; 10(15): e021318, 2021 08 03.
Artigo em Inglês | MEDLINE | ID: mdl-34308679

RESUMO

Background The mechanisms underlying the association between obstructive sleep apnea (OSA) and cardiovascular disease may include accelerated vascular aging. The aim was to compare the magnitude of vascular aging in patients with high versus low risk of OSA. Methods and Results In 2 community-based studies, the PPS3 (Paris Prospective Study 3) and the Maastricht Study, high risk of OSA was determined with the Berlin questionnaire (a screening questionnaire for OSA). We assessed carotid artery properties (carotid intima-media thickness, Young's elastic modulus, carotid-femoral pulse wave velocity, carotid pulse wave velocity, carotid diameter using high precision ultrasound echography), and carotid-femoral pulse wave velocity (in the Maastricht Study only). Regression coefficients were estimated on pooled data using multivariate linear regression. A total of 8615 participants without prior cardiovascular disease were included (6840 from PPS3, 62% men, mean age 59.5±6.2 years, and 1775 from the Maastricht Study, 51% men, 58.9±8.1 years). Overall, high risk of OSA prevalence was 16.8% (n=1150) in PPS3 and 23.8% (n=423) in the Maastricht Study. A high risk of OSA was associated with greater carotid intima-media thickness (ß=0.21; 0.17-0.26), Young's elastic modulus (ß=0.21; 0.17-0.25), carotid-femoral pulse wave velocity (ß=0.24; 0.14-0.34), carotid pulse wave velocity (ß=0.31; 0.26-0.35), and carotid diameter (ß=0.43; 0.38-0.48), after adjustment for age, sex, total cholesterol, smoking, education level, diabetes mellitus, heart rate, and study site. Consistent associations were observed after additional adjustments for mean blood pressure, body mass index, or antihypertensive medications. Conclusions These data lend support for accelerated vascular aging in individuals with high risk of OSA. This may, at least in part, underlie the association between OSA and cardiovascular disease.


Assuntos
Envelhecimento/fisiologia , Doenças Cardiovasculares , Espessura Intima-Media Carotídea/estatística & dados numéricos , Medição de Risco , Apneia Obstrutiva do Sono , Rigidez Vascular , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/fisiopatologia , Velocidade da Onda de Pulso Carótido-Femoral , Correlação de Dados , Europa (Continente)/epidemiologia , Feminino , Fatores de Risco de Doenças Cardíacas , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Medição de Risco/métodos , Medição de Risco/estatística & dados numéricos , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/epidemiologia , Apneia Obstrutiva do Sono/fisiopatologia , Ultrassonografia/métodos
10.
Sci Rep ; 11(1): 13935, 2021 07 06.
Artigo em Inglês | MEDLINE | ID: mdl-34230571

RESUMO

Continuous positive airway pressure (CPAP) is simple and effective treatment for obstructive sleep apnea (OSA) patients. However, the CPAP prediction equation in each country is different. This study aimed to predict CPAP in Thai patients with OSA. A retrospective study was conducted in Thai patients, who OSA was confirmed by polysomnography and CPAP titration from January 2015 to December 2018. Demographics, body mass index (BMI), neck circumference (NC), Epworth sleepiness scale, apnea-hypopnea index (AHI), respiratory disturbance index (RDI), mean and lowest pulse oxygen saturation (SpO2), and optimal pressure were recorded. A total of 180 subjects were included: 72.8% men, age 48.7 ± 12.7 years, BMI 31.0 ± 6.3 kg/m2, NC 40.7 ± 4.1 cm, AHI 42.5 ± 33.0 per hour, RDI 47.1 ± 32.8 per hour, and lowest SpO2 77.1 ± 11.0%. Multiple linear regression analysis identified NC, BMI, RDI, and lowest SpO2. A final CPAP predictive equation was: optimal CPAP (cmH2O) = 4.614 + (0.173 × NC) + (0.067 × BMI) + (0.030 × RDI) - (0.076 × lowest SpO2). This model accounted for 50.0% of the variance in the optimal pressure (R2 = 0.50). In conclusion, a CPAP prediction equation can be used to explain a moderate proportion of the titrated CPAP in Thai patients with OSA. However, the CPAP predictive equation in each country may be different due to differences of ethnicity and physiology.Trial registration: TCTR20200108003.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas , Apneia Obstrutiva do Sono/fisiopatologia , Antropometria , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polissonografia , Pressão , Tailândia
12.
Sci Rep ; 11(1): 15341, 2021 07 28.
Artigo em Inglês | MEDLINE | ID: mdl-34321577

RESUMO

The aim of the study was to assess the factors associated with periodic limb movements during sleep (PLMS) among obstructive sleep apnea syndrome (OSAS) patients and identify the role of PLMS in patients with OSAS. 303 adult patients with OSAS were included in the study. All patients completed physical examination, Epworth sleepiness scale (ESS), and polysomnography. Diagnosis of PLMS was made if the periodic leg movements index (PLMI) was ≥ 15. Chi-square test, ANOVA, univariate and multivariate logistic regression analyses were conducted to identify factors associated with PLMS among OSAS patients. Statistical analyses were performed with SPSS 26.0 for mac. Statistically significant difference was considered if P value < 0 .05. Among the 303 adult patients with OSAS, 98 patients had significant PLMS and the other 205 had no significant PLMS. Compared with OSAS patients without PLMS, OSAS patient with PLMS were older, had shorter REM duration and greater apnea-hypopnea index (AHI) (P < 0.05). The study suggests that PLMS is a matter of concern among patients with OSAS. A better understanding of the role of PLMS among OSAS patients could be useful in better recognition, intervention and treatment of OSAS.


Assuntos
Discinesias/diagnóstico , Apneia Obstrutiva do Sono/diagnóstico , Escala de Movimento Involuntário Anormal , Adulto , Índice de Massa Corporal , Estudos de Casos e Controles , Discinesias/fisiopatologia , Feminino , Humanos , Perna (Membro) , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Polissonografia/métodos , Apneia Obstrutiva do Sono/fisiopatologia , Sono REM/fisiologia , Inquéritos e Questionários
13.
Sci Rep ; 11(1): 11481, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-34075091

RESUMO

Obstructive sleep apnea (OSA) is a highly prevalent condition worldwide. Untreated, it is associated with multiple medical complications as well as a reduced quality of life. Home sleep apnea tests are increasingly used for its diagnosis and evaluation of severity, but using total bed time rather than total sleep time may underestimate OSA severity. We aim to uncover the extent and predictors of OSA misclassification when using total bed time. A retrospective observational study was conducted using data from the sleep laboratory of the National University Hospital, Singapore, a tertiary hospital with 1200 beds. Misclassification of OSA was defined as any OSA severity that was less severe using total bed time versus total sleep time. Logistic regression was used to identify predictors of OSA misclassification. A total of 1621 patients were studied (mean age 45.6 ± 15.9 years; 73.4% male). 300 (18.5%) patients were misclassified. Risk factors for OSA misclassification included age (OR 1.02, 95% CI 1.01-1.03, P = 0.001) and body-mass index (BMI) (OR 0.97, 95% CI 0.95-0.99, P = 0.015). Risk for misclassification was significant in patients aged ≥ 57 years old, with BMI < 32.3 kg/m2. Using total bed time rather than total sleep time to quantify OSA severity was associated with a significant risk of misclassification, particularly in patients aged ≥ 57 years old, with BMI < 32.3 kg/m2.


Assuntos
Polissonografia , Qualidade de Vida , Apneia Obstrutiva do Sono , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Singapura , Sono , Apneia Obstrutiva do Sono/classificação , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/fisiopatologia
14.
Med Sci Sports Exerc ; 53(11): 2233-2244, 2021 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-34081056

RESUMO

PURPOSE: In normotensive patients with obstructive sleep apnea (OSA), the muscle sympathetic nerve activity (MSNA) response to exercise is increased while metaboreflex control of MSNA is decreased. We tested the hypotheses that acute intermittent hypercapnic hypoxia (IHH) in males free from OSA and associated comorbidities would augment the MSNA response to exercise but attenuate the change in MSNA during metaboreflex activation. METHODS: Thirteen healthy males (age = 24 ± 4 yr) were exposed to 40 min of IHH. Before and after IHH, the pressor response to exercise was studied during 2 min of isometric handgrip exercise (at 30% maximal voluntary contraction), whereas the metaboreflex was studied during 4 min of postexercise circulatory occlusion (PECO). Mean arterial pressure (MAP), heart rate (HR), and fibular MSNA were recorded continuously. MSNA was quantified as burst frequency (BF) and total activity (TA). Mixed effects linear models were used to compare the exercise pressor and metaboreflex before and after IHH. RESULTS: As expected, IHH led to significant increases in MSNA BF, TA, and MAP at baseline and throughout exercise and PECO. However, during handgrip exercise, the change from baseline in MAP, HR, MSNA BF, and TA was similar before and after IHH (All P > 0.31). During PECO, the change from baseline in MSNA BF and TA was similar after IHH, whereas the change from baseline in MAP (Δ14 mm Hg, 95% CI = 7-19, vs Δ16 mm Hg, 95% CI = 10-21; P < 0.01) was modestly increased. CONCLUSION: After acute IHH, MSNA response to handgrip exercise and metaboreflex activation were preserved in healthy young males despite overall increases in resting MSNA and MAP. Chronic IHH and comorbidities often associated with OSA may be required to modulate the exercise pressor reflex and metaboreflex.


Assuntos
Hipercapnia/fisiopatologia , Hipóxia/fisiopatologia , Músculo Esquelético/inervação , Músculo Esquelético/fisiologia , Reflexo , Sistema Nervoso Simpático/fisiologia , Adulto , Humanos , Masculino , Contração Muscular , Apneia Obstrutiva do Sono/fisiopatologia , Adulto Jovem
15.
Am J Respir Crit Care Med ; 204(6): 703-712, 2021 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-34156917

RESUMO

Rationale: Untreated obstructive sleep apnea (OSA) is associated with adverse outcomes in patients with coronary artery disease (CAD). Continuous positive airway pressure (CPAP) is the most common treatment, but despite interventions addressing established adherence determinants, CPAP use remains poor. Objectives: To determine whether physiological traits that cause OSA are associated with long-term CPAP adherence in patients with CAD. Methods: Participants in the RICCADSA (Randomized Intervention with CPAP in CAD and OSA) trial with objective CPAP adherence (h/night) over 2 years and analyzable raw polysomnography data were included (N = 249). The physiological traits-loop gain, arousal threshold (ArTH), pharyngeal collapsibility (Vpassive), and pharyngeal muscle compensation (Vcomp)-were measured by using polysomnography. Linear mixed models were used to assess the relationship between the traits and adherence. We also compared actual CPAP adherence between those with physiologically predicted "poor" adherence (lowest quartile of predicted adherence) and those with physiologically predicted "good" adherence (all others). Measurements and Main Results: The median (interquartile range) CPAP use declined from 3.2 (1.0-5.8) h/night to 3.0 (0.0-5.6) h/night over 24 months (P < 0.001). In analyses adjusted for demographics, anthropometrics, OSA characteristics, and clinical comorbidities, a lower ArTH was associated with worse CPAP adherence (0.7 h/SD of the ArTH; P = 0.021). Both high and low Vcomp were associated with lower adherence (P = 0.008). Those with predicted poor adherence exhibited markedly lower CPAP use than those with predicted good adherence for up to 2 years of follow-up (group differences of 2.0-3.2 h/night; P < 0.003 for all). Conclusions: A low ArTH, as well as a very low and high Vcomp, are associated with worse long-term CPAP adherence in patients with CAD and OSA. Physiological traits-alongside established determinants-may help predict and improve CPAP adherence. Clinical trial registered with www.clinicaltrials.gov (NCT00519597).


Assuntos
Pressão Positiva Contínua nas Vias Aéreas , Doença da Artéria Coronariana/complicações , Cooperação do Paciente , Apneia Obstrutiva do Sono/fisiopatologia , Apneia Obstrutiva do Sono/terapia , Idoso , Feminino , Seguimentos , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente/estatística & dados numéricos , Polissonografia , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/psicologia
16.
Sci Rep ; 11(1): 13528, 2021 06 29.
Artigo em Inglês | MEDLINE | ID: mdl-34188172

RESUMO

Obstructive sleep apnea (OSA) is much common and associated with worse clinical outcomes in patients with hypertrophic cardiomyopathy (HCM), however, the diagnosis of OSA in HCM is still insufficient. We aim to investigate the clinical predictors of OSA in a large series of patients with HCM. A total of 589 patients with HCM who underwent sleep evaluations were retrospectively enrolled. Data from clinical characteristics and polysomnography studies were recorded. OSA was present in 346 patients (58.7%). Patients who had OSA were older, more likely to be male and had more clinical comorbidities such as hypertension, atrial fibrillation and cardiac remodeling. Multivariate logistic analyses showed that male, age, body mass index, hypertension and left ventricular outflow tract obstruction were significant factors associated with OSA. The area under the ROC curve (AUC) was 0.78 (95% CI 0.74-0.82; P < 0.001). These factors were also able to identify moderate to severe OSA with an AUC of 0.77 (95% CI 0.73-0.81; P < 0.001). These findings suggest that identifying HCM patients with high risk for OSA is feasible using characteristics from clinical practices and clinicians should have no hesitate to conduct sleep test in these patients.


Assuntos
Cardiomiopatia Hipertrófica , Apneia Obstrutiva do Sono , Adulto , Fatores Etários , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/etiologia , Fibrilação Atrial/fisiopatologia , Índice de Massa Corporal , Cardiomiopatia Hipertrófica/complicações , Cardiomiopatia Hipertrófica/epidemiologia , Cardiomiopatia Hipertrófica/fisiopatologia , Feminino , Humanos , Hipertensão/epidemiologia , Hipertensão/etiologia , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Polissonografia , Estudos Retrospectivos , Fatores de Risco , Apneia Obstrutiva do Sono/epidemiologia , Apneia Obstrutiva do Sono/etiologia , Apneia Obstrutiva do Sono/fisiopatologia
17.
BMC Cardiovasc Disord ; 21(1): 310, 2021 06 23.
Artigo em Inglês | MEDLINE | ID: mdl-34162333

RESUMO

BACKGROUND: Hypertensive crisis is an urgent/emergency condition. Although obstructive sleep apnea (OSA) in resistant hypertension has been thoroughly examined, information regarding the risk factors and prevalence of hypertensive crisis in co-existing OSA and hypertension is limited. This study thus aimed to determine prevalence of and risk factors for hypertensive crisis in patients with hypertension caused by OSA. METHODS: The inclusion criteria were age of 18 years or over and diagnosis of co-existing OSA and hypertension. Those patients with other causes of secondary hypertension were excluded. Patients were categorized by occurrence of hypertensive crisis. Factors associated with hypertensive crisis were calculated using multivariate logistic regression analysis. RESULTS: There were 121 patients met the study criteria. Of those, 19 patients (15.70%) had history of hypertensive crisis. Those patients in hypertensive crisis group had significant higher systolic and diastolic blood pressure at regular follow-ups than those without hypertensive crisis patients (177 vs. 141 mmHg and 108 vs. 85 mmHg; p value < 0.001 for both factors). After adjusted for age, sex, and Mallampati classification, only systolic blood pressure was independently associated with hypertensive crisis with adjusted odds ratio (95% CI) of 1.046 (1.012, 1.080). CONCLUSIONS: The prevalence of hypertensive crisis in co-existing OSA and hypertension was 15.70% and high systolic blood pressure or uncontrolled blood pressure associated with hypertensive crisis in patients with OSA-associated hypertension.


Assuntos
Pressão Sanguínea , Hipertensão/epidemiologia , Apneia Obstrutiva do Sono/epidemiologia , Adulto , Comorbidade , Emergências , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/fisiopatologia , Tailândia/epidemiologia
18.
Life Sci ; 280: 119702, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34111462

RESUMO

AIMS: Nearly a third of U.S. veterans who deployed in support of the 1990-1991 Persian Gulf War are affected by Gulf War illness (GWI). Here we aimed to characterize whether subjective sleep complaints in GWI veterans are associated with objective sleep EEG disturbances relative to healthy veterans and controls; and whether Gulf War veterans show alterations in neural activity during sleep that differentiate them from healthy subjects. MAIN METHODS: We used high-density EEG (HDEEG) to assess regional patterns of rapid eye movement (REM) sleep and non-REM (NREM) sleep between three groups: Gulf War male veterans with fatigue and GWI, Gulf War male veterans without fatigue or GWI, and control males. The groups were matched relative to age, sex and obstructive sleep apnea. Topographic comparisons of nocturnal NREM and REM sleep were made between groups for all frequency bands. KEY FINDINGS: Topographic analysis revealed a broadband reduction in EEG power in a circumscribed region overlying the frontal lobe in both groups of Gulf War veterans, regardless of GWI and fatigue. This frontal reduction in neural activity was present, to some extent, across all frequency bands in NREM and REM sleep. SIGNIFICANCE: Given that our findings were observed in all Gulf War veterans, it appears unlikely that frontal sleep HDEEG power reductions prove wholly responsible for fatigue symptoms. These results provide avenues for research which may someday contribute to improved clinical care of formerly deployed veterans of the Persian Gulf War.


Assuntos
Lobo Frontal/fisiopatologia , Síndrome do Golfo Pérsico/fisiopatologia , Apneia Obstrutiva do Sono/fisiopatologia , Sono , Adulto , Estudos de Casos e Controles , Eletroencefalografia , Fadiga/etiologia , Fadiga/fisiopatologia , Guerra do Golfo , Humanos , Masculino , Pessoa de Meia-Idade , Síndrome do Golfo Pérsico/complicações , Polissonografia , Estudos Prospectivos , Apneia Obstrutiva do Sono/etiologia
19.
Comput Math Methods Med ; 2021: 6683828, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34040651

RESUMO

Obstructive sleep apnea (OSA) is a common disorder which may need to be treated by the upper respiratory tract (URT) surgery. To increase the success rate of the URT surgery, it is crucial to understand the flow features in the URT models. In this work, the turbulent flow characteristics in four 3D anatomically accurate URT models reconstructed from two OSA subjects with successful and failed surgery are numerically studied by the large-eddy simulation (LES) and unsteady Reynolds-averaged Navier-Stokes (RANS). The features of velocity fields, pressure fields, and wall shear stress fields as well as the spectral analysis of wall shear stress between successful and failed surgery are explored. The results indicate that LES is capable of capturing flow patterns and flow oscillation and is effective for OSA surgery prediction. Even if the unsteady RANS can obtain the correct pressure drop across the airways, it may not be appropriate to be used for surgery prediction. Moreover, it is found that the quality of oscillating signal of wall shear stress is a key factor in surgery prediction. In a successful surgery, the wall shear stress oscillation is always strong, and the oscillating signal can perform a dominant frequency near 3~5 Hz, while in a failed surgery it does not show this clear intrinsic property. The results not only will gain new insights in the URT surgical planning but also will improve the prediction of surgical outcome for OSA patients.


Assuntos
Apneia Obstrutiva do Sono/fisiopatologia , Apneia Obstrutiva do Sono/cirurgia , Adulto , Fenômenos Biomecânicos , Biologia Computacional , Simulação por Computador , Análise de Fourier , Humanos , Imageamento Tridimensional , Masculino , Pessoa de Meia-Idade , Modelos Biológicos , Ventilação Pulmonar/fisiologia , Mecânica Respiratória/fisiologia , Sistema Respiratório/fisiopatologia , Estresse Mecânico , Falha de Tratamento
20.
Heart Fail Clin ; 17(3): 369-376, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34051969

RESUMO

It is generally considered that obstructive sleep apnea is a potential cause of heart failure (HF), and insomnia and central sleep apnea are results of HF. However, the number of reports describing the bidirectional relationship between sleep disorder and HF has increased. Sleep disorder may contribute to left ventricular diastolic dysfunction via left atrial overload, left ventricular remodeling, pulmonary hypertension, and atrial fibrillation, which lead to HF with preserved left ventricular ejection fraction. Overnight rostral fluid shift and lung congestion may lead to airflow obstruction in the upper pharynx and stimulate pulmonary irritant receptors, which induce hyperventilation and sleep disorder.


Assuntos
Insuficiência Cardíaca/fisiopatologia , Apneia Obstrutiva do Sono/fisiopatologia , Volume Sistólico/fisiologia , Função Ventricular Esquerda/fisiologia , Insuficiência Cardíaca/complicações , Humanos , Apneia Obstrutiva do Sono/etiologia
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