Exercise is associated with a reduced incidence of sleep-disordered breathing

BackgroundThe effect of exercise on sleep-disordered breathing is unknown. While diet and weight loss have been shown to reduce the severity of sleep-disordered breathing, it is unclear whether exercise has an independent effect.MethodsA population-based longitudinal epidemiologic study of adults measured the association between exercise and incidence and severity of sleep-disordered breathing. Hours of weekly exercise were assessed by 2 mailed surveys (1988 and 2000). Sleep-disordered breathing was assessed by 18-channel in-laboratory polysomnography at baseline and at follow-up.ResultsAssociations were modeled using linear and logistic regression, adjusting for body mass index, age, sex, and other covariates. Hours of exercise were associated with reduced incidence of mild (odds ratio 0.76, P = .011) and moderate (odds ratio 0.67, P = .002) sleep-disordered breathing. A decrease in exercise duration also was associated with worsening sleep-disordered breathing, as measured by the apnea-hypopnea index (β = 2.368, P = .048). Adjustment for body mass index attenuated these effects.ConclusionsExercise is associated with a reduced incidence of mild and moderate sleep-disordered breathing, and decreasing exercise is associated with worsening of sleep-disordered breathing. The effect of exercise on sleep-disordered breathing appears to be largely, but perhaps not entirely, mediated by changes in body habitus.     

REM-related sleep-disordered breathing is associated with depressive symptoms in men but not in women

Purpose

The purposes of the present study are to determine the prevalence and demographic features of rapid eye movement (REM)-related sleep-disordered breathing (SDB) in Korean adults with newly diagnosed obstructive sleep apnea (OSA) and determine if REM-related SDB is associated with depressive symptoms and health-related quality of life (HRQoL) in OSA patients.

Methods

In this cross-sectional study, we evaluated 1281 OSA adults who were consecutively recruited. REM-related SDB was defined as an overall apnea-hypopnea index (AHI) ≥5, an AHI_NREM <15, and AHI_REM to AHI_NREM ratio of >2. The Epworth Sleepiness Scale (ESS), Beck Depression Inventory (BDI), and Medical Outcomes Study Short-Form Health survey (SF-36) were used to evaluate all patients. Multiple regression analyses were performed to determine the associations between REM-related SDB and clinical outcomes.

Results

The prevalence of REM-related SDB was 18 % in this study. REM-related SDB was more commonly observed in patients with mild or moderate OSA (p < 0.001) and women (p < 0.001). The linear regression analysis showed that the presence of REM-related SDB was significantly associated with higher BDI scores, but only in men. AHI_REM was positively associated with the BDI scores, but only in men with REM-related SDB. There were no differences in ESS and SF-36 scores between patients with and without REM-related SDB.

Conclusions

Patients with REM-related SDB account for 18 % of Korean OSA adults. REM-related SDB was associated with depressive symptoms, but only in men. AHI_REM is positively related to the degree of depressive symptoms in men with REM-related SDB.

     

Aortic valve sclerosis is associated with systemic endothelial dysfunction

OBJECTIVES: We sought to examine the association between aortic valve sclerosis (AVS) and systemic endothelial manifestations of the atherosclerotic process. BACKGROUND: Clinical and experimental studies suggest that AVS is a manifestation of the atherosclerotic process. Systemic endothelial dysfunction is an early sign of the atherosclerotic process and can be assessed by ultrasonography of the brachial artery. METHODS: A total of 102 in-hospital patients (76 men; mean age 63.5 +/- 9.7 years) referred to the stress echocardiography laboratory underwent: 1) transthoracic echocardiography, with specific assessment of AVS (thickened valve leaflets with a transaortic flow velocity <2.5 m/s); 2) stress echocardiography; 3) coronary angiography, with evaluation of the Duke score (from 0 [normal] to 100 [most severe disease]); and 4) an endothelial function study, with assessment of endothelium-dependent, post-ischemic, flow-mediated dilation (FMD). RESULTS: Aortic valve sclerosis was present in 35 patients (group I) and absent in 67 (group II). Groups I and II were similar in terms of the frequency of stress-induced wall motion abnormalities (35.3% vs. 19.4%, p = NS) and the angiographic Duke score (33.8 +/- 28.6 vs. 35.2 +/- 29.1, p = NS). Patients with AVS showed a markedly lower FMD than those without AVS (2.2 +/- 3.5% vs. 5.3 +/- 5.3%, p < 0.01). On multivariate analysis, only FMD was highly predictive of AVS, with an odds ratio of 1.18 for each percent decrease in FMD (95% confidence interval 1.05 to 1.32; p = 0.01). CONCLUSIONS: Aortic valve stenosis is associated with systemic endothelial dysfunction. This observation may provide a mechanistic insight into the emerging association between AVS and cardiovascular events.     

The impact of obesity on cardiac dysfunction in patients with sleep-disordered breathing

Introduction

Obesity and heart failure are strongly associated with sleep-disordered breathing (SDB). However, the determinants of cardiac dysfunction in patients with SDB are not known.

Methods

We studied 90 patients suspected of having SDB (66 % women and 67 % black), age 50.4?±?13.4 years and body mass index (BMI) 38.6?±?9.8 kg/m². Apnea–hypopnea index (AHI) and nadir pulse oximetry (SpO₂) were determined by polysomnography recordings. Left atrial (LA) diameter and left ventricular posterior wall (LVPW) thickness were determined by echocardiography. Patients who had EF?<?50 %, estimated right ventricular systolic pressure >45 mmHg or valvular heart disease were excluded.

Results

Univariate analysis revealed a positive correlation between LA diameter and each of BMI, neck circumference (NC), and AHI (coefficients, 0.28, 0.34, and 0.36, respectively; p?<?0.05). Multivariable linear regression analysis revealed that BMI was the only independent predictor of LA enlargement (coefficient 0.02, p?<?0.05). LVPW thickness correlated with BMI, NC, and AHI (correlation coefficients were 0.43, 0.47, and 0.33, respectively; p?<?0.05). Multivariable linear regression analysis revealed a significant relationship between LVPW thickness and each of BMI and NC (coefficients 0.016 and 0.007, respectively; p?<?0.05) but not AHI. BMI and LVPW associated with nadir SpO₂ (r?=??0.60, p?<?0.01 and r?=??0.21, p?=?0.05; respectively), and BMI was a predictor of nadir SpO₂ during sleep (B?=??0.59; CI: ?0.84, ?0.33; p?=?0.01).

Conclusions

Obesity can predict cardiovascular morbidity and nocturnal hypoxemia independent of the severity of the SDB. Our findings suggest the independent contribution of excess body weight on cardiac dysfunction and hypoxia in SDB patients.     

Alcohol consumption before sleep is associated with severity of sleep-disordered breathing among professional Japanese truck drivers

Background:  Alcohol consumption as well as overweight is known to aggravate the severity of sleep-disordered breathing (SDB), but little is known about alcohol consumption in truck drivers. The aim of this study was to examine the relationship between alcohol consumption and SDB among truck drivers.
Methods:  We conducted a cross-sectional study of 1,465 men aged 20–69 years who were registered with the Japanese Trucking Association. The 3% oxygen desaturation index (3%ODI) was selected as an indicator of SDB, representing the number of desaturation events per hour of recording time in which blood oxygen fell by ≥3% based on overnight pulse-oximetry. Participants completed a self-administered questionnaire including alcohol consumption on the same night for SDB assessment.
Results:  The prevalence of 3%ODI ≥5, ≥10, and ≥15/h was 25.4%, 11.1%, and 6.6% respectively. The multivariable odds ratios (OR) of 3%ODI ≥ 10/h were 1.5(0.9–2.5) for 0.5 to <1.0 g of alcohol intake/kg and 3.4(1.8–6.6) for ≥1.0 g of alcohol intake/kg compared with non-drinkers. Similar associations with alcohol consumption were observed for 3%ODI ≥5 and ≥15/h. The relation between alcohol consumption (≥1.0 g of alcohol intake/kg) and 3%ODI ≥ 10/h tended to be more evident among men with body mass index (BMI) <23.4 kg/m² than those with BMI ≥ 23.4 kg/m² [11.4 (3.2–41) vs. 1.2 (0.6–2.7), p  = 0.18 for interaction]. A similar trend was observed for 3%ODI ≥ 5/h.
Conclusions:  The prevalence of undiagnosed SDB and the significant association of alcohol consumption with SDB severity emphasize the need for SDB screening and alcohol modification as well as weight control to prevent and control SDB among truck drivers.     

Evaluation of sleep-disordered breathing is polysomnography necessary?

To determine whether polysomnography is necessary to assess the presence and severity of sleep-disordered breathing, bedside observations by physicians were compared with the results of polysomnography in 37 patients with clinically suspected obstructive sleep apnea. Physician observations correlated with objective findings from polysomnography in detecting the presence of obstructive apnea (p less than 0.01), and had a high specificity and positive predictive value. The 20 patients correctly identified by clinical observation had a longer duration of apneic episodes (p = 0.02), increased severity of snoring (p = 0.02), resuscitative snoring (p less than 0.02), and paradoxic thoracoabdominal movement (p less than 0.05). However, 11 other patients with sleep-disordered breathing were not identified clinically; therefore, the sensitivity (64.5 percent) and diagnostic accuracy (70.3 percent) of brief clinical observation were low. Furthermore, the physicians' determinations of the severity of the condition on the basis of bedside estimates of disordered breathing rate, duration of episodes, and the degree of associated hemoglobin oxygen desaturation did not correlate with objective measurements. These findings suggest that a single, brief clinical observation alone is an ineffective screening procedure for detecting obstructive sleep apnea.     

Coronary endothelial dysfunction is associated with erectile dysfunction and elevated asymmetric dimethylarginine in patients with early atherosclerosis.

AIMS: Coronary endothelial dysfunction (CED) precedes atherosclerosis and is associated with cardiovascular events. Both CED and erectile dysfunction (ED) are partly mediated by impairment in the nitric oxide pathway. ED is associated with established coronary atherosclerosis, but its relationship with early coronary atherosclerosis and CED is unknown. This study was designed to test the hypothesis that CED is associated with ED in men with early coronary atherosclerosis. Moreover, the role of the nitric oxide synthase inhibitor asymmetric dimethylarginine (ADMA) was investigated; ADMA is a novel endogenous competitive inhibitor of nitric oxide synthase and has been shown to be an independent marker for cardiovascular disease. METHODS AND RESULTS: Fifty-six men without obstructive coronary artery disease (CAD) who underwent coronary endothelial function testing were studied. ADMA levels were determined and all men were asked to complete the International Index of Erectile Function-5 questionnaire to assess erectile function. Patients were divided according to the presence (n = 32) or absence (n = 24) of CED. Men with CED had significant impairment of erectile function (P = 0.008) and significantly higher ADMA levels (0.50 +/- 0.06 vs. 0.45 +/- 0.07 ng/mL, P = 0.017) compared with men with normal endothelial function. Erectile function positively correlated with coronary endothelial function. This correlation was independent of age, body mass index, high-density lipoprotein, C-reactive protein, homeostasis model assessment of insulin resistance index, and smoking status. CONCLUSION: CED is independently associated with ED and plasma ADMA concentration in men with early coronary atherosclerosis. This study further supports the role of the endothelium in systemic vascular diseases and the role of ADMA in the systemic manifestations of endothelial dysfunction.     

Factors associated with nightly variability in sleep-disordered breathing in the elderly

The purpose of this study was to evaluate factors associated with nightly variability in sleep-disordered breathing. In this study, variability in sleep-disordered breathing over two consecutive laboratory nights was evaluated in 71 aged volunteers with varying levels of sleep apnea. High variability (n = 13) and low variability (n = 58) groups were formed on the basis of an absolute two-night apnea/hypopnea index difference of a minimum ten events per hour. Results indicate high variability was related to longer soft palate measurements and the presence of nasal obstruction on physical examination. Within the high variability group, variation in sleep-disordered breathing occurred within identical gross body position over the two nights. The results suggest that local, anatomic factors affecting airway patency may not be constant from night to night.     

Prediction formulae for sleep-disordered breathing.

Prediction formulae for sleep-disordered breathing can be useful for excluding a diagnosis, establishing an a priori probability of having a positive test, and for prioritizing patient testing. In general, prediction models have high sensitivity but low specificity. In a study analyzing the performance of four previously described prediction models, sensitivities ranged from 76% to 96%, specificities ranged from 13% to 54%, while positive predictive values ranged between 69% and 77%. The models were useful in identifying patients with a respiratory disturbance index of > or = 20 so that these patients could undergo alternative diagnostic testing strategies. The Berlin Questionnaire was tested in primary care settings and was able to identify high-risk patients fairly accurately. A regression neural network performed well with a sensitivity of 99%, a specificity of 80%, a positive predictive value of 88%, and a negative predictive value of 98%. In obese snorers, a regression model utilizing daytime arterial O2 saturation and specific respiratory conductance was effective for excluding obstructive sleep apnea (OSA). In congestive heart failure patients, risk factors for central sleep apnea include male gender, atrial fibrillation, age >60 years, and wake time PaCO2 <38 mm Hg. In children, risk factors for sleep apnea include obesity, African-American race, sinus problems, and persistent wheezing. There are also racial anthropomorphic differences in OSA patients, with whites having a tendency towards brachycephaly facial types (reduced anterior-posterior cranial dimension) and African-Americans having a tendency toward leptoproscopic facial types (longer facial height and decreased facial width). Further refinement of prediction formulae will improve diagnostic accuracy.     

Radiofrequency ablation for sleep-disordered breathing.

Radiofrequency volumetric tissue reduction (RFVTR) has been applied to the nose, palate, and tongue as a treatment for sleep-disordered breathing. Data on the outcome of this procedure are very scant. When applied to the palate, RFVTR seems to be moderately effective for simple snoring. It has not been shown to be effective treatment for significant sleep apnea. Application of RFVTR to the tongue and turbinates has not been studied thoroughly enough to assess its efficacy at present.     

Blood pressure associated with sleep-disordered breathing in a population sample of children

The current criteria for sleep-disordered breathing (SDB) in children are not based on a clinically relevant outcome. The purpose of this study was to assess the association of blood pressure with SDB in a random sample of the local elementary school children (kindergarten through grade 5) using a 2-phased strategy. During phase 1, a brief questionnaire was completed for all of the children (N=5740) with a response rate of 78.5%. During phase 2, 700 randomly selected children from phase 1 with a response rate of 70.0% were assessed with a full polysomnograph and a history/physical, including an ECG; ear, nose, and throat; and pulmonary evaluation. We observed a significantly elevated systolic blood pressure associated with the apnea hypopnea index (AHI): AHI >or=1 (2.9 mm Hg); AHI >or=3 (7.1 mm Hg); and AHI >or=5 (12.9 mm Hg). The SDB and blood pressure association remained significant after adjusting for age, sex, race, body mass index percentile or waist circumference, sleep efficiency, percentage of rapid eye movement sleep, and snoring. In addition, older age, body mass index percentile, waist circumference, and snoring were significantly associated with blood pressure, independent of SDB. Based on these findings, our study suggests that SDB is significantly associated with higher levels of systolic blood pressure in children aged 5 to 12 years even after adjusting for the various confounding factors. Clinically, the data support the threshold of AHI >or=5 for the initiation of treatment for SDB. Additional research is indicated to assess the efficacy of SDB treatment on reducing blood pressure.     

Shorter sleep duration is associated with poorer glycemic control in type 2 diabetes patients with untreated sleep-disordered breathing

Purpose

The purpose of this study is to explore the impact of sleep duration on glycemic control in type 2 diabetes patients with untreated sleep-disordered breathing (SDB).

Methods

Ninety type 2 diabetes patients participated in the study. SDB was diagnosed using an overnight in-home monitoring device (WatchPAT200). Sleep duration was recorded by wrist actigraphy for 7 days. Medical records were reviewed for hemoglobin A1c (HbA1c) values.

Results

Seventy-one patients (78.8 %) were diagnosed with SDB [apnea-hypopnea index (AHI) ≥ 5]. In patients with SDB, there was no significant relationship between AHI and glycemic control. In addition, oxygen desaturation index, minimum oxygen saturation, and time spent below oxygen saturation of 90 % were not significantly correlated with glycemic control. Sleep duration, however, was inversely correlated with HbA1c (r = ?0.264, p 0.026). Multiple regression analysis adjusting for age, sex, body mass index, insulin use, diabetes duration, and AHI revealed that sleep duration was significantly associated with HbA1c (p = 0.005). Each hour reduction in sleep duration was associated with a 4.8 % increase in HbA1c of its original value (95 % CI 1.5–8.0).

Conclusion

In type 2 diabetes patients with untreated SDB, shorter sleep duration was independently associated with poorer glycemic control. Sleep duration optimization may lead to improved glycemic control in this population.

     

Impact of microarousal associated with increased negative esophageal pressure in sleep-disordered breathing

Purpose  

“Microarousals” during sleep have not been analyzed systematically. We investigated the importance of “microarousals” (lasting 1.5–3 s).     

老年住院患者睡眠呼吸紊乱相关非杓型高血压危险因素分析

目的 探讨老年睡眠呼吸紊乱患者发生非杓型高血压的危险因素.方法 选择扬州大学临床医学院2019年7月至2020年12月收治的124例老年睡眠呼吸紊乱相关的高血压患者为研究对象,根据昼夜血压下降比率,将患者分为杓型高血压组(61例)和非杓型高血压组(63例).采用SPSS 23.0统计软件进行数据分析.根据数据类型,分别...     

Pre-eclampsia is associated with Helicobacter pylori seropositivity in Italy

OBJECTIVES: Pre-eclampsia (PE) is characterized by an excess of inflammation and endothelial dysfunction. Helicobacter pylori (H. pylori) causes chronic inflammatory changes and endothelial damage. We investigated the prevalence of seropositivity for IgG against H. pylori and cytotoxin-associated antigen A (CagA) in PE patients and the presence of H. pylori DNA in their placentas. METHODS: We tested 47 pregnant women with PE and 47 with uneventful pregnancies for serum antibodies against H. pylori (enzyme immunoassays) and CagA protein (immunoblot assays). In 20 of them (10 normal and 10 PE) we assessed the presence, in the placenta, of H. pylori DNA by means of nested polymerase chain reaction (PCR). The odds ratios (OR) and 95% confidence intervals (CI), adjusted for parity, were calculated using logistic regression analysis to assess the risk of PE associated with H. pylori infection. RESULTS: Helicobacter pylori seropositivity frequency was higher in mothers with PE (51.1%) compared to women with uneventful pregnancy (31.9%) (OR, 2.668; 95% CI, 1.084-6.566; P = 0.033). The difference was even greater for CagA seropositivity (80.9 and 14.9%, respectively) (OR, 26.035; 95% CI, 8.193-82.729; P < 0.001). All placentas were negative for H. pylori DNA. CONCLUSIONS: Helicobacter pylori, and especially strains carrying the CagA gene, may contribute to the inflammatory mechanisms involved in the pathogenesis of PE.