Sleep and Breathing最新文献

Background: The impact of snoring and diabetes on stroke risk is unclear. This study examined the association between snoring and stroke risk and how it varies with diabetes mellitus (DM) status.

Methods: This research was conducted as a prospective cohort study. A total of 4,352 subjects were included in the analysis, with a mean follow-up time of 13.7 years. The study used snoring history obtained through interviews as the primary exposure variable and DM as the secondary exposure variable. The main outcome measured was the occurrence of stroke. Cox regression analysis was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Additionally, a joint test was conducted to evaluate the combined effect of snoring and diabetes on the occurrence of stroke.

Results: In our study of 4,352 subjects, 1,135 (26.1%) had a history of snoring, 233 (5.4%) had diabetes mellitus, and over the 18-year observation period, there were 168 cases of new-onset stroke. Snoring was not associated with an increased risk of stroke (HR: 0.95, 95% CI [0.68-1.33]), but DM significantly elevated the risk of stroke (3.02 [1.96-4.65]). In the interaction analysis of snoring and DM status on stroke risk, snoring was a significant risk factor for stroke only in the population with DM (2.89 [1.07-7.60]). Compared to non-snoring and non-DM, the multivariate HRs for stroke were 1.09 (0.76-1.57) for snoring and non-DM, 1.64 (0.83-2.82) for non-snoring and DM, and 2.95 (1.42-5.45) for snoring and DM.

Conclusion: Diabetes mellitus was associated with an increased risk of stroke, while a history of snoring was not. In a sub analysis, snoring appeared to be associated with an increased risk of stroke among subjects with diabetes mellitus.

Purpose: There is a paucity of data on preferences for obstructive sleep apnoea (OSA) diagnostic tests during pregnancy. Simple test completion rates fail to capture patient preference or experience of completing sleep diagnostic tests. We assessed preference, ease of use, convenience, and the repeatability of level I, II and III sleep diagnostic tests, using questionnaires, in pregnant women in early to mid-gestation.

Methods: Pregnant women with signs or symptoms of OSA, or at high risk of cardiometabolic disorders of pregnancy completed level I, II and III sleep studies by 24 weeks gestation. Participants then completed a questionnaire to rank test preference. Additional questionnaires assessed ease of use, convenience, and acceptability to repeat test, using 5-point Likert scale questions, yes/no response and optional linked text fields.

Results: Of fifty-two consented participants, 43 completed any questionnaire (mean age 32.7 ± 5.4 years, BMI 32.7 ± 5.4, median gestation at Level I polysomnography (PSG) of 14.2 weeks (interquartile range (IQR) 13.5-17.6)). Of the 29 respondents who completed test ranking questionnaire, level III was the preferred test ((n = 21 / 29, 75%)), followed by level 1 (n = 6 / 29, 20.7%) and level II (n = 2 / 29, 7.1%) (p for diff < 0.001). Level III was reported the easiest test (very easy to complete) (n = 16, 51.6%), followed by level I(n = 10, 33.3%), and level II (n = 9, 9.1%) (p for diff < 0.001)). Level III was reported most convenient test (very convenient to complete) (n = 16, 51.6%), followed by level I (n = 4, 13.3%) and level II (n = 4, 13.3%) (p for diff < 0.001)). Level III was reported most acceptable to repeat (very acceptable to repeat) (n = 13, 41.9%), followed by level I (n = 3, 10.0%) and level II (n = 3, 10.0%) (p for diff < 0.001)).

Conclusion: Pregnant women being assessed for OSA by 24 weeks gestation preferred to undertake level III sleep studies and found level III easier to use, more convenient and most acceptable to repeat than Level I and II studies. Given autonomy is an important principle, patient preference of sleep diagnostic tests should be taken into consideration in sleep clinical services and research involving pregnant women.

Purpose: To develop and evaluate an intervention tailored to patients' needs to increase the rate of positive airway pressure (PAP) adherence in patients afflicted with obstructive sleep apnea (OSA), who undergo PAP therapy.

Methods: A multi-center, 3 parallel-arm, randomized, controlled trial was conducted. Participants with OSA who undergo a PAP therapy were randomized to one of three groups: control arm (usual care), educational booklet arm, and mobile-based application arm. PAP usage, the percentage of days using the device for more than 4 h, change in knowledge, risk perception, outcome expectancy, self-efficacy, and ESS were assessed before and one month after interventions in the three groups. Also, the application usage data were analyzed.

Results: The result showed the change in average PAP usage, knowledge, risk perception, and self-efficacy in the application group was significantly higher than the control and booklet groups. Also, the change in use for more than 4 h in the application group was significantly higher than the control group. Comparing the actual and patients' self-report PAP use indicated patients' self-report about the use of the device is about 50 min (0.8 h) more than the actual amount of use.

Conclusion: The study results indicated that the improvement of primary and secondary outcomes in adherence to PAP was significantly higher in the application group than in other study groups. Given the increasingly penetrating influence of smartphone-based technologies, it seems that mobile-based applications could potentially be adopted in the population of patients with OSA.

Clinical trials registration: IRCT2017092236314N1; https://en.irct.ir/trial/27185.

Purpose: Assessing whether single-lead ECG can be effectively and relatively inexpensively used in large-scale OSA screening, and identifying factors influencing moderate-to-severe OSA among elderly hypertensive patients without atypical symptoms in primary care.

Methods: The study gathered data from 15 medical institutions in Ningxia between January and December 2022 using cloud platforms. The dataset included basic information and 72-h ECG monitoring for 2573 hypertensive patients over 65. OSA screening was conducted using the single-lead wearable ECG devices based on the ACAT algorithm. A multivariable logistic regression identified the main factors affecting OSA severity in these patients, and the AUC was used to assess the model's predictive accuracy.

Results: The study found an OSA detection rate of 87.10%, with 55.42% being moderate to severe cases. Key risk factors associated with developing moderate-to-severe OSA included cardiac irregularities like supraventricular extrasystole and atrioventricular block, male gender, lifestyle factors like alcohol consumption and smoking, and health indicators such as SDNN ≤ 100 ms, abnormal LF/HF ratio, BMI, and age. The model's accuracy for predicting OSA, indicated by a ROAUC of 0.625, was moderate. Factors like gender, tea consumption, stroke history, and ventricular tachycardia were also independently linked to OSA severity.

Conclusion: This study combines single-lead wearable ECG devices with the ACAT algorithm for OSA screening in Ningxia, China. Initial screening identified 87.10% of participants as having OSA, with 55.42% being moderate to severe cases. This suggests a convenient, low-cost, and repeatable ECG-based method for OSA screening, potentially improving early detection and management of OSA by identifying potential risk factors.

Objective: Triglyceride-glucose index (TyG) and its derived indices which better reflect metabolic disturbances on atherosclerosis has not been reliably compared in patients with type 2 diabetes mellitus (T2DM). Besides, obstructive sleep apnea hypopnea syndrome (OSAHS), a driver of atherosclerosis (AS), can exacerbate metabolic disturbances strongly. The aim of this study is to explore the mediating effect of glycolipid metabolism on the association between OSAHS and arterial stiffness in T2DM patients.

Methods: 154 T2DM patients were involved in this study and were split into two groups: T2DM and T2DM + AS. Logistic regression analysis determined the accurate effects of different factors on the AS of T2DM patients. The capacity of TyG and the indices it derives to predict AS was assessed using the receiver operating characteristic (ROC) curve. Mediation analysis was employed to investigate the mediating effect of TyG and its derived indices on the association between OSAHS and arterial stiffness in T2DM patients.

Results: OSAHS, TyG, and its derived indices were independent risk factors for AS in T2DM patients. Stratified by age, the hazardous effects of TyG and its derived indices remained significant in T2DM patients aged ≥ 50 years, but not in those aged < 50 years. In T2DM patients aged ≥ 50 years, the novel indices have a high predictive value for AS, with TyG-BMI exhibiting the largest AUC(AUC:0.788;95% CI:0.647 ∼ 0.928; P < 0.001). The mediation analysis results indicated that in T2DM patients aged ≥ 50 years, TyG, TyG-BMI, TyG-WC, and TyG-WHtR acted as potential mediators in the association between OSAHS and AS, with mediation effects of 33.42%, 48.2%, 37.7%, and 40.21%, respectively. However, there was no significant mediating effect observed in the younger patients.

Conclusion: TyG and its derived indices are strongly correlated with AS in T2DM patients, of which TyG-BMI has the best predictive performance. Besides, OSAHS partially exerts its atherogenic effect through glucolipid metabolism disorder in the T2DM population aged ≥ 50 years, while it mainly exerts a direct atherogenic effect in patients aged < 50 years.

Purpose: To investigate the separate and joint association between snoring and total sleep duration with the risk of type 2 diabetes mellitus (T2DM) in both genders within Chinese rural community.

Methods: The Henan Rural Cohort Study included a total of 28093 participants. Data on snoring and total sleep duration were obtained through the Pittsburgh Sleep Quality Index (PSQI). Binary logistic regression was employed to assess the correlation between snoring and total sleep duration with T2DM.

Results: The prevalences of T2DM were 8.53% in males and 9.27% in females. Males exhibited a higher prevalence of snoring (34.90%) compared to females (22.42%), and the median of total sleep duration was also longer in males (8.83 h) than in females (8.67 h), respectively (P < 0.001). Females who snored had an adjusted odds ratio (OR) and 95% confidence interval (CI) for T2DM of 1.19 (1.06, 1.35) when contrasted with non-snorers. Compared with optimal total sleep duration (6-8 h), longer total sleep duration (≥ 8 h) increased the prevalence of T2DM by 17% (95%CI: 3%, 32%) in females. Additionally, the participants with shorter total sleep duration (< 6 h) and snoring have the highest risk of T2DM, with an increase of 91% (95%CI: 20%, 204%) than those with optimal total sleep duration and non-snorers in females. These significant associations were not found in males.

Conclusions: Snoring and longer total sleep duration independently elevated the prevalence of T2DM. Meantime, a synergistic relationship was observed between snoring and total sleep duration with a higher prevalence of T2DM. These associations exhibited gender-specific differences.

Study objectives: Sleep-disordered breathing (SDB) is a very common and underdiagnosed condition in head and neck cancers (HNC) patients. If untreated, SDB can lead to negative health consequences. The identification of SDB in HNC patients is crucial to ensure appropriate treatment and to improve outcomes. The purpose of the study was to investigate the incidence of coexisting SDB in HNC patients and to evaluate methods of assessing SDB in the population.

Methods: A systematic search of PubMed, Embase, CINAHL, Cochrane Database, the Web of Science, and Scopus was performed for studies related to SDB in HNC patients. In total, 1713 articles were identified. 19 articles were selected for qualitative synthesis. The studies involved 584 subjects.

Results: The prevalence of SDB ranged from 57 to 90% before cancer treatment and from 12 to 96% after. When using an apnea-hypopnea index (AHI) cut-off ≥ 5/h to diagnosis SDB, the prevalence of SDB was 57-90% before cancer treatment and 12-94% after treatment. Sleep studies using polysomnography are the most commonly used assessment tools, but thresholds for diagnosis have been inconsistent.

Conclusions: There is a high prevalence of SDB in HNC patients. However, the diagnostic and thresholds methods used for detecting SDB vary widely. To determine the accurate prevalence of SDB, prospective, systematic studies of SDB in unselected cohorts of HNC participants are required.

Introduction: Obstructive Sleep Apnea Syndrome (OSAS) is a respiratory disorder characterized by repeated episodes of partial or complete airway obstruction. Continuous Positive Airway Pressure therapy (CPAP) is effective in improving sleep quality and daytime sleepiness. The aim of the study was to evaluate therapeutic adherence in a sample of patients with OSAS from the Pneumology ward of the "Cardinal Massaia" Hospital in Asti.

Materials and methods: A sample of 221 patients with OSAS were collected and retrospectively analyzed from January 2019 to December 2021. Ventilation hours during device titration (T1), possible second titration (T2) and one-year control (T3) were considered. The use of the CPAP device equal to or greater than 4 h/night was considered as therapeutic adherence. Age, gender, severity of OSAS, smoking, interface used and Epworth Sleepiness Scale (ESS) score were considered.

Results: The analysis data showed that the percentage of adhesion during T1 was 84%. Only 9% needed T2, with 84% adherence. At T3 the adherence was 86%. Correlation studies showed that only smoking had a positive correlation with adherence, while OSAS severity, gender, ESS score, interface used and age had no statistically significant correlation.

Conclusion: It was important to understand that OSAS is a disease with prolonged treatment, which affects the life of the person and his family. Therefore, the concept of assistance network was born, which sees the healthcare operators, the person and his family as the main actors involved in a care process.

Purpose: Snoring frequently occurs among pregnant women, particularly in the later stages of pregnancy. It often signals obstructive sleep apnea (OSA), which could potentially affect pregnancy outcomes negatively. Hence, our study aimed to investigate how snoring influences the likelihood of pregnancy complications and fetal outcomes in a cohort of expectant mothers.

Methods: We enrolled pregnant women in their second and third trimesters and had them fill out a questionnaire concerning sleep-related symptoms such as snoring, excessive daytime sleepiness, and frequency of nighttime awakenings, along with anthropometric measurements. Subsequently, the participants were divided into snorers and non-snorers, and the occurrence of pregnancy complications and fetal outcomes was monitored.

Results: The study enrolled a total of 212 pregnant women, among whom 35 were identified as snorers and 177 as non-snorers during mid to late pregnancy. This indicated a snoring prevalence of 16.5% in our sample. Significant differences were noted between the two groups regarding the occurrence of oligohydramnios (11.43% vs. 2.82%, p = 0.044) and fetal distress (28.57% vs. 8.47%, p = 0.003). Logistic regression analyses revealed that snoring was independently associated with fetal distress (odds ratio [OR] = 4.99, 95% confidence interval [CI] 1.88-13.23, p = 0.001).

Conclusions: Our findings suggest that habitual snoring was the independent risk factor fetal distress after adjusting for potential confounders, indicating that habitual snoring may have a detrimental effect during mid to late pregnancy.

Purpose: Endocan is a biomarker of endothelial dysfunction, which is a precursor to cardiovascular disease. Obstructive sleep apnoea (OSA) is associated with elevated endocan levels but the effects of treatment on endocan levels in OSA are not fully established. We aimed to determine whether endocan levels could be detected by immunoassay and to determine the effect of supplemental oxygen during continuous positive airway pressure (CPAP) withdrawal on circulating endocan levels.

Methods: We conducted an exploratory analysis from a randomised controlled crossover study which included participants with OSA. Participants stopped their CPAP therapy and were randomised to receive either supplemental oxygen or sham for 14 nights before crossing over. Supplemental oxygen blocked the rise in blood pressure seen in the sham group. We analysed plasma endocan levels by immunoassay at baseline and after 14 nights of intervention in both groups.

Results: Twenty-five participants were included, with a total of 100 samples. Endocan levels were detectable at all time points in 22 participants (88%), and in 93 (93%) samples. Supplemental oxygen had no effect on endocan levels compared to sham (+ 0.52 ng/ml, 95%CI -0.21 to + 1.25, p = 0.16), and there was no significant difference in endocan levels from baseline to follow-up in either the sham (-0.30 ng/ml, 95%CI -0.89 to + 0.30, p = 0.31) or supplemental oxygen (+ 0.22 ng/ml, 95%CI 0.00 to + 0.44, p = 0.05) arm.

Conclusions: We have shown that endocan levels are detectable before and after CPAP withdrawal. However, we found no effect of supplemental oxygen following CPAP withdrawal on circulating endocan levels.

Trial registration and date: ISRCTN 17,987,510 19/02/2015.