Death and Disability in Patients with Sleep Apnea - A Meta-analysis

Fonseca, Maria Inês Pires; Pereira, Telmo; Caseiro, Paulo

doi:10.5935/abc.20140172

Cited by 15 publications

(10 citation statements)

References 31 publications

(55 reference statements)

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“…15,26,27 Third, sleep apnea may have also been under-reported, resulting in lower prevalence and lack of power to enter the final model. 38 However, hypertension might also help to explain the risk of new-onset AF associated with this sleep disturbance. 39 Fourth, some residual confounding may have remained.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Incident Atrial Fibrillation Hazard in Hypertensive Population

et al. 2015

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Determining the risk of atrial fibrillation within the hypertensive population without ischemic vascular disease would aid in decision making on preventive approaches. Accordingly, we aimed to estimate the risk of incident atrial fibrillation in this population. We conducted an historical cohort study between July 1, 2006, and December 31, 2011, using anonymized longitudinal patient information from primary care and hospital discharge records contained in the System for the Development of Research in Primary Care database. We included 255 440 hypertensive patients, aged ≥55 years at the time of study entry. Individuals with previous atrial fibrillation, ischemic heart disease, stroke, and peripheral artery disease were excluded. To build the incident atrial fibrillation risk function, a derivation and a validation cohort were defined, representing 60% and 40% of the entire database, respectively, and a Cox proportional hazards model was fitted. Atrial fibrillation incidence was 7.24 per 1000 person-years (95% confidence interval, 7.08–7.40). The final model included age, weight, total cholesterol, heart failure, valvular heart disease, and antihypertensive treatment. Its concordance index (standard error) was 0.769 (0.004) and 0.768 (0.005) in the derivation and validation datasets, respectively. This research provides a tool, built with variables from daily clinical practice, that can be readily used in the primary care setting to predict atrial fibrillation incidence in the hypertensive population without ischemic vascular disease. The tool may help tailor individualized diagnostic and preventive care decisions.

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Section: Strengths and Limitationsmentioning

confidence: 99%

Incident Atrial Fibrillation Hazard in Hypertensive Population

et al. 2015

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“…[95][96][97] Although CPAP is held to be the most effective treatment, adherence is suboptimal. 98 McGinley et al found that HFNC for OSA alleviated upper airway obstruction in children and that, both in children and adults, HFNC reduced arousals and apneahypopnea index ratings.…”

Section: Sleep Apneamentioning

confidence: 99%

High-Flow Nasal Cannula Oxygen Therapy in Adults: Physiological Benefits, Indication, Clinical Benefits, and Adverse Effects

2016

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High-flow nasal cannula (HFNC) oxygen therapy is carried out using an air/oxygen blender, active humidifier, single heated tube, and nasal cannula. Able to deliver adequately heated and humidified medical gas at flows up to 60 L/min, it is considered to have a number of physiological advantages compared with other standard oxygen therapies, including reduced anatomical dead space, PEEP, constant F IO 2 , and good humidification. Although few large randomized clinical trials have been performed, HFNC has been gaining attention as an alternative respiratory support for critically ill patients. Published data are mostly available for neonates. For critically ill adults, however, evidence is uneven because the reports cover various subjects with diverse underlying conditions, such as hypoxemic respiratory failure, exacerbation of COPD, postextubation, preintubation oxygenation, sleep apnea, acute heart failure, and conditions entailing do-not-intubate orders. Even so, across the diversity, many published reports suggest that HFNC decreases breathing frequency and work of breathing and reduces the need for respiratory support escalation. Some important issues remain to be resolved, such as definitive indications for HFNC and criteria for timing the starting and stopping of HFNC and for escalating treatment. Despite these issues, HFNC has emerged as an innovative and effective modality for early treatment of adults with respiratory failure with diverse underlying diseases.

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“…Variables associated with an REI ≥ 15 events/h with a value of P > .1 were entered into a binary logistic regression analysis to identify variables independently contributing to variance of REI ≥ 15 events/h. Receiver operator characteristic (ROC) curves were created by plotting sensitivity against 1 − specificity at various REI cutoff points (5,15, and 30 events/h) and to assess the total area under the curve for each questionnaire. Analysis was performed using SPSS version 22 (IBM Corp., Armonk, New York, United States).…”

Section: Discussionmentioning

confidence: 99%

Comparison of Commonly Used Questionnaires to Identify Obstructive Sleep Apnea in a High-Risk Population

Kee

Dixon

Shaw

et al. 2018

Journal of Clinical Sleep Medicine

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Study Objectives: Sleep apnea is associated with adverse health outcomes. Despite being an important comorbidity in obesity, type 2 diabetes, heart failure, and resistant hypertension, it is underdiagnosed in these patient groups. An inexpensive and readily accessible sleep apnea screening tool would help address this problem. We sought to compare three commonly used screening tools. Methods: We recruited 812 patients who had not previously been investigated for sleep apnea from our institution's diabetes (n = 512), obesity (n = 129), resistant hypertension (n = 74) and heart failure (n = 43) clinics. Patients completed three frequently used sleep apnea screening questionnaires (STOP-BANG, Berlin, and OSA50). A total of 758 patients had a valid (> 4 hours' duration) level 3 home sleep study. Studies were reported by a sleep physician and were deemed positive if they recorded a respiratory event index (REI) ≥ 15 events/h. Results: The 758 patients with valid sleep studies were age 59 ± 11 years and 63% were male. A total of 38% of patients had a positive test. The respective sensitivities and specificities of the screening questionnaires at the recommended screening thresholds (REI ≥ 15 events/h) were STOP-BANG ≥ 3 (95% and 19%), STOP-BANG ≥ 5 (60% and 69%), Berlin (75% and 38%), and OSA50 (88% and 21%). We identified six independent predictors (age, sex, body mass index, neck circumference, snoring ≥ 3 days per week, observed apnea ≥ 3 days per week). However, combining these factors was no better than the STOP-BANG in predicting sleep apnea. All patients with a STOP-BANG < 3 had an REI < 30 events/h. Conclusions: There is a high prevalence of undiagnosed symptomatic sleep apnea in high-risk patient groups. The STOP-BANG questionnaire appeared superior, though all questionnaires had significant limitations. Incorporation of STOP-BANG ≥ 3 in this high-risk population might reduce the need for sleep testing in a resource-constrained setting.

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Death and Disability in Patients with Sleep Apnea - A Meta-analysis

Cited by 15 publications

References 31 publications

Incident Atrial Fibrillation Hazard in Hypertensive Population

Incident Atrial Fibrillation Hazard in Hypertensive Population

High-Flow Nasal Cannula Oxygen Therapy in Adults: Physiological Benefits, Indication, Clinical Benefits, and Adverse Effects

Comparison of Commonly Used Questionnaires to Identify Obstructive Sleep Apnea in a High-Risk Population

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