A Reappraisal on the Associations between Sleep-disordered Breathing, Insomnia, and Cardiometabolic Risk

Cruz, Miguel Meira e; Salles, Cristina; Gozal, David

doi:10.1164/rccm.202102-0337le

Cited by 16 publications

(4 citation statements)

References 10 publications

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“…As shown in the present study, the prevalence of COMISA in this initial study was markedly lower than the prevalence reported for adults, i.e., ~39% (De Gennaro, 2021; Lundetræ et al, 2021; Meira E Cruz et al, 2021a; Smith et al, 2004; Sweetman et al, 2021a, 2021b; Wallace & Wohlgemuth, 2019). Furthermore, Sweetman et al (2021a, 2021b) observed in their sample that 60% of the patients in the group with symptoms of COMISA were male ( p < 0.001), whereas in the present study there was no significant difference in the frequency between boys and girls.…”

Section: Discussioncontrasting

confidence: 58%

“…It has also become apparent that adult patients with COMISA present greater impairments in daytime functioning and quality of life when compared to those with insomnia or sleep apnea alone (Benetó et al, 2009; Luyster et al, 2010; Meira E Cruz et al, 2021a, 2021b). For example, Krakow et al (2001), reported that when compared to patients with OSA alone, patients with COMISA manifested greater emotional and cognitive impairments, such as irritability, reduced ability to concentrate on task, depressive symptoms, and anxiety.…”

Section: Discussionmentioning

confidence: 99%

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Comorbid insomnia and sleep apnea in children: a preliminary explorative study

Cruz

Salles

Seixas

et al. 2022

Journal of Sleep Research

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Insomnia and sleep-disordered breathing (SDB) are prevalent sleep disorders. These disorders can therefore be concurrently presentcomorbid insomnia and sleep apnea (COMISA). The prevalence of COMISA in the paediatric age range is unclear.As such, phenotypic constructs should help better define this comorbid condition if it exists in children and improve both diagnostic sensitivity and ultimately clinical care outcomes. We aimed to evaluate the frequency of insomnia in children and adolescents referred for evaluation of sleep symptoms suggestive of SDB in one initial (Cohort#1) and verify such findings in an independent cohort (Cohort#2) using a retrospective cross-sectional approach in patients aged 9-19 years presenting at a sleep centre to be evaluated for symptoms of SDB. Cohort #1 comprised 50 consecutive children (58% males; mean [SD] age 13.6 [3.3] years; median [interquartile range, IQR] Epworth Sleepiness Scale score 10 [6-12]) who were evaluated using validated SDB and insomnia questionnaires. Cohort#2 was extracted from electronic medical records and included 384 polysomnographically evaluated children (mean [SD] age 12.9 [3.6] years; mean [SD] body mass index z score 1.27 [0.28]; median Epworth Sleepiness Scale score 9. 7 [4-17]). In Cohort #1, 56% were at high risk of SDB, 36% had insomnia alone, and 18% were at high risk of COMISA. The prevalence of COMISA in Cohort #2 was 16%, 72% had SDB alone, and 12% had insomnia alone.In both cohorts, COMISA manifested as increased propensity for sleepiness and fatigue during both waking and daytime. Thus, the presence of COMISA is frequent in the paediatric age range and accompanied by a more prominent symptomatic phenotype.

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Section: Discussioncontrasting

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Comorbid insomnia and sleep apnea in children: a preliminary explorative study

Cruz

Salles

Seixas

et al. 2022

Journal of Sleep Research

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“…In a recent retrospective cross‐sectional study, the association between insomnia, sleep apnea, and cardiometabolic risk was evaluated; comorbid insomnia and sleep apnea were associated with significantly higher hypertension and diabetes risk than each of the disorders separately (relative frequency of 54.3% and 13.3% respectively, compared with 41.9% and 10.1% in isolated OSA or 10.1% and 1.8% in isolated insomnia). It was presumed that comorbid OSA and insomnia may exert further deleterious effects on cardiovascular system through circadian dysregulation (Meira et al, 2021). A recent study evaluated the circadian rhythm of motor activity, body position and wrist temperature in sleep disordered breathing: the abovementioned parameters were monitored for 7 days in 78 patients and 32 controls.…”

Section: Review On Circadian System Sleep Disordersmentioning

confidence: 99%

Is obstructive sleep apnea a circadian rhythm disorder?

Šmon

Kočar

Pintar

et al. 2023

Journal of Sleep Research

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Obstructive sleep apnea is the most common sleep-related breathing disorder worldwide and remains underdiagnosed. Its multiple associated comorbidities contribute to a decreased quality of life and work performance as well as an increased risk of death. Standard treatment seems to have limited effects on cardiovascular and metabolic aspects of the disease, emphasising the need for early diagnosis and additional therapeutic approaches. Recent evidence suggests that the dysregulation of circadian rhythms, processes with endogenous rhythmicity that are adjusted to the environment through various cues, is involved in the pathogenesis of comorbidities.In patients with obstructive sleep apnea, altered circadian gene expression patterns have been demonstrated. Obstructive respiratory events may promote circadian dysregulation through the effects of sleep disturbance and intermittent hypoxia, with subsequent inflammation and disruption of neural and hormonal homeostasis. In this review, current knowledge on obstructive sleep apnea, circadian rhythm regulation, and circadian rhythm sleep disorders is summarised. Studies that connect obstructive sleep apnea to circadian rhythm abnormalities are critically evaluated. Furthermore, pathogenetic mechanisms that may underlie this association, most notably hypoxia signalling, are presented. A bidirectional relationship between obstructive sleep apnea and circadian rhythm dysregulation is proposed. Approaching obstructive sleep apnea as a circadian rhythm disorder may prove beneficial for the development of new, personalised diagnostic, therapeutic and prognostic tools. However, further studies are needed before the clinical approach to obstructive sleep apnea includes targeting the circadian system.

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“…The pathophysiology of OSA is complex, involving a multitude of genetic, craniofacial - anatomical, neuromuscular, and inflammatory factors whose contributions differ from patient to patient 13 . Furthermore, OSA and insomnia may frequently co-occur challenging the usual standards of care 14 . In an effort to preserve the patency of the upper airway during sleep, various treatment modalities have been proposed 13 .…”

Section: Introductionmentioning

confidence: 99%

Mandibular advancement devices in obstructive sleep apnea: an updated review

Manetta¹,

Ettlin²,

Sanz³

et al. 2022

Sleep Sci

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Obstructive sleep apnea (OSA) is the most prevalent sleep-disordered breathing in the adult population and if untreated remains a significant cause of morbidity and mortality. Continuous positive airway pressure (CPAP) therapy is still the gold standard treatment for OSA, but patient acceptance and adherence are often poor due to a multitude of factors, thereby compromising treatment success. Mandibular advancement devices (MADs) have been proposed not only as a first line therapy for symptomatic snoring patients, but also for those suﬀering from mild to moderate OSA, or those who refuse or do not tolerate CPAP. Yet, improved understanding of MAD regarding design, construction, and mechanisms of action is an important requirement to successfully implement MAD as a therapeutic tool. Therefore, the main focus of this paper is to focus on the general concepts and mechanisms of action of MAD, while highlighting important characteristics in the context of their use as a viable and effective treatment option for OSA patients.

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A Reappraisal on the Associations between Sleep-disordered Breathing, Insomnia, and Cardiometabolic Risk

Cited by 16 publications

References 10 publications

Comorbid insomnia and sleep apnea in children: a preliminary explorative study

Comorbid insomnia and sleep apnea in children: a preliminary explorative study

Is obstructive sleep apnea a circadian rhythm disorder?

Mandibular advancement devices in obstructive sleep apnea: an updated review

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