Predictors of Sleep-Disordered Breathing in Community-Dwelling Adults&lt;subtitle&gt;The Sleep Heart Health Study&lt;/subtitle&gt;

Young, Terry; Shahar, Eyal; Nieto, F. Javier; Redline, Susan; Newman, Anne B.; Gottlieb, Daniel J.; Walsleben, Joyce A.; Finn, Laurel; Enright, Paul; Samet, Jonathan M.

doi:10.1001/archinte.162.8.893

Cited by 1,181 publications

(867 citation statements)

References 31 publications

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“…Eleven percent of women and 25% of men aged 40 years or older have at least 15 apneas plus hypopneas per hour of sleep (apnea-hypopnea index, AHI). 1 OSA is associated with multiple adverse outcomes, including pathological daytime sleepiness, 2 a ~2-fold increase in motor vehicle accidents, 3 depression, 4 hypertension, 5 and all-cause mortality. 6 The main treatments include continuous positive airway pressure (CPAP), mandibular advancement splint devices, weight loss, and upper airway or bariatric surgery.…”

Section: S C I E N T I F I C I N V E S T I G a T I O N Smentioning

confidence: 99%

Accurate Position Monitoring and Improved Supine-Dependent Obstructive Sleep Apnea with a New Position Recording and Supine Avoidance Device

Bignold

Mercer

Antic³

et al. 2011

Journal of Clinical Sleep Medicine

124

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Study Objectives: Approximately 30% of obstructive sleep apnea (OSA) patients have supine-predominant OSA, and simply avoiding supine sleep should normalise respiratory disturbance event rates. However, traditional supineavoidance therapies are inherently uncomfortable, and treatment adherence is poor and diffi cult to monitor objectively. This study evaluated the effi cacy of a novel, potentially more acceptable position monitor and supine-avoidance device for managing supine-predominant OSA and snoring. Design and Setting: In-laboratory evaluation of position recording accuracy versus video recordings (validation study), and randomized controlled crossover trial of active versus inactive supine-avoidance therapy in the home setting (effi cacy study). Patients: 17 patients undergoing in-laboratory sleep studies (validation) and 15 patients with supine-predominant OSA (effi cacy). Interventions: Effi cacy study: 1 week of inactive and 1 week of active treatment in randomized order, separated by 1 week. Measurements and Results: Agreement between 30-sec epoch-based posture classifi cations from device versus video records was high (median κ 0.95, interquartile range: 0.88-1.00), and there was good supine time agreement (bias 0.3%, 95%CI: −4.0% to 4.6%). In the effi cacy study, apnea-hypopnea index (AHI) and snoring frequency were measured in-home using a nasal pressure and microphone based system during inactive and active treatment weeks. The position monitoring and supine alarm device markedly inhibited supine time (mean ± SEM 19.3% ± 4.3% to 0.4% ± 0.3%, p < 0.001) and reduced AHI (25.0 ± 1.7 to 13.7 ± 1.1 events/h, p = 0.030) but not snoring frequency.

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Section: S C I E N T I F I C I N V E S T I G a T I O N Smentioning

confidence: 99%

Accurate Position Monitoring and Improved Supine-Dependent Obstructive Sleep Apnea with a New Position Recording and Supine Avoidance Device

Bignold

Mercer

Antic³

et al. 2011

Journal of Clinical Sleep Medicine

124

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“…(43) Previously demonstrating that CPAP positively affected blood pressure in a sample that included sleepy participants,(35) the investigators suggested that the impact of CPAP on this outcome may be mechanistically related to daytime sleepiness. This possibility has implication for the treatment of sleep apnea in older adults where there is a higher prevalence of sleep disordered breathing in older compared to middle aged adults, (3,47) but who experience less daytime sleepiness. (4,48)…”

Section: Functional Status and Quality Of Lifementioning

confidence: 99%

Continuous positive airway pressure treatment for sleep apnea in older adults

Weaver

Chasens

2007

Sleep Medicine Reviews

147

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Daytime sleepiness and sleep disordered breathing are increased in older compared to middle-aged adults. The cognitive and cardiovascular sequelae associated with obstructive sleep apnea (OSA) have significant implications for the older adult who may already be suffering from chronic illness. Most of the evidence supporting the utilization of continuous positive airway pressure (CPAP) for the treatment of OSA has been generated from studies employing samples consisting predominately of middle-aged adults. To examine the efficacy of CPAP for the treatment of obstructive sleep apnea in older adults with an emphasis on adherence and related treatment outcomes, this paper reviews findings from clinical trials including older individuals as well as those specifically targeting this population. These studies have demonstrated that following CPAP therapy, older adults have increased alertness, improved neurobehavioral outcomes in cognitive processing, memory, and executive function, decreased sleep disruption from nocturia and a positive effect on factors affecting cardiac function, including vascular resistance, platelet coagulability and other aspects of cardiovascular health. Physiological differences in respiratory structure and function between younger and older adults of similar disease severity are believed to result in older individuals requiring titration at lower CPAP levels. Once initiated, CPAP treatment is tolerated by older adults, including those with Alzheimer's disease. Patterns of adherence in older individuals are consistent with that of middle-aged adults.

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“…It is characterized primarily by recurrent occlusion of the upper airway that results in oxyhemoglobin desaturation and periodic arousals from sleep (2). It now appears that even mild to moderate sleep apnea is associated with the development of hypertension, diabetes mellitus (3), and cardiovascular risk (4,5). With increasing obesity, sleep apnea can contribute to the development of daytime alveolar hypoventilation (obesity hypoventilation syndrome), cor pulmonale, and frank respiratory failure (6,7).…”

mentioning

confidence: 99%

Obesity and Obstructive Sleep Apnea: Pathogenic Mechanisms and Therapeutic Approaches

Schwartz

Patil²,

Laffan

et al. 2008

Proceedings of the American Thoracic Society

574

395

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Obstructive sleep apnea is a common disorder whose prevalence is linked to an epidemic of obesity in Western society. Sleep apnea is due to recurrent episodes of upper airway obstruction during sleep that are caused by elevations in upper airway collapsibility during sleep. Collapsibility can be increased by underlying anatomic alterations and/or disturbances in upper airway neuromuscular control, both of which play key roles in the pathogenesis of obstructive sleep apnea. Obesity and particularly central adiposity are potent risk factors for sleep apnea. They can increase pharyngeal collapsibility through mechanical effects on pharyngeal soft tissues and lung volume, and through central nervous system-acting signaling proteins (adipokines) that may affect airway neuromuscular control. Specific molecular signaling pathways encode differences in the distribution and metabolic activity of adipose tissue. These differences can produce alterations in the mechanical and neural control of upper airway collapsibility, which determine sleep apnea susceptibility. Although weight loss reduces upper airway collapsibility during sleep, it is not known whether its effects are mediated primarily by improvement in upper airway mechanical properties or neuromuscular control. A variety of behavioral, pharmacologic, and surgical approaches to weight loss may be of benefit to patients with sleep apnea, through distinct effects on the mass and activity of regional adipose stores. Examining responses to specific weight loss strategies will provide critical insight into mechanisms linking obesity and sleep apnea, and will help to elucidate the humoral and molecular predictors of weight loss responses.

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Predictors of Sleep-Disordered Breathing in Community-Dwelling Adults<subtitle>The Sleep Heart Health Study</subtitle>

Cited by 1,181 publications

References 31 publications

Accurate Position Monitoring and Improved Supine-Dependent Obstructive Sleep Apnea with a New Position Recording and Supine Avoidance Device

Accurate Position Monitoring and Improved Supine-Dependent Obstructive Sleep Apnea with a New Position Recording and Supine Avoidance Device

Continuous positive airway pressure treatment for sleep apnea in older adults

Obesity and Obstructive Sleep Apnea: Pathogenic Mechanisms and Therapeutic Approaches

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