Prevalence and Correlates of Sleep Apnea Among US Male Veterans, 2005–2014

Jackson, Maylen; Becerra, Benjamin J.; Marmolejo, Connie; Avina, Robert M.; Henley, Nicole; Becerra, Monideepa B.

doi:10.5888/pcd14.160365

Cited by 20 publications

(17 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In April 2015, the Veterans Health Administration (VA) approved the use of HGNS for the nine million veterans receiving health care in the VA system . This decision was based on research indicating a steadily increasing incidence of OSA in US veterans; most recent estimates show that the prevalence of OSA among veterans treated in the VA system ranges from 3% to 8% . Although there are no population‐based studies of PAP compliance in veterans, these patients reportedly have a high prevalence of comorbid depression, anxiety, poverty, and post‐traumatic stress disorder, all of which are associated with reduced PAP adherence, suggesting that many veterans might be potential candidates for HGNS therapy .…”

Section: Introductionmentioning

confidence: 94%

“…7 This decision was based on research indicating a steadily increasing incidence of OSA in US veterans; most recent estimates show that the prevalence of OSA among veterans treated in the VA system ranges from 3% to 8%. 7,8 Although there are no population-based studies of PAP compliance in veterans, these patients reportedly have a high prevalence of comorbid depression, anxiety, poverty, and post-traumatic stress disorder, all of which are associated with reduced PAP adherence, suggesting that many veterans might be potential candidates for HGNS therapy. [9][10][11][12] Once the Inspire HGNS was placed on the Federal Supply Schedule, indications for its use are determined by VA treating physicians (both otolaryngology and sleep medicine) in collaboration with the patient.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Hypoglossal Nerve Stimulator Outcomes for Patients Outside the U.S. FDA Recommendations

et al. 2019

View full text Add to dashboard Cite

Objectives The hypoglossal nerve stimulator (HGNS) is currently approved for the treatment of obstructive sleep apnea (OSA) in patients with an apnea‐hypopnea index (AHI) of >15 to ≤65 events/hour, and a central apnea index (CAI) <25% of the AHI, no complete concentric collapse on drug‐induced sleep endoscopy, and a recommended body mass index (BMI) <32 kg/m2. We present 18 patients implanted as a salvage procedure despite being outside these guidelines. Methods We included all patients who underwent HGNS but who did not meet all FDA guidelines. Demographic data, previous OSA treatments, polysomnographic (PSG) parameters from baseline and HGNS titration PSG, Epworth sleepiness score (ESS), and BMI were compared before and after surgery. Results Eighteen patients were identified: 94.4% male, median age 63 years. Seven underwent previous sleep surgery. Four had an AHI <15 (mean 10.5 events/hour), four had an AHI >65 (mean 86.9 events/hour), two had an elevated CAI (mean 31.3% of AHI), and 12 had a BMI >32 kg/m2 (range 32.1–39.1). Median AHI decreased from 25.3 to 3.75 events/hour on titration polysomnography (P = .0006), oxyhemoglobin saturation nadir increased from 82% to 88.5% (P = .0001) and median ESS dropped from 11 to 7.5 (P = .0016). Fifteen (83.3%) patients achieved surgical success (decrease in AHI >50% and AHI <20 events/hour) and 12 (66.7%) had an AHI <5 events/hour. Neither patient with CAI >25% was successfully treated. Median adherence = 33.5 hours/week. Conclusion Our success rate for patients outside the Food and Drug Administration guidelines for HGNS (67%) was similar to the 1‐year STAR trial results (66%). Future studies are necessary to consider expansion of these guidelines. Level of Evidence 4 Laryngoscope, 130:866–872, 2020

show abstract

Section: Introductionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

Hypoglossal Nerve Stimulator Outcomes for Patients Outside the U.S. FDA Recommendations

et al. 2019

View full text Add to dashboard Cite

show abstract

“…In the United States, it is estimated that 26% of adults aged 30-70 live with sleep apnea, and more than 25 million adults suffer from OSA [3]. According to the 2005-2014 National Survey among the United States male veterans, the prevalence of sleep apnea increased from 3.7% to 8.1% (p-value for trend <0.001) [4]. The MESA study conducted by Xiaoli Chen shows that the black population had higher risks of developing sleep apnea syndrome (adjusted odds ratio [OR] = 1.78, 95% confidence interval [CI]: 1.20, 2.63), compared with whites [4].…”

Section: Introductionmentioning

confidence: 99%

“…According to the 2005-2014 National Survey among the United States male veterans, the prevalence of sleep apnea increased from 3.7% to 8.1% (p-value for trend <0.001) [4]. The MESA study conducted by Xiaoli Chen shows that the black population had higher risks of developing sleep apnea syndrome (adjusted odds ratio [OR] = 1.78, 95% confidence interval [CI]: 1.20, 2.63), compared with whites [4]. Furthermore, in a community-based study among a multiethnic Asian population, the prevalence of sleep apnea is 18.1%, and the prevalence in Malays is higher than that in China and India [5].…”

Section: Introductionmentioning

confidence: 99%

Risk of suicidal ideation, suicide attempts, and suicide deaths in persons with sleep apnea: Protocol for a systematic review and meta-analysis

et al. 2020

View full text Add to dashboard Cite

To estimate the pooled prevalence and incidence of suicidal ideation, attempts, and deaths in people with sleep apnea. Method We will identify epidemiological studies reporting the prevalence or incidence rate of suicide in people with sleep apnea. We will search the following databases: PubMed (MEDLINE), Scopus, Cochrane Library, OVID (HEALTH STAR), OVID (MEDLINE) and Joana Briggs Institute EBF Database. No age, geographical location, study-design or language limits will be applied. This protocol was developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) guidelines. Two reviewers (YY and YP) will independently screen citations, abstracts and will identify full-text articles for inclusion, extract data, and appraise the quality and bias of included studies. Discrepancies will be resolved by consulting with a third researcher (MC). Study quality will be assessed by the Newcastle-Ottawa Scale. The primary outcomes will be the overall prevalence or incidence of suicidal ideation, attempts and completion and the risk of suicide in people with sleep apnea. For pooling of the studies, we will use a random-effects model with a logit transformation. The DerSimonian and Laird (DL) random-effects method will be used to estimate the pooled inter-study variance. We will assess the between-study heterogeneity using I 2 statistics, and Cochrane's Q statistic (significance level < 0.05). If the I 2 is high (>75%), we will perform subgroup meta-analyses and conduct a meta-regression analysis to explore sources of study heterogeneity using study level median age, study-level This is a Registered Report and may have an associated publication; please check the article page on the journal site for any related articles.

show abstract

“…However, the impact of CSA on clinical outcomes has not been studied in large clinical populations. Additionally, the distribution and the clinical correlates of CSA in the veteran population remain unknown [19]. This poses a major gap in the literature, as the scarcity of clinical outcomes data prevents delineation and prioritization of care for patients with CSA.…”

Section: Introductionmentioning

confidence: 99%

Correlates and consequences of central sleep apnea in a national sample of US veterans

Ratz

Wiitala

Badr

et al. 2018

Sleep

View full text Add to dashboard Cite

The prevalence and consequences of central sleep apnea (CSA) in adults are not well described. By utilizing the large Veterans Health Administration (VHA) national administrative databases, we sought to determine the incidence, clinical correlates, and impact of CSA on healthcare utilization in Veterans. Analysis of a retrospective cohort of patients with sleep disorders was performed from outpatient visits and inpatient admissions from fiscal years 2006 through 2012. The CSA group, defined by International Classification of Diseases-9, was compared with a comparison group. The number of newly diagnosed CSA cases increased fivefold during this timeframe; however, the prevalence was highly variable depending on the VHA site. The important predictors of CSA were male gender (odds ratio [OR] = 2.31, 95% confidence interval [CI]: 1.94-2.76, p < 0.0001), heart failure (HF) (OR = 1.78, 95% CI: 1.64-1.92, p < 0.0001), atrial fibrillation (OR = 1.83, 95% CI: 1.69-2.00, p < 0.0001), pulmonary hypertension (OR = 1.38, 95% CI:1.19-1.59, p < 0.0001), stroke (OR = 1.65, 95% CI: 1.50-1.82, p < 0.0001), and chronic prescription opioid use (OR = 1.99, 95% CI: 1.87-2.13, p < 0.0001). Veterans with CSA were at an increased risk for hospital admissions related to cardiovascular disorders compared with the comparison group (incidence rate ratio [IRR] = 1.50, 95% CI: 1.16-1.95, p = 0.002). Additionally, the effect of prior HF on future admissions was greater in the CSA group (IRR: 4.78, 95% CI: 3.87-5.91, p < 0.0001) compared with the comparison group (IRR = 3.32, 95% CI: 3.18-3.47, p < 0.0001). Thus, CSA in veterans is associated with cardiovascular disorders, chronic prescription opioid use, and increased admissions related to the comorbid cardiovascular disorders. Furthermore, there is a need for standardization of diagnostics methods across the VHA to accurately diagnose CSA in high-risk populations.Key words: central sleep apnea; heart failure; prescription opioids; health care utilization; obstructive sleep apnea; cardiovascular morbidity; incidence; prevalence; hospital admission Statement of SignificanceThis retrospective study describes for the first time, the distribution, risk factors, and clinical correlates of central sleep apnea (CSA) in a large administrative database of veterans. Comorbid cardiovascular disorders and chronic prescription opioid use are strongly associated with CSA. A novel finding was that CSA was associated with an increased risk for cardiac disease-related hospital admissions. A prior diagnosis of heart failure was further associated with an increased risk for admissions in patients with CSA, thus underscoring the need for aggressively identifying and managing CSA in high-risk populations. Although the large national database was the strength of the study, the limitations included potential inaccurate diagnostic coding, unavailability of opioid dosing, and inability to determine whether the patients had received therapy.

show abstract

Prevalence and Correlates of Sleep Apnea Among US Male Veterans, 2005–2014

Cited by 20 publications

References 7 publications

Hypoglossal Nerve Stimulator Outcomes for Patients Outside the U.S. FDA Recommendations

Hypoglossal Nerve Stimulator Outcomes for Patients Outside the U.S. FDA Recommendations

Risk of suicidal ideation, suicide attempts, and suicide deaths in persons with sleep apnea: Protocol for a systematic review and meta-analysis

Correlates and consequences of central sleep apnea in a national sample of US veterans

Contact Info

Product

Resources

About