Prevalence, clinical features, and CPAP adherence in REM-related sleep-disordered breathing: a cross-sectional analysis of a large clinical population

Conwell, Walter D.; Patel, Bhakti; Doeing, Diana; Pamidi, Sushmita; Knutson, Kristen L.; Ghods, Farbod; Mokhlesi, Babak

doi:10.1007/s11325-011-0537-6

Cited by 117 publications

(177 citation statements)

References 16 publications

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“…However, during REM sleep, cholinergic-mediated inhibition of the hypoglossal nerve results in the suppression of genioglossus muscle tone, which substantially increases the propensity for upper airway collapse (16)(17)(18). This increased propensity for upper airway collapse can lead to REM-predominant OSA or simply OSA that becomes more severe during REM sleep (19)(20)(21)(22)(23). In patients with mild or moderate OSA, who represent more than 80% of individuals with OSA in the community (14,15), obstructive events often cluster in REM sleep resulting in selective fragmentation of REM sleep (20).…”

Section: Measurements and Main Resultsmentioning

confidence: 99%

“…It is estimated that at least 25 million American men and women suffer from undiagnosed mild to moderate OSA and as many as 20% of these individuals may have REM-related OSA (19,21,22,38). This is a problem of major clinical significance and public health importance given that REMrelated OSA occurs more commonly in women and younger individuals (19)(20)(21)(22)48), including children (49), and may determine a lifelong elevated cardiometabolic risk if undiagnosed and untreated.…”

Section: Discussionmentioning

confidence: 99%

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Obstructive Sleep Apnea during REM Sleep and Hypertension. Results of the Wisconsin Sleep Cohort

Mokhlesi

Finn²,

Hagen³

et al. 2014

Am J Respir Crit Care Med

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257

211

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Rationale: Obstructive sleep apnea (OSA) is associated with hypertension.Objectives: We aimed to quantify the independent association of OSA during REM sleep with prevalent and incident hypertension.Methods: We included adults enrolled in the longitudinal community-based Wisconsin Sleep Cohort Study with at least 30 minutes of REM sleep obtained from overnight in-laboratory polysomnography. Studies were repeated at 4-year intervals to quantify OSA. Repeated measures logistic regression models were fitted to explore the association between REM sleep OSA and prevalent hypertension in the entire cohort (n = 4,385 sleep studies on 1,451 individuals) and additionally in a subset with ambulatory blood pressure data (n = 1,085 sleep studies on 742 individuals). Conditional logistic regression models were fitted to longitudinally explore the association between REM OSA and development of hypertension. All models controlled for OSA events during non-REM sleep, either by statistical adjustment or by stratification. Measurements and Main Results:Fully adjusted models demonstrated significant dose-relationships between REM apnea-hypopnea index (AHI) and prevalent hypertension. The higher relative odds of prevalent hypertension were most evident with REM AHI greater than or equal to 15. In individuals with non-REM AHI less than or equal to 5, a twofold increase in REM AHI was associated with 24% higher odds of hypertension (odds ratio, 1.24; 95% confidence interval, 1.08-1.41). Longitudinal analysis revealed a significant association between REM AHI categories and the development of hypertension (P trend = 0.017). Non-REM AHI was not a significant predictor of hypertension in any of the models.Conclusions: Our findings indicate that REM OSA is crosssectionally and longitudinally associated with hypertension. This is clinically relevant because treatment of OSA is often limited to the first half of the sleep period leaving most of REM sleep untreated.

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Section: Measurements and Main Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Obstructive Sleep Apnea during REM Sleep and Hypertension. Results of the Wisconsin Sleep Cohort

Mokhlesi

Finn²,

Hagen³

et al. 2014

Am J Respir Crit Care Med

Self Cite

257

211

View full text Add to dashboard Cite

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“…The current 31-to 90-day requirement for documentation of CPAP adherence is arbitrary and not supported by evidence. The committee members prefer to document CPAP adherence earlier (i.e., 7-90 d) because there is evidence that addressing CPAP intolerance early may improve long-term adherence (81)(82)(83). Moreover, CPAP adherence needs to be monitored long term (for as long as the patient is using CPAP).…”

Section: -69)mentioning

confidence: 99%

An Official American Thoracic Society Statement: Continuous Positive Airway Pressure Adherence Tracking Systems. The Optimal Monitoring Strategies and Outcome Measures in Adults

Schwab

Badr

Epstein

et al. 2013

Am J Respir Crit Care Med

248

200

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Background: Continuous positive airway pressure (CPAP) is considered the treatment of choice for obstructive sleep apnea (OSA), and studies have shown that there is a correlation between patient adherence and treatment outcomes. Newer CPAP machines can track adherence, hours of use, mask leak, and residual apnea-hypopnea index (AHI). Such data provide a strong platform to examine OSA outcomes in a chronic disease management model. However, there are no standards for capturing CPAP adherence data, scoring flow signals, or measuring mask leak, or for how clinicians should use these data. Methods: American Thoracic Society (ATS) committee members were invited, based on their expertise in OSA and CPAP monitoring. Their conclusions were based on both empirical evidence identified by a comprehensive literature review and clinical experience. Results: CPAP usage can be reliably determined from CPAP tracking systems, but the residual events (apnea/hypopnea) and leak data are not as easy to interpret as CPAP usage and the definitions of these parameters differ among CPAP manufacturers. Nonetheless, ends of the spectrum (very high or low values for residual events or mask leak) appear to be clinically meaningful. Conclusions: Providers need to understand how to interpret CPAP adherence tracking data. CPAP tracking systems are able to reliably track CPAP adherence. Nomenclature on the CPAP adherence tracking reports needs to be standardized between manufacturers and AHI Flow should be used to describe residual events. Studies should be performed examining the usefulness of the CPAP tracking systems and how these systems affect OSA outcomes.Keywords: CPAP adherence; sleep apnea; CPAP tracking systems EXECUTIVE SUMMARYObstructive sleep apnea (OSA) is an extremely common condition and is associated with significant morbidity and mortality (1-18). Optimal treatment of sleep apnea is critical because sleepdisordered breathing is associated with the increased risk of vehicular crashes and cardiovascular morbidity and mortality (6, 9-18). Continuous positive airway pressure (CPAP) is the treatment of choice for sleep apnea (19)(20)(21)(22). Increased CPAP adherence has been shown to improve outcomes such as daytime sleepiness, quality of life, and mortality (23-25). OSA should be considered in a chronic disease management model in which CPAP adherence is tracked over time. To assess CPAP adherence and efficacy, tracking systems have been implemented. Such systems monitor CPAP efficacy (residual sleep-disordered breathing), hours of CPAP use, mask leak, and a number of different flow signals. However, there are no standards on how to use the data from these new CPAP tracking systems nor do we have evidence that these systems ultimately improve outcomes. See the online supplement for full discussion of the literature on the accuracy of the residual AHI and mask leak.The purpose of this document is to (1) review the data (adherence, leak, efficacy, flow signals) obtained from CPAP adherence tracking systems and the reliability of th...

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“…Similarly, in individuals who are awake, there are reductions in functional residual capacity and expiratory reserve volume with obesity. 19,20 The prior studies evaluating ΔEELV had methodological limitations, such as placing esophageal and epiglottis catheters, arousing subjects frequently throughout the night, and not allowing the subject to engage in the natural course of sleep. These issues were avoided in the current study as magnetometry provided a noninvasive means for measuring changes in lung volume and allowed the subject to sleep for the complete duration of the study.…”

Section: Discussionmentioning

confidence: 99%

Change in End-Expiratory Lung Volume During Sleep in Patients at Risk for Obstructive Sleep Apnea

Koo

Gartman

Sethi

et al. 2017

Journal of Clinical Sleep Medicine

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Study Objectives: As lung volume decreases radial traction on the upper airway is reduced, making it more collapsible. The purpose of this study was to measure change in end-expiratory lung volume (EELV) following sleep onset and to evaluate the relationship between change in EELV and sleep-disordered breathing. Methods: Twenty subjects underwent overnight polysomnography, of whom 14 (70%) had obstructive sleep apnea (OSA). Change in EELV was measured throughout the night using magnetometry. Sleep was staged and respiratory events scored using American Academy of Sleep Medicine criteria. An additional 10 subjects had change in EELV measured simultaneously by magnetometer and spirometer while awake. Results: In the subjects studied while awake, change in EELV calculated from magnetometer data correlated very strongly (r = 0.89, P < .001) with that obtained by spirometry. In the 20 subjects who underwent polysomnography, there was a decline in EELV for sleep stages N1, N2, N3, and R (REM sleep); 17.9 ± 121.0 mL (mean ± standard deviation), 228.5 ± 151.8 mL, 198.1 ± 122.1 mL, and 316.7 ± 131.9 mL, respectively. Mean EELV reduction during stage R sleep doubled that noted during non-stage R sleep (316.7 ± 131.9 mL versus 150.9 ± 89.7 mL, respectively) (P < .001). The difference in EELV between non-stage R and stage R sleep inversely correlated with mean oxygen saturation (r = −0.56, P = .06). EELV reduction in individuals with moderate and severe OSA was greater than in those with mild SDB but did not reach statistical significance. Conclusions:Magnetometry provides a precise, unobtrusive, and continuous means to study lung volume changes during sleep. EELV declines from sleep onset, reaching its nadir during stage R sleep. The reduction in EELV in stage R sleep was associated with lower mean oxygen saturation but was not associated with greater sleep-disordered breathing. Keywords: end-expiratory lung volume, magnetometry, REM sleep, sleep-disordered breathing Citation: Koo P, Gartman EJ, Sethi JM, Kawar E, McCool FD. Change in end-expiratory lung volume during sleep in patients at risk for obstructive sleep apnea. J Clin Sleep Med. 2017;13(8):941-947.

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Prevalence, clinical features, and CPAP adherence in REM-related sleep-disordered breathing: a cross-sectional analysis of a large clinical population

Cited by 117 publications

References 16 publications

Obstructive Sleep Apnea during REM Sleep and Hypertension. Results of the Wisconsin Sleep Cohort

Obstructive Sleep Apnea during REM Sleep and Hypertension. Results of the Wisconsin Sleep Cohort

An Official American Thoracic Society Statement: Continuous Positive Airway Pressure Adherence Tracking Systems. The Optimal Monitoring Strategies and Outcome Measures in Adults

Change in End-Expiratory Lung Volume During Sleep in Patients at Risk for Obstructive Sleep Apnea

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