The hypoxic burden of sleep apnoea predicts cardiovascular disease-related mortality: the Osteoporotic Fractures in Men Study and the Sleep Heart Health Study

Azarbarzin, Ali; Sands, Scott A.; Stone, Katie L.; Taranto‐Montemurro, Luigi; Messineo, Ludovico; Terrill, Philip I.; Ancoli‐Israel, Sonia; Ensrud, Kristine E.; Purcell, Shaun; White, David P.; Redline, Susan; Wellman, Andrew

doi:10.1093/eurheartj/ehy624

Cited by 438 publications

(273 citation statements)

References 47 publications

(72 reference statements)

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“…Also, it has been suggested that PLMS may actually be evoked by basal sympathetic hyperactivity (Guggisberg, Hess, & Mathis, 2007 (Prabhakar, Kumar, & Peng, 2012). Notably, hypoxaemia is more closely related to adverse outcomes than AHI and other OSA markers (Azarbarzin et al, 2019;Lavie, 2015). (Gottlieb, Somers, Punjabi, & Winkelman, 2017;Guyon et al, 2014;Meerlo, Sgoifo, & Suchecki, 2008).…”

Section: Discussionmentioning

confidence: 99%

Interaction effect of obstructive sleep apnea and periodic limb movements during sleep on heart rate variability

Xiao

Covassin

Zhou

et al. 2019

Journal of Sleep Research

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Summary We aimed at assessing cardiac autonomic function by heart rate variability during sleep in patients with obstructive sleep apnea and periodic limb movements during sleep, and to compare it with that of patients with obstructive sleep apnea only, periodic limb movements during sleep only, and controls. We also aimed at investigating the interaction effect between apnea–hypopnea index and periodic limb movement index on heart rate variability. Four groups of patients (n = 42 each, total = 168) were identified based on the presence/absence of obstructive sleep apnea and periodic limb movements during sleep: + obstructive sleep apnea/− periodic limb movements during sleep (5 ≤ apnea–hypopnea index < 30 events per hr), − obstructive sleep apnea/+ periodic limb movements during sleep (periodic limb movement index > 15 events per hr), + obstructive sleep apnea/+ periodic limb movements during sleep, − obstructive sleep apnea/− periodic limb movements during sleep (controls). All groups were matched for age, sex and body mass index. Time‐ and frequency‐domain heart rate variability measures were calculated over 5‐min periods of stable stage 2 non‐rapid eye movement sleep. In patients with both obstructive sleep apnea and periodic limb movements during sleep, LFnu and LF/HF ratio were higher than in those with obstructive sleep apnea only, periodic limb movements during sleep only, and controls, while HFnu was the lowest among the four groups. LFnu, HFnu and LF/HF ratio were significantly and independently associated with minimal oxygen saturation in the + obstructive sleep apnea/+ periodic limb movements during sleep group. There was a significant interaction effect between apnea–hypopnea index and periodic limb movement index on LF/HF ratio (p = 0.038) in patients with obstructive sleep apnea. Patients with elevated apnea–hypopnea index and elevated periodic limb movement index exhibited higher sympathovagal balance compared with those with high apnea–hypopnea index and low periodic limb movement index, and compared with those with low apnea–hypopnea index (regardless of periodic limb movement index). Increased sympathetic activation and decreased parasympathetic control appear to be related to the severity of oxygen desaturation. Apnea–hypopnea index and periodic limb movement index had interactive effects on increased sympathovagal balance in patients with obstructive sleep apnea.

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Section: Discussionmentioning

confidence: 99%

Interaction effect of obstructive sleep apnea and periodic limb movements during sleep on heart rate variability

Xiao

Covassin

Zhou

et al. 2019

Journal of Sleep Research

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“…The desaturation area is a manifestation of both desaturation depth and duration, and quantifies the area between the baseline and the SpO 2 trace during a desaturation, and therefore quantifies an overall hypoxaemic burden associated with events.…”

Section: Approaches For Quantifying Patterns In Pulse Oximetry Datamentioning

confidence: 99%

“…Azarbarzin et al . later used a similar approach to define ‘hypoxic burden’ as the total desaturation area across an overnight recording, and applied this metric to two independent prospective follow‐up studies (Sleep Heart Health Study and The Outcomes of Sleep Disorders in Older Men study) where it was a sensitive predictor of cardiovascular mortality in elderly men (hazard ratio ≈1.6–2) …”

Section: Beyond the Odi And Ahi: Detailed Analysis Of Oximetry To Prementioning

confidence: 99%

A review of approaches for analysing obstructive sleep apnoea‐related patterns in pulse oximetry data

Terrill

2019

Respirology

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Overnight pulse oximetry allows the relatively noninvasive estimation of peripheral blood haemoglobin oxygen saturations (SpO 2 ), and forms part of the typical polysomnogram (PSG) for investigation of obstructive sleep apnoea (OSA). While the raw SpO 2 signal can provide detailed information about OSA-related pathophysiology, this information is typically summarized with simple statistics such as the oxygen desaturation index (ODI, number of desaturations per hour). As such, this study reviews the technical methods for quantifying OSA-related patterns in oximetry data. The technical methods described in literature can be broadly grouped into four categories: (i) Describing the detailed characteristics of desaturations events; (ii) Time series statistics; (iii) Analysis of power spectral distribution (i.e. frequency domain analysis); and (d) Non-linear analysis. These are described and illustrated with examples of oximetry traces. The utilization of these techniques is then described in two applications. First, the application of detailed oximetry analysis allows the accurate automated classification of PSG-defined OSA. Second, quantifications which better characterize the severity of desaturation events are better predictors of OSA-related epidemiological outcomes than standard clinical metrics. Finally, methodological considerations and further applications and opportunities are considered.

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“…In a recent study, the area under the oxygen desaturation curve associated with a respiratory event compared to baseline has been used to measure ‘hypoxic burden’. This measure was applied in cohort studies with PSG and long‐term follow‐up for health outcomes, showing that hypoxic burden, but not AHI, is associated with cardiovascular disease mortality …”

Section: Enhanced Psg Signal Analysis Methodsmentioning

confidence: 99%

“…This measure was applied in cohort studies with PSG and long-term follow-up for health outcomes, showing that hypoxic burden, but not AHI, is associated with cardiovascular disease mortality. 55 The severity of the apnea event (measured as the product of apnea duration and desaturation area) was associated with increased mortality rates for patients with severe OSA. 56 Weight loss reduced the number of short duration events but did not change the number of longer events leading to the suggestion that the impact of weight loss on OSA reduction may be less previously thought.…”

Section: Oximetrymentioning

confidence: 99%

Advanced polysomnographic analysis for OSA: A pathway to personalized management?

2019

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Obstructive sleep apnea (OSA) is a highly heterogeneous disorder, with diverse pathways to disease, expression of disease, susceptibility to co‐morbidities and response to therapy, and is ideally suited to precision medicine approaches. Clinically, the content of the information‐rich polysomnogram (PSG) is not currently fully utilized in determining patient management. Novel PSG parameters such as hypoxic burden, pulse transit time, cardiopulmonary coupling and the frequency representations of PSG sensor signals could predict a variety of cardiovascular disease, cancer and neurodegeneration co‐morbidities. The PSG can also be used to identify key pathophysiological parameters such as loop gain, arousal threshold and muscle compensation which can enhance understanding of the causes of OSA in an individual, and thereby guide choices on therapy. Machine learning methods performing their own parameter extraction coupled with large PSG data sets offer an exciting opportunity for discovering new links between the PSG variables and disease outcomes. By exploiting existing and emerging analytical methods, the PSG may offer a pathway to personalized management for OSA.

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The hypoxic burden of sleep apnoea predicts cardiovascular disease-related mortality: the Osteoporotic Fractures in Men Study and the Sleep Heart Health Study

Cited by 438 publications

References 47 publications

Interaction effect of obstructive sleep apnea and periodic limb movements during sleep on heart rate variability

Interaction effect of obstructive sleep apnea and periodic limb movements during sleep on heart rate variability

A review of approaches for analysing obstructive sleep apnoea‐related patterns in pulse oximetry data

Advanced polysomnographic analysis for OSA: A pathway to personalized management?

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