Underdiagnosis of Sleep Apnea Syndrome in U.S. Communities

Kapur, Vishesh K.; Strohl, Kingman P.; Redline, Susan; Iber, Conrad; O’Connor, George T.; Nieto, Javier

doi:10.1007/s11325-002-0049-5

Cited by 261 publications

(193 citation statements)

References 14 publications

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“…Second, the diagnosis of sleep apnea was based on self-reported information, which may be influenced by recall bias and is likely a specific but not sensitive indicator of sleep apnea. The 3.5 % prevalence of PDSA in this sample is approximately 3-fold lower than what has been reported in population studies, indicating the likely underestimation of this disorder [29, 30]. Third, there were no objective measures of sleep apnea severity such as measures of intermittent hypoxemia and we did not have information on subjects who might have been treated for their sleep apnea.…”

Section: Discussionmentioning

confidence: 72%

Sleep apnea and retinal signs in cardiovascular disease: the Multi-Ethnic Study of Atherosclerosis

et al. 2015

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Purpose The aim of the study was to examine the relationship between sleep apnea, retinal vascular caliber and retinopathy, and their impact on cardiovascular disease (CVD) risk. Methods A multi-ethnic cohort of 5,803 participants was examined based on standardized grading of retinal vascular caliber and retinopathy from digital fundus photographs, self-reported physician-diagnosed sleep apnea (PDSA), and incident cardiovascular events. Results In women, PDSA was associated with narrower arterioles (regression coefficient [β] −5.76; 95 % confidence Interval [CI] −8.51, −3.02) after adjusting for cardio-metabolic risk factors. The incident rate ratio (IRR) of CVD was also associated with narrower arterioles (IRR for highest versus lowest tertile 1.91; 95 % CI 1.08, 3.38). In men, PDSA was not associated with arteriolar caliber. However, incident CVD was associated with narrower arterioles (IRR 1.67; 95 % CI 1.10, 2.52), wider venules (IRR 1.71; 95% CI 1.13, 2.59) and PDSA (IRR 2.03, 95 % CI 1.17, 3.51). The IRR of CVD in men with PDSA increased minimally to 2.06 (95 % CI 1.18, 3.56) after adjustment for retinal arteriolar and venular caliber. Combining women and men, the IRR of CVD was 3.41 (95 % CI 1.79, 6.50) in those with both PDSA and narrower retinal arterioles. Conclusions Sleep apnea was associated with narrower retinal arterioles in women but not in men. However, sleep apnea was also associated with incident CVD in men. These suggest potential gender differences in susceptibility to microvascular disease in association with sleep apnea.

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Section: Discussionmentioning

confidence: 72%

Sleep apnea and retinal signs in cardiovascular disease: the Multi-Ethnic Study of Atherosclerosis

et al. 2015

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“…In rodents, sleep disruption and intermittent hypoxia (features of sleep disordered breathing) increase amyloid production and deposition (Kang et al, 2009; Shiota et al, 2013). We chose not to consider diagnosis of sleep disorders in this analysis because obstructive sleep apnea is underdiagnosed (Kapur et al, 2002). We measured self-reported symptoms, however sleep disordered breathing can be present without awareness or endorsement of symptoms (Gooneratne and Vitiello, 2014; Halász et al, 2004).…”

Section: Discussionmentioning

confidence: 99%

Amyloid burden is associated with self-reported sleep in nondemented late middle-aged adults

Sprecher

Bendlin

Racine

et al. 2015

Neurobiology of Aging

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Midlife may be an ideal window for intervention in Alzheimer’s disease (AD). To determine whether sleep is associated with early signs of AD neuropathology (amyloid deposition) in late midlife, we imaged brain amyloid deposits using Positron Emission Tomography (PET) with [C-11]Pittsburgh Compound B (PiB), and assessed sleep with the Epworth Sleepiness Scale (ESS) and the Medical Outcomes Study (MOS) Sleep Scale in 98 cognitively healthy adults (aged 62.4 ± 5.7 years) from the Wisconsin Registry for Alzheimer’s Prevention. We used multiple regression to test the extent to which sleep scores predicted regional amyloid burden. Participants reporting less adequate sleep, more sleep problems and greater somnolence on the MOS had greater amyloid burden in AD-sensitive brain regions (angular gyrus, frontal medial orbital cortex, cingulate gyrus and precuneus). Amyloid was not associated with reported sleep amount, symptoms of sleep disordered breathing, trouble falling asleep or ESS. Poor sleep may be a risk factor for AD and a potential early marker of AD or target for preventative interventions in mid-life.

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“…Barriers to referral for specialty care by insurance status and location also may lead to persistent disparities. The limited training of primary care providers in sleep medicine contributes to the high proportion of patients with OSA and insomnia who are not diagnosed or treated adequately (83). Disparities in care and outcomes are likely to worsen without interventions to improve access.…”

Section: A Conceptual Framework For the Role Of Sleep In Cardiovasculmentioning

confidence: 99%

Sleep as a Potential Fundamental Contributor to Disparities in Cardiovascular Health

Jackson

Redline

Emmons

2015

Annu. Rev. Public Health

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Optimal sleep is integral to health but is commonly not obtained. Despite its wide ranging public health impact, sleep health is under-appreciated by the general public and is only rarely considered by policy makers, employers, schools, and others whose policies and structures can adversely affect sleep. Inadequate sleep duration and quality are prevalent in minority and low-income populations and may play a fundamental role in racial and socioeconomic status (SES) inequities for a wide range of health conditions including cardiovascular disease (CVD).The goal of this review is to examine the relationship between sleep and CVD health disparities. To this end, we describe the overall public health importance of sleep and the role of sleep duration as well as the two most common disorders (sleep apnea and insomnia) as risk factors for a number of chronic diseases. We then focus on the potential link between sleep and CVD disparities. A multilevel model developed for the analysis of population health and health disparities as a part of the National Cancer Institute’s Centers on Population Health and Health Disparities served as our conceptual framework. It is based on the notion that individual behaviors, like sleep, are influenced by complex and dynamic interrelations among the individual and his or her physical and social environments across the lifespan. Using this model, we describe modifiable factors that contribute to insufficient sleep and circadian misalignment, propose potential interventions in various sectors (e.g. neighborhoods, schools, workplaces) that address social structures that contribute to disparities, and conclude by recommending critical areas for future sleep research. We ultimately suggest that integrating sleep into public health research will identify novel approaches for closing the gap in health disparities, such as CVD.

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Underdiagnosis of Sleep Apnea Syndrome in U.S. Communities

Cited by 261 publications

References 14 publications

Sleep apnea and retinal signs in cardiovascular disease: the Multi-Ethnic Study of Atherosclerosis

Sleep apnea and retinal signs in cardiovascular disease: the Multi-Ethnic Study of Atherosclerosis

Amyloid burden is associated with self-reported sleep in nondemented late middle-aged adults

Sleep as a Potential Fundamental Contributor to Disparities in Cardiovascular Health

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