Sleep-Disordered Breathing and Nocturnal Hypoxemia in Precapillary Pulmonary Hypertension: Prevalence, Pathophysiological Determinants, and Clinical Consequences

Respiration ◽  
2021 ◽  
pp. 1-12
Author(s):  
Jens Spiesshoefer ◽  
Simon Herkenrath ◽  
Katharina Harre ◽  
Florian Kahles ◽  
Anca Florian ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Sleep Apnea ◽  
Sleep Quality ◽  
Sleep Disordered Breathing ◽  
Central Sleep Apnea ◽  
Apnea Hypopnea Index ◽  
Amino Terminal ◽  
Nocturnal Hypoxemia ◽  
Obstructive Sleep ◽  
Disordered Breathing

<b><i>Background and objective:</i></b> The clinical relevance and interrelation of sleep-disordered breathing and nocturnal hypoxemia in patients with precapillary pulmonary hypertension (PH) is not fully understood. <b><i>Methods:</i></b> Seventy-one patients with PH (age 63 ± 15 years, 41% male) and 35 matched controls were enrolled. Patients with PH underwent clinical examination with assessment of sleep quality, daytime sleepiness, 6-minute walk distance (6MWD), overnight cardiorespiratory polygraphy, lung function, hypercapnic ventilatory response (HCVR; by rebreathing technique), amino-terminal pro-brain natriuretic peptide (NT-proBNP) levels, and cardiac MRI (<i>n</i> = 34). <b><i>Results:</i></b> Prevalence of obstructive sleep apnea (OSA) was 68% in patients with PH (34% mild, apnea-hypopnea index [AHI] ≥5 to &#x3c;15/h; 34% moderate to severe, AHI ≥15/h) versus 5% in controls (<i>p</i> &#x3c; 0.01). Only 1 patient with PH showed predominant central sleep apnea (CSA). Nocturnal hypoxemia (mean oxygen saturation [SpO<sub>2</sub>] &#x3c;90%) was present in 48% of patients with PH, independent of the presence of OSA. There were no significant differences in mean nocturnal SpO<sub>2</sub>, self-reported sleep quality, 6MWD, HCVR, and lung and cardiac function between patients with moderate to severe OSA and those with mild or no OSA (all <i>p</i> &#x3e; 0.05). Right ventricular (RV) end-diastolic (<i>r</i> = −0.39; <i>p</i> = 0.03) and end-systolic (<i>r</i> = −0.36; <i>p</i> = 0.04) volumes were inversely correlated with mean nocturnal SpO<sub>2</sub> but not with measures of OSA severity or daytime clinical variables. <b><i>Conclusion:</i></b> OSA, but not CSA, is highly prevalent in patients with PH, and OSA severity is not associated with nighttime SpO<sub>2</sub>, clinical and functional status. Nocturnal hypoxemia is a frequent finding and (in contrast to OSA) relates to structural RV remodeling in PH.

scholarly journals 0968 Sleep-disordered Breathing In Schaaf-yang Syndrome

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A367-A368
Author(s):  
W Powell ◽  
M Rech ◽  
C Schaaf ◽  
J Wrede
Keyword(s):  
Sleep Apnea ◽  
Sleep Disordered Breathing ◽  
Central Sleep Apnea ◽  
Sleep Time ◽  
Sleep Stages ◽  
Apnea Hypopnea Index ◽  
Sleep Study ◽  
Central Index ◽  
Obstructive Sleep ◽  
Disordered Breathing

Abstract Introduction Schaaf-Yang Syndrome (SYS) is a genetic disorder caused by truncating variants in the MAGEL2 gene located in the maternally imprinted, paternally expressed Prader-Willi syndrome (PWS) region at 15q11-13. The SYS phenotype shares features with PWS, a disorder with known high incidence of central and obstructive sleep apnea (OSA). However the spectrum of sleep-disordered breathing in SYS has not been described. Methods We performed a retrospective analysis of polysomnograms from 22 of the known 115 patients with molecular diagnosis of SYS. Sleep characteristics including total sleep time, latency, efficiency, % sleep stages, apnea-hypopnea index (AHI), obstructive index, central index, and oxygenation were analyzed for the whole group and by truncation location (c.1996dupC variants [n=11] or other locations [n=11]). Only the initial diagnostic study or initial diagnostic portion of a split-night study was used in analysis (analytic n=21). Results We collected 33 sleep study reports from 22 patients, ages 2 months - 18.5 years. Mean analyzed sleep time was 357 minutes (129-589 min) with mean sleep efficiency of 71.45% (45-94%) and sleep latency of 24.8 minutes (0-146 min). The mean apnea-hypopnea index (AHI) was 19.1/hr (0.9 -49/hr) with mean obstructive AHI of 16.3 (0.6-49/hr). Mean central index was 2.8/hr (0-14/hr). 18/21 (86%) were diagnosed with OSA, and 13/21 (62%) with moderate or severe OSA (oAHI &gt;5/hr). Central sleep apnea was diagnosed in 2/21 (9.5%). 15 studies reported periodic limb movement index (PLMI) with mean of 7.8 (0-67/hr) and 4/15 (26%) with PLMI &gt;5. Comparison of genotype groups did not reveal any difference in presence of OSA or severity of OSA. Conclusion OSA is frequently identified on polysomnography in patients with SYS. Central sleep apnea is less common, which is in contrast to PWS. The majority of patients with OSA had moderate or severe OSA, and 47% had severe OSA. Support N/A

Postoperative Changes in Sleep-disordered Breathing and Sleep Architecture in Patients with Obstructive Sleep Apnea

2014 ◽  
Vol 120 (2) ◽  
pp. 287-298 ◽  
Author(s):  
Frances Chung ◽  
Pu Liao ◽  
Balaji Yegneswaran ◽  
Colin M. Shapiro ◽  
Weimin Kang
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Sleep Disordered Breathing ◽  
Slow Wave Sleep ◽  
Sleep Architecture ◽  
Secondary Outcome ◽  
Apnea Hypopnea Index ◽  
Postoperative Changes ◽  
Obstructive Sleep ◽  
Disordered Breathing

Abstract Background: Anesthetics, analgesics, and surgery may profoundly affect sleep architecture and aggravate sleep-related breathing disturbances. The authors hypothesized that patients with preoperative polysomnographic evidence of obstructive sleep apnea (OSA) would experience greater changes in these parameters than patients without OSA. Methods: After obtaining approvals from the Institutional Review Boards, consented patients underwent portable polysomnography preoperatively and on postoperative nights (N) 1, 3, 5, and 7 at home or in hospital. The primary and secondary outcome measurements were polysomnographic parameters of sleep-disordered breathing and sleep architecture. Results: Of the 58 patients completed the study, 38 patients had OSA (apnea hypopnea index [AHI] &gt;5) with median preoperative AHI of 18 events per hour and 20 non-OSA patients had median preoperative AHI of 2. AHI was increased after surgery in both OSA and non-OSA patients (P &lt; 0.05), with peak increase on postoperative N3 (OSA vs. non-OSA, 29 [14, 57] vs. 8 [2, 18], median [25th, 75th percentile], P &lt; 0.05). Hypopnea index accounted for 72% of the postoperative increase in AHI. The central apnea index was low (median = 0) but was significantly increased on postoperative N1 in only non-OSA patients. Sleep efficiency, rapid eye movement sleep, and slow-wave sleep were decreased on N1 in both groups, with gradual recovery. Conclusions: Postoperatively, sleep architecture was disturbed and AHI was increased in both OSA and non-OSA patients. Although the disturbances in sleep architecture were greatest on postoperative N1, breathing disturbances during sleep were greatest on postoperative N3.

scholarly journals P.069 Respiratory dysfunction and sleep disordered breathing in children with Myasthenia Gravis

2018 ◽  
Vol 45 (s2) ◽  
pp. S34-S34
Author(s):  
HF Qashqari ◽  
I Narang ◽  
H Katzberg ◽  
K Vezina ◽  
A Khayat ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Myasthenia Gravis ◽  
Sleep Disordered Breathing ◽  
Pediatric Population ◽  
Respiratory Muscles ◽  
Apnea Hypopnea Index ◽  
Respiratory Dysfunction ◽  
Obstructive Sleep ◽  
Disordered Breathing

Background: Myasthenia Gravis ( MG) is an autoimmune disease that affects the neuromuscular junction. It typically presents with fluctuating muscle weakness which can affect respiratory muscles. Data about the prevalence of sleep disordered breathing in children with MG and the benefits of non-invasive ventilation outside the setting of MG crisis has not been studied so far. Methods: Eleven children between 3 and 18 years old with confirmed MG were recruited from the The Hospital for Sick Children Neuromuscular clinic in a prospective observational study. Informed consent was obtained and patients underwent PFTs, MIP/MEP, SNIP, FVC and standard polysomnography testing’s. Results: In our study, we found that 2/11 children had abnormal Apnea Hypopnea index (AHI) and were diagnosed with obstructive sleep apnea (OSA). One of them has juvenile ocular MG with mild to moderate OSA and the second child has congenital MG with mild OSA. CPAP therapy was initiated for both patients. Conclusions: In our cohort, obstructive sleep apnea rate was significantly higher in children with MG than the known prevalence in general pediatric population ( 18% vs 2-3% ). Early diagnosis and management of OSA can have great impact on children’s health and quality of life. A larger study is needed to validate our findings.

scholarly journals Sleep-disordered Breathing in Uncontrolled Blood Pressure: Our Experience

2018 ◽  
Vol 1 (1) ◽  
pp. 36-38
Author(s):  
Milesh Jung Sijapati ◽  
Minalma Pandey ◽  
Nirupama Khadka ◽  
Poojyashree Karki
Keyword(s):  
Blood Pressure ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Sleep Disordered Breathing ◽  
Central Sleep Apnea ◽  
Upper Airway Resistance Syndrome ◽  
Uncontrolled Blood Pressure ◽  
Antihypertensive Regimen ◽  
Obstructive Sleep ◽  
Disordered Breathing

Introduction: Sleep-disordered breathing is one of the greatest health problems. It comprises of obstructive sleep apnea, central sleep apnea, periodic breathing, and upper airway resistance syndrome. There are several studies reporting association of uncontrolled blood pressurewith individuals having sleep disordered breathing. Data regarding this were sparse in developing countries. Therefore this study was performed to find out the sleep-disordered breathing among uncontrolled hypertensive patients.Materials and Methods: Study was performed from January, 2014 to January, 2017 in sleep center in Kathmandu, Nepal. Patient with uncontrolled BP were included. Uncontrolled BP was defined as blood pressure>130/80mmHg not on intensive antihypertensive regimen and resistant elevated BP was defined as blood pressure >130/80 mmHg despite intensive antihypertensive regimen. These patients were subjected for polysomnography.Results: Three hundred patients were selected out of which 250 patients with uncontrolled blood pressure were included. They were subjected for overnight polysomnography. Among them, 70patients (28%)were found to have mild obstructive sleep apnea, 20 patients had moderate obstructive sleep apnea (8%)&15 had severe obstructive sleep apnea (6%).Conclusions: This study concludes that those individuals having uncontrolled blood pressure has obstructive sleep apnea and these individuals have to undergo polysomnography.Nepalese Medical Journal, vol.1, No. 1, 2018, page: 36-38

scholarly journals Canadian Thoracic Society 2011 Guideline Update: Diagnosis and Treatment of Sleep Disordered Breathing

2011 ◽  
Vol 18 (1) ◽  
pp. 25-47 ◽  
Author(s):  
John Fleetham ◽  
Najib Ayas ◽  
Douglas Bradley ◽  
Michael Fitzpatrick ◽  
Thomas K Oliver ◽  
...  
Keyword(s):  
Sleep Apnea ◽  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Sleep Disordered Breathing ◽  
Positive Airway Pressure ◽  
Sleep Apnea Syndrome ◽  
Central Sleep Apnea ◽  
Diagnosis And Treatment ◽  
Obstructive Sleep ◽  
Disordered Breathing

The Canadian Thoracic Society (CTS) published an executive summary of guidelines for the diagnosis and treatment of sleep disordered breathing in 2006/2007. These guidelines were developed during several meetings by a group of experts with evidence grading based on committee consensus. These guidelines were well received and the majority of the recommendations remain unchanged. The CTS embarked on a more rigorous process for the 2011 guideline update, and addressed eight areas that were believed to be controversial or in which new data emerged. The CTS Sleep Disordered Breathing Committee posed specific questions for each area. The recommendations regarding maximum assessment wait times, portable monitoring, treatment of asymptomatic adult obstructive sleep apnea patients, treatment with conventional continuous positive airway pressure compared with automatic continuous positive airway pressure, and treatment of central sleep apnea syndrome in heart failure patients replace the recommendations in the 2006/2007 guidelines. The recommendations on bariatric surgery, complex sleep apnea and optimum positive airway pressure technologies are new topics, which were not covered in the 2006/2007 guidelines.

Looking both ways before crossing the street: Assessing the benefits and risk of opioids in treating patients at risk of sleep disordered breathing for pain and dyspnea

2017 ◽  
Vol 13 (3) ◽  
pp. 183 ◽  
Author(s):  
Mellar P. Davis, MD, FCCP, FAAHPM ◽  
Bertrand Behm, MD ◽  
Diwakar Balachandran, MD
Keyword(s):  
At Risk ◽  
Sleep Apnea ◽  
Cardiovascular Events ◽  
Sleep Disordered Breathing ◽  
Central Sleep Apnea ◽  
Chronic Obstructive ◽  
Chronic Noncancer Pain ◽  
Obstructive Sleep ◽  
Increased Risk ◽  
Disordered Breathing

Opioids adversely influence respiration in five distinct ways. Opioids reduce the respiratory rate, tidal volume, amplitude, reflex responses to hypercapnia and hypoxia, and arousability related necessary for respiratory adaptive responses. Opioids cause impairment of upper pharyngeal dilator muscles leading to obstructive apnea. Opioids cause complex sleep disordered breathing (SDB) consisting of central sleep apnea and obstructive sleep apnea. Clinically opioids worsen preexisting SDB. Recent studies have shown increased morbidity and mortality in patients receiving opioids for chronic noncancer pain and chronic obstructive pulmonary disease, which appear to be related to cardiovascular events, not overdose. Both patient populations are at risk for sleep disordered breathing and increased risk for adverse cardiovascular events on opioids for dyspnea or pain. This review discusses the influence of opioids on respiration and SDB and will review the adverse respiratory and cardiovascular effects of opioid use in at risk populations. Recommendations regarding management will follow as a summary.

scholarly journals The Association between Sleep-Disordered Breathing and Magnetic Resonance Imaging Findings in a Pediatric Cohort with Chiari 1 Malformation

2015 ◽  
Vol 22 (1) ◽  
pp. 31-36 ◽  
Author(s):  
Reshma Amin ◽  
Priya Sayal ◽  
Aarti Sayal ◽  
Colin Massicote ◽  
Robin Pham ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Sleep Disordered Breathing ◽  
Clinical Symptoms ◽  
Apnea Hypopnea Index ◽  
Imaging Findings ◽  
Tonsillar Herniation ◽  
Predominant Type ◽  
Obstructive Sleep ◽  
Disordered Breathing

BACKGROUND: The prevalence of sleep-disordered breathing (SDB) reported in the literature for Chiari malformation type 1 (CM1) is uniformly high (24% to 70%). In Canada, there is limited access to pediatric polysomnography (PSG). Therefore, the identification of clinical features would be invaluable for triaging these children.OBJECTIVE: To identify demographic features, clinical symptoms/signs and radiological findings associated with SDB in a large pediatric cohort with CM1.METHODS: A retrospective review was conducted on children with CM1 who underwent baseline PSG. Data were collected on patient demographics (age, sex, weight, height, body mass index), clinical symptoms (chart review and clinical questionnaires), diagnostic imaging of the brain and cervicothoracic spine, and medical history at the time of referral.RESULTS: A total of 68 children were included in the review. The mean (± SD) age of the children at the time of PSG was 7.33±4.01 years; 56% (n=38) were male. There was a 49% prevalence of SDB in this cohort based on the overall apnea-hypopnea index. Obstructive sleep apnea was the predominant type of SDB. Tonsillar herniation was significantly correlated with obstructive apnea-hypopnea index (r=0.24; P=0.036).CONCLUSIONS: A direct relationship between the degree of cerebellar tonsillar herniation and obstructive sleep apnea was demonstrated. However, further prospective studies that include neurophysiological assessment are needed to further translate the central nervous system imaging findings to predict the presence of SDB.

scholarly journals Sleep-Disordered Breathing During Congestive Heart Failure: To Intervene or Not to Intervene?

2017 ◽  
Vol 3 (2) ◽  
pp. 134 ◽  
Author(s):  
Ali Valika ◽  
Maria Rosa Costanzo ◽  
◽  
Keyword(s):  
Heart Failure ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Ejection Fraction ◽  
Sleep Disordered Breathing ◽  
Treatment Strategies ◽  
Central Sleep Apnea ◽  
Reduced Ejection Fraction ◽  
Obstructive Sleep ◽  
Disordered Breathing

Sleep-disordered breathing is common in heart failure patients and is associated with increased morbidity and mortality. Central sleep apnea occurs more commonly in heart failure-reduced ejection fraction, and obstructive sleep apnea occurs more frequently in heart failure with preserved ejection fraction. Although the two types of sleep-disordered breathing have distinct pathophysiologic mechanisms, both contribute to abnormal cardiovascular consequences. Treatment with continuous positive airway pressure for obstructive sleep apnea in heart failure has been well defined, whereas treatment strategies for central sleep apnea in heart failure continue to evolve. Unilateral transvenous neurostimulation has shown promise for the treatment of central sleep apnea. In this paper, we examine the current state of knowledge of treatment options for sleep-disordered breathing in heart failure.

Sleep-disordered breathing in adult patients with mitochondrial diseases

Neurology ◽  
2020 ◽  
pp. 10.1212/WNL.0000000000011005
Author(s):  
Guido Primiano ◽  
Valerio Brunetti ◽  
Catello Vollono ◽  
Anna Losurdo ◽  
Rossana Moroni ◽  
...  
Keyword(s):  
Sleep Apnea ◽  
Sleep Disordered Breathing ◽  
Prospective Observational Study ◽  
Central Sleep Apnea ◽  
Mitochondrial Diseases ◽  
Population Based ◽  
Genotype Combination ◽  
Obstructive Sleep ◽  
Specific Subgroup ◽  
Disordered Breathing

ObjectiveTo describe the prevalence and characteristics of sleep-disordered breathing (SDB) in a large cohort of patients with genetically confirmed mitochondrial diseases.MethodsThis is a prospective observational study performed at the Neurophysiopatology Unit of Fondazione Policlinico Universitario A. Gemelli IRCCS. All subjects had a defined mitochondrial disease and were investigated by full night polysomnography.Results103 consecutive patients were enrolled. SDB was demonstrated in 49 patients (47.6%). Regarding phenotypes, we found differences in distribution between the groups: patients affected by PEO with single or multiple mtDNA deletions frequently had obstructive apneas (50% and 43.8%) or REM-related hypoventilation when associated with m.3243A>G mutations (75%). Furthermore, a high percentage of subjects with MIDD and MERRF syndromes were characterized respectively by obstructive sleep apnea and REM-related hypoventilation. Differently from what is previously reported, central sleep apnea was rarely reported in our cohort.ConclusionsSDB has a higher prevalence in MDs compared to general population-based data. Overall, these results suggest that patients characterized by a specific phenotype-genotype combination are most at risk of developing a specific subgroup of SDB. The early identification of this disorder is crucial in the management of these fragile patients.

Sleep-disordered breathing in patients on opioids for chronic pain

2020 ◽  
Vol 45 (10) ◽  
pp. 826-830
Author(s):  
Janannii Selvanathan ◽  
Philip W H Peng ◽  
Jean Wong ◽  
Clodagh M Ryan ◽  
Frances Chung
Keyword(s):  
Chronic Pain ◽  
Sleep Apnea ◽  
Sleep Disordered Breathing ◽  
Clinical Care ◽  
Central Sleep Apnea ◽  
Well Being ◽  
Pressure Therapy ◽  
Obstructive Sleep ◽  
Pain Clinics ◽  
Disordered Breathing

The past two decades has seen a substantial rise in the use of opioids for chronic pain, along with opioid-related mortality and adverse effects. A contributor to opioid-associated mortality is the high prevalence of moderate/severe sleep-disordered breathing, including central sleep apnea and obstructive sleep apnea, in patients with chronic pain. Although evidence-based treatments are available for sleep-disordered breathing, patients are not frequently assessed for sleep-disordered breathing in pain clinics. To aid healthcare providers in this area of clinical uncertainty, we present evidence on the interaction between opioids and sleep-disordered breathing, and the prevalence and predictive factors for sleep-disordered breathing in patients on opioids for chronic pain. We provide recommendations on how to evaluate patients on opioids for risk of moderate/severe sleep-disordered breathing in clinical care, which could lead to earlier use of therapeutic interventions for opioid-associated sleep-disordered breathing, such as opioid cessation or positive airway pressure therapy. This would improve quality of life and well-being of patients with chronic pain.

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