RESUMEN
Many patients with obstructive sleep apnea (OSA), but not all, have a reduction in blood pressure (BP) with positive airway pressure (PAP) treatment. Our objective was to determine whether the BP response following PAP treatment is related to obesity. A total of 188 adults with OSA underwent 24-hour BP monitoring and 24-hour urinary norepinephrine collection at baseline. Obesity was assessed by waist circumference, body mass index, and abdominal visceral fat volume. Participants adherent to PAP treatment were reassessed after 4 months. Primary outcomes were 24-hour mean arterial pressure (MAP) and 24-hour urinary norepinephrine level. Obstructive sleep apnea participants had a significant reduction in 24-hour MAP following PAP treatment (-1.22 [95% CI: -2.38, -0.06] mm Hg; P = .039). No significant correlations were present with any of the 3 obesity measures for BP or urinary norepinephrine measures at baseline in all OSA participants or for changes in BP measures in participants adherent to PAP treatment. Changes in BP measures following treatment were not correlated with baseline or change in urinary norepinephrine. Similar results were obtained when BP or urinary norepinephrine measures were compared between participants dichotomized using the sex-specific median of each obesity measure. Greater reductions in urinary norepinephrine were correlated with higher waist circumference (rho = -0.21, P = .037), with a greater decrease from baseline in obese compared to non-obese participants (-6.26 [-8.82, -3.69] vs -2.14 [-4.63, 0.35] ng/mg creatinine; P = .027). The results indicate that the BP response to PAP treatment in adults with OSA is not related to obesity or urinary norepinephrine levels.
Asunto(s)
Presión Sanguínea/fisiología , Norepinefrina/orina , Obesidad/complicaciones , Apnea Obstructiva del Sueño/metabolismo , Apnea Obstructiva del Sueño/fisiopatología , Presión Arterial/fisiología , Monitoreo Ambulatorio de la Presión Arterial/métodos , Índice de Masa Corporal , Estudios de Casos y Controles , Presión de las Vías Aéreas Positiva Contínua/métodos , Femenino , Humanos , Islandia/epidemiología , Grasa Intraabdominal/crecimiento & desarrollo , Masculino , Persona de Mediana Edad , Obesidad/epidemiología , Apnea Obstructiva del Sueño/terapia , Sistema Nervioso Simpático/fisiopatología , Circunferencia de la Cintura/fisiologíaRESUMEN
STUDY OBJECTIVES: Few studies have objectively evaluated sleep characteristics during pregnancy or investigated the relationship between altered spectral electroencephalogram (EEG) bands and sleep-disordered breathing (SDB). The study aimed to describe changes in sleep as measured by polysomnography (PSG) and spectral EEG bands during pregnancy and to examine the relationship between delta power in non-rapid eye movement (NREM) sleep and SDB. METHODS: This is a secondary analysis of a prospective study. One hundred twenty-three women underwent full PSG in early pregnancy, and 97 repeated PSG in late pregnancy. Spectral analysis of the EEG in NREM sleep was performed. We used linear and logistic mixed-model regression to analyze the sleep measures and linear regression to explore the association between delta power and apnea-hypopnea index (AHI) changes during pregnancy. RESULTS: In late pregnancy, women had shorter sleep duration, poorer sleep efficiency, more awakenings, more stage N2 sleep, less slow wave sleep, less REM sleep, higher AHI, and higher periodic limb movement index compared to early pregnancy. The percentage of stage N1 sleep, sleep latency, REM sleep latency, and arousal index frequency did not change. Regarding EEG-spectra, delta and theta powers decreased, but beta-2 power increased during pregnancy. In multivariable analyses, greater reduction of delta power was associated with larger increases in AHI (ß [95% confidence interval] = -0.038 [-0.073, -0.002], P = .040). Estimates suggest that each one-unit increase in AHI reduces delta power by 4% in late pregnancy. CONCLUSIONS: PSG-measured sleep characteristics change during pregnancy. Delta power decreases when the severity of SDB increases during pregnancy. COMMENTARY: A commentary on this article appears in this issue on page 1095.
Asunto(s)
Electroencefalografía/estadística & datos numéricos , Polisomnografía/estadística & datos numéricos , Complicaciones del Embarazo/fisiopatología , Síndromes de la Apnea del Sueño/fisiopatología , Fases del Sueño/fisiología , Adulto , Femenino , Humanos , Estudios Longitudinales , Pennsylvania , Embarazo , Complicaciones del Embarazo/diagnóstico , Primer Trimestre del Embarazo , Tercer Trimestre del Embarazo , Estudios Prospectivos , Síndromes de la Apnea del Sueño/diagnósticoRESUMEN
OBJECTIVE: To evaluate joint task force criteria-based screening for severe obstructive sleep apnea (s-OSA) in commercial drivers. METHODS: Among a community-based cohort of licensed commercial vehicle drivers, we assessed utility of the joint task force criteria. We conducted full, 14-channel overnight polysomnography in all drivers, defining s-OSA as an apnea-hypopnea index of 30 or more per hour. RESULTS: One hundred of 104 drivers with successful polysomnography studies were predominantly obese (median body mass index = 32.8 kg/m; interquartile range = 26.8 to 37.4) and had a median apnea-hypopnea index of 20.6 per hour (interquartile range = 10.0 to 34.2). Examination-based criteria were more effective (sensitivity = 80%; negative posttest probability [nPTP] = 17%) than symptom-based criteria (sensitivity = 63%; nPTP = 23%). Examination and symptom-based criteria combined had high sensitivity (97%) and low nPTP (7%), but poor specificity (19%). CONCLUSIONS: Examination-based criteria missed 20% of s-OSA cases. Combining examination with confidentially reported symptoms improved sensitivity but required confirmatory polysomnography in 86%, supporting universal screening of all drivers.
Asunto(s)
Conducción de Automóvil , Tamizaje Masivo/métodos , Enfermedades Profesionales/diagnóstico , Examen Físico , Polisomnografía , Apnea Obstructiva del Sueño/diagnóstico , Adolescente , Adulto , Comités Consultivos , Anciano , Índice de Masa Corporal , Femenino , Humanos , Masculino , Persona de Mediana Edad , Obesidad/complicaciones , Obesidad/diagnóstico , Enfermedades Profesionales/epidemiología , Enfermedades Profesionales/etiología , Pennsylvania/epidemiología , Guías de Práctica Clínica como Asunto , Prevalencia , Estudios Prospectivos , Factores de Riesgo , Autoinforme , Sensibilidad y Especificidad , Índice de Severidad de la Enfermedad , Método Simple Ciego , Apnea Obstructiva del Sueño/epidemiología , Apnea Obstructiva del Sueño/etiología , Adulto JovenRESUMEN
Older adults have high prevalence rates of insomnia symptoms, yet it is unclear if these insomnia symptoms are associated with objective impairments in sleep. We hypothesized that insomnia complaints in older adults would be associated with objective differences in sleep compared with those without insomnia complaints. To test this hypothesis, we conducted a cross-sectional study in which older adults with insomnia complaints (cases, n=100) were compared with older adults without insomnia complaints (controls, n=100) using dual-night in-lab nocturnal polysomnography, study questionnaires and 7 days of at-home actigraphy and sleep diaries. Cases were noted to have reduced objective total sleep time compared with controls (25.8 ± 8.56 min, P=0.003). This was largely due to increased wakefulness after sleep onset, and not increased sleep latency. When participants with sleep-related breathing disorder or periodic limb movement disorder were excluded, the polysomnography total sleep time difference became even larger. Cases also had reduced slow-wave sleep (5.10 ± 1.38 min versus 10.57 ± 2.29 min, effect size -0.29, P=0.04). When comparing self-reported sleep latency and sleep efficiency with objective polysomnographic findings, cases demonstrated low, but statistically significant correlations, while no such correlations were observed in controls. Cases tended to underestimate their sleep efficiency by 1.6% (±18.4%), while controls overestimated their sleep efficiency by 12.4% (±14.5%). In conclusion, we noted that older adults with insomnia complaints have significant differences in several objective sleep findings relative to controls, suggesting that insomnia complaints in older adults are associated with objective impairments in sleep.