Sleep Apnea Increases Amyloid Load In Brain, A Hallmark of Alzheimer’s Disease

MedicalResearch.com Interview with:

Ricardo S Osorio MD Center for Brain Health Department of Psychiatry Center of Excellence on Brain Aging NYU Langone Medical Center New York, NY 10016, USA

Dr. Osorio

Ricardo S Osorio MD
Center for Brain Health
Department of Psychiatry
Center of Excellence on Brain Aging
NYU Langone Medical Center
New York, NY 10016, USA 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: This was a study that was performed in a group of healthy normal elderly from the community that volunteered for studies on memory and aging.

The main findings were that sleep apnea was very common, in almost all cases undiagnosed, and that it was associated with a longitudinal increase in amyloid burden which is considered one of the hallmark lesions of Alzheimer’s disease

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Women With Severe Hot Flashes At Higher Risk of Obstructive Sleep Apnea

MedicalResearch.com Interview with:
Stephanie S. Faubion, MD, FACP, NCMP, IF
Director, Executive and International Medicine
Director, Office of Women’s Health
Associate Professor of Medicine
Division of General Internal Medicine 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The Data Registry on Experiences of Aging, Menopause and Sexuality (DREAMS) was used for this study investigating the association between vasomotor symptoms (hot flashes and night sweats) and risk for obstructive sleep apnea, a common and underdiagnosed sleep disorder in women which is associated with increased cardiovascular risk.

We found that Women who had severe or very severe hot flashes or night sweats were more likely to be at increased risk for obstructive sleep apnea.  This association held even after adjusting for age, body mass index, smoking and hypertension, such that the odds of women having intermediate /high risk for obstructive sleep apnea were 1.87 times higher for those with severe/very severe hot flashes/night sweats compared to those with less severe symptoms.  We decided to analyze the group of women with normal body mass index, and indeed, this finding was still significant in the lean group of women.

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Sleep-Disordered Breathing Associated With Increased Risk of Cognitive Impairment

MedicalResearch.com Interview with:
Yue Leng, M.Phil, MD, PhD

Postdoctoral Research Fellow
Department of Psychiatry,
University of California, San Francisco
SFVAMC 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Sleep-disordered breathing (SDB) is a very common but treatable condition in older adults. Recent evidence has suggested a link between SDB and cognitive decline in the elderly, but previous studies have been conflicting and have used different methods to examine SDB or cognition. Therefore, it is difficult to draw conclusion on the consistency of this association based on each individual study. Moreover, because each study has reported on specific domains using different scales, it is unclear if Sleep-disordered breathing has differential effects on cognitive domains.

The current study is the first to quantitively synthesize all published population-based studies, which covers a total of over 4 million adults, and concluded that people with Sleep-disordered breathing were 26% more likely to develop cognitive impairment than those without SDB. They also had slightly worse performance in executive function but not in global cognition or memory.  Continue reading

Adaptive Servo-Ventilation Therapy Has Variable Effects in Heart Failure Patients

MedicalResearch.com Interview with:

Christopher M. O’Connor, MD FACC  CEO and Executive Director,  Inova Heart & Vascular Institute IHVI Administration Falls Church, Virginia 22042

Dr. Christopher O’Connor

Christopher M. O’Connor, MD FACC 
CEO and Executive Director,
Inova Heart & Vascular Institute
IHVI Administration
Falls Church, Virginia 22042

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Sleep apnea is a very common comorbidity of patients with heart failure (both reduced ejection fraction and preserved ejection fraction). Early evidence from observational and small studies suggested that treating sleep apnea with adaptive servo-ventilation (ASV) therapy may improve patient outcomes. There is minimal clinical evidence about identifying and treating sleep apnea in those who’ve been hospitalized with acute decompensated heart failure. The CAT-HF study was designed to help address this, with the primary endpoint being cardiovascular outcomes measured as a Global Rank Score that included survival free from cardiovascular hospitalization and change in functional capacity as measured by the six-minute walk distance. It was also planned to expand on the SERVE-HF study that was investigating the use of ASV therapy to treat central sleep apnea (CSA) in chronic stable heart failure patients with reduced ejection fraction patients (HFrEF).

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Drug-Induced Sleep Endoscopy With Cardiorespiratory Monitoring For OSA

MedicalResearch.com Interview with:

Dr. Simone Baiardi MD Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna

Dr. Simone Baiardi

Dr. Simone Baiardi MD
Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum
University of Bologna

MedicalResearch.com: What is the background for this study?

Response: Drug-induced sleep endoscopy (DISE) is an useful tool for studying the upper airway dynamic in patients with obstructive sleep apnea syndrome (OSAS), and it’s crucial for the therapeutic choice (especially for non ventilatory treatment, such as surgery). The main limits of DISE are the lack of standardization of procedure and the low inter-observer reliability among non-experienced ENT surgeons.

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Vitamin D Level Likely Has No Impact on Sleep Apnea

Ken M. Kunisaki , MD Associate Professor of Medicine Pulmonary, Allergy, Critical Care and Sleep Medicine University of Minnesota

Dr. Kunisaki

MedicalResearch.com Interview with:
Ken M. Kunisaki , MD
Associate Professor of Medicine
Pulmonary, Allergy, Critical Care and Sleep Medicine
University of Minnesota 

Medical Research: What is the background for this study? What are the main findings?

Dr. Kunisaki : Obstructive sleep apnea (OSA) is a very common condition that is the result of recurrent complete or partial closure of the upper airway during sleep.  OSA leads to poor sleep quality and excessive daytime sleepiness.

A previous study suggested that OSA is more common in the winter, but there were no vitamin D measurements in that study, which seemed potentially relevant since many people have lower vitamin D levels in the winter, due to less sunlight exposure in the winter.  Several studies have also shown that people with low vitamin D levels have worse muscle function.  Since muscles are partially responsible for keeping the upper airway open during sleep, we wondered whether people with low vitamin D levels might have weaker upper airway muscles and therefore be more prone to having OSA.

In our study, we found that indeed, persons with OSA had lower vitamin D levels than those without OSA, but this was explained by obesity.  In other words, the low vitamin D levels seen in OSA patients is likely just a marker of obesity and not likely related to the presence or absence of OSA.
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Both CPAP and Mandibular Advancement Devices Improve Blood Pressure in Sleep Apnea

Prof. Malcolm Kohler, MD Chair Respiratory Medicine Clinical Director Department of Pulmonology University Hospital of Zurich Zurich Switzerland

Dr. Kohler

MedicalResearch.com Interview with:
Prof. Malcolm Kohler, MD
Chair Respiratory Medicine
Clinical Director Department of Pulmonology
University Hospital of Zurich
Zurich Switzerland

Medical Research: What is the background for this study? What are the main findings?

Dr. Kohler: CPAP and Mandibular Advancement Devices (MADs) have been shown to reduce symptoms of obstructive sleep apnea (eg sleepiness, see Bratton et al. Lancet Respir Med 2015). Whether this is also true for both treatments re blood pressure was not answerable from individual studies. Our metanalysis shows that both treatments have similar positive effects on blood pressure, the treatment effect of CPAP seems to be larger in patients with higher number of hours of nightly usage of CPAP.

Medical Research: What should clinicians and patients take away from your report?

Dr. Kohler: Both treatments are effective not only in reducing symptoms of obstructive sleep apnea but also in reducing blood pressure. Mandibular Advancement Devices are to be considered as an alternative treatment to the more widely used CPAP, especially in patients who fail to adapt to CPAP treatment.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Kohler: The effects of other OSA treatment approaches (eg weight loss) on blood pressure and other clinically relevant outcomes should be evaluated in metanalyses.

Citation:

Dr. Malcolm Kohler (2015). Both CPAP and Mandibular Advancement Devices Improve Blood Pressure in Sleep Apnea 

Surgical Treatment An Option For Patients With Recalcitrant Sleep Apnea

Dr-Soroush-Zaghi.jpg

Dr. Soroush Zaghi

MedicalResearch.com Interview with:
Soroush Zaghi, MD
Department of Head and Neck Surgery
David Geffen School of Medicine at UCLA
University of California, Los Angeles

MedicalResearch: What is the central message for clinicians and surgeons from your results?

Dr. Zaghi: Multiple studies from different practitioners and institutions agree that Maxillomandibular Advancement (MMA) is a highly effective surgical option for patients with obstructive sleep apnea who cannot tolerate positive pressure therapy and have not found success with other surgical procedures.

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Cost-Effective Clinical Pathway Determined Hospitalized Patients’ Risk of Sleep Apnea

Sunil Sharma, M.D Associate professor of pulmonary medicine Sidney Kimmel Medical College at Thomas Jefferson UniversityMedicalResearch.com Interview with:
Sunil Sharma, M.D
Associate professor of pulmonary medicine
Sidney Kimmel Medical College at Thomas Jefferson University

Medical Research: What is the background for this study? What are the main findings?

Dr. Sharma: Obstructive sleep apnea (OSA) is a highly prevalent disorder with significant cardiovascular implications. In this condition the patient may repeatedly quit breathing during sleep, sometimes hundreds of times, leading to loss of oxygen and frequent arousals throughout the night. OSA has been associated with high blood pressure, congestive heart failure, coronary artery disease, arrhythmias and stroke, among other conditions. While overall awareness is improving, the condition is under-recognized in hospitalized patients. Due to multiple co-morbid conditions these patients may be at higher risk for complications. Recent studies have also shown that early recognition of OSA in hospitalized patients may reduce readmission rates. In our study, we used a simple and cost-effective clinical pathway to determine high-risk patients. Of the 149 patient’s determined to be high risk by our protocol, 128 (87%) were confirmed with the diagnosis by a polysomnography (gold standard test). Furthermore, data derived from a simple and cost-effective oxygen measuring device (pulse-oximeter) was found to co-relate well with the polysomnography.  Continue reading

Custom Oral Appliance Reduced Sleep Apnea and Restless Legs

Marie Marklund, DDS senior lecturer Department of Odontology, Faculty of Medicine Umeå University SwedenMedicalResearch.com Interview with:
Marie Marklund, DDS senior lecturer
Department of Odontology, Faculty of Medicine
Umeå University
Sweden

MedicalResearch: What is the background for this study? What are the main findings?

Response: Snoring and obstructive sleep apnea are common in the population and these disorders continuously increase because of the ongoing obesity epidemic in many countries. Today, 34% of men and 17% of women in the US suffer from obstructive sleep apnea of all severities. Symptoms include daytime sleepiness, poor sleep quality, headache, insomnia and restless legs. In the longer term, a more severe sleep apnea is associated with serious consequences, such as hypertension, stroke, cancer, traffic accidents and early death.

Continuous positive airway pressure is a highly effective treatment for sleep apnea patients. Adherence problems, for instance from nasal stuffiness and claustrophobia reduces its effectiveness. An oral appliance holds the lower jaw forwards during sleep in order to reduce snoring and sleep apneas. This therapy has primarily been suggested for snorers and patients with mild and moderate sleep apnea. No previous placebo-controlled study has, however, evaluated this specific group of patients. Results from more severe sleep apnea patients have shown a good effect on sleep apneas. The effect of oral appliances on daytime symptoms is unclear. Symptomatic improvement is an important outcome for milder sleep apnea patients.

The primary aims of the present study were to study the effects on daytime sleepiness and quality of life of a custom-made, adjustable oral appliance in patients with daytime sleepiness and snoring or mild to moderate sleep apnea, i.e. the primary target group for this type of therapy. Secondary aims included the effects on sleep apnea, snoring and various other symptoms of sleep disordered breathing such as headaches and restless legs. We found that oral appliance therapy was effective in reducing sleep apneas, snoring and symptoms of restless legs. The apnea-hypopnea index was normal (<5) in 49% of patients using the active appliance and in 11% using placebo, with a numbers needed to treat of three. Daytime sleepiness and quality of life did not differ during active treatment and the placebo intervention. The patients experienced reduced headaches with active treatment, but the results did not differ from placebo. It was concluded, that a custom-made, adjustable oral appliance reduces obstructive sleep apneas, snoring and possibly restless legs. The efficacy on daytime sleepiness and quality of life was weak and did not differ from placebo in this group of patients. Continue reading

CPAP For Sleep Apnea May Decrease Atrial Fibrillation Recurrence

Dr. Larry Chinitz MD Professor of Medicine and Director, Cardiac Electrophysiology NYU Langone Medical CenterMedicalResearch.com Interview with:
Dr. Larry Chinitz MD

Professor of Medicine and Director, Cardiac Electrophysiology
NYU Langone Medical Center

MedicalResearch: What is the background for this study? What are the main findings?

Dr. Chinitz: The treatment algorithms proposed currently for maintenance of sinus rhythm in patients with atrial fibrillation focus on use of anti-arrhythmic drugs and catheter ablation. Data available to evaluate the effect of modification of known adverse clinical factors on atrial fibrillation recurrence is scant.

Obstructive sleep apnea in a known factor associated with both new onset atrial fibrillation as well as its recurrence after catheter ablation. Through a meta-analysis of available data we found that use of continuous positive airway pressure in patients with sleep apnea was associated with a 42% relative risk reduction in recurrence of atrial fibrillation. This effect was similar across patient groups irrespective of whether they were medically managed or with catheter ablation.
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Sleep Apnea Increases Stroke Risk in Atrial Fibrillation Patients

Dmitry Yaranov, MD Danbury Hospital Western Connecticut Health NetworkMedicalResearch.com Interview with:
Dmitry Yaranov, MD

Danbury Hospital
Western Connecticut Health Network

Medical Research: What is the background for this study? What are the main findings?

Dr. Yaranov: Obstructive sleep apnea (OSA) is an independent risk factor for ischemic stroke (CVA) that is not included in the usual cardioembolic risk assessments for patients with atrial fibrillation. The aim of this study was to investigate the impact of OSA on CVA rate in patients with atrial fibrillation. We found that Obstructive sleep apnea in patients with atrial fibrillation is an independent predictor of CVA and this association may have important clinical implications in CVA risk stratification. Continue reading

Polysomnography Remains Standard For Pediatric Obstructive Sleep Apnea Diagnosis

Ron B. Mitchell, MD Professor of Otolaryngology and Pediatrics William Beckner Distinguished Chair in Otolaryngology Chief of Pediatric Otolaryngology UT Southwestern and Children's Medical Center Dallas ENT Clinic Dallas, TX 75207MedicalResearch.com Interview with:
Ron B. Mitchell, MD

Professor of Otolaryngology and Pediatrics
William Beckner Distinguished Chair in Otolaryngology
Chief of Pediatric Otolaryngology
UT Southwestern and Children’s Medical Center Dallas
ENT Clinic Dallas, TX 75207

Medical Research: What is the background for this study? What are the main findings?

Dr. Mitchell: The “gold standard” for the diagnosis of and quantification of obstructive sleep apnea (OSA) is polysomnography (PSG or a ‘sleep study’). However, the majorities of T&A procedures are done without PSG and are based on a clinical diagnosis. This is because PSG is expensive, requires overnight observation and is often unavailable. It is important to diagnose and quantify OSA as it allows for surgical planning and predicts the need and type of treatment after surgery.

We used data from the Childhood Adenotonsillectomy (CHAT) study; a large multicenter
trial (RCT), to look at the ability of clinical parameters to predict the severity of obstructive sleep apnea in children scheduled for a T&A.

The main findings of the study are that certain clinical parameters such as obesity and African American race as well as high scores on certain validated questionnaires (such as the pediatric sleep questionnaire- PSQ) are associated, but cannot predict OSA severity. PSG remains the only way to measure objectively the severity of OSA.

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Sleep Apnea Predicts Atrial Fibrillation after CABG

MedicalResearch.comInterview with:
Amro Qaddoura BHSc
Research Student of Adrian Baranchuk, MD
Department of Medicine, Queen’s University, Kingston, Ontario, Canada

MedicalResearch: What is the background for this study? What are the main findings?

Response: This publication was a letter to the editor in response to comments on our recent systematic review and meta-analysis that showed obstructive sleep apnea to be a strong predictor of atrial fibrillation after coronary artery bypass grafting (CABG). See the details in another interview: https://medicalresearch.com/heart-disease/sleep_apnea_increases_risk_of_atrial_fibrillation_after_bypass_surgery/8369/

The letter to the editor included an analysis not included in the initial publication, which provided more evidence that obstructive sleep apnea is a predictor of atrial fibrillation after CABG surgery.

As well, it elucidated the reasoning behind one of the analyses that we chose to conduct.

MedicalResearch: What should clinicians and patients take away from your report?

Response:  Healthcare specialists of multiple disciplines should equip themselves with the necessary tools and knowledge to be able to screen and diagnose obstructive sleep apnea.

For patients, it provides further incentive to report any sleep disturbances or snoring to their healthcare providers so that the patients can be optimally cared for and managed.

MedicalResearch: What recommendations do you have for future research as a result of this study?

Response:  Only one study that we are aware of investigated the association between severe obstructive sleep apnea and atrial fibrillation after CABG surgery. This provides an impetus to explore this association further.

As well, although the evidence to date indicates that obstructive sleep apnea is a risk factor for atrial fibrillation after CABG surgery, larger high-quality studies may help to confirm the findings of our review.

Citation:

Obstructive Sleep Apnea is a Risk Factor for Post Coronary Artery Bypass Graft Atrial Fibrillation
Qaddoura, Amro et al.
Canadian Journal of Cardiology , Volume 30 , Issue 12 , 1516 – 1522

 

CPAP May Improve Depression In Patients With Sleep Apnea

Dr. Marcus Povitz MD Department of Community Health Sciences University of Calgary, Calgary, Alberta, Canada Adjunct Professor and Clinical Fellow Western University Department of Medicine, Western University, London, Ontario, CanadaMedicalResearch.com Interview with:
Dr. Marcus Povitz MD
Department of Community Health Sciences
University of Calgary, Calgary, Alberta, Canada
Adjunct Professor and Clinical Fellow
Western University Department of Medicine,
Western University, London, Ontario, Canada

Medical Research: What is the background for this study? What are the main findings?

Dr. Povitz: Both depression and obstructive sleep apnea are important causes of illness and have overlapping symptoms. Both feature poor quality sleep, difficulty with concentration and memory as well as daytime sleepiness or fatigue. Previous research showed that depression is common in individuals with sleep apnea, but studies investigating the effect of treating sleep apnea on depressive symptoms have had conflicting results. Our study combined the results of all randomized controlled trials of participants who were treated for sleep apnea with CPAP or mandibular advancement devices where symptoms of depression were measured both before and after treatment. We found that in studies of individuals without a lot of symptoms of depression there was still a small improvement in these symptoms after treatment with CPAP or mandibular advancement device. In 2 studies of individuals with more symptoms of depression there was a large improvement in symptoms of depression.

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Snoring During Twenties May Be Predictive of Sleep Apnea in Forties

MedicalResearch.com Interview with:
Dr. Swati Gulati, MD Internal Medicine
John H. Stroger Hospital of Cook County
Chicago, IL

Medical Research: What are the main findings of the study?

Dr. Gulati: We conducted an observational study by providing questionnaire about the onset and progression of sleep apnea symptoms to patients seen in our sleep clinic for CPAP set up. In our cohort, mean age at the onset of snoring was 28 years and the mean age at diagnosis was 52 years. There was a lag of almost 23 years between the onset of snoring and the diagnosis of sleep apnea. The snoring started in mid twenties (Phase I) and patients noticed poor concentration and headaches in mid thirties (Phase II). Later, patients developed cardiopulmonary symptoms in mid forties to the time of diagnosis (Phase III).

The evolution of simple snoring into apneic episodes occurred around 40 years of age after which there was a rapid progression of disease marked by development of Excessive daytime sleepiness (EDS), dyspnea and morning headaches. We also found that patients who had started snoring earlier or at a very young age had a more severe disease as documented by apnea-hypopnea index (AHI).

In the literature, most of the natural history studies have looked at the progression of sleep apnea after diagnosis with a shorter follow up period ranging from 6 to 10 years.   Through our study, we have aimed to determine the natural history of disease progression from simple snoring until the time of diagnosis.

Medical Research: What was most surprising about the results?

Dr. Gulati: We were surprised to find out that the symptoms of snoring started in the mid twenties and progressed over 2 decades before diagnosis. It was also surprising that the duration of snoring and change in weight were better predictors of obstructive sleep apnea (OSA)  severity than the patient characteristics at the time of diagnosis, such as age and BMI. In our study, weight gain per year was the strongest predictor of severity of sleep apnea and it made the BMI at the time of diagnosis insignificant. Surprisingly, we found no association between gender and AHI.

Medical Research: What should clinicians and patients take away from your report?

Dr. Gulati: Based on our study, snoring in these patients starts at an early age and not necessarily in the middle age. Evolution of simple snoring into sleep apnea and symptomatic manifestations takes at least a decade on average.

Significant symptoms of sleep apnea were ignored for at least 20 years by the patients or their physicians. This should provide ample time opportunity for physicians to screen patients for sleep disordered breathing. Timely screening and diagnosis of obstructive sleep apnea will lead to early initiation of treatment and will slow its progression.

 

Medical Research: What recommendations you have for future research as a result of this study?

Dr. Gulati: Since our study population consisted of patients with severe OSA, these findings should be tested on a sample of patient that includes mild to moderate OSA. Randomized controlled trials should be done to see if screening for snoring in young adults and initiation of early treatment can prevent the development of OSA and associated mortality.

 

CHEST abstract:

Progression of Symptoms of Obstructive Sleep Apnea  and Their Association With Its Severity at Diagnosis?
Swati Gulati; Aiman Tulaimat
Chest. 2014;146(4_MeetingAbstracts):946A. doi:10.1378/chest.1992430

 

 

 

 

CHEST 2014: Obstructive Sleep Apnea Linked To Cognitive Difficulties in Postmenopausal Women

Chitra Lal, MD. Assistant Professor Medical University of South CarolinaMedicalResearch.com Interview with:
Chitra Lal, MD. Assistant Professor
Medical University of South Carolina

 

 

Medical Research: What are the main findings of the study?

Dr. Lal: We studied the prevalence of cognitive problems in early postmenopausal women (age 45-60 years) with obstructive sleep apnea syndrome (OSAS+) and without obstructive sleep apnea syndrome (OSAS-) using a questionnaire called the Mail-In Cognitive Function Screening Instrument (MCFSI).

We found that the mean MCFSI scores after adjusting for depression were significantly higher in obstructive sleep apnea syndrome+ then the OSAS- group, indicating more self-reported cognitive difficulty in OSAS+ women

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Sleep Apnea Increases Risk of Atrial Fibrillation After Bypass Surgery

Adrian Baranchuk MD FACC FRCPC Associate Professor of Medicine Director, EP Training Program Queen's University Kingston, Ontario, CanadaMedicalResearch.com Interview with:
Adrian Baranchuk MD FACC FRCPC
Associate Professor of Medicine
Director, EP Training Program Queen’s University
Kingston, Ontario, Canada

Medical Research: What are the main findings of the study?

Dr. Baranchuk: In this study, we investigated whether obstructive sleep apnea increases the risk of atrial fibrillation after coronary artery bypass surgery. We found the risk to increase by approximately two-fold for patients with obstructive sleep apnea, suggesting that this disease is a strong predictor of atrial fibrillation after coronary artery bypass surgery.

We also found that the risk increases in patients with more severe obstructive sleep apnea.

This is an important association to explore since atrial fibrillation after coronary artery bypass surgery increases patient mortality, the risk of stroke, hospital stay, healthcare costs, and has substantial burden on patients and their families. It is also a common complication of the surgery, occurring in up to half of the patients. Knowing which factors increase its risk gives us a better understanding of how to manage it and mitigate its negative consequences.
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Sleep Apnea Predisposes To Impaired Brain Blood Flow With Physical Activity

Paul M. Macey, Ph.D. Assistant Professor in Residence Associate Dean for Information Technology and Innovations, Chief Innovation Officer UCLA School of Nursing and Brain Research InstituteMedicalResearch.com Interview with:
Paul M. Macey, Ph.D.
Assistant Professor in Residence
Associate Dean for Information Technology and Innovations,
Chief Innovation Officer UCLA School of Nursing and Brain Research Institute

Medical Research: What are the main findings of the study?

Dr. Macey: People with sleep apnea are less able to control the blood flowing to their brain, in particular when they grip tightly, or have their foot put in cold water. We measured changes in blood flowing through the brain using an MRI scanner while people gripped hard, had their foot placed in cold water, and breathed out hard into a tube with a very small hole in it. These activities all lead to more blood flowing to the brain in healthy people, which probably helps protect the cells from being starved of blood and oxygen. However, people with sleep apnea send less blood that the healthy participants during the gripped and cold foot activities.

A further important finding is that women with sleep apnea are worse off than men. The female patients showed much weaker blood flow than the males, even accounting for normal differences between men and women.
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Sleep Apnea May Be Improved By Moderate Calorie Restriction

MedicalResearch.com Interview with:
Marcia Klein M.D., Ph.D.
Adjunctive professor Rio de Janeiro State University
This study was conducted at the Discipline of Clinical and Experimental Pathophysiology – Rio de Janeiro State University and the financial support of FAPERJ.

Medical Research: What was the main findings of the study?

Dr. Klein: The main findings were that a diet with moderate calories restriction in obese patients with obstructive sleep apnea may be able not only to reduce body fat but also to reduce obstructive sleep apnea severity and blood pressure.
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CPAP Effective In Elderly Sleep Apnea Patients

MedicalResearch.com Interview with:
Prof. Mary J Morrell
Faculty of MedicineNational Heart & Lung Institute
Professor of Sleep & Respiratory Physiology
Imperial College, London


Medical Research: What are the main findings of the study?

Prof. Morrell: Our results showed that when older patients with obstructive sleep apnea were treated with continuous positive airway pressure (CPAP) they had significantly less daytime sleepiness than those not treated with CPAP. A comparison of the costs and benefits of treatment suggested that CPAP would meet the usual criteria for being funded by the NHS.
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No Close Link Between Cancer and Obstructive Sleep Apnea

Tetyana Kendzerska MD, PhD Postdoctoral Fellow Institute for Clinical Evaluative Science, Sunnybrook Health Sciences Center, Toronto, ONMedicalResearch.com Interview with:
Dr. Tetyana Kendzerska
Institute for Clinical Evaluative Science
Women’s College Research Institute
Women’s College Hospital
Department of Medicine
University of Toronto

Medical Research: What are the main findings of the study?

Dr. Kendzerska: In a large cohort with varying degrees of obstructive sleep apnea (OSA), severity of obstructive sleep apnea was not found to be independently associated with either prevalent or incident cancer, except in one subgroup analysis in smoking-related cancer.
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Obstructive Sleep Apnea: Obesity, Sleep Apnea and Hypertension Linked

Julio A. Chirinos, MD, PhD Assistant Professor of Medicine Director, CTRC Cardiovascular Phenotyping Unit Perelman School of Medicine, University of Pennsylvania Director of Non-Invasive Imaging Philadelphia VA Medical CenterMedicalResearch.com Interview with:
Julio A. Chirinos, MD, PhD
Assistant Professor of Medicine
Director, CTRC Cardiovascular Phenotyping Unit
Perelman School of Medicine, University of Pennsylvania
Director of Non-Invasive Imaging
Philadelphia VA Medical Center

MedicalResearch: What are the main findings of the study?

Dr. Chirinos: The main findings of the study is that, among patients with obesity and moderate to severe obstructive sleep apnea, obesity, rather than OSA, appears to be the primary cause of inflammation, insulin resistance and dyslipidemia. However, both obesity and obstructive sleep apnea appear to be causally related to hypertension. In this population, weight loss, but not CPAP, can be expected to reduce the burden of inflammation, insulin resistance and dyslipidemia. However, CPAP, among patients who comply with therapy, can be expected to provide a significant incremental benefit on blood pressure. The latter is an important potential benefit of CPAP and should not be disregarded.
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Obstructive Sleep Apnea May Increase Risk of Diabetes

Tetyana   Kendzerska MD, PhD Postdoctoral Fellow        Institute for Clinical Evaluative Science, Sunnybrook Health Sciences Center, Toronto, ONMedicalResearch.com Interview with:
Tetyana Kendzerska MD, PhD
Postdoctoral Fellow
Institute for Clinical Evaluative Science,
Sunnybrook Health Sciences Center, Toronto, ON


MedicalResearch: What are the main findings of the study?

Dr.  Kendzerska: Based on a large sample of more than 8,500 participants with suspected sleep apnea, our study shows that among people with obstructive sleep apnea (OSA), and controlling for risk factors for diabetes development, initial OSA severity predicted risk for incident diabetes. Measures of the physiologic consequences of OSA (e.g., low level of oxygen, sleep deprivation) were also risk factors for diabetes in this population.
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Obstructive Sleep Apnea Raises Risk of Osteoporosis

Kai-Jen Tien, MD Division of Endocrinology and Metabolism, Department of Internal Medicine, Chi Mei Medical Center Assistant Professor, Center of General Education Chia Nan University of Pharmacy and Science Tainan, TaiwanMedicalResearch.com Interview with:
Kai-Jen Tien, MD
Division of Endocrinology and Metabolism,
Department of Internal Medicine,  Chi Mei Medical Center
Assistant Professor, Center of General Education
Chia Nan University of Pharmacy and Science
Tainan, Taiwan

MedicalResearch.com: What are the main findings of the study?

Answer:  We conducted the first and largest population-based cohort study to evaluate the association of obstructive sleep apnea (OSA) and osteoporosis in a 6-year follow-up investigation of an Asian population. OSA is characterized by repetitive episodes of apnea/hypopnea and hypoxia in tissue, which might impact the bone metabolism. The results of the study showed that patients with obstructive sleep apnea had 2.74 times the risk of osteoporosis than patents without obstructive sleep apnea after adjustment for the patient`s characteristics and comorbidities. Across all age groups and sex groups, individuals with OSA had higher incidence rate of osteoporosis than individuals without obstructive sleep apnea. Subgroup analysis showed that older patients and female patients had a higher risk for osteoporosis than their younger and male counterparts.
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Pneumonia Risk Increased From Sleep Apnea

Dr. Vincent Yi-Fong Su Department of Chest Medicine Taipei Veterans General Hospital Taipei, TaiwanMedicalResearch.com Interview with:
Dr. Vincent Yi-Fong Su
Department of Chest Medicine
Taipei Veterans General Hospital
Taipei, Taiwan


MedicalResearch.com: What are the main findings of the study?

Answer: We found interestingly that patients with sleep apnea experienced a 1.20-fold (95% CI, 1.10-1.31; p <0.001) increase in incident pneumonia compared to patients without sleep apnea. We also demonstrated an “exposure-response relationship,” in that the patients with more severe sleep apnea might have a higher risk for pneumonia than did those of milder severity.
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Childhood Obstructive Sleep Apnea and Anti-Inflammatory Treatment

David Gozal, MD The Herbert T. Abelson Professor and Chair Department of Pediatrics Physician-in-Chief, Comer Children's Hospital The University of Chicago Chicago, IL 60637MedicalResearch.com Interview with:
David Gozal, MD
The Herbert T. Abelson Professor and Chair
Department of Pediatrics
Physician-in-Chief, Comer Children’s Hospital
The University of Chicago  Chicago, IL 60637

MedicalResearch.com: What are the main findings of the study?

Dr. Gozal: Our study shows that in children with mild obstructive apnea, treatment with an anti-inflammatory combination of 2 medications, namely nasal corticosteroid and oral montelukast is associated with favorable outcomes in the vast majority of the children. Thus, rather than pursue treatment with adenotonsillectomy as is currently the case in most places, this study paves the way for non-surgical alternative therapies in pediatric OSA.
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Obstructive Sleep Apnea: Outcomes in Hospitalized Pneumonia Patients

Dr. Peter Lindenauer MD MS Director, Center for Quality of Care Research Baystate Medical Center, Springfield, MA, USMedicalResearch.com Interview Invitation with:
Dr. Peter Lindenauer MD MS
Director, Center for Quality of Care Research
Baystate Medical Center, Springfield, MA, US

MedicalResearch.com: What are the main findings of the study?

Answer: Among a cohort of 250,000 patients hospitalized for pneumonia at 347 US hospitals, those with a diagnosis of obstructive sleep apnea were twice as likely to be intubated at the time of hospital admission than patients without sleep apnea.  In addition, patients with sleep apnea had approximately 50% higher risk of needing to be transferred to the ICU after initial admission to a regular bed, and a 70% increased risk of requiring intubation later in the hospital stay.  Patients with sleep apnea stayed longer in the hospital and incurred higher costs than those without sleep apnea.

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Obstructive Sleep Apnea: Value of Being Elbowed by Bed-Partner

M.E. Fenton MD MSc FRCPC FCCP Associate Professor Program Director, Respirology Training Program Division of Respirology, Critical Care and Sleep Medicine University of SaskatchewanMedicalResearch.com Interview Invitation
M.E. Fenton MD MSc FRCPC FCCP
Associate Professor
Program Director, Respirology Training Program
Division of Respirology, Critical Care and Sleep Medicine
University of Saskatchewan

MedicalResearch.com: What are the main findings of the study?

Dr. Fenton: This study demonstrates that asking a simple question in the outpatient clinic – Does your bed-partner ever poke or elbow you because you have stopped breathing? – has significant predictive value for a diagnosis of obstructive sleep apnea.

MedicalResearch.com: Were any of the findings unexpected?

Dr. Fenton: Prior to doing this study, we had observed that many patients being evaluated for obstructive sleep apnea (OSA) report this phenomenon in the outpatient clinic, so we were not surprised that the Elbow Sign has predictive value in diagnosing OSA.  However, we were pleasantly surprised at the high specificity (96.6%) demonstrated in men who have a body mass index of 31 or higher.  This is the most common demographic being assessed for OSA and the possibility of making a diagnosis without a polysomnogram is exciting, as there are long wait times for such testing in many jurisdictions.

MedicalResearch.com: What should clinicians take away from your report?

Dr. Fenton: The primary message is that in a Sleep Disorders Clinic a positive Elbow Sign has high predictive value for a diagnosis of OSA, particularly in obese men.  The other, more controversial, message is that this study suggests that not all patients being evaluated for OSA need a diagnostic test (e.g. polysomnogram) to make the diagnosis.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Dr. Fenton: This is a single center study and needs to be validated more broadly.

Citation:

The Utility of the Elbow Sign in the diagnosis of Obstructive Sleep Apnea

Mark E. Fenton, MD, FCCP; Karen Heathcote, MD; Rhonda Bryce, MD; Robert Skomro, MD, FCCP; John K. Reid, MD, FCCP; John Gjevre, MD, FCCP; David Cotton, MD, FCCP
Chest. 2013. doi:10.1378/chest.13-1046

Blood Pressure: Effect of CPAP in Patients with Obstructive Sleep Apnea

MedicalResearch.com Interview with:
Dr. Miguel-Ángel Martínez-García
Respiratory Department, Hospital Universitario y Politécnico La Fe
Valencia, Spain

MedicalResearch.com: What are the main findings of this study:

Answer: The main findings of the study are:

1. The treatment with CPAP
(continuous positive airway pressure) achieves a clinically and
statistically significant reduction of blood pressure in patients with
resistant hypertension (blood pressure that remains above goal in spite of
the use of at least three antihypertensive drugs) and obstructive sleep
apnea.
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Obstructive Sleep Apnea: Gender-Specific Adiposity and Metabolic Syndrome

MedicalResearch.com Interview with:

MedicalResearch.com Interview with:
Dr. Emilia Mazzuca
Biomedical Department of Internal and Specialistic Medicine (DIBIMIS)
Section of Pneumology and

Dr. Maria R Bonsignore, MD
Associate Professor in Respiratory Medicine
University of Palermo, Palermo, Italy

MedicalResearch.com: What are the main findings of the study?

Answer: Our main goal was to investigate gender-related interactions between obstructive sleep apnea (OSA) and obesity while taking associated metabolic abnormalities into account. We analyzed 423 men and 105 women previously studied for the association of OSA and the Metabolic Syndrome (MetS) (Bonsignore et al, Eur Respir J, 2012), to assess whether markers of general and visceral obesity were differently associated with OSA in men and women. Multivariate analysis showed that in men the apnea-hypopnea index (AHI), an indicator of OSA severity, was associated with waist circumference, a marker of visceral obesity, and body mass index (BMI); conversely, in women AHI was associated with hip circumference, a marker of subcutaneous fat deposition, and neck size.  The results were similar when patients without a diagnosis of MetS were analyzed; conversely, in patients with MetS, waist circumference was the only significant marker of OSA in both genders.
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Sleep Apnea: Effect of CPAP on Blood Pressure

MedicalResearch.com Interview with:
Cristiano Fava MD, PhD
University of Verona
Department of Medicine
Division of Internal Medicine C
Hospital “Policlinico G.B. Rossi”
37134 Verona Italy

University of Lund
Department of Clinical Sciences
Division of Endocrinology
CRC, Lund University
S-205 02 Malmö Sweden

MedicalResearch.com: What are the main findings of the study?

Dr. Fava: The main finding of the meta-analysis is that cPAP usage for at least 2 weeks, with respect to either placebo or usual care is associated with a significant reduction in both systolic and diastolic blood pressure. However the effect size of blood pressure reduction is modest.

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Sleep Apnea: CPAP Treatment and Golf Performance

MedicalResearch.com Interview with:

Marc L. Benton, MD, FCCP, FAASM
Morristown Medical Center and Atlantic Sleep & Pulmonary Associates,
300 Madison Ave. Third Floor
Madison, NJ 07940

MedicalResearch.com: What are the main findings of the study?

Dr. Benton:  When compared to a group of matched controls, 12 male golfers who had moderate-severe obstructive sleep apnea syndrome (OSAS) demonstrated statistically significant improvement in their ability to play golf (as measured by changes in the Handicap Index, the standardized indicator of golfing performance) after undergoing CPAP treatment for their condition.  Treatment adherence among the group placed on CPAP was unusually high.
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Gestational Diabetes Mellitus and Sleep Apnea

Sirimon Reutrakul MD Section of Endocrinology Department of Medicine Rush University Medical Center Chicago, Illinois 60612MedicalResearch.com: Interview with
Sirimon Reutrakul MD
Section of Endocrinology Department of Medicine
Rush University Medical Center
Chicago, Illinois 60612

 

MedicalResearch.com: What are the main findings of the study?

Answer: We found a strong association between obstructive sleep apnea and gestational diabetes mellitus. In pregnant women diagnosed with gestational diabetes, the risk of obstructive sleep apnea is increased nearly 7-fold compared to those without gestational diabetes.  In addition, we found that in non-diabetic women, pregnancy is associated with more disrupted sleep.

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Independent associations between fatty acids and sleep quality among obese patients with obstructive sleep apnoea syndrome.

MedicalResearch.com Interview with Dr. Christopher Papandreou
Department of Social Medicine, Preventive Medicine and Nutrition Clinic, Medical School, University of Crete, Heraklion, Greece.

MedicalResearch.com: What are the main findings of the study?

Dr. Papandreou: Certain adipose tissue fatty acids measured in the gluteal site were found to be associated with sleep quality parameters in obese patients with obstructive sleep apnoea syndrome after controlling for possible confounders.
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Compression Stockings May Reduce Sleep Apnea in Some Patients

August 4 2011

Newswise — Wearing compression stockings may be a simple low-tech way to improve obstructive sleep apnea in patients with chronic venous insufficiency, according to French researchers.

”We found that in patients with chronic venous insufficiency, compression stockings reduced daytime fluid accumulation in the legs, which in turn reduced the amount of fluid flowing into the neck at night, thereby reducing the number of apneas and hypopnea by more than a third,” said Stefania Redolfi, MD, of the University of Brescia in Italy, who led the research.

CVI occurs when a patient’s veins cannot pump enough oxygen-depleted blood back to the heart. It occurs most often in the veins of the legs.

The findings appear online ahead of the final publication of the American Thoracic Society’s American Journal of Respiratory and Critical Care Medicine.

Continuous positive airway pressure machines, known as CPAP, are one of the only treatment options currently recommended for people with OSA. However, many find wearing a mask all night prohibitively uncomfortable, and compliance is low, resulting in many patients living with untreated OSA and its serious health consequences. Finding a more effective means of treating OSA, therefore, is a high priority.

Dr. Redolfi and colleagues sought to determine whether a simple intervention like wearing compression stockings might be effective in some OSA patients.

In active people, fluid accumulation in the legs is counteracted by leg muscle contractions that squeeze the veins. However, prolonged sitting can prevent this process, and the accumulated fluid in the legs then shifts rostrally overnight. This shift results in fluid accumulation in neck tissue and is thought to increase apneic events by increasing the volume of the tissue, leading to repetitive collapse of the pharynx during night breathing. In otherwise healthy subjects who have heart failure or hypertension, the amount of this overnight rostral fluid shift is strongly correlated with the degree of overnight increase in neck circumference and the number of apneas and hypopnea per hour of sleep.

“We hypothesized that the fluid accumulation that occurs in the legs of people with chronic venous insufficiency would be reduced by wearing compression stockings, and that the reduction in the fluid would also reduce the shift of that fluid to the neck during the night,” said Dr. Redolfi. “There is strong evidence linking that rostral shift of fluid overnight to apnea. If we could reduce that, we would expect that apneic events would likewise be reduced.”

To investigate whether compression stockings could alleviate this problem, the researchers recruited subjects from the chronic venous insufficiency clinic at La Pitié-Salpêtrière hospital in Paris. Twelve patients were randomly assigned to one week of wearing the compression stockings or to a one-week control period without compression stockings. At the end of the first week, they crossed over to the other arm of the study. Each subject underwent polysomnography and overnight changes in leg fluid volume and neck circumference were measured at baseline and at the end of the compression stockings and control periods.

At the end of the compression stocking period, subjects had an average of a 62 percent reduction in overnight leg fluid volume change as compared to when they did not wear the stockings. Patients also had a 60 percent reduction in neck circumference increase, which the researchers used as a proxy measurement to estimate fluid shift into the neck and a 36 percent reduction in the number of apneas and hypopnea per hour of sleep.

“Our findings provide proof-of-concept that among subjects with CVI, overnight rostral fluid displacement is a mechanism of disease for OSA. The effect of compression stockings on OSA is based on counteracting this fluid displacement. Prevention of dependent fluid accumulation could constitute a new therapeutic approach to OSA,” said Dr. Redolfi.

“These findings are what we expected,” she continued, “but the extent to which simply wearing compression stockings reduced apnea in just one week was not expected. It would be very interesting to see whether the wearing of the stockings over longer periods would have an even greater effect.

“Whether prevention of overnight rostral fluid displacement can attenuate OSA in other patient populations is an important issue that remains to be addressed in future studies,” she added.

Full text of the original article can be found here: http://www.thoracic.org/media/press-releases/resources/redolfi-080211.pdf