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