This review summarizes the recent literature on the epidemiology of adult obstructive sleep apnea (OSA) from various population-based studies. Despite methodologic differences, comparisons have yielded similar prevalence rates of the OSA syndrome in various geographic regions and amongst a number of ethnic groups. Risk factors for OSA including obesity, aging, gender, menopause, and ethnicity are analyzed. We also provide discussion on adverse medical conditions associated with OSA including hypertension, stroke, congestive heart failure, coronary artery disease, cardiovascular mortality, insulin resistance, and neurocognitive dysfunction. Finally with the progression of the global obesity epidemic, we focus on the economic health care burden of OSA and the importance of recognizing the largely undiagnosed OSA population with emphasis on strategies to improve access to diagnostic resources.

BackgroundPolysomnograms are not always feasible when sleep disordered breathing (SDB) is suspected in hospitalized patients. Portable monitoring is a practical alternative; however, it has not been recommended in patients with comorbidities.ObjectiveWe evaluated the accuracy of portable monitoring in hospitalized patients suspected of having SDB.DesignProspective observational study.SettingLarge, public, urban, teaching hospital in the United States.ParticipantsHospitalized patients suspected of having SDB.MethodsPatients underwent portable monitoring combined with actigraphy during the hospitalization and then polysomnography after discharge. We determined the accuracy of portable monitoring in predicting moderate to severe SDB and the agreement between the apnea hypopnea index measured by portable monitor (AHIPM) and by polysomnogram (AHIPSG).ResultsSeventy-one symptomatic patients completed both tests. The median time between the two tests was 97 days (IQR 25–75: 24–109). Forty-five percent were hospitalized for cardiovascular disease. Mean age was 52±10 years, 41% were women, and the majority had symptoms of SDB. Based on AHIPSG, SDB was moderate in 9 patients and severe in 39. The area under the receiver operator characteristics curve for AHIPM was 0.8, and increased to 0.86 in patients without central sleep apnea; it was 0.88 in the 31 patients with hypercapnia. For predicting moderate to severe SDB, an AHIPM of 14 had a sensitivity of 90%, and an AHIPM of 36 had a specificity of 87%. The mean±SD difference between AHIPM and AHIPSG was 2±29 event/hr.ConclusionIn hospitalized, symptomatic patients, portable monitoring is reasonably accurate in detecting moderate to severe SDB.

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Stroke is an identified sequela of severe coronavirus disease 2019 (COVID-19) infection. While the pathophysiology remains poorly understood, endothelial dysfunction and intravascular thrombosis secondary to sepsis-induced hypercoagulability likely increase the risk of stroke. This report describes the rare case of an otherwise healthy 42-year-old male who developed large bilateral ischemic infarcts during admission for severe hypoxemic respiratory failure secondary to COVID pneumonia. This report adds to scarce literature describing massive cerebrovascular injury in COVID patients and emphasizes the importance of increased clinical suspicion for stroke in patients who exhibit acute change in mental status or motor function, as well as rapid clinical deterioration.

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