Factors Associated with Nightly Variability in Sleep-disordered Breathing in the Elderly

Bliwise, Donald L.; Benkert, Robert E.; Ingham, Robert H.

doi:10.1378/chest.100.4.973

Cited by 86 publications

(48 citation statements)

References 12 publications

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“…[1][2][3][4] We found that 35% of patients had a change in AHI between PSGs of greater than 10, which is comparable to the only other study assessing AHI variability over non-consecutive nights, in which 30% of patients had a change in AHI of greater than 10 between PSGs performed one month apart.…”

Section: Fluid Shift and Sleep Apnea Variabilitysupporting

confidence: 78%

Section: Brief Summarymentioning

confidence: 99%

“…Previous studies found a change in the frequency of apneas and hypopneas per hour of sleep (apnea-hypopnea index, AHI) greater than 10 in 18% to 65% of patients undergoing polysomnograms (PSGs) on consecutive nights or one month apart. [1][2][3][4] Furthermore, in one study, 50% of patients undergoing consecutive night PSGs met criteria for OSA diagnosis (AHI ≥ 10) on one PSG but not on the other. 3 Few studies have examined the reasons for this AHI variability.…”

mentioning

confidence: 98%

“…2,5 Changes in rapid-eye movement (REM) or supine sleep times do not explain the AHI differences, as there was also signifi cant variability in the AHI within REM and supine sleep. 4 One study found that nasal obstruction or a deviated septum was more common in patients with higher AHI variability, but there were no differences in other factors including age, sex, body mass index (BMI), or lung function. 4 During the daytime, fl uid accumulates in the interstitial and intravascular spaces of the legs due to gravity, and on lying down at night, fl uid shifts rostrally towards the neck, where it may narrow the upper airway, predisposing to upper airway collapse and OSA.…”

mentioning

confidence: 99%

“…4 One study found that nasal obstruction or a deviated septum was more common in patients with higher AHI variability, but there were no differences in other factors including age, sex, body mass index (BMI), or lung function. 4 During the daytime, fl uid accumulates in the interstitial and intravascular spaces of the legs due to gravity, and on lying down at night, fl uid shifts rostrally towards the neck, where it may narrow the upper airway, predisposing to upper airway collapse and OSA. 6 In non-obese men, men with heart failure and in hypertensive patients, there are strong relationships between the AHI and the amount of fl uid moving out from the legs overnight and with the overnight increase in neck circumference.…”

mentioning

confidence: 99%

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Night-to-night Variability in Obstructive Sleep Apnea Severity: Relationship to Overnight Rostral Fluid Shift

White

Lyons

Yadollahi

et al. 2015

Journal of Clinical Sleep Medicine

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Study Objectives: Overnight rostral fl uid shift from the legs to the neck may narrow the pharynx and contribute to obstructive sleep apnea (OSA) pathogenesis. We hypothesized that night-to-night changes in the apneahypopnea index (AHI) would be associated with changes in overnight rostral fl uid shift. Methods: Twenty-six patients with OSA (AHI ≥ 10) underwent two polysomnograms 14 days apart with measurement of neck and leg fl uid volumes (LFV), neck circumference and upper-airway cross-sectional area before and after sleep. Results: Although mean AHI did not differ between polysomnograms, 35% of patients had a difference in AHI > 10, indicating signifi cant intra-individual variability. There were direct correlations between change in non-rapid-eye movement (NREM), but not REM AHI and change in evening LFV between polysomnograms (r = 0.440, p = 0.036 and r = 0.005, p = 0.982, respectively) and between change in supine, but not non-supine AHI and change in evening LFV (r = 0.483, p = 0.020 and r = 0.269, p = 0.280, respectively). An increase in evening LFV between polysomnograms was associated with a greater overnight decrease in LFV (r = 0.560, p = 0.005) and a greater overnight increase in neck fl uid volume (r = 0.498, p = 0.016). Additionally, a greater overnight increase in neck circumference was associated with a greater overnight increase in neck fl uid volume between polysomnograms (r = 0.453, p = 0.020) and a greater overnight decrease in upperairway cross-sectional area (r = −0.587, p = 0.005). Conclusion: Intra-individual variability in OSA severity may be partly explained by day-to-day changes in evening leg fl uid volume and overnight rostral fl uid shift, which may be most important in the pathogenesis of OSA during NREM and supine sleep. S C I E N T I F I C I N V E S T I G AT I O N S BRIEF SUMMARYCurrent Knowledge/Study Rationale: Overnight rostral fl uid shift from the legs to the neck may narrow the upper airway and contribute to obstructive sleep apnea (OSA) pathogenesis. Intra-individual night-tonight variability in OSA severity may relate to night-to-night variations in overnight rostral fl uid shift. Study Impact: This study found that intra-individual variability in OSA severity may be partly explained by day-to-day changes in evening leg fl uid volume and overnight rostral fl uid shift, which may be most important in the pathogenesis of OSA during NREM and supine sleep. S everity of obstructive sleep apnea (OSA) can vary considerably from night to night, but the reasons for this are unclear. Previous studies found a change in the frequency of apneas and hypopneas per hour of sleep (apnea-hypopnea index, AHI) greater than 10 in 18% to 65% of patients undergoing polysomnograms (PSGs) on consecutive nights or one month apart. [1][2][3][4] Furthermore, in one study, 50% of patients undergoing consecutive night PSGs met criteria for OSA diagnosis (AHI ≥ 10) on one PSG but not on the other. Few studies have examined the reasons for this AHI variability. While one study found increased variabi...

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Section: Fluid Shift and Sleep Apnea Variabilitysupporting

confidence: 78%

Section: Brief Summarymentioning

confidence: 99%

mentioning

confidence: 98%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

Night-to-night Variability in Obstructive Sleep Apnea Severity: Relationship to Overnight Rostral Fluid Shift

White

Lyons

Yadollahi

et al. 2015

Journal of Clinical Sleep Medicine

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A 54-Year-Old Man With Obstructive Sleep Apnea

Kuna¹

2002

JAMA

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Mr J is a 54-year-old man with a history of sleep apnea. He lives in a suburb of Boston with his wife and 2 children, owns a small company, and has managed care insurance.In 1995, Mr J's wife noted that he stopped breathing at night. Mr J also recalled that he awoke, on occasion, in the middle of the night with palpitations. He mentioned this to his primary care physician, Dr M, who referred him for a sleep study. The study revealed 206 obstructive events, giving an apnea hypopnea index (AHI) of 36 per hour. He had oxygen desaturation to a nadir of 74%. Based on these results, his pulmonologist recommended that Mr J proceed with nasal continuous positive airway pressure (CPAP) titration. The results of his CPAP study showed that 5 to 6 cm of water pressure eliminated the obstructive events and oxygen desaturation. Mr J seemed to have some difficulty falling asleep with the mask, but overall it appeared to be well tolerated during both rapid eye movement (REM) and non-REM sleep.With the nasal CPAP, Mr J's palpitations ceased, but after about a year he discontinued the nasal CPAP because it interfered with his ability to fall asleep and with his sex life. A trial of clonazepam, 0.25 mg, about a half hour before sleep did not improve his ability to sleep with the CPAP. When he pursued the use of an oral device, Mr J was told that the most effective agent for treatment of sleep apnea was nasal CPAP, but he did not resume its use.Currently, Mr J states that he feels well. He falls asleep without difficulty and is able to sleep about 8 hours per night. He does not experience shortness of breath and he does not perceive any difficulties with his sleep patterns or daytime sleepiness.Mr J has a medical history of coronary artery disease (with stent placement), hypertension, hyperlipidemia, diverticulitis, recurrent sinusitis, and L5-S1 radiculopathy. Because of his history of coronary artery disease and hypertension, Dr M strongly encouraged Mr J to use his nasal CPAP. Mr J stated that he could not tolerate CPAP, but he did lose 20 lb and now weighs 205 lb (his body mass index [BMI] is now 28.6). Mr J's current medications include aspirin, atenolol, atorvastatin, gabapentin, and ibuprofen. He does not smoke and rarely drinks.

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