Gender difference in sleep profile of severely obese patients with obstructive sleep apnea (OSA)

Resta, Onofrio; Carpagnano, Giovanna Elisiana; Lacedonia, Donato; Gioia, Giuseppe Di; Giliberti, T.; Stefàno, A; Bonfitto, P

doi:10.1016/j.rmed.2004.05.014

Cited by 78 publications

(59 citation statements)

References 24 publications

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“…However, during REM sleep, cholinergic-mediated inhibition of the hypoglossal nerve results in the suppression of genioglossus muscle tone, which substantially increases the propensity for upper airway collapse (16)(17)(18). This increased propensity for upper airway collapse can lead to REM-predominant OSA or simply OSA that becomes more severe during REM sleep (19)(20)(21)(22)(23). In patients with mild or moderate OSA, who represent more than 80% of individuals with OSA in the community (14,15), obstructive events often cluster in REM sleep resulting in selective fragmentation of REM sleep (20).…”

Section: Measurements and Main Resultsmentioning

confidence: 99%

Obstructive Sleep Apnea during REM Sleep and Hypertension. Results of the Wisconsin Sleep Cohort

Mokhlesi

Finn²,

Hagen³

et al. 2014

Am J Respir Crit Care Med

263

211

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Rationale: Obstructive sleep apnea (OSA) is associated with hypertension.Objectives: We aimed to quantify the independent association of OSA during REM sleep with prevalent and incident hypertension.Methods: We included adults enrolled in the longitudinal community-based Wisconsin Sleep Cohort Study with at least 30 minutes of REM sleep obtained from overnight in-laboratory polysomnography. Studies were repeated at 4-year intervals to quantify OSA. Repeated measures logistic regression models were fitted to explore the association between REM sleep OSA and prevalent hypertension in the entire cohort (n = 4,385 sleep studies on 1,451 individuals) and additionally in a subset with ambulatory blood pressure data (n = 1,085 sleep studies on 742 individuals). Conditional logistic regression models were fitted to longitudinally explore the association between REM OSA and development of hypertension. All models controlled for OSA events during non-REM sleep, either by statistical adjustment or by stratification. Measurements and Main Results:Fully adjusted models demonstrated significant dose-relationships between REM apnea-hypopnea index (AHI) and prevalent hypertension. The higher relative odds of prevalent hypertension were most evident with REM AHI greater than or equal to 15. In individuals with non-REM AHI less than or equal to 5, a twofold increase in REM AHI was associated with 24% higher odds of hypertension (odds ratio, 1.24; 95% confidence interval, 1.08-1.41). Longitudinal analysis revealed a significant association between REM AHI categories and the development of hypertension (P trend = 0.017). Non-REM AHI was not a significant predictor of hypertension in any of the models.Conclusions: Our findings indicate that REM OSA is crosssectionally and longitudinally associated with hypertension. This is clinically relevant because treatment of OSA is often limited to the first half of the sleep period leaving most of REM sleep untreated.

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Section: Measurements and Main Resultsmentioning

confidence: 99%

Obstructive Sleep Apnea during REM Sleep and Hypertension. Results of the Wisconsin Sleep Cohort

Mokhlesi

Finn²,

Hagen³

et al. 2014

Am J Respir Crit Care Med

263

211

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“…There is a possibility that the latter has more effect on female OSA patients, for whom more sensitivity to factors disturbing sleep has been reported [38]. As observed in one of the first studies describing central apnoeas with CPAP [1], central apnoeas often appear in wake-sleep transition.…”

Section: Initial Compsamentioning

confidence: 99%

A prospective polysomnographic study on the evolution of complex sleep apnoea

Cassel¹,

Canisius²,

Becker³

et al. 2011

Eur Respir J

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Complex sleep apnoea (CompSA) may be observed following continuous positive airway pressure (CPAP) treatment.In a prospective study, 675 obstructive sleep apnoea patients (mean age 55.9 yrs; 13.9% female) participated. Full-night polysomnography was performed at diagnosis, during the first night with stable CPAP and after 3 months of CPAP.12.2% (82 out of 675 patients) had initial CompSA. 28 of those were lost to follow-up. Only 14 out of the remaining 54 patients continued to satisfy criteria for CompSA at follow-up. 16 out of 382 patients not initially diagnosed with CompSA exhibited novel CompSA after 3 months. 30 (6.9%) out of 436 patients had follow-up CompSA. Individuals with CompSA were 5 yrs older and 40% had coronary artery disease. At diagnosis, they had similar sleep quality but more central and mixed apnoeas. On the first CPAP night and at follow-up, sleep quality was impaired (more wakefulness after sleep onset) for patients with CompSA. Sleepiness was improved with CPAP, and was similar for patients with or without CompSA at diagnosis and follow-up.CompSA is not stable over time and is mainly observed in predisposed patients on nights with impaired sleep quality. It remains unclear to what extent sleep impairment is cause or effect of CompSA.

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“…Üst hava yolu tonusu non-REM uykuda azalır ve REM uykuda da azalmaya devam eder, böylece üst hava yolu rezistansında ve kollapsında artış meydana gelir. Ayrıca, uykunun REM evresinde hipoksi ve hiperkapniye meduller duyarlılık azalır ve tüm bunların sonucunda REM'de daha fazla solunumsal olayların yanında daha fazla oksijen desatürasyonu olur (2)(3)(4)(5).…”

Section: Introductionunclassified

The frequency and properties of REM related obstructive sleep apnea among the patients with mild related obstructive sleep apnea

Özçelik

Akkoyunlu²,

Bostanlı³

et al. 2013

Tuberk Toraks

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ÖZET Hafif obstrüktif uyku apneli hastalarda REM ile ilişkili obstrüktif uyku apne sıklığı ve özellikleri GİRİŞObstrüktif uyku apne (OUA); üst hava yolunda tekrarlayan tıkanmalarla karakterize, erişkin popülasyonun %2-4'ünü etkileyen uykuyla ilişkili solunum hastalıkları-nın yaygın bir formudur. Uyku sırasında üst hava yolunda gelişen tıkanıklıkların hipoksemi, hiperkapni, otonomik sinir sistemi değişiklikleri ve uykuda bölünmeye yol açması OUA patofizyolojisinde belirleyicidir (1). REM ile ilişkili OUA ise apne ve hipopnelerin REM uykusu esnasında daha yoğun olduğu bir durumdur. REM ile ilişkili OUA prevalansının sınırlı sayıda yapılan klinik çalışma-larda tüm OUA'lı popülasyon içinde %10-36 arasında olduğu ve daha çok kadınlarda görüldüğü gösterilmiştir. Üst hava yolu tonusu non-REM uykuda azalır ve REM uykuda da azalmaya devam eder, böylece üst hava yolu rezistansında ve kollapsında artış meydana gelir. Ayrıca, uykunun REM evresinde hipoksi ve hiperkapniye meduller duyarlılık azalır ve tüm bunların sonucunda REM'de daha fazla solunumsal olayların yanında daha fazla oksijen desatürasyonu olur (2-5).REM ile ilişkili OUA, "Hafif ve orta OUA olgularında daha fazla görülmesi nedeniyle uykuda solunum bozuklukları spektrumunun erken bir işareti midir?" yoksa "Tamamen ayrı bir antite midir?"sorusu araştırmacıla-rın son zamanlarda oldukça dikkatini çekmektedir. Bu çalışmada, hafif OUA tanılı hastalar arasında REM ile ilişkili OUA hastalarının sıklığını ve diğer hafif OUA tanılı hastalardan farkını görmek; ayrıca REM ile ilişkili OUA hastalarında gündüz aşırı uykululuk ile AHİ ilişki-sini değerlendirmek amaçlanmıştır. MATERYAL ve METOD

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Gender difference in sleep profile of severely obese patients with obstructive sleep apnea (OSA)

Abstract: Severely obese women with OSA, even with milder OSA, present greater disturbances of the sleep architecture with a more severe sleep disruption and more frequently REM OSA in comparison with men matched by age and weight.

Cited by 78 publications

References 24 publications

Obstructive Sleep Apnea during REM Sleep and Hypertension. Results of the Wisconsin Sleep Cohort

Obstructive Sleep Apnea during REM Sleep and Hypertension. Results of the Wisconsin Sleep Cohort

A prospective polysomnographic study on the evolution of complex sleep apnoea

The frequency and properties of REM related obstructive sleep apnea among the patients with mild related obstructive sleep apnea

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