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

White, Laura H.; Lyons, Owen D.; Yadollahi, Azadeh; Ryan, Clodagh M.; Bradley, T. Douglas

doi:10.5664/jcsm.4462

Cited by 72 publications

(49 citation statements)

References 34 publications

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“…In addition to the above mechanisms, rostral fluid shifts may con- overload states (Table 4) (Redolfi et al, 2009;White, Lyons, Yadollahi, Ryan, & Bradley, 2015a,2015bYadollahi et al, 2015;Yumino et al, 2010). In this study, we demonstrated greater ECFV shifts in the PH subjects compared with previous studies in the healthy population .…”

Section: Discussionsupporting

confidence: 52%

“…In addition to the above mechanisms, rostral fluid shifts may contribute to the pathogenesis of SA or modulate the type of SA. In support of this hypothesis, overnight ECFV shifts have been demonstrated in otherwise healthy SA subjects, and in those with fluid overload states (Table ) (Redolfi et al., ; White, Lyons, Yadollahi, Ryan, & Bradley, ,; Yadollahi et al., ; Yumino et al., ). In this study, we demonstrated greater ECFV shifts in the PH subjects compared with previous studies in the healthy population (Yadollahi et al., ).…”

Section: Discussionmentioning

confidence: 86%

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Temporal shifts in fluid in pulmonary hypertension with and without sleep apnea

Carvalho

Yadollahi

Granton

et al. 2019

Journal of Sleep Research

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Summary Overnight extracellular rostral fluid shifts have been shown to be of importance in patients with fluid‐retaining states and are associated with a higher prevalence of sleep apnea. Pulmonary hypertension is frequently associated with right ventricular dysfunction and progressive right ventricular failure, and an increased prevalence of sleep apnea has been described. In light of the importance of fluid shifts in the pathophysiology of sleep apnea, we aimed to explore temporal fluid shifts in patients with pulmonary hypertension with and without sleep apnea. Patients with pulmonary hypertension (WHO Group 1 or 4) had overnight extracellular rostral fluid shift assessment before and a minimum of 3 months after initiation of pulmonary hypertension‐specific therapy. Fluid shift measurements of extracellular leg, abdominal, thoracic and neck fluid volumes were performed simultaneously. Twenty‐nine patients with pulmonary hypertension (age 55 ± 16 years, 69% female) participated. Sleep apnea was diagnosed in 15 subjects (apnea–hypopnea index 14 [8–27] per hr). There were no significant differences in baseline or overnight leg extracellular rostral fluid, abdominal extracellular rostral fluid, thoracic extracellular rostral fluid or neck extracellular rostral fluid between those with and without sleep apnea. There was a significant inverse correlation between the sleep apnea severity and the overnight change in leg extracellular rostral fluid (r = −0.375, p = 0.049). There were no significant differences detected in overnight extracellular rostral fluid shifts from baseline to follow‐up. Treatment‐naïve patients with pulmonary hypertension both with and without sleep apnea demonstrate overnight extracellular rostral fluid shifts from the legs into the thorax and neck. Pulmonary hypertension‐specific treatment, while significantly improving cardiac haemodynamics, had little impact on nocturnal extracellular rostral fluid shifts or the presence of sleep apnea.

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Section: Discussionsupporting

confidence: 52%

Section: Discussionmentioning

confidence: 86%

Temporal shifts in fluid in pulmonary hypertension with and without sleep apnea

Carvalho

Yadollahi

Granton

et al. 2019

Journal of Sleep Research

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“…We chose this threshold because a change in AHI higher than 20 events·h −1 is considered generally beyond normal night-to-night variability [23, 24] and the improvement is more likely due to the medication effect. Using this criterion, we identified five responders (dashed line in the graphs in figure 4).…”

Section: Resultsmentioning

confidence: 99%

Desipramine improves upper airway collapsibility and reduces OSA severity in patients with minimal muscle compensation

et al. 2016

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We recently demonstrated that desipramine reduces the sleep-related loss of upper airway dilator muscle activity and reduces pharyngeal collapsibility in healthy humans without obstructive sleep apnoea (OSA). The aim of the present physiological study was to determine the effects of desipramine on upper airway collapsibility and apnoea–hypopnea index (AHI) in OSA patients. A placebo-controlled, double-blind, randomised crossover trial in 14 OSA patients was performed. Participants received treatment or placebo in randomised order before sleep. Pharyngeal collapsibility (critical collapsing pressure of the upper airway (Pcrit)) and ventilation under both passive (V′0,passive) and active (V′0,active) upper airway muscle conditions were evaluated with continuous positive airway pressure (CPAP) manipulation. AHI was quantified off CPAP. Desipramine reduced active Pcrit (median (interquartile range) −5.2 (4.3) cmH2O on desipramine versus −1.9 (2.7) cmH2O on placebo; p=0.049) but not passive Pcrit (−2.2 (3.4) versus −0.7 (2.1) cmH2O; p=0.135). A greater reduction in AHI occurred in those with minimal muscle compensation (defined as V′0,active−V′0, passive) on placebo (r=0.71, p=0.009). The reduction in AHI was driven by the improvement in muscle compensation (r=0.72, p=0.009). In OSA patients, noradrenergic stimulation with desipramine improves pharyngeal collapsibility and may be an effective treatment in patients with minimal upper airway muscle compensation.

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“…The clinical significance of this difference remains to be established. Nonetheless, previous work documents the role of night-to-night variability as a factor in obstructive sleep apnea 37 , individual differences in sleep quality 38 , and responsiveness to treatment 39 . Future work with older adults, including those with OA, clearly should examine other predictors of individual variability over multiple nights, as well as the association of variability with physical (e.g., fatigue, weight gain) and mental health outcomes (e.g., anxiety, depression).…”

Section: Discussionmentioning

confidence: 99%

Racial/ethnic differences in sleep quality among older adults with osteoarthritis

et al. 2017

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Objective To examine racial/ethnic differences in sleep quality and the pain-sleep association among older adults with osteoarthritis (OA) of the knee. Design Baseline interview followed by a 7-day microlongitudinal study using accelerometry and self-reports. Setting Participants were community residents in western Alabama and Long Island, NY. Participants Ninety-six African Americans (AAs) and 128 non-Hispanic Whites (NHWs) with physician-diagnosed knee OA, recruited from a variety of clinical and community settings. Measurements: Self-reports yielded demographics, body mass index, physical health problems, and depressive symptoms. Sleep quality was measured over 3 to 7 nights using wrist-worn accelerometers; pain was self-reported daily over the same period. Results With demographics and health controlled, AAs displayed poorer sleep efficiency, greater time awake after sleep onset and sleep fragmentation, and marginally more awakenings during the night, but no differences in total sleep time (TST). AAs also showed greater night-to-night variability in number of awakenings and sleep fragmentation, and marginally greater variability in TST and sleep efficiency. Sleep quality was not associated with pain either the day before sleep nor the day after. Average daily pain interacted with race: whereas AAs displayed no effect of pain on sleep efficiency, NHWs exhibited better sleep efficiency at higher levels of average pain. Conclusions These data corroborate previous studies documenting poorer sleep among AAs vs. NHWs. The findings of greater night-to-night variability in sleep among AAs, as well as a negative association of pain with sleep quality among NHWs, are unique. Further study is needed to elucidate these findings.

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

Cited by 72 publications

References 34 publications

Temporal shifts in fluid in pulmonary hypertension with and without sleep apnea

Temporal shifts in fluid in pulmonary hypertension with and without sleep apnea

Desipramine improves upper airway collapsibility and reduces OSA severity in patients with minimal muscle compensation

Racial/ethnic differences in sleep quality among older adults with osteoarthritis

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