Respiratory effort during sleep and prevalent hypertension in obstructive sleep apnoea

Abstract

Mechanisms underlying blood pressure changes in obstructive sleep apnoea (OSA) are incompletely understood. Increased respiratory effort (RE) is one of the main features of OSA and is associated with sympathetic overactivity, leading to increased vascular wall stiffness and remodelling. This study investigated associations between a new measure of RE (percentage of sleep time spent with increased RE based on measurement of mandibular jaw movements [MJM]; REMOV, %TST) and prevalent hypertension in adults referred for evaluation of suspected OSA. A machine learning model was built to predict hypertension from clinical data, conventional polysomnography (PSG) indices, and MJM-derived parameters (including REMOV, %TST). The model was evaluated in a training subset and a test subset. The analysis included 1127 patients, 901 (80%) in the training subset and 226 (20%) in the test subset. The prevalence of hypertension was 31% and 30%, respectively, in the training and test subsets. A risk stratification model based on eighteen input features including REMOV had good accuracy for predicting prevalent hypertension (sensitivity 0.75, specificity 0.83). Using the Shapley additive explanation (SHAP) method, REMOV was the best predictor of hypertension after clinical risk factors (age, sex, body mass index, neck circumference) and time with oxygen saturation <90%, ahead òf standard PSG metrics (including the apnoea-hypopnoea index and oxygen desaturation index). The proportion of sleep time spent with increased RE automatically derived from MJM was identified as a potential new reliable metric to predict prevalent hypertension in patients with OSA.

Respiratory effort during sleep and the rate of prevalent type 2 diabetes in obstructive sleep apnoea

“…We have previously reported that RE is also independently associated with prevalent hypertension even in individuals without significant hypoxic burden. 30 , 40 Our data have clinical significance because some future therapeutic decisions for Continuous Positive Airway Press CPAP or alternative primary treatment for OSA will be based on high levels of RE during sleep and not only AHI, especially in individuals with hypertension and/or type 2 diabetes.…”

“… 7 , 9 , 13 Relatively few studies have evaluated the relevance of other metrics, such as the proportion of sleep time spent with an oxygen saturation below 90%. 8 , 13 Increased RE in individuals with OSA has recently been associated with an increased prevalence of hypertension 30 but has otherwise been poorly studied and is probably underestimated as a risk factor for the cardiovascular and metabolic consequences of OSA.…”

Innovations in mandibular advancement splint therapy for obstructive sleep apnoea

“…More recent work by the same group (Le-Dong et al, 2021) demonstrated that machine learning also enabled accurate sleep staging to be performed with an AUC for wake of 0.98, N1/N2 sleep of 0.86, N3 sleep of 0.97, and REM sleep of 0.96. Additionally, mandibular jaw movements (MJM) can be used as a surrogate measure for nocturnal respiratory effort (RE), since the slight protrusions of the mandible during sleep are reflective of respiratory drive (Martinot et al, 2022). Respiratory effort measured via MJM was a stronger predictor of prevalent hypertension than AHI (Martinot et al, 2022).…”

“…Additionally, mandibular jaw movements (MJM) can be used as a surrogate measure for nocturnal respiratory effort (RE), since the slight protrusions of the mandible during sleep are reflective of respiratory drive (Martinot et al, 2022). Respiratory effort measured via MJM was a stronger predictor of prevalent hypertension than AHI (Martinot et al, 2022). Such sensors potentially could be embedded within MAS devices to allow capture of compliance data and cardiovascular risk profiling.…”

Outpatient screening for obstructive sleep apnea-hypopnea syndrome: what place for the Sunrise device?

“…Après évaluation de ces 8 articles selon ces critères d'inclusion, 5 articles ont été sélectionnés et 4 articles supplémentaires ont pu être identifiés sur base de leurs bibliographies (figure 1). 11,12 . La dernière étude cherche à évaluer la réponse thérapeutique de l'OAM chez les patients SAHOS afin de guider les praticiens dans la titration de ce dispositif 13 .…”