scholarly journals Σύνδρομο αποφρακτικών απνοιών-υποπνοιών ύπνου, φλεγμονή και οξειδωτικό στρες σε χρονίως αιμοκαθαιρόμενους ασθενείς

2014 ◽  
Author(s):  
Όλγα Νικητίδου
Keyword(s):  
Apnea Hypopnea Index ◽  
Respiratory Disturbance Index ◽  
Desaturation Index ◽  
Disturbance Index ◽  
Tnf Α ◽  
Respiratory Disturbance ◽  
Hs Crp

Το Σύνδρομο αποφρακτικών απνοιών-υποπνοιών ύπνου (ΣΑΑΥ-Υ) θεωρείται παράγοντας καρδιαγγειακού κινδύνου στο γενικό πληθυσμό και σχετίζεται με τη φλεγμονή και το οξειδωτικό στρες. Ο επιπολασμός του στους αιμοκαθαιρόμενους ασθενείς είναι ιδιαίτερα υψηλός. Σκοπός της μελέτης ήταν η αναζήτηση μιας ενδεχόμενης συμμετοχής του στην επίταση της φλεγμονής και του οξειδωτικού στρες που παρατηρείται σε σημαντικό ποσοστό των αιμοκαθαιρόμενων ασθενών. Τριάντα επτά αιμοκαθαιρόμενοι ασθενείς (23 άνδρες) την επόμενη ημέρα μιας μεσοβδομαδιαίας συνεδρίας αιμοκάθαρσης υποβλήθηκαν σε πολυ-υπνογραφία με τη συσκευή SOMNOscreenTM (SOMNOmedics & co GmbH, Germany) και καταγράφηκαν οι αναπνευστικές τους παράμετροι κατά τη διάρκεια του ύπνου: η συνολική διάρκεια ύπνου, οι δείκτες ΑΗΙ (Apnea-Hypopnea Index), RDI (Respiratory Disturbance Index) και DI (Desaturation Index), o μέσος και ελάχιστος SpO2 και το ποσοστό χρόνου ύπνου με SpO2<90%. Το ακόλουθο πρωινό υποβλήθηκαν σε αιμοληψία για τη μέτρηση των δεικτών φλεγμονής και οξειδωτικού στρες: ICAM-1, VCAM-1, L-σελεκτίνη, TNF-α, IL-6, MPO, oxLDL και hs-CRP. Η μέση ηλικία των ασθενών ήταν τα 57,8±12,4 έτη, ο μέσος ΒΜΙ τα 26,8±5,6 kg/m2 και το διάμεσο χρονικό διάστημα που υποβάλλονταν σε αιμοκάθαρση οι 21,5 μήνες (εύρος: 3,1 έως 218 μήνες). Τα ICAM-1 και VCAM-1 συσχετίστηκαν με το χρονικό διάστημα που οι ασθενείς υποβάλλονται σε αιμοκάθαρση (r=0,421, p=0,009 και r=0,525, p=0,001, αντιστοίχως) και η L-σελεκτίνη με τον RDI (r=0,363, p=0,027). Ο ΤΝF-α συσχετίστηκε με το BMI (r=0,510, p<0,0001) και το συνολικό χρονικό διάστημα ύπνου (r=0,370, p=0,027) και η IL-6 με τον ΑΗΙ (r=0,385, p=0,018), τον DI (r=0,336, p=0,042), το ποσοστό χρόνου ύπνου με SpO2 <90% (r=0,415, p=0,012) και το μέσο SpO2 (r=-0,364, p=0,027). Η ΜΡΟ συσχετίστηκε με τον ΑΗΙ (r=0,385, p=0,018), τον DI (r=0,380, p=0,020) και το ποσοστό χρόνο ύπνου με SpO2<90% (r=0,388, p=0,019) και η oxLDL με τον ΑΗΙ (r=0,395, p=0,015), τον RDI (r=0,328, p=0,048) και το ποσοστό χρόνου ύπνου με κορεσμό αιμοσφαιρίνης κάτω από 90% (r=0,389, p=0,019). Η hs-CRP δεν συσχετίστηκε με κάποιο από τα χαρακτηριστικά των ασθενών ή τις αναπνευστικές τους παραμέτρους.Με βάση τη βαρύτητα του ΣΑΑΥ-Υ οι ασθενείς χωρίστηκαν σε 3 ομάδες (ήπιο, μέτριο και σοβαρό σύνδρομο), οι οποίες δεν διέφεραν μεταξύ τους ως προς την ηλικία, το συνολικό χρονικό διάστημα υπό αιμοκάθαρση, το ΒΜΙ και την αναλογία ανδρών/γυναικών. Όσον αφορά στους δείκτες φλεγμονής και οξειδωτικού στρες διαπιστώθηκε ότι: 1) τα επίπεδα της ΜΡΟ ήταν υψηλότερα στους ασθενείς με σοβαρό σύνδρομο σε σχέση με αυτούς με ήπιο και μέτριο (p<0,05 και p<0,05, αντιστοίχως) και 2) τα επίπεδα της oxLDL ήταν χαμηλότερα στους ασθενείς με ήπιο σε σχέση με αυτούς με μέτριο και σοβαρό (p<0,0001 και p<0,001, αντιστοίχως). Συνοψίζοντας, διαπιστώνουμε ότι η βαρύτητα του ΣΑΑΥ-Υ και η νυκτερινή υποξία συμμετέχουν στην προσέλκυση των μονοκυττάρων από το ενδοθηλιακό τοίχωμα των αγγείων, την έκλυση παραγόντων σημαντικών για την προαγωγή της φλεγμονής και οξειδωτικών παραγόντων και στην οξείδωση της LDL. Φαίνεται δηλαδή ότι το ΣΑΑΥ-Υ παίζει ρόλο στην επίταση της φλεγμονής και του οξειδωτικού στρες που χαρακτηρίζει τους ασθενείς με ΧΝΝ τελικού σταδίου υπό αιμοκάθαρση και ίσως τελικά να συμβάλλει με τον τρόπο αυτό στην αύξηση του καρδιαγγειακού τους κινδύνου.

scholarly journals Implantable defibrillator-computed respiratory disturbance index predicts new-onset atrial fibrillation: the DASAP-HF study

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
G Boriani ◽  
E.C.L Pisano' ◽  
P Pieragnoli ◽  
A Locatelli ◽  
A Capucci ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Apnea Hypopnea Index ◽  
Respiratory Disturbance Index ◽  
Sleep Study ◽  
Ventricular Ejection Fraction ◽  
Disturbance Index ◽  
Respiratory Disturbance

Abstract Introduction Sleep apnea (SA), as measured by polysomnography, is a risk factor for atrial fibrillation (AF). The DASAP-HF study previously demonstrated that the Respiratory Disturbance Index (RDI) computed by an implantable cardioverter defibrillator (ICD) algorithm accurately identifies severe SA, is associated with cardiovascular events, and independently predicts death. Purpose In the present analysis we tested the hypothesis that device-detected RDI could also predict AF burden. Methods Patients with left ventricular ejection fraction ≤35% implanted with an ICD were enrolled and followed-up for 24 months. One month after implantation, patients underwent a polysomnographic study. The weekly average RDI value was considered, as calculated by the algorithm during the entire follow-up period and over a 1 week period preceding the sleep study, and patients were stratified according to an RDI value ≥ or &lt;30 episodes/hour. The endpoints were: daily AF burden of ≥5 minutes, ≥6 hours, ≥23 hours. Results 164 enrolled patients had usable RDI values during the entire follow-up period. Severe SA (RDI≥30 episodes/h) was diagnosed in 92 (56%) patients at the time of the polysomnographic study. During a median follow-up of 25 months, AF burden ≥5 minutes/day was documented in 70 (43%), ≥6 hours/day in 48 (29%), and ≥23 hours/day in 33 (20%) patients. Device-detected RDI≥30 episodes/h at the time of the polysomnographic study, as well as the polysomnography-measured apnea hypopnea index ≥30 episodes/h, were not associated with the occurrence of the endpoints, using a Cox regression model. However, using time-dependent Cox model continuously measured weekly average RDI≥30episodes/h was independently associated with AF burden ≥5 minutes/day (HR: 2.13, 95% CI: 1.24–3.65, p=0.006), ≥6 hours/day (HR: 2.75, 95% CI: 1.37–5.49, p=0.004), and ≥23 hours/day (HR: 2.26, 95% CI: 1.05–4.86, p=0.037), after correction for history of AF, left atrial diameter, and gender. Conclusions In heart failure patients implanted with an ICD, device-diagnosed severe SA is associated with a higher risk of AF. In particular, severe SA on follow-up data review identifies patients who are from two- to three-fold more likely to experience an AF episode, according to various thresholds of daily AF burden. FUNDunding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Promoted by the Italian Heart Rhythm Society (AIAC).Supported by a research grant from Boston Scientific.

scholarly journals A validation study of an esophageal probe–based polygraph against polysomnography in obstructive sleep apnea

2021 ◽  
Author(s):  
Thorarinn Arnar Olafsson ◽  
Eivind Andreas Steinsvik ◽  
Gregor Bachmann-Harildstad ◽  
Harald Hrubos-Strøm
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Likelihood Ratio ◽  
Saturation Index ◽  
Positive Likelihood Ratio ◽  
Apnea Hypopnea Index ◽  
Respiratory Disturbance Index ◽  
Disturbance Index ◽  
Obstructive Sleep ◽  
Respiratory Disturbance

Abstract Study objectives The aim of this study was to validate the automatically scored results of an esophageal probe–based polygraph system (ApneaGraph® Spiro) against manually scored polysomnography (Nox A1, PSG) results. We compared the apnea–hypopnea index, oxygen saturation index, and respiratory disturbance index of the devices. Methods Consenting patients, referred for obstructive sleep apnea workup, were tested simultaneously with the ApneaGraph® Spiro and Nox A1® polysomnograph. Each participant made one set of simultaneous registrations for one night. PSG results were scored independently. Apnea–hypopnea index, oxygen desaturation index, and respiratory disturbance index were compared using Pearson’s correlation and scatter plots. Sensitivity, specificity, and positive likelihood ratio of all indices at 5, 15, and 30 were calculated. Results A total of 83 participants had successful registrations. The apnea–hypopnea index showed sensitivity of 0.83, specificity of 0.95, and a positive likelihood ratio of 5.11 at an index cutoff of 15. At a cutoff of 30, the positive likelihood ratio rose to 31.43. The respiratory disturbance index showed high sensitivity (> 0.9) at all cutoffs, but specificity was below 0.5 at all cutoffs. Scatterplots revealed overestimation in mild OSA and underestimation in severe OSA for all three indices. Conclusions The ApneaGraph® Spiro performed acceptably when OSA was defined by an AHI of 15. The equipment overestimated mild OSA and underestimated severe OSA, compared to the PSG.

scholarly journals Compared to Individuals with Mild to Moderate Obstructive Sleep Apnea (OSA), Individuals with Severe OSA Had Higher BMI and Respiratory-Disturbance Scores

Life ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. 368
Author(s):  
Leeba Rezaie ◽  
Soroush Maazinezhad ◽  
Donald J. Fogelberg ◽  
Habibolah Khazaie ◽  
Dena Sadeghi-Bahmani ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Multiple Regression ◽  
Daytime Sleepiness ◽  
Respiratory Disturbance Index ◽  
Disturbance Index ◽  
Related Data ◽  
Obstructive Sleep ◽  
Increased Risk ◽  
Respiratory Disturbance

Objective: Individuals with obstructive sleep apnea (OSA) are at increased risk to suffer from further somatic and sleep-related complaints. To assess OSA, demographic, anthropometric, and subjective/objective sleep parameters are taken into consideration, but often separately. Here, we entered demographic, anthropometric, subjective, and objective sleep- and breathing-related dimensions in one model. Methods: We reviewed the demographic, anthropometric, subjective and objective sleep- and breathing-related data, and polysomnographic records of 251 individuals with diagnosed OSA. OSA was considered as a continuous and as categorical variable (mild, moderate, and severe OSA). A series of correlational computations, X2-tests, F-tests, and a multiple regression model were performed to investigate which demographic, anthropometric, and subjective and objective sleep dimensions were associated with and predicted dimensions of OSA. Results: Higher apnea/hypopnea index (AHI) scores were associated with higher BMI, higher daytime sleepiness, a higher respiratory disturbance index, and higher snoring. Compared to individuals with mild to moderate OSA, individuals with severe OSA had a higher BMI, a higher respiratory disturbance index (RDI) and a higher snoring index, while subjective sleep quality and daytime sleepiness did not differ. Results from the multiple regression analysis showed that an objectively shorter sleep duration, more N2 sleep, and a higher RDI predicted AHI scores. Conclusion: The pattern of results suggests that blending demographic, anthropometric, and subjective/objective sleep- and breathing-related data enabled more effective discrimination of individuals at higher risk for OSA. The results are of practical and clinical importance: demographic, anthropometric, and breathing-related issues derived from self-rating scales provide a quick and reliable identification of individuals at risk of OSA; objective assessments provide further certainty and reliability.

scholarly journals 0501 ASSOCIATION BETWEEN SLEEP-RELATED SYMPTOMS AND RESPIRATORY DISTURBANCE INDEX AMONG COMMUNITY-DWELLING SCHOOL CHILDREN

SLEEP ◽  
2017 ◽  
Vol 40 (suppl_1) ◽  
pp. A186-A187
Author(s):  
H Wada ◽  
M Kimura ◽  
R Shirahama ◽  
T Hayashi ◽  
Y Suzuki ◽  
...  
Keyword(s):  
School Children ◽  
Community Dwelling ◽  
Respiratory Disturbance Index ◽  
Disturbance Index ◽  
Respiratory Disturbance

scholarly journals Growth Hormone Therapy and Respiratory Disorders: Long-Term Follow-up in PWS Children

2013 ◽  
Vol 98 (9) ◽  
pp. E1516-E1523 ◽  
Author(s):  
Jenny Berini ◽  
Valeria Spica Russotto ◽  
Paolo Castelnuovo ◽  
Stefania Di Candia ◽  
Luigi Gargantini ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Central Apnea ◽  
Respiratory Disturbance Index ◽  
Gh Therapy ◽  
Gh Treatment ◽  
Adenotonsillar Hypertrophy ◽  
Disturbance Index ◽  
Obstructive Sleep ◽  
Respiratory Disturbance

Context: Adenotonsillar tissue hypertrophy and obstructive sleep apnea have been reported during short-term GH treatment in children with Prader-Willi syndrome (PWS). Objective: We conducted an observational study to evaluate the effects of long-term GH therapy on sleep-disordered breathing and adenotonsillar hypertrophy in children with PWS. Design: This was a longitudinal observational study. Patients and Methods: We evaluated 75 children with genetically confirmed PWS, of whom 50 fulfilled the criteria and were admitted to our study. The patients were evaluated before treatment (t0), after 6 weeks (t1), after 6 months (t2), after 12 months (t3), and yearly (t4–t6) thereafter, for up to 4 years of GH therapy. The central apnea index, obstructive apnea hypopnea index (OAHI), respiratory disturbance index, and minimal blood oxygen saturation were evaluated overnight using polysomnography. We evaluated the adenotonsillar size using a flexible fiberoptic endoscope. Results: The percentage of patients with an OAHI of &gt;1 increased from 3 to 22, 36, and 38 at t1, t4, and t6, respectively (χ2 = 12.2; P &lt; .05). We observed a decrease in the respiratory disturbance index from 1.4 (t0) to 0.8 (t3) (P &lt; .05) and the central apnea index from 1.2 (t0) to 0.1 (t4) (P &lt; .0001). We had to temporarily suspend treatment for 3 patients at t1, t4, and t5 because of severe obstructive sleep apnea. The percentage of patients with severe adenotonsillar hypertrophy was significantly higher at t4 and t5 than at t0. The OAHI directly correlated with the adenoid size (adjusted for age) (P &lt; .01) but not with the tonsil size and IGF-1 levels. Conclusion: Long-term GH treatment in patients with PWS is safe; however, we recommend annual polysomnography and adenotonsillar evaluation.

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