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Susan Redline - One of the best experts on this subject based on the ideXlab platform.
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associations of pm10 with sleep and sleep disordered breathing in adults from seven u s urban areas
American Journal of Respiratory and Critical Care Medicine, 2010Co-Authors: Antonella Zanobetti, Susan Redline, Michael D Lebowitz, Joel Schwartz, Dennis Rosen, Sanjay R Patel, George T Oconnor, Brent A Coull, Diane R GoldAbstract:Rationale: Sleep-disordered breathing (SDB), the recurrent episodic disruption of normal breathing during sleep, affects as much as 17% of U.S. adults, and may be more prevalent in poor urban environments. SDB and air pollution have been linked to increased cardiovascular diseases and mortality, but the association between pollution and SDB is poorly understood. Objectives: We used data from the Sleep Heart Health Study (SHHS), a U.S. multicenter cohort study assessing cardiovascular and other consequences of SDB, to examine whether particulate air matter less than 10 μm in aerodynamic diameter (PM10) was associated with SDB among persons 39 years of age and older. Methods: Using baseline data from SHHS urban sites, outcomes included the following: the Respiratory Disturbance Index (RDI); percentage of sleep time at less than 90% O2 saturation; and sleep efficiency, measured by overnight in-home polysomnography. We applied a fixed-effect model containing a city effect, controlling for potential predictors. In all models we included both the 365-day moving averages of PM10 and temperature (long-term effects) and the differences between the daily measures of these two predictors and their 365-day average (short-term effects). Measurements and Main Results: In summer, increases in RDI or percentage of sleep time at less than 90% O2 saturation, and decreases in sleep efficiency, were all associated with increases in short-term variation in PM10. Over all seasons, we found that increased RDI was associated with an 11.5% (95% confidence interval: 1.96, 22.01) increase per interquartile range increase (25.5°F) in temperature. Conclusions: Reduction in air pollution exposure may decrease the severity of SDB and nocturnal hypoxemia and may improve cardiac risk.
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sleep disordered breathing and impaired glucose metabolism in normal weight and overweight obese individuals the sleep heart health study
Diabetes Care, 2008Co-Authors: Sinziana Seicean, Mark H. Sanders, Daniel J. Gottlieb, Lester H Kirchner, Naresh M Punjabi, Helaine E Resnick, Rohit Budhiraja, Mendel E Singer, Susan RedlineAbstract:OBJECTIVE —To characterize the association between sleep-disordered breathing (SDB) and impaired fasting glucose (IFG), impaired glucose tolerance (IGT), combined IFG and IGT, and occult diabetes in individuals of different body habitus. RESEARCH DESIGN AND METHODS —Cross-sectional analysis of 2,588 participants (aged 52–96 years; 46% men) without known diabetes. SDB was defined as Respiratory Disturbance Index ≥10 events/h. IFG, IGT, occult diabetes, and body weight were classified according to recent accepted guidelines. Participants with and without SDB were compared on prevalence and odds ratios for measures of impaired glucose metabolism (IGM), adjusting for age, sex, race, BMI, and waist circumference. RESULTS —SDB was observed in 209 nonoverweight and 1,036 overweight/obese participants. SDB groups had significantly higher adjusted prevalence and adjusted odds of IFG, IFG plus IGT, and occult diabetes. The adjusted odds ratio for all subjects was 1.3 (95% CI 1.1–1.6) for IFG, 1.2 (1.0–1.4) for IGT, 1.4 (1.1–2.7) for IFG plus IGT, and 1.7 (1.1–2.7) for occult diabetes. CONCLUSIONS —SDB was associated with occult diabetes, IFG, and IFG plus IGT, after adjusting for age, sex, race, BMI, and waist circumference. The magnitude of these associations was similar in nonoverweight and overweight participants. The consistency of associations across all measures of IGM and body habitus groups and the significant association between SDB and IFG plus IGT, a risk factor for rapid progression to diabetes, cardiovascular disease, and mortality, suggests the importance of SDB as a risk factor for clinically important levels of metabolic dysfunction.
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association of nocturnal arrhythmias with sleep disordered breathing the sleep heart health study
American Journal of Respiratory and Critical Care Medicine, 2006Co-Authors: Reena Mehra, Daniel J. Gottlieb, Emelia J Benjamin, Eyal Shahar, R Nawabit, Lester H Kirchner, Jayakumar Sahadevan, Susan RedlineAbstract:Rationale: Sleep-disordered breathing recurrent intermittent hypoxia and sympathetic nervous system activity surges provide the milieu for cardiac arrhythmia development.Objective: We postulate that the prevalence of nocturnal cardiac arrhythmias is higher among subjects with than without sleep-disordered breathing.Methods: The prevalence of arrhythmias was compared in two samples of participants from the Sleep Heart Health Study frequency-matched on age, sex, race/ethnicity, and body mass Index: (1) 228 subjects with sleep-disordered breathing (Respiratory Disturbance Index ⩾ 30) and (2) 338 subjects without sleep-disordered breathing (Respiratory Disturbance Index < 5).Results: Atrial fibrillation, nonsustained ventricular tachycardia, and complex ventricular ectopy (nonsustained ventricular tachycardia or bigeminy or trigeminy or quadrigeminy) were more common in subjects with sleep-disordered breathing compared with those without sleep-disordered breathing: 4.8 versus 0.9% (p = 0.003) for atrial fibri...
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progression and regression of sleep disordered breathing with changes in weight the sleep heart health study
JAMA Internal Medicine, 2005Co-Authors: Anne B Newman, Susan Redline, Rachel J Givelber, Javier F Nieto, Greg Foster, Terry YoungAbstract:Background The relationship of weight changes to the incidence, progression, and remission of sleep-disordered breathing (SDB) is not well defined. This study aims to determine the relationship between change in weight and progression or remission of SDB by polysomnography. Methods We performed a longitudinal cohort study of the cardiovascular consequences of sleep apnea in diverse US communities. Sleep apnea and polysomnographic indicators of SDB were assessed 5 years apart. Results A total of 2968 men and women (mean age, 62 years) participated in the study. Men were more likely to have an increase in Respiratory Disturbance Index (RDI) with a given increase in weight than were women, and this was not explained by differences in starting weight, waist circumference, age, or ethnicity. In a linear regression analysis, both men and women had a greater increase in RDI with weight gain than a decrease in RDI with weight loss. In a categorical analysis of larger degrees of change, this sex difference was also evident. Associations were similar in diverse ethnic groups. However, SDB progressed over time, even in those with stable weight. Conclusion Modest changes in weight were related to an increase or decrease in SDB, and this association was stronger in men than in women.
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sleep disordered breathing glucose intolerance and insulin resistance the sleep heart health study
American Journal of Epidemiology, 2004Co-Authors: Naresh M Punjabi, Susan Redline, Daniel J. Gottlieb, Eyal Shahar, Rachel J Givelber, Helaine E ResnickAbstract:Clinic-based studies suggest that sleep-disordered breathing (SDB) is associated with glucose intolerance and insulin resistance. However, in the available studies, researchers have not rigorously controlled for confounding variables to assess the independent relation between SDB and impaired glucose metabolism. The objective of this study was to determine whether SDB was associated with glucose intolerance and insulin resistance among community-dwelling subjects (n=2,656) participating in the Sleep Heart Health Study (1994-1999). SDB was characterized with the Respiratory Disturbance Index and measurements of oxygen saturation during sleep. Fasting and 2-hour glucose levels measured during an oral glucose tolerance test were used to assess glycemic status. Relative to subjects with a Respiratory Disturbance Index of less than 5.0 events/hour (the reference category), subjects with mild SDB (5.0-14.9 events/hour) and moderate to severe SDB (> or =15 events/hour) had adjusted odds ratios of 1.27 (95% confidence interval: 0.98, 1.64) and 1.46 (95% confidence interval: 1.09, 1.97), respectively, for fasting glucose intolerance (p for trend < 0.01). Sleep-related hypoxemia was also associated with glucose intolerance independently of age, gender, body mass Index, and waist circumference. The results of this study suggest that SDB is independently associated with glucose intolerance and insulin resistance and may lead to type 2 diabetes mellitus.
Christian Guilleminault - One of the best experts on this subject based on the ideXlab platform.
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acoustic assessment of snoring sound intensity in 1 139 individuals undergoing polysomnography
2017Co-Authors: Kent Wilson, Riccardo A. Stoohs, Thomas F. Mulrooney, Christian Guilleminault, Linda J Johnson, Zhen HuangAbstract:Study objectives: To quantify the snoring sound intensity levels generated by individuals during polysomnographic testing and to examine the relationships between acoustic, polysomnographic, and clinical variables. Design: The prospective acquisition of acoustic and polysomnographic data with a retrospective medical chart review. Setting: A sleep laboratory at a primary care hospital. Participants: All 1,139 of the patients referred to the sleep laboratory for polysomnographic testing from 1980 to 1994. Interventions: The acoustic measurement of snoring sound intensity during sleep concurrent with polysomnographic testing. Measurements and results: Four decibel levels were derived from snoring sound intensity recordings. L1 ,L 5, and L10 are measures of the sound pressure measurement in decibels employing the A-weighting network that yields the response of the human ear exceeded, respectively, for 1, 5, and 10% of the test period. The Leq is a measure of the A-weighted average intensity of a fluctuating acoustic signal over the total test period. L10 levels above 55 dBA were exceeded by 12.3% of the patients. The average levels of snoring sound intensity were significantly higher for men than for women. The levels of snoring sound intensity were associated significantly with the following: polysomnographic testing results, including the Respiratory Disturbance Index (RDI), sleep latency, and the percentage of slow-wave sleep; demographic factors, including gender and body mass; and clinical factors, including snoring history, hypersomnolence, and breathing stoppage. Men with a body mass Index of > 30 and an average snoring sound intensity of > 38 dBA were 4.1 times more likely to have an RDI of > 10. Conclusions: Snoring sound intensity levels are related to a number of demographic, clinical, and polysomnographic test results. Snoring sound intensity is closely related to apnea/hypopnea during sleep. The noise generated by snoring can disturb or disrupt a snorer’s sleep, as well as the sleep of a bed partner. (CHEST 1999; 115:762‐770) Abbreviations: BMI 5 body mass Index; CI 5 confidence interval; dB 5 decibel; dBA 5 sound pressure measurement in decibels employing the A-weighting network that yields the response of the human ear; L1 5 measure of the dBA level exceeded for 1% of the test period; L5 5 measure of the dBA level exceeded for 5% of the test period; L10 5 measure of the dBA level exceeded for 10% of the test period; Leq 5 a measurement of the A-weighted average energy of a fluctuating acoustic signal over a specific measurement period; LS 5 light sleep; MPCA 5 Minnesota Pollution Control Agency; OSHA 5 Occupational Safety and Health Administration; RDI 5 Respiratory Disturbance Index; SWS 5 slow wave sleep
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accurate scoring of the apnea hypopnea Index using a simple non contact breathing sensor
Journal of Sleep Research, 2013Co-Authors: Zachary Beattie, Christian Guilleminault, Tamara L Hayes, Chad C HagenAbstract:Sleep apnea is a serious condition that afflicts many individuals and is associated with serious health complications. Polysomnography, the gold standard for assessing and diagnosing sleep apnea, uses breathing sensors that are intrusive and can disrupt the patient’s sleep during the overnight testing. We investigated the use of breathing signals derived from non-contact force sensors (i.e. load cells) placed under the supports of the bed as an alternative to traditional polysomnography breathing sensors (e.g. nasal pressure, oral-nasal thermistor, chest belt, and abdominal belt). The Apnea-Hypopnea Index estimated using the load cells was not different than that estimated using standard polysomnography leads (t44 = 0.37, p = 0.71). Overnight polysomnography sleep studies scored using load cell breathing signals had an intra-class correlation coefficient of 0.97 for the Apnea-Hypopnea Index and an intra-class correlation coefficient of 0.85 for the Respiratory Disturbance Index when compared to scoring using traditional polysomnography breathing sensors following American Academy of Sleep Medicine guidelines. These results demonstrate the feasibility of using unobtrusive load cells installed under the bed to measure the Apnea-Hypopnea Index.
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sleep disordered breathing and gestational hypertension postpartum follow up study
Sleep, 2013Co-Authors: John Reid, Robert Skomro, David J. Cotton, Femi Olatunbosun, John A. Gjevre, Riley A Glew, Mark Fenton, Christian GuilleminaultAbstract:BACKGROUND Gestational hypertension (GH) is a newly recognized risk factor for adverse cardiovascular events later in life. Sleep disordered breathing (SDB) is an established risk factor for adverse cardiovascular events. Recent research has suggested that women with GH may have an increased rate of SDB during pregnancy, but it is not known if this higher rate of SDB persists into the postpartum state. OBJECTIVE To assess whether women with GH continue to have an increased rate of SDB compared to healthy pregnant women, after the physiologic changes of pregnancy resolve. METHODS We previously studied women with GH and uncomplicated pregnancies with sleep questionnaires and level 1 polysomnography. Participants were invited to participate in repeat testing 1-2 years postpartum. Respiratory Disturbance Index (RDI) differences were assessed. RESULTS Eighteen subjects (11 GH and 7 healthy) had complete follow-up data available for comparison with antepartum data. This group was representative of the initial antepartum cohort. Women with GH experienced a decrease in mean RDI from antepartum to postpartum (12.0 ± 12.3 vs. 2.9 ± 2.9; P = 0.02). Healthy women did not experience the same change (2.8 ± 5.3 vs. 2.1 ± 3.2; P = 0.81). Postpartum comparisons showed the mean RDI of women with GH had decreased to be similar to that of healthy women (P = 0.75). CONCLUSIONS SDB in women with gestational hypertension improved in the postpartum state to levels indistinguishable from our healthy subjects. This suggests that the physiologic effects of pregnancy may have had a pathologic role in the development of antepartum SDB in women with GH.
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pregnant women with gestational hypertension may have a high frequency of sleep disordered breathing
Sleep, 2011Co-Authors: John Reid, Robert Skomro, David J. Cotton, Heather Burrell Ward, Femi Olatunbosun, John A. Gjevre, Christian GuilleminaultAbstract:BACKGROUND Gestational hypertension is a common complication of pregnancy. Recent evidence suggests that women with gestational hypertension have a high rate of sleep disordered breathing (SDB). Using laboratory-based polysomnography, we evaluated for the frequency of SDB in women with gestational hypertension compared to healthy women with uncomplicated pregnancies. METHODS In this single-center cross-sectional study, women with the diagnosis of gestational hypertension were screened in the Fetal Assessment Unit and Antepartum ward. Healthy subjects were recruited by local advertising. Subjects completed a series of questionnaires addressing sleep quality and daytime sleepiness, followed by full night polysomnography. The primary outcome was frequency of SDB (defined as a Respiratory Disturbance Index ≥ 5) in the gestational hypertension and healthy groups. RESULTS A total of 34 women with gestational hypertension and singleton pregnancies and 26 healthy women with uncomplicated singleton pregnancies consented to participate in the study. The mean ages and gestational ages, but not the body mass indices, of the 2 groups were similar. The frequencies of SDB in the more obese gestational hypertension group and the healthy group were 53% and 12%, respectively (P < 0.001). INTERPRETATION Women with gestational hypertension may have a significantly higher frequency of SDB than do healthy women with uncomplicated pregnancies of similar gestational age. The relative causal contributions, if any, of SDB and obesity remain to be determined.
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upper airway resistance syndrome a long term outcome study
Journal of Psychiatric Research, 2006Co-Authors: Christian Guilleminault, Ceyda Kirisoglu, Dalva Poyares, Luciana Palombini, Damien Leger, Mehran Faridmoayer, Maurice M OhayonAbstract:UNLABELLED: This prospective study aimed to assess symptomatic evolution of patients diagnosed with Upper Airway Resistance Syndrome (UARS) four and half years after the initial UARS diagnosis. For this purpose, 138 UARS patients were contacted by mail between 43 and 69 months after the initial evaluation; 105 responded to the letter and 94 patients accepted to undergo new clinical and polysomnographic evaluations. Initial and follow-up polysomnographic recordings were scored using the same criteria. RESULTS: Of the 94 patients who completed the follow-up examination, none of them were using nasal CPAP. It was related to refusal by insurance providers to provide equipment based on initial apnea-hypopnea Index (AHI) in 90/94 subjects. Percentage of patients with sleep related-complaints significantly increased over the four and half year period: daytime fatigue, insomnia and depressive mood increased by 12 to 20 times. Reports of sleep maintenance sleep onset insomnia and depressive mood was significantly increased. Hypnotic, antidepressant and stimulant prescription increased from initial to follow-up visit (from 11.7% to 61.7%; from 3.2% to 25.5% and from 0% to 9.6%, respectively) with antidepressant given as much for sleep Disturbance as mood disorder. The polysomnography results at follow-up showed that 5 subjects had AHI compatible with Obstructive Sleep Apnea Syndrome (OSAS) but overall, Respiratory Disturbance Index had no significant change. Total sleep time was significantly reduced compared to initial visit. CONCLUSIONS: Many UARS patients remained untreated following initial evaluation. Worsening of symptoms of insomnia, fatigue and depressive mood were seen with absence of treatment of UARS.
David J Terris - One of the best experts on this subject based on the ideXlab platform.
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cephalometric parameters after multilevel pharyngeal surgery for patients with obstructive sleep apnea
Laryngoscope, 1998Co-Authors: Mike Yao, David S Utley, David J TerrisAbstract:Cephalometric studies have shown narrowing in the upper airway at multiple levels in patients with obstructive sleep apnea. Uvulopalatopharyngoplasty (UPPP), mandibular osteotomy with genioglossus advancement, and hyoid myotomy with advancement address narrowing in the retropalatal and retrolingual regions. In an effort to relate postoperative clinical changes to anatomic changes, cephalometric studies were performed on 44 patients who underwent multilevel pharyngeal surgery (UPPP, genioglossus advancement, hyoid myotomy with advancement). Both preand postoperative radiographs were available for 23 of these patients. The posterior airway space (P = .09), minimal posterior airway space (P = .04), posterior uvular space (P = .06), mandibular plane-to-hyoid distance (MP-H) (P = .06) and central incisor-to-tongue base distance (P = .02) all improved after surgery. None of the measurements of the posterior airway were significantly different between responders and nonresponders. The degree of collapse of the palate on modified Muller maneuver was highly correlated with the severity of sleep apnea as measured by the Respiratory Disturbance Index; the collapse of the lateral pharyngeal walls was moderately correlated; and collapse of the base of tongue was not correlated. Cephalometric radiographs may reflect the anatomic changes that result from upper airway surgery for sleep apnea, but these changes are not useful for assessing surgical efficacy. The modified Muller maneuver, however, may represent a more predictive evaluation.
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a cost effective and rational surgical approach to patients with snoring upper airway resistance syndrome or obstructive sleep apnea syndrome
Laryngoscope, 1997Co-Authors: David S Utley, Edward J Shin, Alex Clerk, David J TerrisAbstract:The past decade has seen several innovations in the surgical techniques available for treatment of patients with sleep-disordered breathing. Outpatient techniques such as laser-assisted uvulopalatoplasty (LAUP) and more aggressive procedures designed to address hypopharyngeal and base of tongue obstruction (genioglossus advancement and hyoid myotomy) have been developed and proven successful. We describe the efficacy of LAUP for snoring (72.7%), upper airway resistance syndrome (81.8%), and mild (mean [±SD] Respiratory Disturbance Index [RDI] = 12 ± 8.1) obstructive sleep apnea (41.7%) in 56 patients who underwent 132 LAUP procedures in a 26-month period. Thirty-two patients with more significant obstructive sleep apnea (mean RDI = 41.8 ± 23.1) underwent multilevel pharyngeal surgery consisting of genioglossus advancement and hyoid myotomy combined with uvulopalatopharyngoplasty. The surgical success rate in this group of patients was 85.7% when commonly accepted criteria were applied. We recommend a stratified surgical approach to patients with sleep-disordered breathing. Progressively worse airway obstruction marked by multilevel pharyngeal collapse and more severe sleep-disordered breathing is treated with incrementally more aggressive surgery addressing multiple areas of the upper airway.
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recognition and surgical management of the upper airway resistance syndrome
Laryngoscope, 1996Co-Authors: James P Newman, David S Utley, Alex Clerk, Michelle Moore, David J TerrisAbstract:Patients with upper airway resistance syndrome (UARS) have clinical signs and symptoms of excessive daytime somnolence (EDS) in the absence of obstructive sleep apnea. These patients have increased upper airway resistance, reflected by an elevated intrathoracic pressure measurement, despite a normal Respiratory Disturbance Index (RDI). Physical findings often include excessive palatal tissue and narrowing of the oropharynx and hypopharynx. Nine patients with UARS who received surgical treatment were prospectively evaluated. The four men and five women had signs of EDS, with or without snoring. The mean (±standard deviation) RDI was 2.1 (±1.2), and the mean esophageal pressure recording during polysomnography was -36.7 (±16.2) cm H 2 O. The Epworth sleepiness scale was used to quantify EDS. The preoperative score of 12.0 (±6.6) decreased to 3.4 (±1.9) (P=.001) after surgical treatment. A variety of procedures, all including some type of palatal surgery, were performed. No treatment complications occurred. The recognition of UARS and an understanding of the mechanisms responsible for the progressive development of obstructive sleep apnea syndrome may facilitate the prompt identification and treatment of such patients. The pathophysiology of UARS and a preliminary report of its surgical treatment are discussed.
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characterization of postoperative edema following laser assisted uvulopalatoplasty using mri and polysomnography implications for the outpatient treatment of obstructive sleep apnea syndrome
Laryngoscope, 1996Co-Authors: David J Terris, Alex Clerk, Alexander Norbash, Robert J TroellAbstract:Laser-assisted uvulopalatoplasty (LAUP) has been introduced as an alternative to uvuloplatopharyngoplasty for the treatment of snoring. Despite limited study, the use of this procedure has been expanded to include patients with obstructive sleep apnea syndrome. Although the potential cost-savings of performing sleep apnea surgery on an outpatient basis are self-evident, concern exists regarding the safety of this practice. In an effort to characterize the risk of performing LAUP on an outpatient basis, eight patients with mild or no sleep apnea were identified and intensively studied before and after the first stage of LAUP to cure snoring. Assessment included preoperative magnetic resonance imaging (MRI) scans, polysomnography, and videoendoscopy. Each of these diagnostic studies was then repeated between 48 and 72 hours after LAUP. Complete polysomnographic data were available for seven of the eight patients. The mean ( +/- SD) preoperative Respiratory Disturbance Index (RDI) was 11.3 +/- 10.9, and the mean oxygen saturation nadir (LSAT) was 87.7 +/- 6.2% (n = 7). The mean airway cross-sectional area at the palate (by MRI) was 49.8 +/- 22.8 mm2 (n = 8). After LAUP, the mean RDI nearly doubled to 21.7 +/- 9.9 (P > .1). The apnea Index increased fourfold from 3.3 +/- 3.5 to 14.8 +/- 10.9 (P .5). The cross-sectional area of the airway decreased to a mean of 47.9 +/- 22.4 mm2 (P > .5). These data suggest that LAUP may temporarily worsen obstructive sleep apnea. Although the clinical significance of this degree of worsening is uncertain, it would be prudent to consider perioperative use of nasal continuous positive airway pressure in patients with more than mild obstructive sleep apnea who undergo ambulatory LAUP.
Daniel J. Gottlieb - One of the best experts on this subject based on the ideXlab platform.
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sleep disordered breathing and impaired glucose metabolism in normal weight and overweight obese individuals the sleep heart health study
Diabetes Care, 2008Co-Authors: Sinziana Seicean, Mark H. Sanders, Daniel J. Gottlieb, Lester H Kirchner, Naresh M Punjabi, Helaine E Resnick, Rohit Budhiraja, Mendel E Singer, Susan RedlineAbstract:OBJECTIVE —To characterize the association between sleep-disordered breathing (SDB) and impaired fasting glucose (IFG), impaired glucose tolerance (IGT), combined IFG and IGT, and occult diabetes in individuals of different body habitus. RESEARCH DESIGN AND METHODS —Cross-sectional analysis of 2,588 participants (aged 52–96 years; 46% men) without known diabetes. SDB was defined as Respiratory Disturbance Index ≥10 events/h. IFG, IGT, occult diabetes, and body weight were classified according to recent accepted guidelines. Participants with and without SDB were compared on prevalence and odds ratios for measures of impaired glucose metabolism (IGM), adjusting for age, sex, race, BMI, and waist circumference. RESULTS —SDB was observed in 209 nonoverweight and 1,036 overweight/obese participants. SDB groups had significantly higher adjusted prevalence and adjusted odds of IFG, IFG plus IGT, and occult diabetes. The adjusted odds ratio for all subjects was 1.3 (95% CI 1.1–1.6) for IFG, 1.2 (1.0–1.4) for IGT, 1.4 (1.1–2.7) for IFG plus IGT, and 1.7 (1.1–2.7) for occult diabetes. CONCLUSIONS —SDB was associated with occult diabetes, IFG, and IFG plus IGT, after adjusting for age, sex, race, BMI, and waist circumference. The magnitude of these associations was similar in nonoverweight and overweight participants. The consistency of associations across all measures of IGM and body habitus groups and the significant association between SDB and IFG plus IGT, a risk factor for rapid progression to diabetes, cardiovascular disease, and mortality, suggests the importance of SDB as a risk factor for clinically important levels of metabolic dysfunction.
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association of nocturnal arrhythmias with sleep disordered breathing the sleep heart health study
American Journal of Respiratory and Critical Care Medicine, 2006Co-Authors: Reena Mehra, Daniel J. Gottlieb, Emelia J Benjamin, Eyal Shahar, R Nawabit, Lester H Kirchner, Jayakumar Sahadevan, Susan RedlineAbstract:Rationale: Sleep-disordered breathing recurrent intermittent hypoxia and sympathetic nervous system activity surges provide the milieu for cardiac arrhythmia development.Objective: We postulate that the prevalence of nocturnal cardiac arrhythmias is higher among subjects with than without sleep-disordered breathing.Methods: The prevalence of arrhythmias was compared in two samples of participants from the Sleep Heart Health Study frequency-matched on age, sex, race/ethnicity, and body mass Index: (1) 228 subjects with sleep-disordered breathing (Respiratory Disturbance Index ⩾ 30) and (2) 338 subjects without sleep-disordered breathing (Respiratory Disturbance Index < 5).Results: Atrial fibrillation, nonsustained ventricular tachycardia, and complex ventricular ectopy (nonsustained ventricular tachycardia or bigeminy or trigeminy or quadrigeminy) were more common in subjects with sleep-disordered breathing compared with those without sleep-disordered breathing: 4.8 versus 0.9% (p = 0.003) for atrial fibri...
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sleep disordered breathing glucose intolerance and insulin resistance the sleep heart health study
American Journal of Epidemiology, 2004Co-Authors: Naresh M Punjabi, Susan Redline, Daniel J. Gottlieb, Eyal Shahar, Rachel J Givelber, Helaine E ResnickAbstract:Clinic-based studies suggest that sleep-disordered breathing (SDB) is associated with glucose intolerance and insulin resistance. However, in the available studies, researchers have not rigorously controlled for confounding variables to assess the independent relation between SDB and impaired glucose metabolism. The objective of this study was to determine whether SDB was associated with glucose intolerance and insulin resistance among community-dwelling subjects (n=2,656) participating in the Sleep Heart Health Study (1994-1999). SDB was characterized with the Respiratory Disturbance Index and measurements of oxygen saturation during sleep. Fasting and 2-hour glucose levels measured during an oral glucose tolerance test were used to assess glycemic status. Relative to subjects with a Respiratory Disturbance Index of less than 5.0 events/hour (the reference category), subjects with mild SDB (5.0-14.9 events/hour) and moderate to severe SDB (> or =15 events/hour) had adjusted odds ratios of 1.27 (95% confidence interval: 0.98, 1.64) and 1.46 (95% confidence interval: 1.09, 1.97), respectively, for fasting glucose intolerance (p for trend < 0.01). Sleep-related hypoxemia was also associated with glucose intolerance independently of age, gender, body mass Index, and waist circumference. The results of this study suggest that SDB is independently associated with glucose intolerance and insulin resistance and may lead to type 2 diabetes mellitus.
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polysomnography performed in the unattended home versus the attended laboratory setting sleep heart health study methodology
Sleep, 2004Co-Authors: Susan Redline, Daniel J. Gottlieb, Helaine E Resnick, Conrad Iber, Adele Kaplan M Gilpin, Stuart F Quan, Lin Zhang, David M Rapoport, Mark H. SandersAbstract:Study Objective: To compare polysomnographic recordings obtained in the home and laboratory setting. Design and Setting: Multicenter study comparing unsupervised polysomnography performed in the participant's home with polysomnography supervised at an academic sleep disorders center, using a randomized sequence of study setting. Sleep Heart Health Study (SHHS) standardized polysomnographic recording and scoring techniques were used for both settings. Participants: 64 of 76 non-SHHS participants recruited from 7 SHHS field sites who had both a laboratory and home polysomnogram meeting acceptable quality criteria. Measurements and Results: Median sleep duration was greater in the home than in the laboratory (375 vs 318 minutes, respectively, P <.0001) as was sleep efficiency (86% vs 82%, respectively, P <.0024). Very small, but significant increases in percentage of rapid eye movement sleep and decreases in stage 1 sleep were noted in the laboratory. Employing multiple definitions of Respiratory Disturbance Index (RDI), median RDI was similar in both settings (for example, RDI with 3% desaturation: home 12.4, range 0.6-67; laboratory 9.5, range 0.1-93.4, P =.41). Quartile analysis of laboratory RDI showed moderate agreement with home RDI measurements. Based on the mean of laboratory and home RDI and using a cutpoint of 20, there was a biphasic distribution, with the RDI 3% above 20 being more common in the recordings performed in the laboratory than in the home and below 20 being more common in the recordings performed in the home than in the laboratory. These differences could not be attributed to quality of recording, age, sex, or body mass Index. Conclusions: Using SHHS methodology, median RDI was similar in the unattended home and attended laboratory setting with differences of small magnitude in some sleep parameters. Differences in RDI between settings resulted in a rate of disease misclassification that is similar to repeated studies in the same setting. Abbreviations: Arl, arousal Index; BMI, body mass Index; ICC, intraclass correlation coefficient; PSG, polysomnography; RDI, Respiratory Disturbance Index; REM, rapid eye movement sleep; SHHS, Sleep Heart Health Study Citation: Iber C; Redline S; Kaplan Gilpin AM et al. Polysomnography performed in the unattended home versus the attended laboratory setting-sleep heart health study methodology.
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the effects of age sex ethnicity and sleep disordered breathing on sleep architecture
JAMA Internal Medicine, 2004Co-Authors: Susan Redline, Daniel J. Gottlieb, Lester H Kirchner, Stuart F Quan, Vishesh K Kapur, Anne B NewmanAbstract:Background Polysomnography is used to assess sleep quality and to gauge the functional effect of sleep disorders. Few population-based data are available to estimate the variation in sleep architecture across the population and the extent to which sleep-disordered breathing (SDB), a common health condition, contributes to poor sleep independent of other factors. The objective of this study was to describe the population variability in sleep quality and to quantify the independent associations with SDB. Methods Cross-sectional analyses were performed on data from 2685 participants, aged 37 to 92 years, in a community-based multicenter cohort study. Dependent measures included the percentage time in each sleep stage, the arousal Index, and sleep efficiency. Independent measures were age, sex, ethnicity, comorbidity status, and the Respiratory Disturbance Index. Results Lighter sleep was found in men relative to women and in American Indians and blacks relative to other ethnic groups. Increasing age was associated with impaired sleep in men, with less consistent associations in women. Notably, women had, on average, 106% more slow wave sleep. Sleep-disordered breathing was associated with poorer sleep; however, these associations were generally smaller than associations with sex, ethnicity, and age. Current smokers had lighter sleep than ex-smokers or never smokers. Obesity had little effect on sleep. Conclusions Sleep architecture varies with sex, age, ethnicity, and SDB. Individual assessment of the effect of SDB on sleep quality needs to account for other host characteristics. Men, but not women, show evidence of poorer sleep with aging, suggesting important sex differences in sleep physiology.
Javier F Nieto - One of the best experts on this subject based on the ideXlab platform.
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progression and regression of sleep disordered breathing with changes in weight the sleep heart health study
JAMA Internal Medicine, 2005Co-Authors: Anne B Newman, Susan Redline, Rachel J Givelber, Javier F Nieto, Greg Foster, Terry YoungAbstract:Background The relationship of weight changes to the incidence, progression, and remission of sleep-disordered breathing (SDB) is not well defined. This study aims to determine the relationship between change in weight and progression or remission of SDB by polysomnography. Methods We performed a longitudinal cohort study of the cardiovascular consequences of sleep apnea in diverse US communities. Sleep apnea and polysomnographic indicators of SDB were assessed 5 years apart. Results A total of 2968 men and women (mean age, 62 years) participated in the study. Men were more likely to have an increase in Respiratory Disturbance Index (RDI) with a given increase in weight than were women, and this was not explained by differences in starting weight, waist circumference, age, or ethnicity. In a linear regression analysis, both men and women had a greater increase in RDI with weight gain than a decrease in RDI with weight loss. In a categorical analysis of larger degrees of change, this sex difference was also evident. Associations were similar in diverse ethnic groups. However, SDB progressed over time, even in those with stable weight. Conclusion Modest changes in weight were related to an increase or decrease in SDB, and this association was stronger in men than in women.
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associations between gender and measures of daytime somnolence in the sleep heart health study
Sleep, 2004Co-Authors: Carol M Baldwin, Vishesh K Kapur, Catharine J Holberg, Carol L Rosen, Javier F NietoAbstract:STUDY OBJECTIVES: To examine the relationship of gender to subjective measures of sleepiness, including the Epworth Sleepiness Scale (ESS), in a community-based population. DESIGN: A cross-sectional study. SETTING/PARTICIPANTS: Multicenter Sleep Heart Health Study participants (N = 6.440, 52% women) recruited from ongoing cohort studies. INTERVENTIONS: N/A. MEASUREMENTS: Scores from the ESS, Sleep Heart Health Study daytime sleepiness and feeling unrested questions, polysomnography results (Respiratory Disturbance Index at 4% desaturation), as well as data on difficulty initiating and maintaining sleep, insufficient sleep, sedative use, alcohol use, cardiovascular or Respiratory disease, frequent awakening due to leg cramps. RESULTS: Women reported feeling sleepy as often as men did (odds ratio [OR] = 1.06; confidence interval [CI], 0.86-1.32), but women were less likely to have an ESS score > 10 (adjusted OR = 0.77; CI, 0.66-0.90) and more likely to report feeling unrested (adjusted OR = 1.39; CI, 1.14-1.69) than men. In men, the ESS score was more strongly correlated with reports of feeling unrested or sleepy compared to women. CONCLUSIONS: Men and women answer questions on sleepiness differently. Findings indicate that using the ESS to detect subjective sleepiness is more likely to identify men with sleepiness. Since the ESS is more strongly related to other subjective measures in men, the ESS may be a more sensitive measure of subjective sleepiness in men than in women.
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relation of sleep disordered breathing to cardiovascular disease risk factors the sleep heart health study
American Journal of Epidemiology, 2001Co-Authors: Anne B Newman, Susan Redline, Eyal Shahar, Javier F Nieto, Ursula Guidry, Bonnie K Lind, Thomas G PickeringAbstract:Associations between sleep-disordered breathing and cardiovascular disease (CVD) may be mediated by higher cardiovascular risk factor levels in those with sleep-disordered breathing. The authors examined these relations in the Sleep Heart Health Study, a multiethnic cohort of 6,440 men and women over age 40 years conducted from October 1995 to February 1998 and characterized by home polysomnography. In 4,991 participants who were free of self-reported CVD at the time of the sleep study, moderate levels of sleep-disordered breathing were common, with a median Respiratory Disturbance Index (RDI) of 4.0 (interquartile range, 1.25-10.7). The level of RDI was associated cross-sectionally with age, body mass Index, waist-to-hip ratio, hypertension, diabetes, and lipid levels. These relations were more pronounced in those under age 65 years than in those over age 65. Women under age 65 years with RDI in the higher quartiles were more obese than men with similar RDI. Although the pattern of associations was consistent with greater obesity in those with higher RDI, higher body mass Index did not explain all of these associations. If sleep-disordered breathing is shown in future follow-up to increase the risk for incident CVD events, part of the risk is likely to be due to the higher cardiovascular risk factors in those with higher RDI.
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relation of sleepiness to Respiratory Disturbance Index the sleep heart health study
American Journal of Respiratory and Critical Care Medicine, 1999Co-Authors: Daniel J. Gottlieb, Coralyn Whitney, William H Bonekat, Conrad Iber, Gary D James, Michael D Lebowitz, Javier F Nieto, Carl RosenbergAbstract:Obstructive sleep apnea syndrome is a well recognized cause of excessive sleepiness; however, the relation of sleepiness to mild sleep-disordered breathing (SDB), which affects as much as half the adult population, is uncertain. In order to explore this relation, we conducted a cross-sectional cohort study of community-dwelling adults participating in the Sleep Heart Health Study, a longitudinal study of the cardiovascular consequences of SDB. The study sample comprises 886 men and 938 women, with a mean age of 65 (SD 11) yr. Sleepiness was quantified using the Epworth Sleepiness Scale (ESS). Sleep-disordered breathing was quantified by the Respiratory Disturbance Index (RDI), defined as the number of apneas plus hypopneas per hour of sleep, measured during in-home polysomnography. When RDI was categorized into four groups ( /= 30), a significantly progressive increase in mean ESS score was seen across all four levels of SDB, from 7.2 (4.3) in subjects with RDI /= 30 (p /= 11, increased from 21% in subjects with RDI /= 30 (p < 0. 001). We conclude that SDB is associated with excess sleepiness in community-dwelling, middle-aged and older adults, not limited to those with clinically apparent sleep apnea.
