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Sleep disorders as a trigger for cardiovascular pathology
Abstract
Introduction. Sleep disorders are associated with the onset and progression of cardiovascular diseases, including hypertension, stroke, arrhythmias, coronary heart disease, and heart failure. However, awareness of the prevalence of sleep disorders and their impact on comorbidities, including cardiovascular diseases, remains insufficient. The aim of the review: to determine the importance of early detection of sleep disorders for improving the effectiveness of prevention of cardiovascular diseases. A literature search was conducted on the topic: sleep disorders as a trigger of cardiovascular pathology. Significant links have been established between sleep disorders and the development of various forms of pathology of the cardiovascular system, both in adults and children, which necessitates timely sleep screening. Conclusion. A certain connection between sleep disorders and cardiovascular diseases necessitates increased awareness in doctors regarding sleep disorders for the prevention of diseases of the cardiovascular system.
... Значимость преодоления роста детского ожирения обусловлена тем, что эта форма патологии является ведущим метаболическим фактором риска развития сердечно-сосудистых заболеваний, сахарного диабета 2-го типа, а также причиной дерматологических заболеваний (например, псориаза) и бронхиальной астмы, нарушений работы желудочно-кишечного тракта. В некоторых популяционных исследованиях отмечена высокая распространённость синдрома обструктивного апноэ сна среди детей с ожирением (30% против 11,9% у детей с избыточной массой тела) [10]. Сочетание различных заболеваний, обусловленных метаболическими нарушениями при ожирении, получило название метаболической синдемии. ...
Over the past half century, there has been a steady gain in new cases of childhood obesity, which has reached the scale of a non-communicable epidemic, especially in developed countries. All reasons for this trend are being discussed over the world. Due to the development of comorbid pathology leading to disability, and increase in premature death rate, the medical community faces many challenges in the prevention, early diagnosis, and treatment of obesity. The aim of the review is to identify evidence-based approaches to the prevention and treatment of obesity in children. Literature was searched in the following databases: PubMed, Embase, Cochrane Library, Google, RSCI, search depth of 10 years. Overweight and obesity are registered in 25.3% of cases, more often in 8 to 19 years children. To combat overweight and obesity in children measures are developed taking into account genetic, biological, psychological, behavioral, interpersonal factors, as well as environmental influences. There are described conceptual models explaining the mechanisms of overweight and obesity formation in children, which are taken into account when making recommendations for the introduction of healthy habits and a healthy lifestyle: biopsychosocial, theory of ecological systems, the “6 C” model, cascade. These models can be used to develop effective personalized programs for for weight gain prevention. Conclusion. To combat the epidemic of childhood obesity, it is necessary to apply an integrated approach, including prevention, early diagnosis and treatment, as well as the introduction of programs aimed at changing the lifestyle in children and their families. Reducing morbidity and preventing disability requires action at all levels, from families to government health programs.
... Долгосрочные последствия нарушения сна у подростков влияют на психосоциальное здоровье, успеваемость в школе и рискованное поведение. Кроме того, нарушения сна приводят к таким состояниям, как артериальная гипертензия, дислипидемия, сердечно-сосудистые заболевания, увеличение массы тела, метаболический синдром, сахарный диабет 2-го типа [33]. ...
carried out by a group or a specific person using electronic forms of interaction and directed against a victim who cannot defend himself. The aim of the study is to determine the prevalence of cyberbullying among adolescents and assess the impact of bullying on children’s behaviour and health. The following databases were used in the review: RSCI, PubMed, Google Scholar. The prevalence and causes, diagnosis, clinical manifestations, and prevention of cyberbullying when using electronic devices with Internet access have been established. Destructive behaviour in cyberspace is associated with excessive self-disclosure on social networks and the publication of provocative content, substance use, low levels of friendly support, adverse family environment, and virtual violence. The relationship between cyberbullying by peers and childhood loneliness, depression, aggression, suicidal tendencies, lack of social skills, and impulsive behaviour of adolescents has been established.
Background
There are different findings on heart rate variability (HRV) and pediatric obstructive sleep apnea (pOSA) by an overnight HRV or a 1-hr HRV. However, there is limited data of HRV and pOSA diagnosis by using a 24-h HRV test. This study aimed to evaluate if HRV had potential for OSA diagnosis by using a 24-h HRV test.
Methods
This was a prospective study included children age between 5 and 15 years old, presenting with snoring, underwent polysomnography and a 24-h Holter monitoring. Predictors for pOSA diagnosis were analyzed using logistic regression analysis.
Results
During the study period, there were 81 pediatric patients met the study criteria. Of those, 65 patients (80.25%) were diagnosed as OSA. There were three factors were independently associated with OSA: standard deviation of all normal interval (SDNN), high frequency (HF), and low frequency (LF). The adjusted odds ratios of these factors were 0.949 (95% confidence interval 0.913, 0.985), 0.786 (95% confidence interval 0.624, 0.989), and 1.356 (95% confidence interval 1.075, 1.709).
Conclusions
HRV parameters including SDNN, HF, and LF were associated with pOSA diagnosis in children by using the 24-h Holter monitoring.
Background
Sleep apnea is associated with hypertension. Metaanalyses indicate that treatment of sleep apnea by continuous positive airway pressure (CPAP) reduces blood pressure (BP) by a mean of 3 mmHg. To date, predictors of BP response to CPAP remain incompletely understood. We hypothesized that the magnitude of CPAP-induced BP reduction depends on baseline apnea–hypopnea index (AHI) and the extent of daytime sleepiness
Methods
We performed a retrospective study on the association of BP response to CPAP with polysomnographic readings, intensity of sleepiness (measured by Epworth Sleepiness Scale, ESS), and epidemiologic parameters in 2461 patients with obstructive sleep apnea. BP response was defined as the difference between office BP at polysomonography examinations before and after initiation of CPAP.
Results
Five hundred and fifty-five patients fulfilled all inclusion and exclusion criteria and were included in the analysis. Median monthly CPAP usage was 143.7 h (85.4–204.1 h). BP was significantly higher at baseline than at follow-up (129.9 ± 15.5 vs. 128.3 ± 15.2, P = 0.021) resulting in mean reduction of BP of −1.5 ± 19.2 mmHg. patients with a higher than median baseline AHI (median 21) showed a more pronounced reduction of BP than those with lower AHI (AHI ≥21: 130.5 ± 15.3 vs. 128.6 ± 14.6, P = 0.06; AHI <21: 129.5 ± 15.8 vs. 127.9 ± 15.8, P = 0.18). CPAP therapy led to a significant reduction in sleepiness (8.3 ± 4.8 vs. 6.6 ± 4.5, P < 0.0001). Those subjects with higher than median sleepiness score (ESS ≥8), however, did not show a significant difference in BP response compared with those with a lower sleepiness score. Receiver-operating characteristic (ROC) curve analyses investigating the accuracy of AHI and ESS to predict a BP reduction at least 5 mmHg revealed an AUC of 0.51 and 0.52, respectively.
Conclusion
The study confirms that CPAP therapy for sleep apnea has a mild BP lowering effect. Although this effect is slightly higher in patients with above-average AHI, neither AHI nor ESS can be used to define threshold values predicting a BP decrease at least 5 mmHg.
Aim. To analyze newly diagnosed diseases and features of the post-COVID course
in patients after a coronavirus disease 2019 (COVID-19) within 12-month follow-up.
Material and methods. A total of 9364 consecutively hospitalized patients were
included in the ACTIV registry. Enrollment of patients began on June 29, 2020, and
was completed on March 30, 2021, corresponding to the first and second waves of the
pandemic. Demographic, clinical, and laboratory data, computed tomography (CT)
results, information about inhospital clinical course and complications of COVID-19
during hospitalization were extracted from electronic health records using a standardized
data collection form. The design included follow-up telephone interviews with a standard
questionnaire at 3, 6, and 12 months to examine the course of post-COVID period.
Results. According to the ACTIV registry, 18,1% of patients after COVID-19 had
newly diagnosed diseases (NDDs) over the next 12 months. Hypertension (HTN),
type 2 diabetes and coronary artery disease (CAD) prevailed in the NDD structure.
Comparison of the age-standardized incidence of NDDs (HTN, CAD, diabetes) in
the post-COVID period in the ACTIV registry with NDD incidence in 2019 according
to Rosstat and the expected incidence of NDDs according to the EPOHA study
revealed that HTN, diabetes, CAD in patients after COVID-19 were registered more
often as follows: HTN by 7,0 and 4,4 times, diabetes by 7,3 and 8,8 times, CAD by
2,3 and 2,9 times, respectively.
NDDs most often developed in patients aged 47 to 70 years. Comparison of the
actual and expected number of cases of newly diagnosed HTN, CAD and diabetes
depending on age showed that the actual number of cases in the population of
patients in the ACTIV register is significantly higher than expected for patients aged
45-69 years and for patients with hypertension or diabetes and aged <45 years.
Patients with NDDs, compared with patients without NDDs, had a more severe
acute COVID-19 course. Statistically significant independent predictors of
NDD occurrence (HTN and/or diabetes and/or CAD) within 1 year after hospital
discharge were age (direct relationship), body mass index (direct relationship) and
glucose levels upon admission to hospital (direct relationship).
Conclusion. Available evidence suggests that a strategy for managing COVID-19
survivors should include mandatory screening for early detection of cardiovascular
disease and diabetes, which will be key to reducing the risk of further COVID-19
consequences.
Obstructive sleep apnea syndrome (OSAS) is the most common breathing-related sleep disorder. It is characterized by recurrent episodes of partial or complete airway obstruction during sleep, resulting in a reduction in or the total cessation of airflow, despite ongoing respiratory efforts, leading to oxygen desaturation and arousal. The purpose of this literature review is to evaluate the most common characteristics of this pathology, as well as to investigate the most effective treatment options, providing an update on the management of OSA patients.
Introduction
Obstructive sleep apnea syndrome (OSAS) is a chronic disorder characterized by recurring episode obstruction and collapse of upper airways during sleep, leading to hypoxia and sleep disruption. OSAS is commonly associated with an increased prevalence of hypertension. The underlying mechanism in OSA with hypertension is related to intermittent hypoxia. This hypoxia induces endothelial dysfunction, overactivity of sympathetic effects, oxidative stress, and systemic inflammation. Hypoxemia triggers the sympathetic process's overactivity, leading to the development of resistant hypertension in OSA. Thus, we hypothesize to evaluate the association between resistant hypertension and OSA.
Methods
The PubMed, ClinicalTrails.gov, CINAHL, Google Scholar, Cochrane Library, and Science Direct databases were searched from 2000 to January 2022 for studies demonstrating the association between resistant hypertension and OSA. The eligible articles underwent quality appraisal, meta-analysis, and heterogeneity assessment.
Results
This study comprises seven studies, including 2,541 patients ranged from 20 to 70 years. The pooled analysis of six studies demonstrated that OSAS patients with a history of increased age, gender, obesity, and smoking status are at an increased risk for resistant hypertension (OR: 4.16 [3.07, 5.64], I ² :0%) than the non-OSAS patients. Similarly, the pooled effect demonstrated that patients with OSAS were at an increased risk of resistant hypertension (OR: 3.34 [2.44, 4.58]; I ² :0%) than the non-OSAS patients when all associated risk factors were adjusted using multivariate analysis.
Conclusion
This study concludes that OSAS patients with or without related risk factors demonstrated increased risk for resistant hypertension.
Obstructive sleep apnea syndrome (OSAS) is a common breathing disorder in sleep in which the airways narrow or collapse during sleep, causing obstructive sleep apnea. The prevalence of OSAS continues to rise worldwide, particularly in middle-aged and elderly individuals. The mechanism of upper airway collapse is incompletely understood but is associated with several factors, including obesity, craniofacial changes, altered muscle function in the upper airway, pharyngeal neuropathy, and fluid shifts to the neck. The main characteristics of OSAS are recurrent pauses in respiration, which lead to intermittent hypoxia (IH) and hypercapnia, accompanied by blood oxygen desaturation and arousal during sleep, which sharply increases the risk of several diseases. This paper first briefly describes the epidemiology, incidence, and pathophysiological mechanisms of OSAS. Next, the alterations in relevant signaling pathways induced by IH are systematically reviewed and discussed. For example, IH can induce gut microbiota (GM) dysbiosis, impair the intestinal barrier, and alter intestinal metabolites. These mechanisms ultimately lead to secondary oxidative stress, systemic inflammation, and sympathetic activation. We then summarize the effects of IH on disease pathogenesis, including cardiocerebrovascular disorders, neurological disorders, metabolic diseases, cancer, reproductive disorders, and COVID-19. Finally, different therapeutic strategies for OSAS caused by different causes are proposed. Multidisciplinary approaches and shared decision-making are necessary for the successful treatment of OSAS in the future, but more randomized controlled trials are needed for further evaluation to define what treatments are best for specific OSAS patients.
Sleep disorders are a common concomitant comorbidity in patients with heart failure. The aims of our study are to determine the incidence and phenotypic characteristics of sleep apnea in overweight patients with exacerbated heart failure and to assess the degree of involvement of systolic and diastolic function impairment in the individual group. From 100 screened patients with heart failure in our department from 2015 to 2017, 61 met the inclusion criteria and participated in the study. 82% (n = 50) of the patients had obstructive sleep apnea (OSA), and 18% (n = 11) had central sleep apnea (CSA). The CSA group had a significantly lower left ventricular ejection fraction (LVEF) than the OSA group (EF% 49.6 ± 8.5 vs 41.8 ± 11.4; p = 0.013). A negative correlation was found between LVEF and the number of central apnea events (r = -0.52; p < 0.001). More frequent hospitalizations for heart failure (HF) and higher mortality rate were found in the CSA group. Screening for sleep apnea in patients with exacerbated heart failure and obesity is necessary for the complex treatment of these patients.
Background
Obstructive sleep apnea (OSA) is associated with impaired sleep quality and autonomic dysfunction. Adenotonsillectomy significantly improves subjective and objective sleep quality in children with OSA. However, the postoperative changes in heart rate variability (HRV) indices (indicators of cardiac autonomic function) and their importance remain inconclusive in childhood OSA. This retrospective case series aimed to investigate the association of sleep HRV indices, total OSA-18 questionnaire score (a subjective indicator of sleep quality) and polysomnographic parameters (objective indicators of sleep quality), and effects of adenotonsillectomy on HRV indices, total OSA-18 questionnaire score and polysomnographic parameters in children with OSA.
Methods
Seventy-six children with OSA were included in baseline analysis, of whom 64 (84%) completed at least 3 months follow-up examinations after adenotonsillectomy and were included in outcome analysis. Associations between baseline variables, and relationships with treatment-related changes were examined.
Results
Multivariable linear regression models in the baseline analysis revealed independent relationships between tonsil size and obstructive apnea-hypopnea index (OAHI), adenoidal-nasopharyngeal ratio and very low frequency (VLF) power of HRV (an indicator of sympathetic activity), and normalized low frequency power (an indicator of sympathetic activity) and OAHI. The outcome analysis showed that adenotonsillectomy significantly improved standard deviation of all normal-to-normal intervals, and high frequency power, QoL (in terms of reduced total OSA-18 questionnaire score), OAHI and hypoxemia. Using a conceptual serial multiple mediation model, % change in OSA-18 questionnaire score and % change in VLF power serially mediated the relationships between change in tonsil size and % change in OAHI.
Conclusions
The improvement in OAHI after adenotonsillectomy was serially mediated by reductions in total OSA-18 questionnaire score and VLF power. These preliminary findings are novel and provide a direction for future research to investigate the effects of VLF power-guided interventions on childhood OSA.
Study objectives:
To assess whether the association between insomnia and subclinical myocardial injury, as measured by cardiac troponin T (cTnT), differs across insomnia phenotypes.
Methods:
We measured cTnT in 2188 participants in the Multi-Ethnic Study of Atherosclerosis (MESA) study who had completed sleep questionnaires and undergone unattended polysomnography (PSG) and 7-day actigraphy. Insomnia symptoms were defined as reporting at least one of the following ≥5 nights/week over the past four weeks: trouble falling asleep, waking up several times a night, having trouble getting back to sleep after you woke up too early or taking sleeping pills to help them sleep. OSA was defined as an apnea hypopneas index (AHI) >15. Participants were classified into insomnia phenotypes, including comorbid insomnia and OSA (COMISA) and insomnia associated with actigraphy estimated short sleep (<6hrs) or sleep fragmentation.
Results:
The mean age was 68.6 years (SD 9.2), 53.6% were male. 47.8% met threshold levels for insomnia symptoms, and 43.1% had an AHI >15. In adjusted linear regression models COMISA (ß 0.08 (SE 0.03), p<0.01) or insomnia with short sleep duration (ß 0.07 (SE 0.03), p<0.05) were each associated with higher cTnT compared to a reference group with no insomnia. Insomnia with fragmented sleep (ß 0.03 (SE 0.02)) was not associated with higher cTnT (p>0.05) in adjusted analyses. OSA was associated with higher cTnT (ß 0.09 (SE 0.03), p<0.01) in adjusted models.
Conclusions:
COMISA and insomnia with short sleep duration, but not insomnia symptoms alone or fragmented sleep, were associated with increased circulating cTnT in older adults.
INTRODUCTION
Obstructive sleep apnea (OSA) and atrial fibrillation (AF) are disorders that have increased in the United States during recent years. Earlier investigations have shown that underlying undiagnosed and unmanaged OSA plays a significant role in high rates and also as a trigger for newly diagnosed AF. Since the introduction of continuous positive airway pressure (CPAP) as a main therapy for OSA, more studies have evaluated the effect of CPAP on the development or recurrence of AF in OSA patients. However, sample sizes in a limited number of studies have been too small to conclude whether CPAP therapy has a significant effect on the development of AF in patients with OSA. The authors report results of their systematic review and meta-analysis summarizing what is currently known about the efficacy of CPAP for mitigating AF in patients with OSA.
METHOD
The authors systematically reviewed the published reports on CPAP use and the incidence of AF from PubMed, Google Scholar, EMBASE, Web of Science, meeting abstracts, and Cochrane databases published between January 2015 and November 2021. Study data were extracted by two reviewers and a random-effects meta-analysis was performed using RevMan version 5.4.
RESULTS
A total of 17 studies that met inclusion criteria were identified Studies included a total of 6,523 patients, 3,248 (49.8%) who used CPAP and 3,275 (50.2%) who did not use CPAP. In a random effects model, patients treated with CPAP showed a decrease in the incidence of AF (OR, 0.51; 95% CI; 0.27; 0.97, p = 0.04). High heterogeneity among the included studies was also observed (I2 = 97%).
CONCLUSION
Our results add to the increasing evidence that CPAP therapy may reduce the incidence of development of AF in patients with OSA. Prospective future studies and clinical trials are needed to refine our understanding of the relationship between OSA and AF and how CPAP may reduce cardiovascular disease development.
Insomnia and sleep‐disordered breathing (SDB) are prevalent sleep disorders. These disorders can therefore be concurrently present – comorbid insomnia and sleep apnea (COMISA). The prevalence of COMISA in the paediatric age range is unclear. As such, phenotypic constructs should help better define this comorbid condition if it exists in children and improve both diagnostic sensitivity and ultimately clinical care outcomes. We aimed to evaluate the frequency of insomnia in children and adolescents referred for evaluation of sleep symptoms suggestive of SDB in one initial (Cohort#1) and verify such findings in an independent cohort (Cohort#2) using a retrospective cross‐sectional approach in patients aged 9–19 years presenting at a sleep centre to be evaluated for symptoms of SDB. Cohort #1 comprised 50 consecutive children (58% males; mean [SD] age 13.6 [3.3] years; median [interquartile range, IQR] Epworth Sleepiness Scale score 10 [6–12]) who were evaluated using validated SDB and insomnia questionnaires. Cohort#2 was extracted from electronic medical records and included 384 polysomnographically evaluated children (mean [SD] age 12.9 [3.6] years; mean [SD] body mass index z score 1.27 [0.28]; median Epworth Sleepiness Scale score 9.7 [4–17]). In Cohort #1, 56% were at high risk of SDB, 36% had insomnia alone, and 18% were at high risk of COMISA. The prevalence of COMISA in Cohort #2 was 16%, 72% had SDB alone, and 12% had insomnia alone. In both cohorts, COMISA manifested as increased propensity for sleepiness and fatigue during both waking and daytime. Thus, the presence of COMISA is frequent in the paediatric age range and accompanied by a more prominent symptomatic phenotype.
Background:
Refractory hypoxemia episodes are characteristic of obstructive sleep apnea (OSA). Patients with OSA suffer from oxidative stress in all systems. Atrial fibrillation (AF) is a type of arrhythmia that may be induced by OSA. In this study, we explored the dose-response relationship between OSA and AF. Our research provides the basis for a novel approach to AF prevention.
Methods:
We screened four databases (PubMed, Embase, the Cochrane Library, and Web of Science) for observational studies on OSA and AF. Studies were collected from database establishment to November 2020. We performed a traditional subgroup meta-analysis. Linear and spline dose-response models were applied to assess the association between the apnea-hypopnea index, an indicator of OSA severity, and the risk of AF. Review Manager version 5.3 software and Stata 16.0 were used for the analysis.
Results:
Sixteen observational studies were included in the study. We excluded a study from the conventional meta-analysis. In the subgroup analysis, the odds ratios for new onset AF for no obvious reason, new onset AF after surgical operations, such as coronary artery bypass grafting, and AF after ablation treatment were 1.71 (95% CI 1.37-2.13, P < .05), 2.65 (95% CI 2.32-3.01, P < .05), and 2.93 (95% CI 2.47-3.49, P < .05), respectively. Linear dose-response meta-analysis results revealed that the risk of AF increased with increasing apnea-hypopnea index value.
Conclusion:
Through dose-response meta-analysis, we found a potential dose-response relationship between OSA severity and the risk of AF. This relationship should be considered in interventions aimed at AF prevention in the future.
Aim
The objective of the study was to clarify the occurrence of atherosclerosis in patients with insomnia.
Methods
A total of 60 patients with insomnia and 58 patients in a control group were selected to measure blood glucose, blood lipids and other biochemical and physiological indicators. Brachial-ankle pulse wave velocity (baPWV) was measured to assess arterial stiffness, and color Doppler ultrasound was used to examine carotid artery intima-media thickness (CIMT) and plaque incidence. These indicators were used to determine the occurrence and degree of carotid atherosclerosis, and to compare the differences between the two groups.
Results
While there was no significant difference in biochemical or physiological indicators between the two groups (P > 0.05), the baPWV, CIMT, and incidence of carotid plaque in the insomnia group were higher than the control group. In addition, the baPWV, CIMT, and incidence of carotid plaque in the chronic insomnia group were higher than that in the short-term insomnia group. Multiple linear regression analysis was carried out to analyze the effects of insomnia, systolic blood pressure, blood glucose, triglycerides, cholesterol, BMI, age and low-density lipoprotein on atherosclerosis. The results showed that increased CIMT was significantly correlated with insomnia in atherosclerosis group (R²=0.27 on the left, R²=0.37 on the right, P < 0.001).
Conclusion
Insomnia correlated with increased arterial stiffness and carotid atherosclerosis, and as the duration of insomnia prolongs, the correlation between them became more obvious.
Atrial fibrillation (AF) is the most common arrhythmia, increasing with age and comorbidities. Obstructive sleep apnea (OSA) is a chronic sleep disorder more common in older men. It has been shown that OSA is linked to AF. Nonetheless, the prevalence of OSA in patients with AF remains unknown because OSA is significantly underdiagnosed. This review, including 54,271 patients, carried out a meta-analysis to investigate the association between OSA and AF. We also performed a meta-regression to explore cofactors influencing this correlation. A strong link was found between these two disorders. The incidence of AF is 88% higher in patients with OSA. Age and hypertension independently strengthened this association, indicating that OSA treatment could help reduce AF recurrence. Further research is needed to confirm these findings. Atrial Fibrillation (AF) is the most common arrhythmia, increasing with age and comorbidities. Obstructive sleep apnea (OSA) is a regulatory respiratory disorder of partial or complete collapse of the upper airways during sleep leading to recurrent pauses in breathing. OSA is more common in older men. Evidence exists that OSA is linked to AF. Nonetheless, the prevalence of OSA in patients with AF remains unknown because OSA is underdiagnosed. In order to investigate the incidence of AF in OSA patients, we carried out a meta-analysis including 20 scientific studies with a total of 54,271 subjects. AF was present in 4801 patients of whom 2203 (45.9%) had OSA and 2598 (54.1%) did not. Of a total of 21,074 patients with OSA, 2203 (10.5%) had AF and 18,871 (89.5%) did not. The incidence of AF was 88% higher in patients with OSA. We performed a meta-regression to explore interacting factors potentially influencing the occurrence of AF in OSA. Older age and hypertension independently strengthened this association. The clinical significance of our results is that patients with OSA should be referred early to the cardiologist. Further research is needed for the definition of the mechanisms of association between AF and OSA.
Abstarct
Background
: Patients hospitalized for COVID-19 may be at high risk of mental health (MH) disorders. This systematic review assesses MH outcomes among adults during and after hospitalization for COVID-19 and ascertains MH care utilization and resource needs.
Methods
: We searched multiple medical literature databases for studies published December 2019 to March 2021. Studies of ≥ 200 participants were synthesized. One reviewer completed article selection, data abstraction and assessed study quality and strength of evidence, with verification by a second.
Results
: Fifty articles met preliminary inclusion criteria; 19 articles that included ≥200 participants were synthesized. Evidence from these primarily fair-quality studies suggests many patients experience symptoms of depression (9-66%), anxiety (30- 39%), and insomnia (24-40%) during and 3 months after hospitalization for COVID-19. However, patients infrequently receive a new MH disorder diagnosis 6 months after hospitalization (5% are diagnosed with a new mood disorder, 7% anxiety disorder, and 3% insomnia). Some hospitalized patients – including women and those with more severe COVID-19 – may be at higher risk of poor MH outcomes. Data on MH care utilization and resource needs are currently limited.
Limitations
: Most included studies were small, did not report the proportion of participants with preexisting MH disorders, and did not use comparison groups
Conclusions
: While many patients experience MH symptoms after hospitalization for COVID-19, most do not go on to develop a new MH disorder. Future studies should report whether participants have preexisting MH disorders and compare patients hospitalized for COVID-19 to patients hospitalized for other causes.
Insomnia and obstructive sleep apnea commonly co‐occur (co‐morbid insomnia and sleep apnea), and their co‐occurrence has been associated with worse cardiometabolic and mental health. However, it remains unknown if people with co‐morbid insomnia and sleep apnea are at a heightened risk of incident cardiovascular events. This study used longitudinal data from the Sleep Heart Health Study (N = 5803) to investigate potential associations between co‐morbid insomnia and sleep apnea and cardiovascular disease prevalence at baseline and cardiovascular event incidence over ~11 years follow‐up. Insomnia was defined as self‐reported difficulties initiating and/or maintaining sleep AND daytime impairment. Obstructive sleep apnea was defined as an apnea–hypopnea index ≥ 15 events per hr sleep. Co‐morbid insomnia and sleep apnea was defined if both conditions were present. Data from 4160 participants were used for this analysis. The prevalence of no insomnia/obstructive sleep apnea, insomnia only, obstructive sleep apnea only and co‐morbid insomnia and sleep apnea was 53.2%, 3.1%, 39.9% and 1.9%, respectively. Co‐morbid insomnia and sleep apnea was associated with a 75% (odd ratios [95% confidence interval]; 1.75 [1.14, 2.67]) increase in likelihood of having cardiovascular disease at baseline after adjusting for pre‐specified confounders. In the unadjusted model, co‐morbid insomnia and sleep apnea was associated with a twofold increase (hazard ratio, 95% confidence interval: 2.00 [1.33, 2.99]) in risk of cardiovascular event incidence. However, after adjusting for pre‐specified covariates, co‐morbid insomnia and sleep apnea was not significantly associated with incident cardiovascular events (hazard ratio 1.38 [0.92, 2.07]). Comparable findings were obtained when an alternative definition of insomnia (difficulties initiating and/or maintaining sleep without daytime impairment) was used.
PurposeChronic upper airway obstruction caused by adenotonsillar hypertrophy is one of the major cause of morbidity in children. It can lead to Obstructive Sleep Apnoea Syndrome, Pulmonary Hypertension, Cor Pulmonale and right heart failure. The study aimed to evaluate and compare various parameters of cardiac function with the help of echocardiography preoperatively and postoperatively in children undergoing adenotonsillectomy.MethodologyA prospective cohort study was conducted on 23 patients at an apex care institute, under the age group of 4–12 years, who were diagnosed with adenotonsillar hypertrophy. Preoperative symptom analysis and Echocardiographic examination were done. After the assessment, all patients underwent surgery in the form of adenotonsillectomy. Follow-up symptom analysis and echocardiographic examination was done after 3 months postoperatively.ResultsSignificant improvement in the obstructive symptoms were noted in postoperative group as expected (p = < 0.001) and also in parameters such as mPAP (p = < 0.001), TAPSE (p = < 0.001), TAV (p = 0.001), Ejection fraction (p = 0.027) and RVMPI (p = 0.044) were improved in postoperative group. 4 patients had Grade 1 Right ventricular diastolic dysfunction, which disappeared in three patients postoperatively.Conclusion
We have concluded that there can be subclinical cardiac dysfunctions which occurs as a result of chronic upper airway obstruction due to untreated adenotonsillar hypertrophy. Routine cardiac screening in children presenting with sleep disordered breathing associated with adenotonsillar hypertrophy may be helpful in identifying and preventing the development of cardiopulmonary complication. These changes can be reversed by performing adenotonsillectomy.
Obstructive sleep apnea (OSA) is a highly prevalent disorder with a growing incidence worldwide that closely mirrors the global obesity epidemic. OSA is associated with enormous healthcare costs in addition to significant morbidity and mortality. Much of the morbidity and mortality related to OSA can be attributed to an increased burden of cardiovascular disease, including cardiac rhythm disorders. Awareness of the relationship between OSA and rhythm disorders is variable among physicians, a fact that can influence patient care, since the presence of OSA can influence the incidence, prevalence, and successful treatment of multiple rhythm disorders. Herein, we provide a review of this topic that is intentionally broad in scope, covering the relationship between OSA and rhythm disorders from epidemiology and pathophysiology to diagnosis and management, with a particular focus on the recognition of undiagnosed OSA in the general clinical population and the intimate relationship between OSA and atrial fibrillation.
Obstructive sleep apnea (OSA) is a known risk factor for cardiovascular disease in adults. It is associated with incident systemic hypertension, arrhythmia, stroke, coronary artery disease, and heart failure. OSA is common in children and adolescents, but there has been less focus on OSA as a primary risk factor for cardiovascular disease in children and adolescents. This scientific statement summarizes what is known regarding the impact of sleep‐disordered breathing and, in particular, OSA on the cardiovascular health of children and adolescents. This statement highlights what is known regarding the impact of OSA on the risk for hypertension, arrhythmia, abnormal ventricular morphology, impaired ventricular contractility, and elevated right heart pressure among children and adolescents. This scientific statement also summarizes current best practices for the diagnosis and evaluation of cardiovascular disease–related complications of OSA in children and adolescents with sleep apnea and highlights potential future research in the area of sleep‐disordered breathing and cardiovascular health during childhood and adolescence.
Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiomyopathy and sleep disordered breathing (SDB) is a treatable risk factor that has been seen to occur concurrently, and is known to propagate mortality and morbidity in a number of cardiovascular disease states including heart failure, and indeed hypertrophic cardiomyopathy. In this review, we summarize past studies that explored the simultaneous occurrence of HCM and SDB, and the pathophysiology of SDB in relation to heart failure, arrhythmias, cardiac ischemia and pulmonary hypertension in HCM. The current therapeutic modalities, with the effect of obstructive sleep apnea (OSA) treatment on HCM, are then discussed along with potential future directions.
Purpose of Review
Given the rising prevalence of obstructive sleep apnea (OSA), we aimed to review the epidemiologic and pathophysiologic relationship of OSA, hypertension, and cardiovascular disease, and to summarize recent advances in the treatment of OSA.
Recent Findings
OSA is associated with an elevated risk of hypertension and cardiovascular disease. Several pathophysiologic factors contribute to the relationship between OSA and vascular risk, including neurohormonal dysregulation, endothelial dysfunction, and inflammation. While CPAP reduces blood pressure, it has not been demonstrated to reduce cardiovascular risk. The combination of CPAP and weight loss has a synergistic effect on blood pressure and several metabolic parameters. Adherence to CPAP is poor across studies, potentially contributing to the attenuation of perceived cardiovascular benefit from CPAP therapy.
Summary
A greater emphasis on adherence to CPAP and the combination of CPAP and weight loss are central to reducing cardiovascular risk among individuals with OSA.
BACKGROUND
Children with significant adenotonsillar hypertrophy (ATH) may show right ventricular (RV) dysfunction. We aimed to evaluate RV dysfunction in such children before adenotonsillectomy by evaluating peak longitudinal right atrial (RA) strain (PLRAS) in systole. PLRAS, electrocardiogram (ECG) and conventional echocardiographic parameters were compared to distinguish children with significant ATH with sleep-related breathing disorder (ATH-SRBD) from controls.
METHODS
Fifty-six children (23 controls and 33 children with ATH-SRBD without symptoms of heart failure) were retrospectively studied. Preoperative echocardiograms and ECGs of children with ATH-SRBD who underwent adenotonsillectomy were compared to those of controls. Available postoperative ECGs and echocardiograms were also analyzed.
RESULTS
Preoperatively, prolonged maximum P-wave duration (Pmax) and P-wave dispersion (PWD), decreased PLRAS, and increased tricuspid annulus E/E′ were found in children with ATH-SRBD compared to those of controls. From the receiver operating characteristic curves, PLRAS was not inferior compared to tricuspid annulus E/E′, Pmax, and PWD in differentiating children with ATH-SRBD from controls; however, the discriminative abilities of all four parameters were poor. In children who underwent adenotonsillectomy, echocardiograms 1.2 ± 0.4 years after adenotonsillectomy showed no difference in postoperative PLRAS and tricuspid annulus E/E′ when compared with those of the preoperative period.
CONCLUSIONS
Impaired RA deformation was reflected as decreased PLRAS in children with ATH-SRBD before adenotonsillectomy. Decreased PLRAS in these children may indicate subtle RV dysfunction and increased proarrhythmic risk. However, usefulness of PLRAS as an individual parameter in differentiating preoperative children with ATH-SRBD from controls was limited, similar to those of tricuspid annulus E/E′, Pmax, and PWD.
Obesity is a major global health issue, and its prevalence is increasing. Obesity is associated with much comorbidity such as obstructive sleep apnea (OSA), type 2 diabetes mellitus (T2DM), and cardiovascular diseases (CVD). Obesity is also one of the major causative factors of OSA, and OSA itself can promote the onset of after T2DM because hypoxic episodes decrease insulin sensitivity, and activation of the sympathetic pathway leads to the release of inflammatory markers associated with insulin resistance. Continuous Positive Airway Pressure (CPAP) can be used to ameliorate both conditions, as CPAP decreased hypoxia episodes and increases insulin sensitivity and improves glucose metabolism. Weight-loss strategies play an important role in improving OSA, T2DM, and other associated comorbidities. Lifestyle modification of diet and exercise, medications or bariatric surgery should be considered weight loss. The purpose of this review is to describe the relationship between obesity, OSA, and T2DM.
Background
This study investigated the association of sex with cardiovascular outcomes in a prospective cohort of patients with heart failure (HF) with obstructive sleep apnea or central sleep apnea.
Methods and Results
Patients were screened for sleep apnea on admission using multichannel cardiopulmonary monitoring from May 2015 to July 2018. The primary outcome was a composite of cardiovascular death or unplanned hospitalization for worsening HF. Ultimately, 453 patients with HF with obstructive sleep apnea or central sleep apnea were included; 71 (15.7%) and 382 (84.3%) were women and men, respectively. During a median follow‐up of 2.33 years, 248 (54.7%) patients experienced the primary outcome. In the overall population, after adjusting for potential confounders, women had an increased risk of the primary outcome (66.2% versus 52.6%; hazard ratio [HR], 1.47 [95% CI, 1.05–2.04]; P =0.024) and HF rehospitalization (62.0% versus 46.6%; HR, 1.55 [95% CI, 1.10–2.19]; P =0.013) compared with men but a comparable risk of cardiovascular death (21.1% versus 23.3%; HR, 0.78 [95% CI, 0.44–1.37]; P =0.383). Likewise, in patients with HF with obstructive sleep apnea, women had a higher risk of the primary outcome (81.8% versus 46.3%, HR, 2.37 [95% CI, 1.28–4.38]; P =0.006) and HF rehospitalization (81.8% versus 44.7%, HR, 2.46 [95% CI, 1.32–4.56], P =0.004). However, in patients with HF with central sleep apnea, there was no statistically significant difference between women and men.
Conclusions
In hospitalized patients with HF, female sex was associated with an increased risk of the primary outcome and HF rehospitalization, especially in those with obstructive sleep apnea. Screening for sleep apnea should be emphasized to improve the prognosis.
Registration
URL: https://www.clinicaltrials.gov . Unique identifier: NCT02664818.
Objective:
Obstructive sleep apnea (OSA) in patients with the acute coronary syndrome (ACS) were at high risk for cardiovascular events, but the results are currently inconclusive. We aimed to conduct a systematic review to determine the incidence of cardiovascular events among ACS patients with OSA by a meta-analysis of observational studies.
Methods:
PubMed, Embase, and Cochrane Library were searched for studies related to the association between OSA and the risk of cardiovascular events in patients with ACS. Risk of bias in observational studies was assessed according to the Risk Of Bias In the Non-randomized Studies-Of Interventions tool.We performed a meta-analysis using a random-effects model to calculate estimates of pooled hazard ratios (HR) with 95% confidence intervals (CI), and heterogeneity was assessed using the statistics.
Results:
A total of 12 studies evaluating ACS patients with OSA were included in the meta-analysis. OSA was related to the increased risk of MACE (HR = 2.2; 95% CI, 1.274-3.805, I2 = 76.1%). The effect of OSA on MACCE (HR = 1.921; 95% CI, 1.45-2.546; I2 = 19.1%) and readmission for unstable angina (HR = 3.137, 95% CI, 1.06-9.283; I2 = 52.4%) were statistically significant in the pooled analysis. All of the outcomes in the included studies had a serious risk of bias and the Grading of Recommendation, Assessment, Development, and Evaluation evidence level of all the evaluation results were very low.
Conclusions:
OSA was associated with a significant increase in the risk of cardiovascular events for patients with ACS. Additional randomized controlled trial studies are required to confirm the results and to prove the treatment of OSA can change the prognosis.
Objectives:
To evaluate existing evidence of prospective cohort studies on associations between insomnia and multiple health outcomes.
Study design:
An umbrella review of meta-analyses of prospective cohort studies.
Methods:
A systematic search was undertaken in Pubmed, Embase, Cochrane, and Web of Science from inception to October 2021 to find meta-analyses of prospective cohort studies investigating the association of insomnia with any health outcome. The summary relative risk (SRR) for each meta-analysis was recalculated with random-effects model. The methodological quality and the quality of evidence were assessed by the A Measurement Tool to Assess Systematic Reviews and Grading of Recommendations, Assessment, Development and Evaluation, respectively.
Results:
A total of 25 published meta-analyses of prospective cohort studies, reporting 63 SRRs for 29 unique outcomes were included. Insomnia was mainly related to cardiovascular outcomes and mental disorders. The former comprised atrial fibrillation (SRR: 1.30, 95% confidence interval: 1.26 to 1.35), cardiovascular diseases (1.45, 1.29 to 1.64), coronary heart disease (1.28, 1.10 to 1.50), myocardial infarction (1.42, 1.17 to 1.72), and stroke (1.55, 1.39 to 1.72). The latter involved alcohol abuse (1.35, 1.08 to 1.67), all mental disorders (2.16, 1.70 to 3.97), anxiety (3.23, 1.52 to 6.85), depression (2.31, 1.90 to 2.81), suicidal ideation (2.26, 1.79 to 2.86), suicidal attempt (1.99, 1.31 to 3.02), and suicidal death (1.72, 1.42 to 2.08). Besides, insomnia enhanced the risk of Alzheimer's disease (1.51, 1.06 to 2.14) and hyperlipidemia (1.64, 1.53 to 1.76).
Conclusion:
Insomnia exhibits considerable adverse outcomes, primarily comprises cardiovascular outcomes and mental disorders, but further studies with robustly designed trials are needed to draw firmer conclusions.
Study objectives:
Obstructive sleep apnea (OSA) is linked to the emergence and progression of cardiovascular complications including hypertension, stroke, arrhythmias, coronary artery disease and heart failure. Epidemiological studies have reported that hypertension is associated with respiratory events during REM sleep. We examined the relationship between respiratory events during REM and morning and evening hypertensive blood pressure (BP) levels in a clinical sleep population.
Methods:
This study included data from in-laboratory diagnostic polysomnographic studies (n=797) from adults attending for investigation of OSA. Hypertensive BP levels were defined using BP measurements taken in the evening before and morning after polysomnography, and use of anti-hypertensive medication. Regression modelling was undertaken to examine the probability of evening and morning hypertensive BP levels according to REM apnea hypopnea index (AHI), NREM AHI, gender, age, body mass index (BMI), alcohol use, total sleep time (TST), sleep time SpO2 <90%, and smoking status.
Results:
The probability of morning hypertensive BP levels was significantly independently associated with age (p<0.001), BMI (p<0.001) and REM AHI (p<0.001). No significant effect was found for male gender, NREM AHI, alcohol use, TST, sleep time SpO2 <90%, or smoking (p>0.05 for all). The probability of evening hypertensive BP levels was only significantly associated with age (p<0.001), male gender (p = 0.012), BMI (p<0.001) and TST (p= 0.032).
Conclusions:
Respiratory events during REM sleep are significantly associated with morning hypertensive BP levels. Future research is needed to determine whether treatment of these events can prevent or reverse morning hypertensive BP levels.
Study objectives:
Pulmonary hypertension (PH) is a rare yet serious complication of obstructive sleep apnea (OSA). Echocardiographic screening for PH is recommended in children with severe OSA, but the healthcare burden of universal screening is high. We sought to determine the prevalence of PH on echocardiogram among children with severe OSA and identify variables associated with positive PH screen.
Methods:
Retrospective study of 318 children with severe OSA (obstructive apnea-hypopnea index [OAHI] ≥ 10 events/h) and echocardiogram within one year of polysomnogram. PH-positive echocardiogram was defined by peak tricuspid regurgitation velocity ≥ 2.5 m/s and/or two or more right heart abnormalities suggestive of elevated pulmonary artery pressure. Patient characteristics and polysomnogram data were compared to identify factors associated with PH.
Results:
Twenty-six children (8.2%; 95% CI 5.4-11.8%) had echocardiographic evidence of PH. There was no difference in age, sex, BMI, OAHI, or oxygenation indices between patients with and without PH. Sleep-related hypoventilation (end-tidal CO2 > 50 mmHg for > 25% total sleep time) was present in 25% of children with PH compared to 6.3% of children without PH (adjusted prevalence ratio [PR] = 2.73; 95% CI 1.18-6.35). Forty-six percent of children (12/26) with PH had Down syndrome versus 14% (41/292) without PH (adjusted PR = 3.11; 95% CI 1.46-6.65).
Conclusions:
There was a relatively high prevalence of PH on echocardiogram in our cohort of children with severe OSA. The findings of increased PH prevalence among children with sleep-related hypoventilation or Down syndrome may help inform the development of targeted screening recommendations for specific pediatric OSA populations.
Background
The association of obstructive sleep apnea (OSA) with bradycardia is not well-characterized, which may confer significant morbidity and mortality if left untreated. We sought to clarify the prevalence of comorbid OSA and bradycardia, and the effect of continuous positive airway pressure (CPAP) therapy on bradycardia outcomes.
Methods
We systematically searched four electronic databases (PubMed, Embase, Cochrane Library, Scopus) for randomized or observational studies reporting the co-prevalence of sleep apnea and bradycardia or evaluated the use of CPAP on the incidence of bradycardias. We used random-effects models in all meta-analyses and evaluated heterogeneity using I.²
Results
We included 34 articles from 7,204 records, comprising 4,852 patients. Among patients with OSA, the pooled prevalence of daytime and nocturnal bradycardia were 25% (95% CI: 18.6 to 32.7) and 69.8% (95% CI: 41.7 to 88.2) respectively. Among patients with bradycardia, the pooled prevalence of OSA was 56.8% (95% CI: 21.5 to 86.3). CPAP treatment, compared to those without, did not significantly reduce the risk of daytime (two randomized trials; RR: 0.50; 95% CI: 0.11 to 2.21) or nocturnal bradycardia (one randomized-controlled trial and one cohort study; RR: 0.76; 95% CI: 0.48 to 1.20).
Conclusions
This meta-analysis demonstrates a high comorbid disease burden between OSA and bradycardia. Future research should explore the treatment effect of CPAP on bradycardia incidence, as compared to placebo.
Objective
To evaluate structural and functional carotid changes and inflammatory profiles in children with OSA (obstructive sleep apnea) and healthy controls.
Study design
Patients with OSA and matched controls (ages 5-13) were recruited. Pro-inflammatory cytokines and acute phase reactants were measured at 6:00 PM. Common carotid artery measures were determined using ultrasound. Confirmatory factor analysis (CFA) was used to determine subgroups of cytokines and their effects on carotid measures.
Results
Ninety-six patients participated (53 healthy controls, 43 patients with OSA). OSA was associated with increased pro-inflammatory cytokines (CD40L, IL6, and IL8) and high sensitivity C-reactive protein (P < .05 for all). One cytokine subgroup (IL-6 and IL-8) was negatively associated with markers of carotid function, indicating reduced arterial distensibility and increased stiffness (p<0.05 for three ultrasound measures); TNF-α had an opposing effect on carotid function compared with this cytokine subgroup (p<0.05 for two ultrasound measures). Linear regression demonstrated significant associations between TNF-α and two measures of carotid function (p<0.05 for each). Children with OSA did not have functional or structural carotid changes compared with controls.
Conclusion
OSA was not directly associated with structural and functional carotid changes but was associated with upregulation of key pro-inflammatory cytokines (sCD40L, IL-6, and IL-8). Together, IL-6 and IL-8 were associated with changes in carotid function. Longitudinal studies are needed to demonstrate that the inflammatory milieu observed in our population is a precursor of atherosclerosis in children.
This chapter summarizes the known associations between COVID-19 and sleep dysfunction, including insomnia, excessive daytime sleepiness, restless legs syndrome and nightmares, as well as obstructive sleep apnea and continuous positive airway pressure treatment during the pandemic. Treatment strategies and management approaches are also briefly discussed.
Obstructive sleep apnea (OSA) is characterized by recurrent complete and partial upper airway obstructive events, resulting in intermittent hypoxemia, autonomic fluctuation, and sleep fragmentation. Approximately 34% and 17% of middle-aged men and women, respectively, meet the diagnostic criteria for OSA. Sleep disturbances are common and underdiagnosed among middle-aged and older adults, and the prevalence varies by race/ethnicity, sex, and obesity status. OSA prevalence is as high as 40% to 80% in patients with hypertension, heart failure, coronary artery disease, pulmonary hypertension, atrial fibrillation, and stroke. Despite its high prevalence in patients with heart disease and the vulnerability of cardiac patients to OSA-related stressors and adverse cardiovascular outcomes, OSA is often underrecognized and undertreated in cardiovascular practice. We recommend screening for OSA in patients with resistant/poorly controlled hypertension, pulmonary hypertension, and recurrent atrial fibrillation after either cardioversion or ablation. In patients with New York Heart Association class II to IV heart failure and suspicion of sleep-disordered breathing or excessive daytime sleepiness, a formal sleep assessment is reasonable. In patients with tachy-brady syndrome or ventricular tachycardia or survivors of sudden cardiac death in whom sleep apnea is suspected after a comprehensive sleep assessment, evaluation for sleep apnea should be considered. After stroke, clinical equipoise exists with respect to screening and treatment. Patients with nocturnally occurring angina, myocardial infarction, arrhythmias, or appropriate shocks from implanted cardioverter-defibrillators may be especially likely to have comorbid sleep apnea. All patients with OSA should be considered for treatment, including behavioral modifications and weight loss as indicated. Continuous positive airway pressure should be offered to patients with severe OSA, whereas oral appliances can be considered for those with mild to moderate OSA or for continuous positive airway pressure–intolerant patients. Follow-up sleep testing should be performed to assess the effectiveness of treatment.
Background
While adenotonsillectomy (T&A) is widely recognized as the first-line therapy for pediatric obstructive sleep apnea (OSA), effects of T&A on blood pressure (BP) remain unclear. This meta-analysis evaluates the associations between T&A and BP in children with OSA.
Methods
The study protocol was registered on PROSPERO (CRD42020154425). Two authors independently searched the PubMed, Medline, EMBASE, and Cochrane databases. The keywords used were “sleep apnea syndromes,” “adenotonsillectomy,” and “child.” A random-effects model was applied to determine office systolic BP (SBP), diastolic BP (DBP), and ambulatory BP changes.
Result
Twelve studies with 1193 children were analyzed (mean age: 7.6 y; 54% boys). The apnea-hypopnea index significantly reduced of 9.4 events/h (95% CI, −12.0 to −6.8) after T&A. Office SBP (−0.24 mmHg; 95% CI, −1.64 to 1.16) and DBP (−1.65 mmHg; 95% CI, −3.47 to 0.17) did not decrease significantly after surgery. No significant decreases were observed in 24-hour ambulatory BP after T&A. Subgroup analysis showed a significant postoperative decrease in office SBP (−6.23 mmHg; 95% CI, −7.78 to −4.67) and DBP (−7.93 mmHg; 95% CI, −10.37 to −5.48) among children with hypertension but a slight increase in office SBP (2.50 mmHg; 95% CI, 1.14 to 3.86) and DBP (1.98 mmHg; 95% CI, −0.02 to 3.98) in those without (P for heterogeneity < .001).
Conclusion
This meta-analysis suggests the office and ambulatory BP changes after T&A in children with OSA are trivial. Moreover, children with hypertension experience a significantly greater decrease in office BP than children without hypertension.
Objective:
Research has consistently found associations between sleep characteristics and cardiovascular disease risk in children, adolescents, and adults. Although primarily investigated in clinical samples (e.g., in those with sleep disorders), greater left ventricular mass is associated with poor sleep quality in non-clinical adult populations as well; however, this has not been evaluated in children or adolescents. Our study aim was to consider the relationship between objectively measured sleef characteristics and left ventricular mass in children.
Methods:
We assessed sleep and cardiac structure in a biracial sample of 9-11 year-old children (N = 176; 41% White, 59% Black; 50% female). Sleep was assessed with actigraphy over 5 nights. Cardiac dimensions were assessed using echocardiography.
Results:
After adjusting for covariates, we found that poor sleep quality was associated with significantly greater left ventricular mass (β = 0.13, t (167) = 2.14, p = 0.034, Cohen's d = 0.16, for activity during sleep, and β = 0.15, t (167) = 2.43, p = 0.016, Cohen's d = 0.18, for sleep fragmentation). Other cardiac dimensions (namely, relative wall thickness and right ventricular dimension) were also significantly associated with sleep characteristics. Notably, associations did not differ as a function of sex or race.Conclusion. The present findings are novel and unique because no prior reports have systematically documented the association between poor sleep quality with potentially detrimental cardiac remodeling in a non-clinical sample of children. However, the novelty and importance of these findings require additional research for confirmation.
Objective. To analyze clinical and instrumental characteristics of sleep disorders in children with cardiomyopathies (CMPs). Patients and methods. We performed retrospective analysis of clinical, laboratory, and instrumental parameters in 107 children with CMPs aged 2 to 17 years treated in the National Medical Research Center of Children's Health in 2018–2019. The study sample was formed in accordance with inclusion criteria (confirmed diagnosis of CMP with functional class I or II, NYHA or Ross R.D.) and exclusion criteria (age <2 years, other heart and vascular diseases). We enrolled 26 children with hypertrophic CMP, 63 children with dilated CMP, and 18 children with unclassified CMP. According to the signs of sleep disorders (from sleep questionnaires filled in by parents), we formed 3 groups: patients with no sleep disorders (n = 40), patients with symptoms of insomnia/parasomnia (n = 26), and patients with indirect and/or direct signs of sleep apnea syndrome (SAS). We analyzed patients’ complaints, as well as clinical, instrumental (liver ultrasound, echocardiography, Holter ECG), and laboratory (glucose, cholesterol, alanine aminotransferase, and aspartate aminotransferase in serum) parameters. Results. Sleep disorders were identified in 63% of children: 58% had signs of insomnia/parasomnia and 38% had signs of SAS. In contrast to the questionnaires, medical records had information about sleep disorders only in two cases. Medical records primarily contained complaints of fatigue and reduced tolerance to physical activity (73%), excessive sweating (23%), and shortness of breath (17%). Patients with SAS usually had more complaints (according to their medical records), and their complaints were more diverse, including abnormal blood pressure, cephalgia, palpitations, and syncope. Body mass index (BMI) (p = 0.001) and serum glucose (p = 0.001) were higher in children with SAS than in children with normal sleep. Even after the exclusion of BMI, glucose levels (although being within the reference range) were still significantly higher in the SAS group (p = 0.020). The QTc interval at the maximum heart rate (HR) (p = 0.018) in children with sleep disorders was longer and had a positive correlation with serum glucose level (r = 0.195, p = 0.052). The analysis of echocardiography parameters (excluding the diagnosis factor) showed a smaller diameter of the pulmonary artery (p = 0.058) in children with SAS and correlation between right atrial remodeling and the factor of sleep disorder in children with various forms of CMP (p = 0.040). Conclusion. The analysis of sleep questionnaires revealed sleep disorders in 63% of children with CMP, including insomnia/parasomnia (24%) and/or SAS (38%). The presence of SAS was associated with a substantial number and variety of subjective complaints. The signs of myocardial electrical instability (longer QTc interval at maximum heart rate), association between QTc and serum glucose level, specific features of remodeling of the heart and blood vessels in patients with sleep disorders, and, most importantly, SAS in children indicate the need for early detection and correction of sleep disorders (insomnia, parasomnia) and main causes of SAS, such as chronic diseases of the ENT organs, overweight, and obesity. Treatment of sleep disorders is very important in terms of prevention of complications, treatment and prognosis of cardiomyopathy in children, which will help to increase therapeutic efficacy. Key words: children, cardiomyopathy, comorbidity, sleep disorders, sleep apnea, sleep questionnaires
Study objectives:
Adults with obesity and obstructive sleep apnea (OSA) are at risk for cardiometabolic disease and this risk likely extends to children with both conditions. Non-invasive ventilation (NIV; including continuous and bilevel positive airway pressure) is often used to treat OSA in children with obesity. The aim of this study was to examine the impact of NIV treatment on heart rate variability, as a marker of cardiovascular risk, in children with obesity and newly diagnosed OSA.
Methods:
A prospective multi-center cohort study was conducted in children with obesity prescribed NIV therapy for newly diagnosed moderate-severe OSA. Measurements of HRV were derived from polysomnography recordings at baseline and after 12 months of treatment. HRV parameters were examined by sleep stage, before and after arousal and oxygen desaturation events. HRV parameters were compared between time points using pair t-tests as well as mixed model analysis.
Results:
Twelve subjects had appropriate data for analysis at baseline and 12 months. Heart rate decreased by 4.5 beats/min after NIV treatment with no change in HRV parameters. HRV parameters differed by sleep stage and showed an increase in arousal related sympathetic-parasympathetic balance after 12 months of NIV treatment. HRV parameters did not differ before and after oxygen desaturation events.
Conclusions:
NIV for the treatment in children with obesity and OSA resulted in a small decrease in heart rate and an increase in arousal related sympathetic-parasympathetic balance. These findings suggest small potentially positive impacts of NIV on cardiovascular risk in children with concurrent obesity and OSA.
Objective:
Sleep disordered breathing (SDB) is associated with increased vascular resistance in children and adults. Persistent increased vascular resistance damages vascular endothelial cells-a marker of which is increased platelet activation. This study compared whole blood impedance platelet aggregation in children diagnosed clinically as SDB warranting adenotonsillectomy and healthy controls.
Methods and results:
Thirty children clinically diagnosed by experienced pediatric otolaryngologists as having SDB warranting intervention were recruited from adenotonsillectomy waitlists and 20 healthy children from the community underwent overnight polysomnography to determine SDB severity (Obstructive Apnea Hypopnea Index (OAHI)). Snoring frequency was collected from parents. In the morning, a fasting blood sample was taken and whole blood platelet aggregation was measured. Children with SDB exhibited increased platelet aggregation to thrombin receptor activating peptide (TRAP) (SDB = 114.8 vs Control = 98.0 AU, p < 0.05); collagen antibody (COL) (96.7 vs 82.2 AU, p < 0.05); and an increased trend in adenosine diphosphate antibody (ADP) (82.3 vs 69.2 AU, p < 0.07); but not aspirin dialuminate (ASP) (82.1 vs 79.5 AU, p > 0.05). No significant association was observed between either OAHI and any aggregation parameter, but parental report of snoring was positively associated with TRAP aggregation (Kendall's τ-c = 0.23, p < 0.05).
Conclusion:
The finding of increased platelet aggregation is consistent with endothelial damage. This suggests that the profile of cardiovascular changes noted in adults with SDB may also occur in children with SDB.
Objective
Heart rate variability (HRV), a noninvasive indicator of autonomic regulation of cardiac rhythm, may represent the physiologic burden of obstructive sleep apnea (OSA). We hypothesized that the treatment-related effects of OSA on HRV in children are causally attributable to the improvement in OSA severity.
Study Design
Secondary analysis of outcomes from the Childhood Adenotonsillectomy Trial (CHAT).
Setting
Analysis of database.
Subjects and Methods
Time- and frequency-domain HRV parameters along with polysomnographic (PSG) and demographic variables were obtained from the CHAT study, which compared early adenotonsillectomy (eAT) to watchful waiting (WW) in children with OSA. The relative contributions of PSG variables and covariates to each HRV parameter were quantified. The proportion of changes in HRV parameters causally attributable to changes in OSA severity, measured by the apnea-hypopnea index (AHI) and oxygen desaturation index (ODI), was estimated.
Results
In total, 404 children aged 5 to 10 years were included. The median (interquartile range) age was 6 (3-9) years. The median body mass index percentile was 82 (53), 195 (48%) children were male, and 147 (36%) were African American. The average heart rate during PSG was the strongest independent predictor of each HRV parameter ( P < .001). Although eAT resulted in statistically significant changes in the majority of HRV parameters, these effects were not causally attributable to treatment-related changes in AHI or ODI.
Conclusions
The average heart rate strongly modulates HRV in children with OSA. Although eAT results in discernible changes in HRV, it appears to not be causally attributable to specific treatment-related changes in AHI or ODI.
Study objectives:
Pulmonary hypertension (PH) has been reported as a serious complication of obstructive sleep apnea (OSA) in children; however, estimated prevalence rates vary widely (zero to 85%). The purpose of this study is to determine the prevalence of PH in children with OSA and identify factors that may predict an increased PH risk in children with OSA.
Methods:
A retrospective review of all pediatric beneficiaries (88,058) in the San Antonio Military Health System with a diagnosis of OSA and a clinical evaluation by a pediatric cardiologist. OSA severity and nadir oxygen saturation were recorded from overnight polysomnography. Reason for referral, comorbid disorders, echocardiogram results, and cardiac diagnoses were obtained from cardiology records.
Results:
OSA was identified in 2,020 pediatric patients (2.3%). A pediatric cardiology consultation was reported for 296 patients with OSA. After excluding 95 patients for incorrect OSA diagnoses, incomplete data, or OSA treatment before cardiology evaluation, 163 patients were included in the final analysis. A diagnosis of PH was found in 3 patients with OSA (1.8%). Two of these patients had obesity, and all three had comorbid cardiac disorders.
Conclusions:
Prevalence of PH in pediatric patients with OSA is low and none of the patients with PH had severe OSA. Current guidelines recommend PH screening in patients with severe OSA, yet OSA severity may not accurately predict risk. Factors evaluated in this study did not demonstrate an increased PH risk; additional research is necessary to improve screening in pediatric patients with OSA.
Citation:
Burns AT, Hansen SL, Turner ZS, Aden JK, Black AB, Hsu DP. Prevalence of pulmonary hypertension in pediatric patients with obstructive sleep apnea and a cardiology evaluation: a retrospective analysis. J Clin Sleep Med. 2019;15(8):1081-1087.
Obesity is a potent cardiovascular disease (CVD) risk factor and is associated with left ventricular hypertrophy (LVH). Obstructive sleep apnea (OSA) is common among individuals with obesity and is also associated with CVD risk. The authors sought to determine the association of OSA, a modifiable CVD risk factor, with LVH among overweight/obese youth with elevated blood pressure (EBP). This was a cross‐sectional analysis of the baseline visit of 61 consecutive overweight/obese children with history of EBP who were evaluated in a pediatric obesity hypertension clinic. OSA was defined via sleep study or validated questionnaire. Children with and without OSA were compared using Fisher's exact tests, Student's t tests, and Wilcoxon rank sum test. Multivariable logistic regression evaluated the association between OSA and LVH. In this cohort, 71.7% of the children had LVH. Children with OSA were more likely to have LVH (85.7% vs 59.4%, P = 0.047). OSA was associated with 4.11 times greater odds of LVH (95% CI 1.15, 14.65; P = 0.030), remaining significant after adjustment for age, sex, race, and BMI z‐score (after adjustment for hypertension, P = 0.051). A severe obstructive apnea‐hypopnea index (AHI >10) was associated with 14 times greater odds of LVH (95% CI 1.14, 172.64, P = 0.039). OSA was significantly associated with LVH among overweight/obese youth with EBP, even after adjustment for age, sex, race, and BMI z‐score. Those with the most severe OSA (AHI >10) had the greatest risk for LVH. Future studies exploring the impact of OSA treatment on CVD risk in children are needed.
Study objectives:
Continuous positive airway pressure (CPAP) is effective but challenging for children with obstructive sleep apnea (OSA). High-flow air via open nasal cannula (HFNC) as treatment in children remains controversial. We report the efficacy of HFNC in children with OSA and CPAP intolerance, a titration protocol, and a discussion of potential mechanisms.
Methods:
Patients aged 1 to 18 years with OSA (defined by obstructive apnea-hypopnea index [OAHI] greater than 1 event/h) and CPAP intolerance were enrolled. Routine polysomnography data obtained during 1 night wearing HFNC was compared with diagnostic data by Wilcoxon rank-sum test.
Results:
Ten school-age subjects (representing all patients attempting HFNC at our institution to date) with varied medical conditions, moderate to severe OSA, and CPAP intolerance wore HFNC from 10 to 50 L/min of room air with oxygen supplementation if needed (room air alone for 6 of the 10). HFNC reduced median OAHI from 11.1 events/h (interquartile range 8.7-18.8 events/h) to 2.1 events/h (1.7-2.2 events/h; P = .002); increased oxyhemoglobin saturation (SpO2) mean from 91.3% (89.6% to 93.5%) to 94.9% (92.4% to 96.0%; P< .002); increased SpO2 nadir from 76.0% (67.3% to 82.3%) to 79.5% (77.2% to 86.0%; P = .032); decreased SpO2 desaturation index from 19.2 events/h (12.7-25.8 events/h) to 6.4 events/h (4.7-10.7 events/h; P = .013); and reduced heart rate from 88 bpm (86-91 bpm) to 74 bpm (67-81 bpm; P = .004). Stratified analysis of the 6 subjects with only room air via HFNC, the OAHI, obstructive hypopnea index, and mean SpO2 still demonstrated improvements (P = .031).
Conclusions:
High-flow nasal cannula reduces respiratory events, improves oxygenation, reduces heart rate, and may be effective for CPAP intolerant children with moderate to severe OSA. Our data suggest HFNC warrants further study and consideration by payers as OSA therapy.
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