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Nocturnal hypoxemia is related to morning negative affectivity in untreated patients with severe obstructive sleep apnea.

ABSTRACT: The relationship between sleep apnea and morning affectivity remains unclear. We aimed to clarify how sleep disturbance in patients with obstructive sleep apnea (OSA) influences their affectivity. The enrolled participants underwent the Positive and Negative Affect Schedule on their beds immediately before and after overnight polysomnography. Thirty patients with OSA were divided into two groups according to the apnea-hypopnea index (AHI): mild to moderate OSA (5 ≤ AHI < 30/h) and severe OSA (AHI ≥ 30/h) groups. Additionally, 11 healthy participants (AHI < 5/h) were included as the control group. No independent association was found between affectivity and OSA severity markers in the whole population; however, the severe OSA group had a significantly higher cumulative percentage of sleep time at saturations < 90% (CT90) and worsened morning negative affectivity. Multiple regression analysis showed that CT90 was an independent factor for increasing negative affectivity in the severe OSA group (p = 0.0422). In patients with OSA, the receiver operating characteristic curve analysis showed that the best cutoff value for CT90 for predicting no decrease in negative affectivity after sleep was 1.0% (sensitivity = 0.56, specificity = 0.86); the corresponding area under the curve was 0.71. Worsening of negative affectivity in the morning was influenced by nocturnal hypoxemia in patients with severe OSA.

SUBMITTER: Kumagai H

PROVIDER: S-EPMC9732184 | biostudies-literature | 2022 Dec

REPOSITORIES: biostudies-literature

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Nocturnal hypoxemia is related to morning negative affectivity in untreated patients with severe obstructive sleep apnea.

Kumagai Hajime H Sawatari Hiroyuki H Kiyohara Yuka Y Kanoh Akiko A Asada Kana K Kawaguchi Kengo K Arita Aki A Murase Yoko Y Konishi Noriyuki N Hoshino Tetsuro T Hayashi Mitsuo M Shiomi Toshiaki T

Scientific reports 20221208 1

The relationship between sleep apnea and morning affectivity remains unclear. We aimed to clarify how sleep disturbance in patients with obstructive sleep apnea (OSA) influences their affectivity. The enrolled participants underwent the Positive and Negative Affect Schedule on their beds immediately before and after overnight polysomnography. Thirty patients with OSA were divided into two groups according to the apnea-hypopnea index (AHI): mild to moderate OSA (5 ≤ AHI < 30/h) and severe OSA (AH ...[more]

PMID: 36482199

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Project description:ImportanceThere are no established measures to prevent nocturnal breathing disturbances and other altitude-related adverse health effects (ARAHEs) among lowlanders with chronic obstructive pulmonary disease (COPD) traveling to high altitude.ObjectiveTo evaluate whether nocturnal oxygen therapy (NOT) prevents nocturnal hypoxemia and breathing disturbances during the first night of a stay at 2048 m and reduces the incidence of ARAHEs.Design, setting, and participantsThis randomized, placebo-controlled crossover trial was performed from January to October 2014 with 32 patients with COPD living below 800 m with forced expiratory volume in the first second of expiration (FEV1) between 30% and 80% predicted, pulse oximetry of at least 92%, not requiring oxygen therapy, and without history of sleep apnea. Evaluations were performed at the University Hospital Zurich (490 m, baseline) and during 2 stays of 2 days and nights each in a Swiss Alpine hotel at 2048 m while NOT or placebo treatment was administered in a randomized order. Between altitude sojourns, patients spent at least 2 weeks below 800 m. Data analysis was performed from January 1, 2015, to December 31, 2018.InterventionDuring nights at 2048 m, NOT or placebo (room air) was administered at 3 L/min by nasal cannula.Main outcomes and measuresCoprimary outcomes were differences between NOT and placebo intervention in altitude-induced change in mean nocturnal oxygen saturation (SpO2) as measured by pulse oximetry and apnea-hypopnea index (AHI) measured by polysomnography during night 1 at 2048 m and analyzed according to the intention-to-treat principle. Further outcomes were the incidence of predefined ARAHE, other variables from polysomnography results and respiratory sleep studies in the 2 nights at 2048 m, clinical findings, and symptoms.ResultsOf the 32 patients included, 17 (53%) were women, with a mean (SD) age of 65.6 (5.6) years and a mean (SD) FEV1 of 53.1% (13.2%) predicted. At 490 m, mean (SD) SpO2 was 92% (2%) and mean (SD) AHI was 21.6/h (22.2/h). At 2048 m with placebo, mean (SD) SpO2 was 86% (3%) and mean (SD) AHI was 34.9/h (20.7/h) (P < .001 for both comparisons). Compared with placebo, NOT increased SpO2 by a mean of 9 percentage points (95% CI, 8-11 percentage points; P < .001), decreased AHI by 19.7/h (95% CI, 11.4/h-27.9/h; P < .001), and improved subjective sleep quality measured on a visual analog scale by 9 percentage points (95% CI, 0-17 percentage points; P = .04). During visits to 2048 m or within 24 hours after descent, 8 patients (26%) using placebo and 1 (4%) using NOT experienced ARAHEs (P < .001).Conclusions and relevanceLowlanders with COPD experienced hypoxemia, sleep apnea, and impaired well-being when staying at 2048 m. Because NOT significantly mitigated these undesirable effects, patients with moderate to severe COPD may benefit from preventive NOT during high altitude travel.Trial registrationClinicalTrials.gov Identifier: NCT02150590.

Project description:Study objectivesTo investigate the effects of different intermittent hypoxemia properties on blood pressure (BP) and short-term blood pressure variability (BPV) in severe obstructive sleep apnea (OSA) patients.MethodsNocturnal BP was continuously monitored by measuring pulse transmit time. Apnea-related systolic BP elevation values were used to reflect BPV. Beat-to-beat R-R interval data were incorporated in polysomnography for heart rate variability analysis. The low-frequency/high-frequency band ratio was used to reflect sympathovagal balance. The rate of pulse oxyhemoglobin saturation (SpO₂) decrease was counted as the change in the percentage of SpO₂ per second after obstructive apnea and expressed as the oxygen desaturation rate (ODR). Patients with severe OSA (n = 102) were divided into 2 groups according to the median ODR: faster ODR (FODR group: ODR > 0.37, n = 50) and slower ODR (ODR ≤ 0.37, n = 52).ResultsComparisons between the 2 groups showed significantly higher systolic BP (SBP) values in the FODR group than in the slower ODR group (awake SBP 149.9 ± 18.3 vs 131.8 ± 15.6 mm Hg; asleep SBP: 149.6 ± 19.9 vs 128.7 ± 15.6 mm Hg; both P < .001), as well as short-term BPV (15.0 ± 4.8 vs 11.6 ± 3.6 mm Hg; P < .001), and the prevalence of hypertension (74.0% vs 26.9%; P < .001). Multiple linear regression analyses revealed that after adjusting for body mass index, functional residual capacity, expiratory reserve volume, and baseline SpO2, ODR, as assessed by ΔSpO₂/Δt, had the strongest association with both BP and short-term BPV. Correlation analysis showed that ODR was positively correlated with the low-frequency/high-frequency band ratio (r = .288, P = .003).ConclusionsODR, as a novel hypoxemia profile, was more closely associated with the elevation of BP and BPV in patients with severe OSA. FODR might be associated with enhanced sympathetic activity.Clinical trial registrationRegistry: ClinicalTrials.gov; Name: Characteristics of Obstructive Sleep Apnea Syndrome Related Hypertension and the Effect of Continuous Positive Airway Pressure Treatment on Blood Pressure; URL: https://clinicaltrials.gov/ct2/show/NCT03246022; Identifier: NCT03246022.

Project description:BackgroundAlthough continuous positive airway pressure (CPAP) is the first line treatment for obstructive sleep apnea (OSA) patients, the perioperative adherence rate is unclear. The objective of this study was to determine the perioperative adherence rate of patients with OSA with a CPAP prescription and the effect of adherence on nocturnal oxygen saturation.MethodsThis prospective cohort study included adult surgical patients with a diagnosis of OSA with CPAP prescription undergoing elective non-cardiac surgery. Patients were divided into CPAP adherent and non-adherent groups based on duration of usage (≥ 4 h/night). Overnight oximetry was performed preoperatively and on postoperative night 1 and 2 (N1, N2). The primary outcome was adherence rate and the secondary outcome was nocturnal oxygen saturation.ResultsOne hundred and thirty-two patients completed the study. CPAP adherence was 61% preoperatively, 58% on postoperative N1, and 59% on N2. Forty-nine percent were consistently CPAP adherent pre- and postoperatively. Using a linear fixed effects regression, oxygen desaturation index (ODI) was significantly improved by CPAP adherence (p = 0.0011). The interaction term CPAP x N1 was significant (p = 0.0015), suggesting that the effect of CPAP adherence varied on N1 vs preoperatively. There was no benefit of CPAP adherence on postoperative mean SpO2, minimum SpO2, and percentage of sleep duration with SpO2 < 90%. Use of supplemental oxygen therapy was much lower in the CPAP adherent group vs non-adherent group (9.8% vs 46.5%, p < 0.001).ConclusionsAmong patients with a preoperative CPAP prescription, approximately 50% were consistently adherent. CPAP adherence was associated with improved preoperative ODI and the benefit was maintained on N1. These modest effects may be underestimated by a higher severity of OSA in the CPAP adherent group and a higher rate of oxygen supplementation in the non-adherent group.Trial registrationClinicalTrials.Gov registry ( NCT02796846 ).

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Nocturnal hypoxemia is related to morning negative affectivity in untreated patients with severe obstructive sleep apnea.

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Nocturnal hypoxemia is related to morning negative affectivity in untreated patients with severe obstructive sleep apnea.

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