Browsing by Subject "sleep apnea"
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Item The Determining Risk of Vascular Events by Apnea Monitoring (DREAM) Study: Design, Rationale and Methods(Springer, 2016-05) Koo, Brian B.; Won, Christine; Selim, Bernardo J.; Qin, Li; Jeon, Sangchoon; Redeker, Nancy S.; Bravata, Dawn M.; Strohl, Kingman P.; Concato, John; Yaggi, Henry K.; Department of Neurology, IU School of MedicinePurpose The goal of the Determining Risk of Vascular Events by Apnea Monitoring (DREAM) study is to develop a prognostic model for cardiovascular outcomes, based on physiologic variables—related to breathing, sleep architecture, and oxygenation—measured during polysomnography in US veterans. Methods The DREAM study is a multi-site, retrospective observational cohort study conducted at three Veterans Affairs (VA) centers (West Haven, CT; Indianapolis, IN; Cleveland, OH). Veterans undergoing polysomnography between January 1, 2000 and December 31, 2004 were included based on referral for evaluation of sleep-disordered breathing, documented history and physical prior to sleep testing, and ≥2-h sleep monitoring. Demographic, anthropomorphic, medical, medication, and social history factors were recorded. Measures to determine sleep apnea, sleep architecture, and oxygenation were recorded from polysomnography. VA Patient Treatment File, VA–Medicare Data, Vista Computerized Patient Record System, and VA Vital Status File were reviewed on dates subsequent to polysomnography, ranging from 0.06 to 8.8 years (5.5 ± 1.3 years; mean ± SD). Results The study population includes 1840 predominantly male, middle-aged veterans. As designed, the main primary outcome is the composite endpoint of acute coronary syndrome, stroke, transient ischemic attack, or death. Secondary outcomes include incidents of neoplasm, congestive heart failure, cardiac arrhythmia, diabetes, depression, and post-traumatic stress disorder. Laboratory outcomes include measures of glycemic control, cholesterol, and kidney function. (Actual results are pending.) Conclusions This manuscript provides the rationale for the inclusion of veterans in a study to determine the association between physiologic sleep measures and cardiovascular outcomes and specifically the development of a corresponding outcome-based prognostic model.Item Diagnosing and managing sleep apnea in patients with chronic cerebrovascular disease: a randomized trial of a home-based strategy(Springer, 2017-07) Bravata, Dawn M.; McClain, Vincent; Austin, Charles; Ferguson, Jared; Burrus, Nicholas; Miech, Edward J.; Matthias, Marianne S.; Chumbler, Neale; Ofner, Susan; Foresman, Brian; Sico, Jason; Vaz Fragoso, Carlos A.; Williams, Linda S.; Agarwal, Rajiv; Concato, John; Yaggi, H. Klar; Department of Medicine, IU School of MedicineBackground Obstructive sleep apnea is common and associated with poor outcomes after stroke or transient ischemic attack (TIA). We sought to determine whether the intervention strategy improved sleep apnea detection, obstructive sleep apnea (OSA) treatment, and hypertension control among patients with chronic cerebrovascular disease and hypertension. Methods In this randomized controlled strategy trial intervention, patients received unattended polysomnography at baseline, and patients with OSA (apnea-hypopnea index ≥5 events/h) received auto-titrating continuous positive airway pressure (CPAP) for up to 1 year. Control patients received usual care and unattended polysomnography at the end of the study, to identify undiagnosed OSA. Both groups received 24-h blood pressure assessments at baseline and end of the study. “Excellent” CPAP adherence was defined as cumulative use of ≥4 h/night for ≥70% of the nights. Results Among 225 randomized patients (115 control; 110 intervention), 61.9% (120/194) had sleep apnea. The strategy successfully diagnosed sleep apnea with 97.1% (102/105) valid studies; 90.6% (48/53, 95% CI 82.7–98.4%) of sleep apnea was undiagnosed among control patients. The intervention improved long-term excellent CPAP use: 38.6% (22/57) intervention versus 0% (0/2) control (p < 0.0001). The intervention did not improve hypertension control in this population with well-controlled baseline blood pressure: intervention, 132.7 mmHg (±standard deviation, 14.1) versus control, 133.8 mmHg (±14.0) (adjusted difference, −1.1 mmHg, 95% CI (−4.2, 2.0)), p = 0.48). Conclusions Patients with cerebrovascular disease and hypertension have a high prevalence of OSA. The use of portable polysomnography, and auto-titrating CPAP in the patients’ homes, improved both the diagnosis and the treatment for sleep apnea compared with usual care but did not lower blood pressure.Item Health outcomes associated with improvement in mouth breathing in children with OSA(Springer, 2021) Bandyopadhyay, Anuja; Slaven, James E.; Pediatrics, School of MedicinePurpose Children with mouth breathing (MB) report poor quality of life. It is unknown whether improvement in MB is associated with improvement in behavior or quality of life. We hypothesized that in children with MB and obstructive sleep apnea (OSA), improvement in MB is associated with improvement in behavior and quality of life, independent of improvement in OSA. Methods This is a retrospective post hoc analysis utilizing Childhood Adenotonsillectomy Trial (CHAT) dataset, a multicenter controlled study evaluating outcomes in children with OSA randomized into early adenotonsillectomy or watchful waiting. Children with OSA and MB at baseline (determined by reporting 2 or greater to OSA-18 questionnaire on mouth breathing) were divided into 2 groups: improved mouth breathing (IMB, determined by a lower score compared to baseline at follow up) and persistent mouth breathing (PMB, determined by an unchanged or higher score). Baseline characteristics, behavior (Conners GI score), sleepiness (Epworth Sleepiness Scale), and quality of life (PedsQL) were compared between the groups using appropriate statistical tests. ANCOVA models were used to analyze change in outcomes, adjusting for treatment arm and change in AHI. Results Of 273 children with OSA and MB at baseline, IMB (N = 195) had significantly improved score between visits for Conner’s GI Total T score, Epworth Sleepiness Scale, and PedsQL compared to PMB (N = 78), after adjusting for treatment arm and change in AHI. Conclusion Our study suggests an interesting association between mouth breathing and quality of life, independent of polysomnographic evidence. Future studies should explore the effect of mouth breathing on quality of life, in absence of OSA.Item Obstructive Sleep Apnea in Infants During the First Year of Life: What the Pediatrician Needs to Know(SAGE, 2020-07-01) Bandyopadhyay, Anuja; Daftary, Ameet S.; Pediatrics, School of MedicineItem Positional Therapy for Sleep Apnea - Patient Handout(2021-03-22) Stahl, Stephanie M.