Evening sock marks as an adjunct to the clinical prediction of obstructive sleep apnea
Tóm tắt
Fluid overload shifting from the legs to the upper airway during sleep promotes obstructive sleep apnea (OSA) and interventions targeting fluid attenuate OSA. Fluid shift has been previously measured by bioelectrical impedance, a complex and time-consuming technique not applicable in the daily clinical settings. The aim of this study is to evaluate the presence of clinically detectable fluid overload and shift and its association with OSA. Patients undergoing sleep study for suspected OSA were asked to report the presence of 11 signs/symptoms associated to excessive accumulation of fluid in different parts of the body at different times of the day. Among 392 patients (male: 53%, median [interquartile range] age: 56 years [1], body mass index, BMI: 29 kg/m2 [2]) included in the study, 135 (34%) had moderate-to-severe OSA (apnea hypopnea index, AHI ≥ 15). Daytime fluid accumulation and nocturnal fluid shift, clinically detectable by patient-reported “evening sock marks,” “heavy legs during the day,” and “morning stuffed nose,” were prevalent in the entire population (46%, 43%, and 33%, respectively). In multivariate analysis, evening sock marks was an independent correlate of having an AHI ≥ 15, together with male sex, older age, and self-reported snoring and apneas. Clinically detectable fluid overload and shift are prevalent in patients addressed for suspected OSA, and evening sock marks, a marker for leg swelling, is an independent correlate of moderate-to-severe OSA. This sign might contribute to OSA diagnosis and identification of patients likely to be treated by interventions targeting fluid overload and shift.
Tài liệu tham khảo
Redolfi S, Bettinzoli M, Venturoli N, Ravanelli M, Pedroni L, Taranto-Montemurro L, Arnulf I, Similowski T, Tantucci C (2015) Attenuation of obstructive sleep apnea and overnight rostral fluid shift by physical activity. Am J Respir Crit Care Med 191(7):856–858. https://doi.org/10.1164/rccm.201412-2192LE
Kyle UG, Bosaeus I, De Lorenzo AD, Deurenberg P, Elia M, Manuel Gomez J, Lilienthal Heitmann B, Kent-Smith L, Melchior JC, Pirlich M, Scharfetter H, MWJS A, Pichard C (2004) Bioelectrical impedance analysis-part II: utilization in clinical practice. Clin Nutr 23(6):1430–1453. https://doi.org/10.1016/j.clnu.2004.09.012
Javaheri S, Barbe F, Campos-Rodriguez F, Dempsey JA, Khayat R, Malhotra A, Martinez-Garcia MA, Mehra R, Pack AI, Polotsky VY, Redline S, Somers VK (2017) Sleep apnea: types, mechanisms, and clinical cardiovascular consequences. J Am Coll Cardiol 69(7):841–858. https://doi.org/10.1016/j.jacc.2016.11.069
Wellman A, Jordan AS, Malhotra A, Fogel RB, Katz ES, Schory K, Edwards JK, White DP (2004) Ventilatory control and airway anatomy in obstructive sleep apnea. Am J Respir Crit Care Med 170(11):1225–1232. https://doi.org/10.1164/rccm.200404-510OC
Eckert DJ (2018) Phenotypic approaches to obstructive sleep apnoea - new pathways for targeted therapy. Sleep Med Rev 37:45–59. https://doi.org/10.1016/j.smrv.2016.12.003
Yadollahi A, Singh B, Bradley TD (2015) Investigating the dynamics of supine fluid redistribution within multiple body segments between men and women. Ann Biomed Eng 43(9):2131–2142. https://doi.org/10.1007/s10439-015-1264-0
White LH, Bradley TD (2013) Role of nocturnal rostral fluid shift in the pathogenesis of obstructive and central sleep apnoea. J Physiol 591(5):1179–1193. https://doi.org/10.1113/jphysiol.2012.245159
Perger E, Jutant EM, Redolfi S (2018) Targeting volume overload and overnight rostral fluid shift: a new perspective to treat sleep apnea. Sleep Med Rev 42:160–170. https://doi.org/10.1016/j.smrv.2018.07.008
Ellis KJ, Wong WW (1998) Human hydrometry: comparison of multifrequency bioelectrical impedance with 2H2O and bromine dilution. J Appl Physiol (1985) 85(3):1056–1062. https://doi.org/10.1152/jappl.1998.85.3.1056
Kushner RF (1992) Bioelectrical impedance analysis: a review of principles and applications. J Am Coll Nutr 11(2):199–209
Rechtschaffen A, Kales A (1968) A manual of standardized terminology, techniques and scoring system for sleep stages of human subjects. UCLA Brain information Service/Brain Research Institute, Los Angeles
Sleep Disorders Atlas Task Force EEG arousals: scoring rules and examples: a preliminary report from the sleep disorders atlas task force of the American Sleep Disorders Association. Sleep Med. 1992;15:173–184
Medicine AAoS (2014) International classification of sleep disorders. In., 3rd edn. American Academy of Sleep Medicine
Hosmer DW, Hosmer T, Le Cessie S, Lemeshow S (1997) A comparison of goodness-of-fit tests for the logistic regression model. Stat Med 16(9):965–980
Hanley JA, McNeil BJ (1982) The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 143(1):29–36. https://doi.org/10.1148/radiology.143.1.7063747
Redolfi S, Yumino D, Ruttanaumpawan P, Yau B, Su MC, Lam J, Bradley TD (2009) Relationship between overnight rostral fluid shift and obstructive sleep apnea in nonobese men. Am J Respir Crit Care Med 179(3):241–246. https://doi.org/10.1164/rccm.200807-1076OC
Lin C-H, Perger E, Lyons OD (2018) Obstructive sleep apnea and chronic kidney disease. Curr Opin Pulm Med (Sleep and Respiratory Neurobiology) 24(6):549–554. https://doi.org/10.1097/MCP.0000000000000525
White LH, Lyons OD, Yadollahi A, Ryan CM, Bradley TD (2015) Effect of below-the-knee compression stockings on severity of obstructive sleep apnea. Sleep Med 16(2):258–264. https://doi.org/10.1016/j.sleep.2014.12.005
Yumino D, Redolfi S, Ruttanaumpawan P, Su MC, Smith S, Newton GE, Mak S, Bradley TD (2010) Nocturnal rostral fluid shift: a unifying concept for the pathogenesis of obstructive and central sleep apnea in men with heart failure. Circulation 121(14):1598–1605. https://doi.org/10.1161/circulationaha.109.902452
Lyons OD, Bradley TD, Chan CT (2015) Hypervolemia and sleep apnea in kidney disease. Semin Nephrol 35(4):373–382. https://doi.org/10.1016/j.semnephrol.2015.06.008
Friedman O, Bradley TD, Chan CT, Parkes R, Logan AG (2010) Relationship between overnight rostral fluid shift and obstructive sleep apnea in drug-resistant hypertension. Hypertension 56(6):1077–1082. https://doi.org/10.1161/hypertensionaha.110.154427
Lyons OD, Inami T, Perger E, Yadollahi A, Chan CT, Bradley TD (2017) The effect of fluid overload on sleep apnoea severity in haemodialysis patients. Eur Respir J 49(4) 1601789. https://doi.org/10.1183/13993003.01789-2016
Lyons OD, Chan CT, Yadollahi A, Bradley TD (2015) Effect of ultrafiltration on sleep apnea and sleep structure in patients with end-stage renal disease. Am J Respir Crit Care Med 191(11):1287–1294. https://doi.org/10.1164/rccm.201412-2288OC
Mendelson M, Lyons OD, Yadollahi A, Inami T, Oh P, Bradley TD (2016) Effects of exercise training on sleep apnoea in patients with coronary artery disease: a randomised trial. Eur Respir J 48(1):142–150. https://doi.org/10.1183/13993003.01897-2015
Redolfi S, Arnulf I, Pottier M, Lajou J, Koskas I, Bradley TD, Similowski T (2011) Attenuation of obstructive sleep apnea by compression stockings in subjects with venous insufficiency. Am J Respir Crit Care Med 184(9):1062–1066. https://doi.org/10.1164/rccm.201102-0350OC
Redolfi S, Arnulf I, Pottier M, Bradley TD, Similowski T (2011) Effects of venous compression of the legs on overnight rostral fluid shift and obstructive sleep apnea. Respir Physiol Neurobiol 175(3):390–393. https://doi.org/10.1016/j.resp.2011.01.001
Jordan AS, McSharry DG, Malhotra A (2014) Adult obstructive sleep apnoea. Lancet 383(9918):736–747. https://doi.org/10.1016/s0140-6736(13)60734-5