Sleep and Breathing

Obstructive sleep apnea (OSA) syndrome is a common condition that can impact clinical outcomes among patients with cardiovascular disease. Screening all subjects with heart disease via polysomnography (PSG) is costly and resource-limited. We sought to compare a Holter monitor-based algorithm to detect OSA to in-laboratory polysomnography (PSG). Prospective cohort study of patients undergoing in-laboratory attended PSG for the evaluation of OSA. A standard 12-lead Holter monitor was attached to patients at the initiation of PSG. Holter-derived respiratory disturbance index (HDRDI) was extracted from the respiratory myogram, based on detecting skeletal muscle “noise” detected on the baseline. Apneic and hypopneic episodes were identified by comparing sudden changes in the myogram to abrupt increases in heart rate. The HDRDI was compared with the PSG-derived apnea-hypopnea index (PDAHI). Thirty patients underwent simultaneous Holter monitoring and overnight diagnostic PSG. An ROC curve for peak HDRDI was 0.79 (95% CI 0.61, 0.97) for OSA, with sensitivity of 94.4% and specificity of 54.5%. A cutoff value of HDRDI < 10 appeared to identify those individuals without clinically significant sleep-disordered breathing. Holter-derived respiration detected OSA comparable to PSG. Further study is warranted to determine its utility for screening and diagnosing OSA in appropriately selected patients.

Sleeping problems and fatigue in pregnancy are often accepted as a normal part of pregnancy; however, these conditions can be linked to serious consequences for both the mother and child. Despite established links between sleeping disturbance and a wide range of pregnancy complications, little is known about the health-care utilisation of women experiencing sleeping problems and fatigue. This study addresses the existing gap in the literature by examining cross-sectional data to identify health service utilisation patterns of pregnant women experiencing sleeping problems and/or tiredness or fatigue. In 2010, a sub-study of the Australian Longitudinal Study on Women’s Health was conducted as a cross-sectional survey of 2445 women who had recently given birth. Associations between reported symptoms of sleeplessness and/or tiredness or fatigue and health service utilisation were determined using logistic regression analysis. During their pregnancy, 15.2 % of women experienced sleeping problems while 35.4 % experienced tiredness or fatigue. Women most commonly consulted with an obstetrician (n = 96) or a general practitioner (GP) (n = 74) for their tiredness or fatigue rather than a midwife (n = 56). A substantial number of women sought help from a complementary and alternative medicine (CAM) practitioner for sleeping problems (33 %) or tiredness/fatigue (28 %). Sleeping problems and/or tiredness or fatigue is reported by a reasonable percentage of pregnant women, and women obtain assistance from conventional and CAM practitioners for their symptoms, but not all seek help. Given the serious implications of untreated sleep- and fatigue-related symptoms for mother and baby, this area of research deserves and requires more attention.

The Epworth Sleepiness Scale (ESS) is extensively used for evaluating daytime sleepiness in patients with sleep apnea–hypopnea syndrome (SAHS). The aim of this study was to translate and validate the ESS in the Serbian language. The Serbian version of the ESS (ESSs) was administered to 112 patients with symptoms of sleep disorder breathing referred to Sleep Center of the Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia and 111 healthy controls. Test–retest reliability was tested in 19 healthy subjects. Patients referred to the Sleep center had significantly higher ESS scores compared to controls (9 vs. 4, p < 0.001). The difference was also present for each item separately, excluding item 5. The ESSs scores were significantly higher in patients with severe (median, 13.5; interquartile range (IQR), 10.3–17.8) compared to moderate (median, 9; IQR, 7.3–9.5; p = 0.005) and mild SAHS (median, 8; IQR, 5.5–9.7; p < 0.001). Item analysis demonstrated good internal consistency of the scale (Cronbach’s alpha 0.88 in patients and 0.72 in healthy controls). Test–retest Spearman’s correlation coefficient was 0.68 (p = 0.001). The Serbian version of the ESS demonstrated good internal consistency and test–retest reliability. The ESSs could be used for both clinical practice and research in Serbian population.

Sleep apnea syndrome (OSAS) has been associated with different ocular manifestations including glaucoma, floppy eye syndrome, punctate keratitis, keratoconus, and optic neuropathy. Angioid streaks are mainly associated with pseudoxanthoma elasticum (PXE) although they can appear in other systemic conditions affecting the elastic fibers. This is a prospective, cross-sectional study. A complete ophthalmic examination was performed in 92 patients undergoing overnight polysomnography for suspicion of OSAS. Diagnosis and classification of OSAS were made based on apnea-hypopnea index (AHI). Stereoscopic optic disc photographs were taken in all patients and independently evaluated by two ophthalmologists. Patients with angioid streaks were referred to a dermatologist for axillary skin biopsy in order to rule out pseudoxanthoma elasticum or other skin abnormalities. Bilateral angioid streaks were observed in three patients who had been diagnosed with severe OSAS (AHI > 30/h). No clinical features characteristic of pseudoxanthoma elasticum or other pathological skin signs were observed. Skin biopsies were normal for all three patients, supporting the diagnosis of idiopathic angioid streaks. One of the patients developed bilateral choroidal neovascularization secondary to the angioid streaks over subsequent years. In view of the low prevalence of idiopathic angioid streaks in the general population, the finding of angioid streaks in patients with severe OSAS suggests OSAS as a possible risk factor for its development. The hypothesis of a connective tissue abnormality that could explain an association between both entities deserves further elucidation.

Telemonitoring (TMg) for patients treated with continuous positive airway pressure (CPAP) is now routine care in some sleep labs. The purpose of the present study was to identify technical interventions associated with improved CPAP compliance in a real-life cohort of newly telemonitored patients with obstructive sleep apnea (OSA) during the first 6 months of treatment. All patients with moderate-to-severe OSA (apnea-hypopnea index (AHI) ≥ 15/h) who were newly treated with CPAP were included in the study and telemonitored. A group educational session was scheduled after 1 month. Technical interventions were performed at the patient’s request and during scheduled visits and the impact of each intervention on CPAP therapy compliance was collected. Between May 2018 and Dec 2019, 349 patients newly diagnosed with OSA were hospitalized in the sleep lab for CPAP titration and 212 patients were included (mean age 54.6 ± 13.1 years, mean BMI 31.7 ± 5.8 kg/m2, mean AHI 42.8 ± 22.0). TMg acceptance rate was 87%. Mean 6-month compliance was 275 ± 154 min, 13% stopped CPAP, and 17% were non-compliant. Correlations were observed between BMI (r = 0.15, p = 0.029), median and 95th percentile leaks (r = −0.23 and −0.18, p = 0.016 and 0.002), and CPAP compliance. During follow-up, 92 interventions were required, mainly for mask change (n = 80). Pressure modification (n = 16) was the only intervention that increased CPAP use > 30 min/night, p = 0.021. Pressure modification was the only adaptation that significantly increased CPAP compliance during the first 6 months. Remote TMg allows providing daily, accurate, and immediate feedback that could help clinicians to confirm that the CPAP treatment is effective.