Browsing by keyword "obstructive sleep apnea"
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Association between risk of obstructive sleep apnea and cognitive performance, frailty, and quality of life among older adults with atrial fibrillationSTUDY OBJECTIVES: Geriatric impairments and obstructive sleep apnea (OSA) are prevalent among older patients with atrial fibrillation (AF). Little is known about the association between OSA and geriatric impairments including frailty, cognitive performance, and AF-related quality of life. The objective of this study was to examine the associations of OSA with frailty, cognitive performance, and AF-related quality of life among older adults with AF. METHODS: Data from the Systemic Assessment of Geriatrics Elements-AF study were used which included AF participants 65 years and older and with a CHA2DS2-VASc > /=2. The STOP-BANG questionnaire was used to assess the risk of OSA. Multivariable logistic regression models were used to examine the association between risk of OSA and geriatric impairments, adjusting for sociodemographic, geriatric, and clinical characteristics. RESULTS: A total of 970 participants (mean age 75 years; 51% male) were studied. Of the 680 participants without a medical history of OSA, 26% (n=179) of participants had a low risk of OSA, 53% (n=360) had an intermediate risk, and 21% (n=141) had a high risk for OSA. Compared to those with low risk of OSA, participants with an intermediate or high risk of OSA were more likely to be frail (adjusted odds ratio [aOR]= 1.67, 95% confidence interval [CI]: 1.08-2.56; aOR= 3.00, 95% CI: 1.69-5.32, respectively) in the fully adjusted models. CONCLUSIONS: Our findings identify a group of patients at high risk who would benefit from early screening for OSA. Future longitudinal studies are needed to assess the effect of OSA treatment on frailty, physical functioning, and QoL among patients with AF.
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ATS Core Curriculum 2021. Adult Sleep Medicine: Sleep ApneaThe American Thoracic Society Sleep Core Curriculum updates clinicians on important sleep topics, presented during the annual meeting, and appearing in summary here. This year's sleep core theme is sleep-disordered breathing and its management. Topics range from pathophysiological mechanisms for the association of obstructive sleep apnea (OSA) and metabolic syndrome, surgical modalities of OSA treatment, comorbid insomnia and OSA, central sleep apnea, and sleep practices during a pandemic. OSA has been associated with metabolic syndrome, independent of the role of obesity, and the pathophysiology suggests a role for sleep fragmentation and intermittent hypoxia in observed metabolic outcomes. In specific patient populations, surgical treatment modalities for OSA have demonstrated large reductions in objective disease severity compared with no treatment and may facilitate adherence to positive airway pressure treatment. Patient-centered approaches to comorbid insomnia and sleep apnea include evaluating for both OSA and insomnia simultaneously and using shared-decision making to determine the order and timing of positive airway pressure therapy and cognitive behavioral therapy for insomnia. The pathophysiology of central sleep apnea is complex and may be due to the loss of drive to breathe or instability in the regulatory pathways that control ventilation. Pandemic-era sleep practices have evolved rapidly to balance safety and sustainability of care for patients with sleep-disordered breathing.
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Extracting signature responses from respiratory flows: Low-dimensional analyses on Direct Numerical Simulation-predicted wakes of a flapping uvulaUvula-induced snoring and associated obstructive sleep apnea is a complex phenomenon characterized by vibrating structures and highly transient vortex dynamics. This study aimed to extract signature features of uvula wake flows of different pathological origins and develop a linear reduced-order surrogate model for flow control. Six airway models were developed with two uvula kinematics and three pharynx constriction levels. A direct numerical simulation (DNS) flow solver based on the immersed boundary method was utilized to resolve the wake flows induced by the flapping uvula. Key spatial and temporal responses of the flow to uvula kinematics and pharynx constriction were investigated using continuous wavelet transform (CWT), proper orthogonal decomposition (POD), and dynamic mode decomposition (DMD). Results showed highly complex patterns in flow topologies. CWT analysis revealed multiscale correlations in both time and space between the flapping uvular and wake flows. POD analysis successfully separated the flows among the six models by projecting the datasets in the vector space spanned by the first three eigenmodes. Perceivable differences were also captured in the time evolution of the DMD modes among the six models. A linear reduced-order surrogate model was constructed from the predominant eigenmodes obtained from the DMD analysis and predicted vortex patterns from this surrogate model agreed well with the corresponding DNS simulations. The computational and analytical platform presented in this study could bring a variety of applications in breathing-related disorders and beyond. The computational efficiency of surrogate modeling makes it well suited for flow control, forecasting, and uncertainty analyses.
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Opportunities, barriers, and recommendations in down syndrome researchBACKGROUND: Recent advances in medical care have increased life expectancy and improved the quality of life for people with Down syndrome (DS). These advances are the result of both pre-clinical and clinical research but much about DS is still poorly understood. In 2020, the NIH announced their plan to update their DS research plan and requested input from the scientific and advocacy community. OBJECTIVE: The National Down Syndrome Society (NDSS) and the LuMind IDSC Foundation worked together with scientific and medical experts to develop recommendations for the NIH research plan. METHODS: NDSS and LuMind IDSC assembled over 50 experts across multiple disciplines and organized them in eleven working groups focused on specific issues for people with DS. RESULTS: This review article summarizes the research gaps and recommendations that have the potential to improve the health and quality of life for people with DS within the next decade. CONCLUSIONS: This review highlights many of the scientific gaps that exist in DS research. Based on these gaps, a multidisciplinary group of DS experts has made recommendations to advance DS research. This paper may also aid policymakers and the DS community to build a comprehensive national DS research strategy.
