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Most arrhythmia clinic patients have undetected OSA
BOSTON – In a study of patients without a previous diagnosis of obstructive sleep apnea (OSA), 85% of participants in outpatient arrhythmia clinics had undetected OSA.
The study, which also excluded patients who had ever been treated for OSA, was presented by Colin Shapiro, MD, of the Department of Psychiatry, Toronto Western Hospital, University of Toronto, at the annual meeting of the Associated Professional Sleep Societies.
A binary logistic regression analysis showed that only age and male gender were significant predictors of OSA.
Along with a home sleep study, researchers tested 75 nonselected consecutive patients (mean age of 64 years; 72% male) from three outpatient arrhythmia clinics for symptoms indicative of OSA using the Epworth Sleepiness Scale (ESS), the Fatigue Severity Scale (FSS), the Non-Restorative Sleep Scale (NRSS), and other questionnaires.
On the ESS, 32% of patients had a score of 8 or greater, indicating higher than normal daytime sleepiness. Almost half (47%) of patients had a high level of fatigue on the FSS, and symptoms of nonrestorative sleep were detected in 15% (NRSS score greater than or equal to 46).
Dr. Shapiro noted that “high scores suggestive of daytime sleepiness, fatigue, or insomnia did not particularly predict the presence of OSA in patients with arrhythmia.” He concluded that, “with a hit rate of 85%, just about every patient with an arrhythmia should have a sleep study.”
Dr. Shapiro informed attendees at the annual meeting of the Professional Sleep Societies that he was presenting in place of his student and the abstract’s first author, Dr. Asmaa M. Abumuamar, MD, who was denied a visa to attend the meeting. Dr. Abumuamar is from the Toronto Western Research Institute, University of Toronto.
Dr. Shapiro reported that Dr. Abumuamar has no conflicts of interest. Dr. Shapiro reported that he is an investor in the company that supplied the home sleep testing apparatus.
BOSTON – In a study of patients without a previous diagnosis of obstructive sleep apnea (OSA), 85% of participants in outpatient arrhythmia clinics had undetected OSA.
The study, which also excluded patients who had ever been treated for OSA, was presented by Colin Shapiro, MD, of the Department of Psychiatry, Toronto Western Hospital, University of Toronto, at the annual meeting of the Associated Professional Sleep Societies.
A binary logistic regression analysis showed that only age and male gender were significant predictors of OSA.
Along with a home sleep study, researchers tested 75 nonselected consecutive patients (mean age of 64 years; 72% male) from three outpatient arrhythmia clinics for symptoms indicative of OSA using the Epworth Sleepiness Scale (ESS), the Fatigue Severity Scale (FSS), the Non-Restorative Sleep Scale (NRSS), and other questionnaires.
On the ESS, 32% of patients had a score of 8 or greater, indicating higher than normal daytime sleepiness. Almost half (47%) of patients had a high level of fatigue on the FSS, and symptoms of nonrestorative sleep were detected in 15% (NRSS score greater than or equal to 46).
Dr. Shapiro noted that “high scores suggestive of daytime sleepiness, fatigue, or insomnia did not particularly predict the presence of OSA in patients with arrhythmia.” He concluded that, “with a hit rate of 85%, just about every patient with an arrhythmia should have a sleep study.”
Dr. Shapiro informed attendees at the annual meeting of the Professional Sleep Societies that he was presenting in place of his student and the abstract’s first author, Dr. Asmaa M. Abumuamar, MD, who was denied a visa to attend the meeting. Dr. Abumuamar is from the Toronto Western Research Institute, University of Toronto.
Dr. Shapiro reported that Dr. Abumuamar has no conflicts of interest. Dr. Shapiro reported that he is an investor in the company that supplied the home sleep testing apparatus.
BOSTON – In a study of patients without a previous diagnosis of obstructive sleep apnea (OSA), 85% of participants in outpatient arrhythmia clinics had undetected OSA.
The study, which also excluded patients who had ever been treated for OSA, was presented by Colin Shapiro, MD, of the Department of Psychiatry, Toronto Western Hospital, University of Toronto, at the annual meeting of the Associated Professional Sleep Societies.
A binary logistic regression analysis showed that only age and male gender were significant predictors of OSA.
Along with a home sleep study, researchers tested 75 nonselected consecutive patients (mean age of 64 years; 72% male) from three outpatient arrhythmia clinics for symptoms indicative of OSA using the Epworth Sleepiness Scale (ESS), the Fatigue Severity Scale (FSS), the Non-Restorative Sleep Scale (NRSS), and other questionnaires.
On the ESS, 32% of patients had a score of 8 or greater, indicating higher than normal daytime sleepiness. Almost half (47%) of patients had a high level of fatigue on the FSS, and symptoms of nonrestorative sleep were detected in 15% (NRSS score greater than or equal to 46).
Dr. Shapiro noted that “high scores suggestive of daytime sleepiness, fatigue, or insomnia did not particularly predict the presence of OSA in patients with arrhythmia.” He concluded that, “with a hit rate of 85%, just about every patient with an arrhythmia should have a sleep study.”
Dr. Shapiro informed attendees at the annual meeting of the Professional Sleep Societies that he was presenting in place of his student and the abstract’s first author, Dr. Asmaa M. Abumuamar, MD, who was denied a visa to attend the meeting. Dr. Abumuamar is from the Toronto Western Research Institute, University of Toronto.
Dr. Shapiro reported that Dr. Abumuamar has no conflicts of interest. Dr. Shapiro reported that he is an investor in the company that supplied the home sleep testing apparatus.
AT SLEEP 2017
Key clinical point: The majority of patients attending an outpatient arrhythmia clinic had undetected OSA.
Major finding: Of the participants, 91% of males and 71% of females with no history of OSA were found to have the disorder (85% of total).
Data source: A screening study using a randomized, unselected population drawn from outpatient arrhythmia clinics. Those with a diagnoses of OSA were excluded.
Disclosures: Dr. Shapiro reported that Dr. Abumuamar has no conflicts of interest. Dr. Shapiro reported that he is an investor in the company that supplied the home sleep testing apparatus.
Telemonitoring with feedback improves CPAP
BOSTON – Remote monitoring of continuous positive airway pressure (CPAP) use with feedback messaging to patients improves adherence but only when patients opt to receive continual feedback on their usage, according to a study.
Dennis Hwang, MD, medical director of Kaiser Permanent Fontana Medical Center in California and his colleagues designed the four-arm Tele-OSA study to evaluate the impact of two automated telemedicine interventions: an obstructive sleep apnea (OSA) education program (provided by Emmi Solutions) and a CPAP remote monitoring system with automated patient feedback (U-Sleep, ResMed). Dr. Hwang, who is also cochair of sleep medicine at Southern California Permanente Medical Group, presented his findings at the annual meeting of the Associated Professional Sleep Societies.
CPAP adherence was compared at 3 months and 1 year for patients in all four groups. Dr. Hwang reported findings from 556 patients who completed one-year follow-up.
At 90 days, patients assigned to either of the telemonitoring arms had significantly higher CPAP usage than those who did not receive telemonitoring.
However, at 3 months when the study protocol called for the automated messaging to be turned off, CPAP adherence dropped off. By 8 months, adherence in patients using the telemonitoring system was no different from that in those who never received the automated messaging. That would have been the end of the story, except that there was a glitch in the system.
“Perhaps serendipitously, we had a group of patients, about one-third, for whom we inadvertently did not turn off the messaging,” explained Dr. Hwang. “In these patients who continued to receive feedback, CPAP usage remained elevated throughout the course of the year and, at 12 months, was significantly higher than in the patients who were not receiving any kind of messaging.”
Dr. Hwang added that the telemonitoring required no additional provider intervention, “suggesting that this could be a cost-effective strategy.”
Only one-third of patients (66.7%) assigned to one of the tele-education groups viewed the video. Additionally, the researchers found that, whether patients used the tele-education alone or in combination with the telemonitoring, tele-education use had no impact on 90-day compliance with CPAP.
Dr. Hwang received support from the American Sleep Medicine Foundation and ResMed Science.
BOSTON – Remote monitoring of continuous positive airway pressure (CPAP) use with feedback messaging to patients improves adherence but only when patients opt to receive continual feedback on their usage, according to a study.
Dennis Hwang, MD, medical director of Kaiser Permanent Fontana Medical Center in California and his colleagues designed the four-arm Tele-OSA study to evaluate the impact of two automated telemedicine interventions: an obstructive sleep apnea (OSA) education program (provided by Emmi Solutions) and a CPAP remote monitoring system with automated patient feedback (U-Sleep, ResMed). Dr. Hwang, who is also cochair of sleep medicine at Southern California Permanente Medical Group, presented his findings at the annual meeting of the Associated Professional Sleep Societies.
CPAP adherence was compared at 3 months and 1 year for patients in all four groups. Dr. Hwang reported findings from 556 patients who completed one-year follow-up.
At 90 days, patients assigned to either of the telemonitoring arms had significantly higher CPAP usage than those who did not receive telemonitoring.
However, at 3 months when the study protocol called for the automated messaging to be turned off, CPAP adherence dropped off. By 8 months, adherence in patients using the telemonitoring system was no different from that in those who never received the automated messaging. That would have been the end of the story, except that there was a glitch in the system.
“Perhaps serendipitously, we had a group of patients, about one-third, for whom we inadvertently did not turn off the messaging,” explained Dr. Hwang. “In these patients who continued to receive feedback, CPAP usage remained elevated throughout the course of the year and, at 12 months, was significantly higher than in the patients who were not receiving any kind of messaging.”
Dr. Hwang added that the telemonitoring required no additional provider intervention, “suggesting that this could be a cost-effective strategy.”
Only one-third of patients (66.7%) assigned to one of the tele-education groups viewed the video. Additionally, the researchers found that, whether patients used the tele-education alone or in combination with the telemonitoring, tele-education use had no impact on 90-day compliance with CPAP.
Dr. Hwang received support from the American Sleep Medicine Foundation and ResMed Science.
BOSTON – Remote monitoring of continuous positive airway pressure (CPAP) use with feedback messaging to patients improves adherence but only when patients opt to receive continual feedback on their usage, according to a study.
Dennis Hwang, MD, medical director of Kaiser Permanent Fontana Medical Center in California and his colleagues designed the four-arm Tele-OSA study to evaluate the impact of two automated telemedicine interventions: an obstructive sleep apnea (OSA) education program (provided by Emmi Solutions) and a CPAP remote monitoring system with automated patient feedback (U-Sleep, ResMed). Dr. Hwang, who is also cochair of sleep medicine at Southern California Permanente Medical Group, presented his findings at the annual meeting of the Associated Professional Sleep Societies.
CPAP adherence was compared at 3 months and 1 year for patients in all four groups. Dr. Hwang reported findings from 556 patients who completed one-year follow-up.
At 90 days, patients assigned to either of the telemonitoring arms had significantly higher CPAP usage than those who did not receive telemonitoring.
However, at 3 months when the study protocol called for the automated messaging to be turned off, CPAP adherence dropped off. By 8 months, adherence in patients using the telemonitoring system was no different from that in those who never received the automated messaging. That would have been the end of the story, except that there was a glitch in the system.
“Perhaps serendipitously, we had a group of patients, about one-third, for whom we inadvertently did not turn off the messaging,” explained Dr. Hwang. “In these patients who continued to receive feedback, CPAP usage remained elevated throughout the course of the year and, at 12 months, was significantly higher than in the patients who were not receiving any kind of messaging.”
Dr. Hwang added that the telemonitoring required no additional provider intervention, “suggesting that this could be a cost-effective strategy.”
Only one-third of patients (66.7%) assigned to one of the tele-education groups viewed the video. Additionally, the researchers found that, whether patients used the tele-education alone or in combination with the telemonitoring, tele-education use had no impact on 90-day compliance with CPAP.
Dr. Hwang received support from the American Sleep Medicine Foundation and ResMed Science.
AT SLEEP 2017
Key clinical point: CPAP telemonitoring with feedback messaging improved CPAP adherence with no additional provider intervention needed.
Major finding: CPAP adherence was significantly higher at 3 months in patients who had remote monitoring of usage with subsequent continuous automated feedback. At one year, usage was only higher in those patients who continued to receive messaging during usage of the telemonitoring system and not in those who had the messaging component “turned off.”
Data source: A four-arm, randomized clinical trial that tested tele-education and CPAP telemonitoring interventions in 1,455 patients.
Disclosures: Dr. Hwang received support from the American Sleep Medicine Foundation and ResMed Science Center.
Daytime sleepiness linked to subsequent brain amyloid
BOSTON – Daytime sleepiness in cognitively intact older adults was significantly associated with subsequent neuroimaging evidence of brain amyloid deposition, according to a data analysis presented at the annual meeting of the Associated Professional Sleep Societies.
Self-reported regular nappers were also more likely to have brain amyloid on subsequent imaging, compared with non-nappers, but this difference just missed statistical significance.
Complementing these findings, Adam P. Spira, PhD, and his colleagues from John’s Hopkins University, Baltimore, previously published a study showing that self-reported sleep duration and poorer sleep quality were associated with greater beta-amyloid deposition in cognitively normal adults. (Spira et al. JAMA Neurology, 2013).
This new study by Dr. Spira and his colleagues sought to look at the link between excessive daytime sleepiness (EDS)/napping in older adults and beta-amyloid burden 15 years later as determined by positron emission tomography (PET) scanning. EDS, defined as a level of sleepiness during the day sufficient to interfere with daily activities, is a common manifestation of sleep disorders, in particular sleep disordered breathing, and is tied to cognitive impairment and accidents.
In unadjusted analyses, participants with EDS were beyond three times more likely to be beta-amyloid+ (odds ratio, 3.37), compared with those who did not meet criteria for EDS. This finding remained significant after adjustment for age, body mass index, and education level (OR, 2.59).
Nappers had an almost twofold greater odds of being beta-amyloid+ than non-nappers after adjustment, but this difference was not statistically meaningful (multivariate adjusted odds ratio, 1.82).
The researchers analyzed data on 124 participants drawn from the National Institute of Aging’s Baltimore Longitudinal Study of Aging (BLSA), the longest-running study of human aging in the U.S. The mean age of these patients at baseline was 60.1 years, and 50.8% of the sample was female. All participants were determined to be cognitively normal at baseline.
At the beginning of the study, participants were asked about their daytime sleepiness and napping habits. Those who reported often being drowsy or falling asleep during the daytime when they preferred to be awake were considered to having EDS. Those who napped once or twice a week or more were considered nappers.
About one-quarter of participants (24.4%) reported EDS, and 28.5% identified themselves as regular nappers. An average of 15.7 years later, participants completed Pittsburgh Compound B PET imaging, at which time 34.7% were deemed beta-amyloid+.
“We were kind of shocked that a single question with a yes/no response was robustly associated with [beta-amyloid] status that many years later,” reported Dr. Spira.
Still unknown, he added, is whether there is utility in quantifying or screening for preclinical Alzheimer’s disease risk using sleep variables. Also unclear is how EDS itself might drive beta-amyloid deposition. “What is likely to be happening here is something like sleep disordered breathing – which has been linked to cognitive impairment and dementia and has been linked to [Alzheimer’s disease] biomarkers – is driving this association,” he speculated.
“We have to keep in mind that even the people at baseline, even though they were cognitively normal, may have had some beta-amyloid deposition, which might have contributed to their EDS,” said Dr. Spira.
Dr. Spira intends to conduct a prospective study using laboratory-based sleep testing (polysomnography) and repeated measures of brain amyloid to clarify whether sleep disordered breathing or other factors were driving the association he found.
Dr. Spira reported having no financial disclosures. This study was supported by grants from the National Institute on Aging.
BOSTON – Daytime sleepiness in cognitively intact older adults was significantly associated with subsequent neuroimaging evidence of brain amyloid deposition, according to a data analysis presented at the annual meeting of the Associated Professional Sleep Societies.
Self-reported regular nappers were also more likely to have brain amyloid on subsequent imaging, compared with non-nappers, but this difference just missed statistical significance.
Complementing these findings, Adam P. Spira, PhD, and his colleagues from John’s Hopkins University, Baltimore, previously published a study showing that self-reported sleep duration and poorer sleep quality were associated with greater beta-amyloid deposition in cognitively normal adults. (Spira et al. JAMA Neurology, 2013).
This new study by Dr. Spira and his colleagues sought to look at the link between excessive daytime sleepiness (EDS)/napping in older adults and beta-amyloid burden 15 years later as determined by positron emission tomography (PET) scanning. EDS, defined as a level of sleepiness during the day sufficient to interfere with daily activities, is a common manifestation of sleep disorders, in particular sleep disordered breathing, and is tied to cognitive impairment and accidents.
In unadjusted analyses, participants with EDS were beyond three times more likely to be beta-amyloid+ (odds ratio, 3.37), compared with those who did not meet criteria for EDS. This finding remained significant after adjustment for age, body mass index, and education level (OR, 2.59).
Nappers had an almost twofold greater odds of being beta-amyloid+ than non-nappers after adjustment, but this difference was not statistically meaningful (multivariate adjusted odds ratio, 1.82).
The researchers analyzed data on 124 participants drawn from the National Institute of Aging’s Baltimore Longitudinal Study of Aging (BLSA), the longest-running study of human aging in the U.S. The mean age of these patients at baseline was 60.1 years, and 50.8% of the sample was female. All participants were determined to be cognitively normal at baseline.
At the beginning of the study, participants were asked about their daytime sleepiness and napping habits. Those who reported often being drowsy or falling asleep during the daytime when they preferred to be awake were considered to having EDS. Those who napped once or twice a week or more were considered nappers.
About one-quarter of participants (24.4%) reported EDS, and 28.5% identified themselves as regular nappers. An average of 15.7 years later, participants completed Pittsburgh Compound B PET imaging, at which time 34.7% were deemed beta-amyloid+.
“We were kind of shocked that a single question with a yes/no response was robustly associated with [beta-amyloid] status that many years later,” reported Dr. Spira.
Still unknown, he added, is whether there is utility in quantifying or screening for preclinical Alzheimer’s disease risk using sleep variables. Also unclear is how EDS itself might drive beta-amyloid deposition. “What is likely to be happening here is something like sleep disordered breathing – which has been linked to cognitive impairment and dementia and has been linked to [Alzheimer’s disease] biomarkers – is driving this association,” he speculated.
“We have to keep in mind that even the people at baseline, even though they were cognitively normal, may have had some beta-amyloid deposition, which might have contributed to their EDS,” said Dr. Spira.
Dr. Spira intends to conduct a prospective study using laboratory-based sleep testing (polysomnography) and repeated measures of brain amyloid to clarify whether sleep disordered breathing or other factors were driving the association he found.
Dr. Spira reported having no financial disclosures. This study was supported by grants from the National Institute on Aging.
BOSTON – Daytime sleepiness in cognitively intact older adults was significantly associated with subsequent neuroimaging evidence of brain amyloid deposition, according to a data analysis presented at the annual meeting of the Associated Professional Sleep Societies.
Self-reported regular nappers were also more likely to have brain amyloid on subsequent imaging, compared with non-nappers, but this difference just missed statistical significance.
Complementing these findings, Adam P. Spira, PhD, and his colleagues from John’s Hopkins University, Baltimore, previously published a study showing that self-reported sleep duration and poorer sleep quality were associated with greater beta-amyloid deposition in cognitively normal adults. (Spira et al. JAMA Neurology, 2013).
This new study by Dr. Spira and his colleagues sought to look at the link between excessive daytime sleepiness (EDS)/napping in older adults and beta-amyloid burden 15 years later as determined by positron emission tomography (PET) scanning. EDS, defined as a level of sleepiness during the day sufficient to interfere with daily activities, is a common manifestation of sleep disorders, in particular sleep disordered breathing, and is tied to cognitive impairment and accidents.
In unadjusted analyses, participants with EDS were beyond three times more likely to be beta-amyloid+ (odds ratio, 3.37), compared with those who did not meet criteria for EDS. This finding remained significant after adjustment for age, body mass index, and education level (OR, 2.59).
Nappers had an almost twofold greater odds of being beta-amyloid+ than non-nappers after adjustment, but this difference was not statistically meaningful (multivariate adjusted odds ratio, 1.82).
The researchers analyzed data on 124 participants drawn from the National Institute of Aging’s Baltimore Longitudinal Study of Aging (BLSA), the longest-running study of human aging in the U.S. The mean age of these patients at baseline was 60.1 years, and 50.8% of the sample was female. All participants were determined to be cognitively normal at baseline.
At the beginning of the study, participants were asked about their daytime sleepiness and napping habits. Those who reported often being drowsy or falling asleep during the daytime when they preferred to be awake were considered to having EDS. Those who napped once or twice a week or more were considered nappers.
About one-quarter of participants (24.4%) reported EDS, and 28.5% identified themselves as regular nappers. An average of 15.7 years later, participants completed Pittsburgh Compound B PET imaging, at which time 34.7% were deemed beta-amyloid+.
“We were kind of shocked that a single question with a yes/no response was robustly associated with [beta-amyloid] status that many years later,” reported Dr. Spira.
Still unknown, he added, is whether there is utility in quantifying or screening for preclinical Alzheimer’s disease risk using sleep variables. Also unclear is how EDS itself might drive beta-amyloid deposition. “What is likely to be happening here is something like sleep disordered breathing – which has been linked to cognitive impairment and dementia and has been linked to [Alzheimer’s disease] biomarkers – is driving this association,” he speculated.
“We have to keep in mind that even the people at baseline, even though they were cognitively normal, may have had some beta-amyloid deposition, which might have contributed to their EDS,” said Dr. Spira.
Dr. Spira intends to conduct a prospective study using laboratory-based sleep testing (polysomnography) and repeated measures of brain amyloid to clarify whether sleep disordered breathing or other factors were driving the association he found.
Dr. Spira reported having no financial disclosures. This study was supported by grants from the National Institute on Aging.
AT SLEEP 2017
Key clinical point: Cognitively normal older adults who reported excessive sleepiness or napping were more likely, at follow-up 15 years later, to have brain amyloid deposition, one of the hallmarks of Alzheimer’s disease.
Major finding: Compared with those who did not report excessive daytime sleepiness, those who did were more than three times more likely to have beta-amyloid deposition on PET imaging more than 15 years later.
Data source: The data analysis included 124 participants in the Baltimore Longitudinal Study of Aging who were queried on their sleep habits and then underwent PET imaging more than 15 years later.
Disclosures: Dr. Spira reported having no financial disclosures. This study was supported by grants from the National Institute on Aging.
OSA in pregnancy linked to congenital anomalies
BOSTON – Newborns exposed to obstructive sleep apnea (OSA) in utero are at a higher risk of being diagnosed with congenital anomalies, according to a new study presented at the annual meeting of the Associated Professional Sleep Societies.
The researchers’ analysis covered data from more than 1.4 million births during 2010-2014. Circulatory, musculoskeletal, and central nervous systems were among the types of anomalies they saw in the 17.3% of babies born to mothers who had OSA during pregnancy. These babies were also more likely to require intensive care at birth, compared with those born to mothers who had not been diagnosed with OSA.
Additionally, the investigators found that the 0.1% of women who had a diagnosis of OSA were 2.76 times more likely to have babies that required some kind of resuscitative effort at birth. Specifically, 0.5% of the newborns of the mothers with OSA required resuscitation, compared with 0.1% of the other group’s babies. The newborns of women with OSA were also 2.25 times more likely to have a longer hospital stay.
Mothers with OSA were older and more likely to be non-Hispanic black and have a diagnosis of obesity, tobacco use, and drug use but not alcohol use.
“We can’t say for sure that sleep apnea is causing these outcomes,” said abstract presenter and principal investigator Ghada Bourjeily, MD, of Brown University and Miriam Hospital, both in Providence, R.I., in an interview.
“We know that women who have sleep apnea also often have other morbidities, so we don’t know what might have contributed to the congenital outcomes,” said Dr. Bourjeily. “We also don’t know if treating sleep apnea can reverse or prevent birth complications or even maternal complications, like preeclampsia or gestational diabetes.”
Ongoing studies are looking at maternal continuous positive airway pressure therapy use and neonatal outcomes, but “they are nothing to write home about yet,” she said.
“This is an underdiagnosed condition and it’s probably undercoded too, but we know from another study that the prevalence of OSA in the first trimester in an all-comers population that was screened for the condition is 4%,” said Dr. Bourjeily. “If another 3% of [the study participants] actually had OSA, then all of these findings are potentially underestimated.”
The majority of OSA in pregnant women that has been identified in prospective studies is mild and not necessarily something that most physicians would treat, she noted. “In our study, the ones who were diagnosed were those who probably went to their doctors and complained of sleepiness or loud snoring.”
The researchers also determined that the newborns of mothers with sleep apnea were more likely to be admitted to an intensive care unit (25.3% vs. 8.1%) or a special care nursery (34.9% vs. 13.6%).
A diagnosis of OSA was established when a diagnosis code for OSA was present on the delivery discharge record. Maternal and infant outcomes were collected for ICD-9 and procedural codes.
Dr. Bourjeily received research equipment support from Respironics.
BOSTON – Newborns exposed to obstructive sleep apnea (OSA) in utero are at a higher risk of being diagnosed with congenital anomalies, according to a new study presented at the annual meeting of the Associated Professional Sleep Societies.
The researchers’ analysis covered data from more than 1.4 million births during 2010-2014. Circulatory, musculoskeletal, and central nervous systems were among the types of anomalies they saw in the 17.3% of babies born to mothers who had OSA during pregnancy. These babies were also more likely to require intensive care at birth, compared with those born to mothers who had not been diagnosed with OSA.
Additionally, the investigators found that the 0.1% of women who had a diagnosis of OSA were 2.76 times more likely to have babies that required some kind of resuscitative effort at birth. Specifically, 0.5% of the newborns of the mothers with OSA required resuscitation, compared with 0.1% of the other group’s babies. The newborns of women with OSA were also 2.25 times more likely to have a longer hospital stay.
Mothers with OSA were older and more likely to be non-Hispanic black and have a diagnosis of obesity, tobacco use, and drug use but not alcohol use.
“We can’t say for sure that sleep apnea is causing these outcomes,” said abstract presenter and principal investigator Ghada Bourjeily, MD, of Brown University and Miriam Hospital, both in Providence, R.I., in an interview.
“We know that women who have sleep apnea also often have other morbidities, so we don’t know what might have contributed to the congenital outcomes,” said Dr. Bourjeily. “We also don’t know if treating sleep apnea can reverse or prevent birth complications or even maternal complications, like preeclampsia or gestational diabetes.”
Ongoing studies are looking at maternal continuous positive airway pressure therapy use and neonatal outcomes, but “they are nothing to write home about yet,” she said.
“This is an underdiagnosed condition and it’s probably undercoded too, but we know from another study that the prevalence of OSA in the first trimester in an all-comers population that was screened for the condition is 4%,” said Dr. Bourjeily. “If another 3% of [the study participants] actually had OSA, then all of these findings are potentially underestimated.”
The majority of OSA in pregnant women that has been identified in prospective studies is mild and not necessarily something that most physicians would treat, she noted. “In our study, the ones who were diagnosed were those who probably went to their doctors and complained of sleepiness or loud snoring.”
The researchers also determined that the newborns of mothers with sleep apnea were more likely to be admitted to an intensive care unit (25.3% vs. 8.1%) or a special care nursery (34.9% vs. 13.6%).
A diagnosis of OSA was established when a diagnosis code for OSA was present on the delivery discharge record. Maternal and infant outcomes were collected for ICD-9 and procedural codes.
Dr. Bourjeily received research equipment support from Respironics.
BOSTON – Newborns exposed to obstructive sleep apnea (OSA) in utero are at a higher risk of being diagnosed with congenital anomalies, according to a new study presented at the annual meeting of the Associated Professional Sleep Societies.
The researchers’ analysis covered data from more than 1.4 million births during 2010-2014. Circulatory, musculoskeletal, and central nervous systems were among the types of anomalies they saw in the 17.3% of babies born to mothers who had OSA during pregnancy. These babies were also more likely to require intensive care at birth, compared with those born to mothers who had not been diagnosed with OSA.
Additionally, the investigators found that the 0.1% of women who had a diagnosis of OSA were 2.76 times more likely to have babies that required some kind of resuscitative effort at birth. Specifically, 0.5% of the newborns of the mothers with OSA required resuscitation, compared with 0.1% of the other group’s babies. The newborns of women with OSA were also 2.25 times more likely to have a longer hospital stay.
Mothers with OSA were older and more likely to be non-Hispanic black and have a diagnosis of obesity, tobacco use, and drug use but not alcohol use.
“We can’t say for sure that sleep apnea is causing these outcomes,” said abstract presenter and principal investigator Ghada Bourjeily, MD, of Brown University and Miriam Hospital, both in Providence, R.I., in an interview.
“We know that women who have sleep apnea also often have other morbidities, so we don’t know what might have contributed to the congenital outcomes,” said Dr. Bourjeily. “We also don’t know if treating sleep apnea can reverse or prevent birth complications or even maternal complications, like preeclampsia or gestational diabetes.”
Ongoing studies are looking at maternal continuous positive airway pressure therapy use and neonatal outcomes, but “they are nothing to write home about yet,” she said.
“This is an underdiagnosed condition and it’s probably undercoded too, but we know from another study that the prevalence of OSA in the first trimester in an all-comers population that was screened for the condition is 4%,” said Dr. Bourjeily. “If another 3% of [the study participants] actually had OSA, then all of these findings are potentially underestimated.”
The majority of OSA in pregnant women that has been identified in prospective studies is mild and not necessarily something that most physicians would treat, she noted. “In our study, the ones who were diagnosed were those who probably went to their doctors and complained of sleepiness or loud snoring.”
The researchers also determined that the newborns of mothers with sleep apnea were more likely to be admitted to an intensive care unit (25.3% vs. 8.1%) or a special care nursery (34.9% vs. 13.6%).
A diagnosis of OSA was established when a diagnosis code for OSA was present on the delivery discharge record. Maternal and infant outcomes were collected for ICD-9 and procedural codes.
Dr. Bourjeily received research equipment support from Respironics.
AT SLEEP 2017
Key clinical point: This large cohort study is the first study to show an increased risk of congenital anomalies and resuscitation at birth in newborns born to mothers with diagnosed obstructive sleep apnea (OSA).
Major finding: Of babies born to a mother with OSA, 17.3% had a congenital anomaly, compared with 10.6% of those born to mothers without OSA (P less than .001). This difference remained significant after adjusting for potential confounders.
Data source: A national cohort study including more than 1.4 million linked maternal and newborn records with a delivery hospitalization during 2010-2014.
Disclosures: Dr. Bourjeily received research equipment support from Respironics.
Personalized snoring video boosts CPAP adherence
BOSTON – Showing patients videos of themselves having apneic episodes may convince them to use continuous positive airway pressure (CPAP), suggests the first results of an ongoing randomized clinical trial.
The investigators based their research project design on a previous pilot study that showed improved adherence to CPAP in patients who were shown videos of themselves sleeping while participating in a sleep study, Mark S. Aloia, PhD, said in a presentation at the annual meeting of the Associated Professional Sleep Societies.
In the new study, patients who had been recently diagnosed with sleep apnea were randomly assigned to participate in one of the three treatment groups. All three groups received sleep apnea and CPAP education prior to the use of CPAP. One group also watched videos of themselves sleeping, snoring, and gasping for air, and another group watched videos of a stranger sleeping and having apneic events.
After adjustment for age, educational level, and baseline sleep apnea severity, those who watched videos of themselves still used their CPAP devices more than 2 hours per night longer than did patients in each of the groups receiving the other two interventions (P = .02).
Both video interventions involved watching 30 minutes of sleep footage shown to each patient once before starting CPAP therapy. CPAP adherence was measured by downloaded data from PAP devices over the first 90 days of use.
The average age of the patients was 50 years, and they had moderate or severe sleep apnea, with mean apnea hypopnea indices ranging from 26.5 to 33.3 in the three study arms. The majority of patients had body mass indexes over 30.
Adherence to CPAP treatment is often poor, with many patients failing to use the device for even 4 hours per night, said Dr. Aloia, a psychologist at National Jewish Health in Denver. Many patients prescribed CPAP for OSA will undergo an educational component that may include watching a video of someone with OSA sleeping and having apneic events, he added. They often have “dramatic responses” to these videos, but then fail to positively change their own behavior.
“Many times we think that if our patient just knew what we know, he or she would use CPAP more, but there is evidence that doctors don’t take their medications any more than patients do, so it is not just a matter of education, it is a little bit deeper than that and it has to be personalized,” he said.
“The use of a personalized video is promising … we hope to present more data next year,” said Dr. Aloia, who has board certification in behavioral sleep medicine,
He noted that the video technique used may be jeopardized as more and more patients partake in home-based rather than lab-based sleep studies. That said, he also reported that the research team had to exclude several patients from the study because they had already viewed videos of themselves sleeping and snoring that had been recorded by their partners.
If the intervention proves effective, Dr. Aloia said he thinks it can be modified for use in home testing.
The study is supported by a grant from the National Heart, Lung, and Blood Institute. Dr. Aloia disclosed that he is a paid employee of Phillips, but that the study used both Phillips and ResMed CPAP devices.
BOSTON – Showing patients videos of themselves having apneic episodes may convince them to use continuous positive airway pressure (CPAP), suggests the first results of an ongoing randomized clinical trial.
The investigators based their research project design on a previous pilot study that showed improved adherence to CPAP in patients who were shown videos of themselves sleeping while participating in a sleep study, Mark S. Aloia, PhD, said in a presentation at the annual meeting of the Associated Professional Sleep Societies.
In the new study, patients who had been recently diagnosed with sleep apnea were randomly assigned to participate in one of the three treatment groups. All three groups received sleep apnea and CPAP education prior to the use of CPAP. One group also watched videos of themselves sleeping, snoring, and gasping for air, and another group watched videos of a stranger sleeping and having apneic events.
After adjustment for age, educational level, and baseline sleep apnea severity, those who watched videos of themselves still used their CPAP devices more than 2 hours per night longer than did patients in each of the groups receiving the other two interventions (P = .02).
Both video interventions involved watching 30 minutes of sleep footage shown to each patient once before starting CPAP therapy. CPAP adherence was measured by downloaded data from PAP devices over the first 90 days of use.
The average age of the patients was 50 years, and they had moderate or severe sleep apnea, with mean apnea hypopnea indices ranging from 26.5 to 33.3 in the three study arms. The majority of patients had body mass indexes over 30.
Adherence to CPAP treatment is often poor, with many patients failing to use the device for even 4 hours per night, said Dr. Aloia, a psychologist at National Jewish Health in Denver. Many patients prescribed CPAP for OSA will undergo an educational component that may include watching a video of someone with OSA sleeping and having apneic events, he added. They often have “dramatic responses” to these videos, but then fail to positively change their own behavior.
“Many times we think that if our patient just knew what we know, he or she would use CPAP more, but there is evidence that doctors don’t take their medications any more than patients do, so it is not just a matter of education, it is a little bit deeper than that and it has to be personalized,” he said.
“The use of a personalized video is promising … we hope to present more data next year,” said Dr. Aloia, who has board certification in behavioral sleep medicine,
He noted that the video technique used may be jeopardized as more and more patients partake in home-based rather than lab-based sleep studies. That said, he also reported that the research team had to exclude several patients from the study because they had already viewed videos of themselves sleeping and snoring that had been recorded by their partners.
If the intervention proves effective, Dr. Aloia said he thinks it can be modified for use in home testing.
The study is supported by a grant from the National Heart, Lung, and Blood Institute. Dr. Aloia disclosed that he is a paid employee of Phillips, but that the study used both Phillips and ResMed CPAP devices.
BOSTON – Showing patients videos of themselves having apneic episodes may convince them to use continuous positive airway pressure (CPAP), suggests the first results of an ongoing randomized clinical trial.
The investigators based their research project design on a previous pilot study that showed improved adherence to CPAP in patients who were shown videos of themselves sleeping while participating in a sleep study, Mark S. Aloia, PhD, said in a presentation at the annual meeting of the Associated Professional Sleep Societies.
In the new study, patients who had been recently diagnosed with sleep apnea were randomly assigned to participate in one of the three treatment groups. All three groups received sleep apnea and CPAP education prior to the use of CPAP. One group also watched videos of themselves sleeping, snoring, and gasping for air, and another group watched videos of a stranger sleeping and having apneic events.
After adjustment for age, educational level, and baseline sleep apnea severity, those who watched videos of themselves still used their CPAP devices more than 2 hours per night longer than did patients in each of the groups receiving the other two interventions (P = .02).
Both video interventions involved watching 30 minutes of sleep footage shown to each patient once before starting CPAP therapy. CPAP adherence was measured by downloaded data from PAP devices over the first 90 days of use.
The average age of the patients was 50 years, and they had moderate or severe sleep apnea, with mean apnea hypopnea indices ranging from 26.5 to 33.3 in the three study arms. The majority of patients had body mass indexes over 30.
Adherence to CPAP treatment is often poor, with many patients failing to use the device for even 4 hours per night, said Dr. Aloia, a psychologist at National Jewish Health in Denver. Many patients prescribed CPAP for OSA will undergo an educational component that may include watching a video of someone with OSA sleeping and having apneic events, he added. They often have “dramatic responses” to these videos, but then fail to positively change their own behavior.
“Many times we think that if our patient just knew what we know, he or she would use CPAP more, but there is evidence that doctors don’t take their medications any more than patients do, so it is not just a matter of education, it is a little bit deeper than that and it has to be personalized,” he said.
“The use of a personalized video is promising … we hope to present more data next year,” said Dr. Aloia, who has board certification in behavioral sleep medicine,
He noted that the video technique used may be jeopardized as more and more patients partake in home-based rather than lab-based sleep studies. That said, he also reported that the research team had to exclude several patients from the study because they had already viewed videos of themselves sleeping and snoring that had been recorded by their partners.
If the intervention proves effective, Dr. Aloia said he thinks it can be modified for use in home testing.
The study is supported by a grant from the National Heart, Lung, and Blood Institute. Dr. Aloia disclosed that he is a paid employee of Phillips, but that the study used both Phillips and ResMed CPAP devices.
AT SLEEP 2017
Key clinical point: Showing patients videos of themselves having an apneic event during CPAP initiation resulted in greater treatment adherence over 3 months, compared to standard ways of initiating CPAP therapy.
Major finding: Patients who watched personalized sleep videos used their CPAP devices more than 2 hours per night longer, compared with those who were not shown a personalized video.
Data source: Randomized controlled trial with 3-month data on 24 individuals out of a planned enrollment of 300 patients.
Disclosures: This ongoing study is supported by a grant from the National Heart, Lung, and Blood Institute. Dr. Aloia disclosed that he is a paid employee of Phillips, but that the study used both Phillips and ResMed CPAP devices.
Mild OSA linked to hypertension
BOSTON – Sleep apnea doesn’t have to be severe or even symptomatic to increase the risk of hypertension and diabetes, according to a pair of new studies.
“We found that even mild sleep apnea was strongly associated with increased risk of developing hypertension by four times, compared to individuals without sleep apnea,” said principal investigator and top sleep researcher Alexandros N. Vgontzas, MD, of Pennsylvania State University College of Medicine in a SLEEP press release. “Similarly, moderate sleep apnea was associated with increased risk of developing diabetes by almost three times, compared to individuals without sleep apnea.”
Dr. Vgontzas presented his team’s results on the link between mild to moderate OSA and hypertension at the annual meeting of the American Academy of Sleep Medicine. In a separate session, his colleague at Penn State, Yun Li, MD, presented the diabetes-related findings of the same study.
After multivariate adjustment, including controlling for change in body mass index over time, both mild and moderate OSA were significantly associated with increased odds for developing hypertension, compared with controls without OSA (odds ratios, 4.36 and 3.46, respectively.).
The researchers found their test for an age interaction was also significant, indicating that younger adults with nonsevere OSA were at increased risk of hypertension, while those over 60 years of age were not.
[polldaddy:9792720]
“In young and middle-aged adults, our findings suggest that early detection and treatment of mild to moderate sleep apnea is warranted in order to prevent future cardiometabolic disease,” said Dr. Li in a press release. “Given the stronger association of sleep apnea with metabolic abnormalities in this age group, emphasis should be placed on yearly monitoring of indices of metabolic symptoms and lifestyle interventions, such as weight control, healthy diet, regular exercise, and stress management.”
For diabetes, moderate OSA was significantly associated with an almost threefold increased odds for developing diabetes after adjusting for a range of baseline and follow-up variables (OR, 2.78), but mild OSA was not associated with incident diabetes (OR, 0.47).
Both studies utilized data from the Penn State Adult Cohort, a random general population sample of 1,741 adults who underwent an overnight polysomnography sleep study and had a detailed medical history interview at baseline. Mild and moderate OSA were defined as an apnea hypopnea index from 5 to 14.9 and from 15 to 29.9, respectively. The presence of hypertension or diabetes at baseline and follow-up was defined by a self-report of receiving treatment for or having a physician diagnosis of either condition.
The age range of the studied population was wide (20-84 years), with a mean age of about 47 years. The incidence of diabetes was 10.2% at follow-up, while hypertension was found in 34.2% of patients. Dr. Vgontzas said the percentage of patients with hypertension was roughly what he had expected for this population.
“Our conclusion is that, the younger a person is, the stronger is the need for detection and treatment of sleep apnea,” said Dr. Vgontzas, though he acknowledged that putting these millions of people on continuous positive airway pressure therapy is not an easy proposition.
The study was supported by National Institutes of Health grants. Dr. Vgontzas reported no conflicts of interest.
BOSTON – Sleep apnea doesn’t have to be severe or even symptomatic to increase the risk of hypertension and diabetes, according to a pair of new studies.
“We found that even mild sleep apnea was strongly associated with increased risk of developing hypertension by four times, compared to individuals without sleep apnea,” said principal investigator and top sleep researcher Alexandros N. Vgontzas, MD, of Pennsylvania State University College of Medicine in a SLEEP press release. “Similarly, moderate sleep apnea was associated with increased risk of developing diabetes by almost three times, compared to individuals without sleep apnea.”
Dr. Vgontzas presented his team’s results on the link between mild to moderate OSA and hypertension at the annual meeting of the American Academy of Sleep Medicine. In a separate session, his colleague at Penn State, Yun Li, MD, presented the diabetes-related findings of the same study.
After multivariate adjustment, including controlling for change in body mass index over time, both mild and moderate OSA were significantly associated with increased odds for developing hypertension, compared with controls without OSA (odds ratios, 4.36 and 3.46, respectively.).
The researchers found their test for an age interaction was also significant, indicating that younger adults with nonsevere OSA were at increased risk of hypertension, while those over 60 years of age were not.
[polldaddy:9792720]
“In young and middle-aged adults, our findings suggest that early detection and treatment of mild to moderate sleep apnea is warranted in order to prevent future cardiometabolic disease,” said Dr. Li in a press release. “Given the stronger association of sleep apnea with metabolic abnormalities in this age group, emphasis should be placed on yearly monitoring of indices of metabolic symptoms and lifestyle interventions, such as weight control, healthy diet, regular exercise, and stress management.”
For diabetes, moderate OSA was significantly associated with an almost threefold increased odds for developing diabetes after adjusting for a range of baseline and follow-up variables (OR, 2.78), but mild OSA was not associated with incident diabetes (OR, 0.47).
Both studies utilized data from the Penn State Adult Cohort, a random general population sample of 1,741 adults who underwent an overnight polysomnography sleep study and had a detailed medical history interview at baseline. Mild and moderate OSA were defined as an apnea hypopnea index from 5 to 14.9 and from 15 to 29.9, respectively. The presence of hypertension or diabetes at baseline and follow-up was defined by a self-report of receiving treatment for or having a physician diagnosis of either condition.
The age range of the studied population was wide (20-84 years), with a mean age of about 47 years. The incidence of diabetes was 10.2% at follow-up, while hypertension was found in 34.2% of patients. Dr. Vgontzas said the percentage of patients with hypertension was roughly what he had expected for this population.
“Our conclusion is that, the younger a person is, the stronger is the need for detection and treatment of sleep apnea,” said Dr. Vgontzas, though he acknowledged that putting these millions of people on continuous positive airway pressure therapy is not an easy proposition.
The study was supported by National Institutes of Health grants. Dr. Vgontzas reported no conflicts of interest.
BOSTON – Sleep apnea doesn’t have to be severe or even symptomatic to increase the risk of hypertension and diabetes, according to a pair of new studies.
“We found that even mild sleep apnea was strongly associated with increased risk of developing hypertension by four times, compared to individuals without sleep apnea,” said principal investigator and top sleep researcher Alexandros N. Vgontzas, MD, of Pennsylvania State University College of Medicine in a SLEEP press release. “Similarly, moderate sleep apnea was associated with increased risk of developing diabetes by almost three times, compared to individuals without sleep apnea.”
Dr. Vgontzas presented his team’s results on the link between mild to moderate OSA and hypertension at the annual meeting of the American Academy of Sleep Medicine. In a separate session, his colleague at Penn State, Yun Li, MD, presented the diabetes-related findings of the same study.
After multivariate adjustment, including controlling for change in body mass index over time, both mild and moderate OSA were significantly associated with increased odds for developing hypertension, compared with controls without OSA (odds ratios, 4.36 and 3.46, respectively.).
The researchers found their test for an age interaction was also significant, indicating that younger adults with nonsevere OSA were at increased risk of hypertension, while those over 60 years of age were not.
[polldaddy:9792720]
“In young and middle-aged adults, our findings suggest that early detection and treatment of mild to moderate sleep apnea is warranted in order to prevent future cardiometabolic disease,” said Dr. Li in a press release. “Given the stronger association of sleep apnea with metabolic abnormalities in this age group, emphasis should be placed on yearly monitoring of indices of metabolic symptoms and lifestyle interventions, such as weight control, healthy diet, regular exercise, and stress management.”
For diabetes, moderate OSA was significantly associated with an almost threefold increased odds for developing diabetes after adjusting for a range of baseline and follow-up variables (OR, 2.78), but mild OSA was not associated with incident diabetes (OR, 0.47).
Both studies utilized data from the Penn State Adult Cohort, a random general population sample of 1,741 adults who underwent an overnight polysomnography sleep study and had a detailed medical history interview at baseline. Mild and moderate OSA were defined as an apnea hypopnea index from 5 to 14.9 and from 15 to 29.9, respectively. The presence of hypertension or diabetes at baseline and follow-up was defined by a self-report of receiving treatment for or having a physician diagnosis of either condition.
The age range of the studied population was wide (20-84 years), with a mean age of about 47 years. The incidence of diabetes was 10.2% at follow-up, while hypertension was found in 34.2% of patients. Dr. Vgontzas said the percentage of patients with hypertension was roughly what he had expected for this population.
“Our conclusion is that, the younger a person is, the stronger is the need for detection and treatment of sleep apnea,” said Dr. Vgontzas, though he acknowledged that putting these millions of people on continuous positive airway pressure therapy is not an easy proposition.
The study was supported by National Institutes of Health grants. Dr. Vgontzas reported no conflicts of interest.
AT SLEEP 2017
Key clinical point: In a random sample of adults, the presence of mild to moderate OSA was associated with a significantly higher risk of hypertension and diabetes.
Major finding: Individuals with mild to moderate OSA had more than a fourfold increased risk of hypertension over 10 years of follow-up (OR, 4.36). Moderate OSA was significantly associated with incident diabetes risk (OR, 2.78), but mild OSA was not.
Data source: An observational study including a random sample of 1,741 adults between the ages of 20 and 84 years.
Disclosures: The study was supported by National Institutes of Health grants. Dr. Vgontzas reported no conflicts of interest.
Loud, frequent snoring increases preterm delivery risk
BOSTON – Women who were prepregnancy, frequent, and loud snorers during pregnancy had a significantly higher risk of preterm or early term delivery, in a study presented at the annual meeting of the Associated Professional Sleep Societies.
“The fact that there is an association between snoring and time to delivery in a cohort which is not hypertensive is alarming, and I think that treatment for snoring earlier on in pregnancy may alleviate some of these outcomes,” reported Galit Levi Dunietz, PhD, MPH, of the University of Michigan in a session at the meeting.
Compared with nonsnorers, frequently loud snorers had about a 60% increased risk of preterm delivery even after adjusting for baseline body mass index, smoking, education, race, and parity. Pregnancy-onset snoring and infrequent or quiet snoring were not associated with preterm birth.
A limitation on the findings was that only a small number of women (4% of the sample) fell into the chronic, frequent, and loud snoring category. These women, however, had significantly lower mean gestational age, mean baseline BMI, and were more likely to be smokers, as compared with nonsnorers and quiet frequent or infrequent snorers.
“I think this is excellent work because it’s a big question,” said Dr. Omavi Gbodossou Bailey, MD, MPH from the University of Arizona, Pheonix, in a Q&A session at the conference. “As a primary care physician, I deliver babies and I also deal with sleep and when I ask the ob.gyns. about sleep apnea in this patient population, they’re not usually interested.”
Dr. Bailey noted in an interview that, often, women who had uncomplicated first pregnancies return with later pregnancies heavier, more sleep deprived, and snoring. “Then, they have higher risk for complications in the second or third pregnancy,” he said.
Snoring is common in pregnancy, affecting about 35% of women, and pregnancy itself is a risk factor for snoring. Previous studies have associated snoring with key pregnancy morbidities including hypertension, preeclampsia, and gestational diabetes, but, prior to this research, the few studies that had looked at snoring and preterm delivery had shown inconsistent results.
The researchers recruited 904 pregnant women in their third trimester and without hypertension or diabetes from prenatal clinics at the University of Michigan cared for between 2008 and 2011. The women were queried on the frequency of their snoring (from never to three or more times per week) along with its intensity (from nonsnoring to loud or very loud snoring). They were also categorized, based on self-report, as either chronic/prepregnancy snorers or incident/pregnancy-onset snorers.
In this low-risk cohort, 25% of the women reported incident snoring and 9% reported chronic prepregnancy snoring.
“The combination of snoring frequency and intensity may be a clinically useful marker to identify otherwise low-risk women who are likely to deliver earlier,” said Dr. Dunietz.
This study was funded by the Gilmore Fund for Sleep Research, the University of Michigan Institute for Clinical and Health Research, and the National Heart, Lung, and Blood Institute. Dr. Dunietz reported having no financial disclosures.
BOSTON – Women who were prepregnancy, frequent, and loud snorers during pregnancy had a significantly higher risk of preterm or early term delivery, in a study presented at the annual meeting of the Associated Professional Sleep Societies.
“The fact that there is an association between snoring and time to delivery in a cohort which is not hypertensive is alarming, and I think that treatment for snoring earlier on in pregnancy may alleviate some of these outcomes,” reported Galit Levi Dunietz, PhD, MPH, of the University of Michigan in a session at the meeting.
Compared with nonsnorers, frequently loud snorers had about a 60% increased risk of preterm delivery even after adjusting for baseline body mass index, smoking, education, race, and parity. Pregnancy-onset snoring and infrequent or quiet snoring were not associated with preterm birth.
A limitation on the findings was that only a small number of women (4% of the sample) fell into the chronic, frequent, and loud snoring category. These women, however, had significantly lower mean gestational age, mean baseline BMI, and were more likely to be smokers, as compared with nonsnorers and quiet frequent or infrequent snorers.
“I think this is excellent work because it’s a big question,” said Dr. Omavi Gbodossou Bailey, MD, MPH from the University of Arizona, Pheonix, in a Q&A session at the conference. “As a primary care physician, I deliver babies and I also deal with sleep and when I ask the ob.gyns. about sleep apnea in this patient population, they’re not usually interested.”
Dr. Bailey noted in an interview that, often, women who had uncomplicated first pregnancies return with later pregnancies heavier, more sleep deprived, and snoring. “Then, they have higher risk for complications in the second or third pregnancy,” he said.
Snoring is common in pregnancy, affecting about 35% of women, and pregnancy itself is a risk factor for snoring. Previous studies have associated snoring with key pregnancy morbidities including hypertension, preeclampsia, and gestational diabetes, but, prior to this research, the few studies that had looked at snoring and preterm delivery had shown inconsistent results.
The researchers recruited 904 pregnant women in their third trimester and without hypertension or diabetes from prenatal clinics at the University of Michigan cared for between 2008 and 2011. The women were queried on the frequency of their snoring (from never to three or more times per week) along with its intensity (from nonsnoring to loud or very loud snoring). They were also categorized, based on self-report, as either chronic/prepregnancy snorers or incident/pregnancy-onset snorers.
In this low-risk cohort, 25% of the women reported incident snoring and 9% reported chronic prepregnancy snoring.
“The combination of snoring frequency and intensity may be a clinically useful marker to identify otherwise low-risk women who are likely to deliver earlier,” said Dr. Dunietz.
This study was funded by the Gilmore Fund for Sleep Research, the University of Michigan Institute for Clinical and Health Research, and the National Heart, Lung, and Blood Institute. Dr. Dunietz reported having no financial disclosures.
BOSTON – Women who were prepregnancy, frequent, and loud snorers during pregnancy had a significantly higher risk of preterm or early term delivery, in a study presented at the annual meeting of the Associated Professional Sleep Societies.
“The fact that there is an association between snoring and time to delivery in a cohort which is not hypertensive is alarming, and I think that treatment for snoring earlier on in pregnancy may alleviate some of these outcomes,” reported Galit Levi Dunietz, PhD, MPH, of the University of Michigan in a session at the meeting.
Compared with nonsnorers, frequently loud snorers had about a 60% increased risk of preterm delivery even after adjusting for baseline body mass index, smoking, education, race, and parity. Pregnancy-onset snoring and infrequent or quiet snoring were not associated with preterm birth.
A limitation on the findings was that only a small number of women (4% of the sample) fell into the chronic, frequent, and loud snoring category. These women, however, had significantly lower mean gestational age, mean baseline BMI, and were more likely to be smokers, as compared with nonsnorers and quiet frequent or infrequent snorers.
“I think this is excellent work because it’s a big question,” said Dr. Omavi Gbodossou Bailey, MD, MPH from the University of Arizona, Pheonix, in a Q&A session at the conference. “As a primary care physician, I deliver babies and I also deal with sleep and when I ask the ob.gyns. about sleep apnea in this patient population, they’re not usually interested.”
Dr. Bailey noted in an interview that, often, women who had uncomplicated first pregnancies return with later pregnancies heavier, more sleep deprived, and snoring. “Then, they have higher risk for complications in the second or third pregnancy,” he said.
Snoring is common in pregnancy, affecting about 35% of women, and pregnancy itself is a risk factor for snoring. Previous studies have associated snoring with key pregnancy morbidities including hypertension, preeclampsia, and gestational diabetes, but, prior to this research, the few studies that had looked at snoring and preterm delivery had shown inconsistent results.
The researchers recruited 904 pregnant women in their third trimester and without hypertension or diabetes from prenatal clinics at the University of Michigan cared for between 2008 and 2011. The women were queried on the frequency of their snoring (from never to three or more times per week) along with its intensity (from nonsnoring to loud or very loud snoring). They were also categorized, based on self-report, as either chronic/prepregnancy snorers or incident/pregnancy-onset snorers.
In this low-risk cohort, 25% of the women reported incident snoring and 9% reported chronic prepregnancy snoring.
“The combination of snoring frequency and intensity may be a clinically useful marker to identify otherwise low-risk women who are likely to deliver earlier,” said Dr. Dunietz.
This study was funded by the Gilmore Fund for Sleep Research, the University of Michigan Institute for Clinical and Health Research, and the National Heart, Lung, and Blood Institute. Dr. Dunietz reported having no financial disclosures.
AT SLEEP 2017
Key clinical point: Compared with those who were nonloud, nonfrequent, or pregnancy-onset snorers, chronic, loud, and frequent snorers were at significantly greater risk for preterm delivery.
Major finding: Of women determined to be chronic, prepregnancy, frequent, and loud snorers, 25% had preterm delivery.
Data source: An observational study including 904 pregnant women in the third trimester.
Disclosures: This study was funded by the Gilmore Fund for Sleep Research, the University of Michigan Institute for Clinical and Health Research, and the National Heart, Lung, and Blood Institute. Dr. Dunietz reported having no financial disclosures.
Late-to-bed adolescents may be early-to-diabetes
BOSTON – Late chronotype may have a deleterious impact on glucose homeostasis independent of obesity in preadolescents aged 10-13 years, according to a small study.
Late chronotype – or an individual’s preference for later sleep and food intake – is associated with higher body mass index (BMI), risk incidence of type 2 diabetes mellitus, hemoglobin A1c, and risk of hypertension in adults. It is also associated with higher BMI, lower dietary restraint, and lower HDL cholesterol in adolescents. This study was the first to focus on chronotype and glycemic control in children on the cusp of or in early puberty.
In participants tested during the summer months, the actigraphy-derived mid-sleep time on free days – an objective measure of chronotype – was associated positively with fasting plasma glucose (P = 0.048). “This is an important point because it highlights the objective measure of chronotype, whereas questionnaires can be more subjective,” said Magdalena Dumin, MD, at the annual meeting of Associated Professional Sleep Societies.
The researcher also noted that higher sleep fragmentation and lower sleep efficiency were both associated with hyperglycemia and hyperinsulinemia, independent of obesity.
“Our preliminary findings suggest that having a late chronotype and less efficient and more fragmented sleep in pre- and early adolescence may have a deleterious glycemic impact independent of obesity and pubertal stage,” she said.
“Advancing bedtimes may reduce glucose levels in preadolescents and adolescents,” Dr. Dumin surmised.
This study included 24 adolescents, 13 of whom were normal weight and 11 of whom were obese. They all underwent anthropometric measurements with fasting glucose, insulin, C-peptide, HbA1c, and lipid levels. Exclusion criteria included a clinical diagnosis of sleep, behavioral, or dietary problems. The obese subjects also underwent a 180-minute glucose tolerance test.
Chronotype was assessed via actigraphy over 1 week to provide mid-sleep time on free days, and secondarily through administration to chronotype questionnaires – the Children’s ChronoType Questionnaire and the Morningness-Eveningness Scale for Children.
Among the normal-weight participants, 31% were morning and 23% evening chronotype (the rest being neutral chronotype), and, in the obese subjects, 27% were morning and 36% were evening chronotype.
The obese subjects were more likely to be in puberty, and had higher systolic blood pressures, higher fasting plasma insulin and levels of insulin resistance, as measured by Homeostatic Model Assessment of Insulin Resistance. Hemoglobin A1c tended to be higher in the obese subjects (P = .06), but fasting plasma glucose did not differ significantly between the obese and normal-weight participants (P = .68).
“We chose this population due to the shift from morningness to eveningness that occurs during adolescence followed by a progressive return to an intermediate or early chronotype at the end of adolescence,” Dr. Dumin said.
Bedtime, wake time, and total sleep time were nearly identical between the two groups (7.84 hours and 7.62 hours; P = .49), although sleep efficiency was numerically lower in the obese subjects (87.0 vs. 89.8; P = .14), while sleep fragmentation was somewhat greater (20.16 vs. 17.38; P = .18).
Dr. Dumin suggested that a continuation of her research with more patients would be useful.
This study is supported by the Endocrine Fellows Foundation and the University of Chicago Institute of Translational Medicine. Dr. Dumin reported having no financial disclosures.
BOSTON – Late chronotype may have a deleterious impact on glucose homeostasis independent of obesity in preadolescents aged 10-13 years, according to a small study.
Late chronotype – or an individual’s preference for later sleep and food intake – is associated with higher body mass index (BMI), risk incidence of type 2 diabetes mellitus, hemoglobin A1c, and risk of hypertension in adults. It is also associated with higher BMI, lower dietary restraint, and lower HDL cholesterol in adolescents. This study was the first to focus on chronotype and glycemic control in children on the cusp of or in early puberty.
In participants tested during the summer months, the actigraphy-derived mid-sleep time on free days – an objective measure of chronotype – was associated positively with fasting plasma glucose (P = 0.048). “This is an important point because it highlights the objective measure of chronotype, whereas questionnaires can be more subjective,” said Magdalena Dumin, MD, at the annual meeting of Associated Professional Sleep Societies.
The researcher also noted that higher sleep fragmentation and lower sleep efficiency were both associated with hyperglycemia and hyperinsulinemia, independent of obesity.
“Our preliminary findings suggest that having a late chronotype and less efficient and more fragmented sleep in pre- and early adolescence may have a deleterious glycemic impact independent of obesity and pubertal stage,” she said.
“Advancing bedtimes may reduce glucose levels in preadolescents and adolescents,” Dr. Dumin surmised.
This study included 24 adolescents, 13 of whom were normal weight and 11 of whom were obese. They all underwent anthropometric measurements with fasting glucose, insulin, C-peptide, HbA1c, and lipid levels. Exclusion criteria included a clinical diagnosis of sleep, behavioral, or dietary problems. The obese subjects also underwent a 180-minute glucose tolerance test.
Chronotype was assessed via actigraphy over 1 week to provide mid-sleep time on free days, and secondarily through administration to chronotype questionnaires – the Children’s ChronoType Questionnaire and the Morningness-Eveningness Scale for Children.
Among the normal-weight participants, 31% were morning and 23% evening chronotype (the rest being neutral chronotype), and, in the obese subjects, 27% were morning and 36% were evening chronotype.
The obese subjects were more likely to be in puberty, and had higher systolic blood pressures, higher fasting plasma insulin and levels of insulin resistance, as measured by Homeostatic Model Assessment of Insulin Resistance. Hemoglobin A1c tended to be higher in the obese subjects (P = .06), but fasting plasma glucose did not differ significantly between the obese and normal-weight participants (P = .68).
“We chose this population due to the shift from morningness to eveningness that occurs during adolescence followed by a progressive return to an intermediate or early chronotype at the end of adolescence,” Dr. Dumin said.
Bedtime, wake time, and total sleep time were nearly identical between the two groups (7.84 hours and 7.62 hours; P = .49), although sleep efficiency was numerically lower in the obese subjects (87.0 vs. 89.8; P = .14), while sleep fragmentation was somewhat greater (20.16 vs. 17.38; P = .18).
Dr. Dumin suggested that a continuation of her research with more patients would be useful.
This study is supported by the Endocrine Fellows Foundation and the University of Chicago Institute of Translational Medicine. Dr. Dumin reported having no financial disclosures.
BOSTON – Late chronotype may have a deleterious impact on glucose homeostasis independent of obesity in preadolescents aged 10-13 years, according to a small study.
Late chronotype – or an individual’s preference for later sleep and food intake – is associated with higher body mass index (BMI), risk incidence of type 2 diabetes mellitus, hemoglobin A1c, and risk of hypertension in adults. It is also associated with higher BMI, lower dietary restraint, and lower HDL cholesterol in adolescents. This study was the first to focus on chronotype and glycemic control in children on the cusp of or in early puberty.
In participants tested during the summer months, the actigraphy-derived mid-sleep time on free days – an objective measure of chronotype – was associated positively with fasting plasma glucose (P = 0.048). “This is an important point because it highlights the objective measure of chronotype, whereas questionnaires can be more subjective,” said Magdalena Dumin, MD, at the annual meeting of Associated Professional Sleep Societies.
The researcher also noted that higher sleep fragmentation and lower sleep efficiency were both associated with hyperglycemia and hyperinsulinemia, independent of obesity.
“Our preliminary findings suggest that having a late chronotype and less efficient and more fragmented sleep in pre- and early adolescence may have a deleterious glycemic impact independent of obesity and pubertal stage,” she said.
“Advancing bedtimes may reduce glucose levels in preadolescents and adolescents,” Dr. Dumin surmised.
This study included 24 adolescents, 13 of whom were normal weight and 11 of whom were obese. They all underwent anthropometric measurements with fasting glucose, insulin, C-peptide, HbA1c, and lipid levels. Exclusion criteria included a clinical diagnosis of sleep, behavioral, or dietary problems. The obese subjects also underwent a 180-minute glucose tolerance test.
Chronotype was assessed via actigraphy over 1 week to provide mid-sleep time on free days, and secondarily through administration to chronotype questionnaires – the Children’s ChronoType Questionnaire and the Morningness-Eveningness Scale for Children.
Among the normal-weight participants, 31% were morning and 23% evening chronotype (the rest being neutral chronotype), and, in the obese subjects, 27% were morning and 36% were evening chronotype.
The obese subjects were more likely to be in puberty, and had higher systolic blood pressures, higher fasting plasma insulin and levels of insulin resistance, as measured by Homeostatic Model Assessment of Insulin Resistance. Hemoglobin A1c tended to be higher in the obese subjects (P = .06), but fasting plasma glucose did not differ significantly between the obese and normal-weight participants (P = .68).
“We chose this population due to the shift from morningness to eveningness that occurs during adolescence followed by a progressive return to an intermediate or early chronotype at the end of adolescence,” Dr. Dumin said.
Bedtime, wake time, and total sleep time were nearly identical between the two groups (7.84 hours and 7.62 hours; P = .49), although sleep efficiency was numerically lower in the obese subjects (87.0 vs. 89.8; P = .14), while sleep fragmentation was somewhat greater (20.16 vs. 17.38; P = .18).
Dr. Dumin suggested that a continuation of her research with more patients would be useful.
This study is supported by the Endocrine Fellows Foundation and the University of Chicago Institute of Translational Medicine. Dr. Dumin reported having no financial disclosures.
AT SLEEP 2017
Key clinical point: Preadolescents with a late chronotype show impaired glucose homeostasis independent of obesity.
Major finding: In participants tested during the summer months, the actigraphy-derived mid-sleep time on free days was positively associated with fasting plasma glucose (P = .048).
Data source: Observational study including 24 adolescents between 10 and 13 years of age. Thirteen were normal weight and 11 were obese.
Disclosures: Dr. Dumin reported having no financial disclosures. This study is supported by the Endocrine Fellows Foundation and the University of Chicago Institute of Translational Medicine.
Later school start tied to more sleep
BOSTON – Teenagers slept more hours when they started school later, a new study found.
With 73% of high schoolers reporting receiving less than the recommended 8 hours of sleep per night, teens are among the most sleep-deprived members of society.
In this study, the later a teenager started school, the later he or she woke up, with average wake-up times having been just after 6:00 a.m. for those starting school between 7:00 and 7:30 a.m. and about 7:00 a.m. for those starting school after 8:30 a.m. But only those teens who started after 8:30 a.m. achieved the 8-hour recommended sleep duration, said Nicole Nahmod, during a presentation at the annual meeting of the Associated Professional Sleep Societies.
The students with the later school start times averaged 32 minutes of extra sleep, when compared with their early-rising colleagues, noted Ms. Nahmod, who is one of the study’s authors, a research technician, and study coordinator at Pennsylvania State University, Hershey. Specifically, adolescents who started school after 8:30 a.m. had a mean sleep duration of 8.1 hours, while those who started school earlier slept for only 7.5 hours a night.*
Acknowledging the importance of adequate sleep on teen health, mood, and school performance, the American Academy of Pediatrics recommends that middle schools and high schools begin at 8:30 a.m. or later. However, most school days start earlier than that, as evidenced by this dataset. While 72% of the study’s participants started school between 7:00 a.m. and 8:30 a.m., as many as 15% of the study participants began school during the narrower 7:00-7:30 a.m. window.
In this study, researchers from Penn State used data from 413 adolescents (mean age, 15.4 years; 46% male), who participated in a substudy of the Fragile Families & Child Wellbeing Study conducted across 20 large American cities. The study oversampled nonmarried pregnant mothers, resulting in a racially diverse sample and a high proportion of low-income families. The household income for 29% of the sample was below the poverty line.*
For this substudy, sleep duration was calculated from app-based daily diary reports of bed times, wake times, and school start times on days when a teen attended school.
The study was limited by its cross-sectional nature, but was enriched by a diverse range of school start times sampled from 20 U.S. cities, the high proportion of at-risk teens, and the use of a daily sleep diary.
“Current literature shows associations between later school start times and academic success, mood, and health. It also shows a decrease in motor vehicle accidents, tardiness, school dropout, and daytime sleepiness,” Ms. Nahmod noted.
Her continued research in this area involves analyzing the relationships between actigraphically assessed sleep measures in students and school start times.
Ms. Nahmod reported having no financial disclosures.
*This article was updated on June 6, 2017.
BOSTON – Teenagers slept more hours when they started school later, a new study found.
With 73% of high schoolers reporting receiving less than the recommended 8 hours of sleep per night, teens are among the most sleep-deprived members of society.
In this study, the later a teenager started school, the later he or she woke up, with average wake-up times having been just after 6:00 a.m. for those starting school between 7:00 and 7:30 a.m. and about 7:00 a.m. for those starting school after 8:30 a.m. But only those teens who started after 8:30 a.m. achieved the 8-hour recommended sleep duration, said Nicole Nahmod, during a presentation at the annual meeting of the Associated Professional Sleep Societies.
The students with the later school start times averaged 32 minutes of extra sleep, when compared with their early-rising colleagues, noted Ms. Nahmod, who is one of the study’s authors, a research technician, and study coordinator at Pennsylvania State University, Hershey. Specifically, adolescents who started school after 8:30 a.m. had a mean sleep duration of 8.1 hours, while those who started school earlier slept for only 7.5 hours a night.*
Acknowledging the importance of adequate sleep on teen health, mood, and school performance, the American Academy of Pediatrics recommends that middle schools and high schools begin at 8:30 a.m. or later. However, most school days start earlier than that, as evidenced by this dataset. While 72% of the study’s participants started school between 7:00 a.m. and 8:30 a.m., as many as 15% of the study participants began school during the narrower 7:00-7:30 a.m. window.
In this study, researchers from Penn State used data from 413 adolescents (mean age, 15.4 years; 46% male), who participated in a substudy of the Fragile Families & Child Wellbeing Study conducted across 20 large American cities. The study oversampled nonmarried pregnant mothers, resulting in a racially diverse sample and a high proportion of low-income families. The household income for 29% of the sample was below the poverty line.*
For this substudy, sleep duration was calculated from app-based daily diary reports of bed times, wake times, and school start times on days when a teen attended school.
The study was limited by its cross-sectional nature, but was enriched by a diverse range of school start times sampled from 20 U.S. cities, the high proportion of at-risk teens, and the use of a daily sleep diary.
“Current literature shows associations between later school start times and academic success, mood, and health. It also shows a decrease in motor vehicle accidents, tardiness, school dropout, and daytime sleepiness,” Ms. Nahmod noted.
Her continued research in this area involves analyzing the relationships between actigraphically assessed sleep measures in students and school start times.
Ms. Nahmod reported having no financial disclosures.
*This article was updated on June 6, 2017.
BOSTON – Teenagers slept more hours when they started school later, a new study found.
With 73% of high schoolers reporting receiving less than the recommended 8 hours of sleep per night, teens are among the most sleep-deprived members of society.
In this study, the later a teenager started school, the later he or she woke up, with average wake-up times having been just after 6:00 a.m. for those starting school between 7:00 and 7:30 a.m. and about 7:00 a.m. for those starting school after 8:30 a.m. But only those teens who started after 8:30 a.m. achieved the 8-hour recommended sleep duration, said Nicole Nahmod, during a presentation at the annual meeting of the Associated Professional Sleep Societies.
The students with the later school start times averaged 32 minutes of extra sleep, when compared with their early-rising colleagues, noted Ms. Nahmod, who is one of the study’s authors, a research technician, and study coordinator at Pennsylvania State University, Hershey. Specifically, adolescents who started school after 8:30 a.m. had a mean sleep duration of 8.1 hours, while those who started school earlier slept for only 7.5 hours a night.*
Acknowledging the importance of adequate sleep on teen health, mood, and school performance, the American Academy of Pediatrics recommends that middle schools and high schools begin at 8:30 a.m. or later. However, most school days start earlier than that, as evidenced by this dataset. While 72% of the study’s participants started school between 7:00 a.m. and 8:30 a.m., as many as 15% of the study participants began school during the narrower 7:00-7:30 a.m. window.
In this study, researchers from Penn State used data from 413 adolescents (mean age, 15.4 years; 46% male), who participated in a substudy of the Fragile Families & Child Wellbeing Study conducted across 20 large American cities. The study oversampled nonmarried pregnant mothers, resulting in a racially diverse sample and a high proportion of low-income families. The household income for 29% of the sample was below the poverty line.*
For this substudy, sleep duration was calculated from app-based daily diary reports of bed times, wake times, and school start times on days when a teen attended school.
The study was limited by its cross-sectional nature, but was enriched by a diverse range of school start times sampled from 20 U.S. cities, the high proportion of at-risk teens, and the use of a daily sleep diary.
“Current literature shows associations between later school start times and academic success, mood, and health. It also shows a decrease in motor vehicle accidents, tardiness, school dropout, and daytime sleepiness,” Ms. Nahmod noted.
Her continued research in this area involves analyzing the relationships between actigraphically assessed sleep measures in students and school start times.
Ms. Nahmod reported having no financial disclosures.
*This article was updated on June 6, 2017.
AT SLEEP 2017
Key clinical point: Teenage students who start school after 8:30 a.m. are more likely to get the recommended 8 hours of sleep than are their counterparts with earlier start times.
Major finding: Adolescents who started school after 8:30 a.m. had a mean sleep duration of 8.1 hours, compared with 7.5 hours for students who started school earlier.
Data source: A national longitudinal birth cohort study of 413 adolescents.
Disclosures: Ms. Nahmod reported having no financial disclosures.