• Agreement in the Scoring of Respiratory Events Among International Sleep Centers for Home Sleep Testing.

      Magalang, Ulysses J; Arnardottir, Erna S; Chen, Ning-Hung; Cistulli, Peter A; Gíslason, Thorarinn; Lim, Diane; Penzel, Thomas; Schwab, Richard; Tufik, Sergio; Pack, Allan I; et al. (Amer Acad Sleep Medicine, 2016-01)
      Home sleep testing (HST) is used worldwide to confirm the presence of obstructive sleep apnea (OSA). We sought to determine the agreement of HST scoring among international sleep centers.
    • Changing Faces of Obstructive Sleep Apnea: Treatment Effects by Cluster Designation in the Icelandic Sleep Apnea Cohort

      Pien, Grace W; Ye, Lichuan; Keenan, Brendan T; Maislin, Greg; Björnsdóttir, Erla; Arnardottir, Erna Sif; Benediktsdottir, Bryndis; Gislason, Thorarinn; Pack, Allan I; 1 ] Johns Hopkins Univ, Sch Med, Div Pulm & Crit Care Med, Baltimore, MD 21224 USA Show more [ 2 ] Northeastern Univ, Sch Nursing, Bouve Coll Hlth Sci, Boston, MA 02115 USA Show more [ 3 ] Univ Penn, Perelman Sch Med, Ctr Sleep & Circadian Neurobiol, Philadelphia, PA 19104 USA [ 4 ] Landspitali, Dept Sleep, Reykjavik, Iceland Show more [ 5 ] Univ Iceland, Sch Hlth Sci, Fac Med, Reykjavik, Iceland Show more [ 6 ] Univ Penn, Dept Med, Div Sleep Med, Perelman Sch Med, Philadelphia, PA 19104 USA (Oxford University Press, 2018-01-02)
      STUDY OBJECTIVES: Distinct clinical phenotypes of obstructive sleep apnea (OSA) have been identified: Disturbed Sleep, Minimally Symptomatic, and Sleepy. Determining whether these phenotypes respond differently to standard treatment helps us to create a foundation for personalized therapies. We compared responses to positive airway pressure (PAP) therapy in these clinical OSA phenotypes. METHODS: The study sample included 706 patients from the Icelandic Sleep Apnea Cohort with moderate-to-severe OSA who were prescribed PAP. Linear and logistic mixed models were used to compare 2-year changes in demographics, comorbid diseases, and sleep-related health issues within and across OSA clinical phenotypes. Relationships between changes in symptoms and PAP adherence were also examined. RESULTS: Overall, effect sizes were moderate to large when comparing sleepiness, insomnia-related, and apneic symptom changes in the Sleepy group with changes in other two groups, especially those in the Minimally Symptomatic group. Within the Disturbed Sleep group, PAP users and nonusers demonstrated similar changes in insomnia-related symptoms. The Minimally Symptomatic group remained relatively asymptomatic, but reported significant decreases in daytime sleepiness and physical fatigue; PAP users generally had larger improvements. The Sleepy group had reductions in nearly all measured symptoms, including large reductions in drowsy driving; almost all of these improvements were greater among PAP users than nonusers. CONCLUSIONS: OSA treatment response patterns differed by initial clinical phenotype and PAP adherence. Individuals with insomnia-related symptoms may require additional targeted therapy for these complaints. These findings underscore the need for a personalized approach to management that recognizes patients with a range of OSA presentations.
    • A Global Comparison of Anatomic Risk Factors and Their Relationship to Obstructive Sleep Apnea Severity in Clinical Samples.

      Sutherland, Kate; Keenan, Brendan T; Bittencourt, Lia; Chen, Ning-Hung; Gislason, Thorarinn; Leinwand, Sarah; Magalang, Ulysses J; Maislin, Greg; Mazzotti, Diego R; McArdle, Nigel; et al. (American Academy of Sleep Medicine, 2019-04-15)
      Obstructive sleep apnea (OSA) is a global health issue and is associated with obesity and oropharyngeal crowding. Global data are limited on the effect of ethnicity and sex on these relationships. We compare associations between the apnea-hypopnea index (AHI) and these risk factors across ethnicities and sexes within sleep clinics. This is a cross-sectional, multicenter study of patients with OSA from eight sleep centers representing the Sleep Apnea Global Interdisciplinary Consortium (SAGIC). Four distinct ethnic groups were analyzed, using a structured questionnaire: Caucasians (Australia, Iceland, Germany, United States), African Americans (United States), Asians (Taiwan), and South Americans (Brazil). Regression analyses and interaction tests were used to assess ethnic and sex differences in relationships between AHI and anthropometric measures (body mass index [BMI], neck circumference, waist circumference) or Mallampati score. Analyses included 1,585 individuals from four ethnic groups: Caucasian (60.6%), African American (17.5%), Asian (13.1%), and South American (8.9%). BMI was most strongly associated with AHI in South Americans (7.8% increase in AHI per 1 kg/m We demonstrate ethnic and sex variations in associations between obesity and OSA. For similar BMI increases, South American patients show greatest AHI increases compared to African Americans. Findings highlight the importance of considering ethnicity and sex in clinical assessments of OSA risk.
    • Recognizable clinical subtypes of obstructive sleep apnea across international sleep centers: a cluster analysis

      Keenan, Brendan T; Kim, Jinyoung; Singh, Bhajan; Bittencourt, Lia; Chen, Ning-Hung; Cistulli, Peter A; Magalang, Ulysses J; McArdle, Nigel; Mindel, Jesse W; Benediktsdottir, Bryndis; et al. (Oxford University Press, 2018-03)
      STUDY OBJECTIVES: A recent study of patients with moderate-severe obstructive sleep apnea (OSA) in Iceland identified three clinical clusters based on symptoms and comorbidities. We sought to verify this finding in a new cohort in Iceland and examine the generalizability of OSA clusters in an international ethnically diverse cohort. METHODS: Using data on 972 patients with moderate-severe OSA (apnea-hypopnea index [AHI] ≥ 15 events per hour) recruited from the Sleep Apnea Global Interdisciplinary Consortium (SAGIC), we performed a latent class analysis of 18 self-reported symptom variables, hypertension, cardiovascular disease, and diabetes. RESULTS: The original OSA clusters of disturbed sleep, minimally symptomatic, and excessively sleepy replicated among 215 SAGIC patients from Iceland. These clusters also generalized to 757 patients from five other countries. The three clusters had similar average AHI values in both Iceland and the international samples, suggesting clusters are not driven by OSA severity; differences in age, gender, and body mass index were also generally small. Within the international sample, the three original clusters were expanded to five optimal clusters: three were similar to those in Iceland (labeled disturbed sleep, minimal symptoms, and upper airway symptoms with sleepiness) and two were new, less symptomatic clusters (labeled upper airway symptoms dominant and sleepiness dominant). The five clusters showed differences in demographics and AHI, although all were middle-aged (44.6-54.5 years), obese (30.6-35.9 kg/m2), and had severe OSA (42.0-51.4 events per hour) on average. CONCLUSIONS: Results confirm and extend previously identified clinical clusters in OSA. These clusters provide an opportunity for a more personalized approach to the management of OSA.
    • Sleep duration and 24-hour ambulatory blood pressure in adults not on antihypertensive medications.

      Shulman, Rachel; Cohen, Debbie L; Grandner, Michael A; Gislason, Thorarinn; Pack, Allan I; Kuna, Samuel T; Townsend, Raymond R; Cohen, Jordana B; 1 Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. 2 Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. 3 Sleep and Health Research Program, Department of Psychiatry, University of Arizona, Tucson, Arizona. 4 Department of Sleep Medicine, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland. 5 Faculty of Medicine, University of Iceland, Reykjavik, Iceland. 6 Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania. 7 Division of Sleep Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. 8 Department of Medicine, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania. 9 Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. (Wiley, 2018-12-01)
      Short sleep duration has been widely linked to increased cardiovascular morbidity and mortality. We performed a post hoc analysis of 24-hour ambulatory blood pressure monitoring (ABPM) in the Lifestyle Modification in Blood Pressure Lowering Study (LIMBS) and Penn Icelandic Sleep Apnea (PISA) Study. The 24-hour mean systolic blood pressure (BP) was 12.7 mm Hg higher in LIMBS (P < 0.001; n = 66) and 4.7 mm Hg higher in PISA (P = 0.005; n = 153) among participants with shorter sleep duration (less than 7 hours) compared to those with longer sleep duration (at least 7 hours). In multivariable adjusted models, shorter sleep duration was strongly associated with higher systolic BP on 24-hour ABPM, independent of nocturnal BP and in-office BP. There was no effect modification by obstructive sleep apnea. Adults with shorter sleep duration may benefit from screening with 24-hour ABPM to promote earlier detection of hypertension and potentially mitigate their increased risk for future cardiovascular disease.