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Sleep and Women's Health
Published in Michelle Tollefson, Nancy Eriksen, Neha Pathak, Improving Women's Health Across the Lifespan, 2021
Sleep-disordered breathing may develop or worsen with advancing pregnancy, potentially exacerbated by nasal congestion and increasing body habitus. Sleep apnea (defined as AHI > 5 by home testing) was associated with a significantly increased risk of preeclampsia, hypertensive disorders of pregnancy, and gestational diabetes in a dose–response relationship.118 Increasing age, body mass index or BMI (as opposed to pregnancy-associated weight gain), and presence of frequent snoring were strong predictors of sleep-disordered breathing in all three trimesters of pregnancy.119 Obstetricians should strongly consider screening for OSA in any pregnant woman with symptoms of snoring, elevated blood pressure or glucose, or pre-pregnancy history of hypertension.
Pulmonary Medicine
Published in James M. Rippe, Manual of Lifestyle Medicine, 2021
Nocturnal apneas are defined as a cessation of airflows during sleep. The term apnea specifically describes a cessation of airflow for ≥10 seconds. Hypopnea is a transient reduction in airflow that lasts ≥10 seconds and is associated with a ≥4% decrease in oxygen saturation. Frequent nocturnal apneas and hypopneas may result in hypoventilation. The diagnostic criteria for clinically significant obstructive sleep apnea is an average of greater than five apneas or hypopneas per hour of sleep. This is typically referred to as “Apnea-Hypopnea Index” (AHI). A sleep study must be performed to accurately measure AHI.
Respiratory Symptoms
Published in James M. Rippe, Lifestyle Medicine, 2019
Jeremy B. Richards, Richard M. Schwartzstein
The definitive diagnosis of OSA requires the presence of associated daytime symptoms and an AHI of ≥5. AHI can only be measured by formal polysomnography, which requires a patient to spend a night in a sleep laboratory. There is no role for PFTs or chest imaging in diagnosing OSA, but these studies may be helpful in searching for associated conditions.
Symptom Cluster Profiles Among Adults with Insomnia and Heart Failure
Published in Behavioral Sleep Medicine, 2023
Samantha Conley, Sangchoon Jeon, Stephen Breazeale, Meghan O’Connell, Christopher S. Hollenbeak, Daniel Jacoby, Sarah Linsky, Henry Klar Yaggi, Nancy S Redeker
Exclusion criteria were the following: untreated restless legs syndrome; conditions that contraindicated sleep restriction (a component of CBT-I), including scores > 18 on the Epworth Sleepiness Scale, seizure disorders, severe depressive symptoms (>14 on the Patient Health Questionnaire-9; Kroenke & Spitzer, 2002), bipolar disorder, active illicit drug use, and neurological/musculoskeletal conditions affecting the motion of the non-dominant arm (due to use of wrist-worn actigraphs). We included people with mild sleep-disordered breathing (Apnea-Hypopnea Index < 15) (based on home sleep apnea screening or medical record review) and those with moderate or severe sleep-disordered breathing who by self-report were adherent to continuous positive airway pressure therapy for at least 4 hours per night (Redeker et al., 2017).
Continuous positive airway pressure affects mitochondrial function and exhaled PGC1-α levels in obstructive sleep apnea
Published in Experimental Lung Research, 2021
Ching-Chi Lin, Wei-Ji Chen, Yi-Kun Sun, Chung-Hsin Chiu, Mei-Wei Lin, I-Shiang Tzeng
According to the American Academy of Sleep Medicine (AASM) scoring rules, respiration and related events are manually scored to evaluate them.18 In short, apnea is defined when the amplitude of the airflow during the apnea period is less than 10% of the baseline amplitude during evaluation by an oronasal thermal sensor. The amplitude standard for apnea is an event that lasts more than 10 s and meets the amplitude standard for more than 9 s. Hypopnea is defined as a reduction of ≥50% in one of the following three respiratory parameters: airflow signal (detected by nasal pressure sensor), or abdominal or chest breathing signal (detected by induction plethysmography) over 10 s, and oxygen desaturation ≥3% or arousal from sleep.18 More than 90% of the duration of the event must meet the amplitude criterion. The AHI is defined as the mean of the sum of hypopnea and apnea per hour of sleep. The desaturation event frequency was defined as the average number of episodes of oxygen desaturation per hour of sleep. The arousal index was defined as the average number of arousals per hour of sleep, and sleep efficiency was calculated as a percentage of the total sleep time divided by the total bed time.18 Obstructive sleep apnea with an AHI score ≥5 and AHI score ≥ 20 was defined as moderate and severe OSA, respectively.
Perceived Stress, Subjective, and Objective Symptoms of Disturbed Sleep in Men and Women with Stable Heart Failure
Published in Behavioral Sleep Medicine, 2021
Allison E. Gaffey, Sangchoon Jeon, Samantha Conley, Daniel Jacoby, Garrett I. Ash, Henry K. Yaggi, Meghan O’Connell, Sarah J. Linsky, Nancy S. Redeker
A total of 166 patients with stable HF were recruited from the community, the VA Connecticut Healthcare System echocardiogram database, and the Yale-New Haven Hospital HF program during a routine visit. Study participants had received stable doses of cardiovascular medications for at least 2 weeks and had no hospitalizations within the past month, were at least 18 years of age, cognitively intact, lived at home, had a NYHA Classification of I–IV, experienced insomnia symptoms for at least 1 month, and scored ≥8 on the Insomnia Severity Index. Thus, each participant had at least subthreshold insomnia (Bastien et al., 2001). Study exclusion criteria were an unstable medical or psychological disorder, untreated sleep disordered breathing, restless legs syndrome, narcolepsy, regularly engaging in night or shift work, a seizure disorder, and neurological or musculoskeletal disorders that restricted the non-dominant arm (due to possible confounding effects on wrist actigraph recordings). Participants with sleep apnea were included if the condition was mild (an apnea hypopnea index of <15 (Zinchuk et al., 2018)) or if they were adherent to continuous positive airway treatment (CPAP) by self-report during a patient interview. If participants did not have a sleep study within the last year recorded in their medical record or were not currently using CPAP therapy we conducted two nights of home polysomnography to screen for sleep apnea (Apnea Risk Evaluation System, SleepMed, Braintree, MA (Redeker et al., 2017)).