Autonomic responses to respiratory events and risk of chronic kidney disease in obstructive sleep apnea.

Study Objectives: Obstructive sleep apnea (OSA)-related hypoxemia, measured by hypoxic burden (HB), is associated with chronic kidney disease (CKD). OSA-related autonomic response may also be associated with CKD. This study examined whether individuals with high HB and varying autonomic responses to OSA have a different risk of CKD progression compared to those with low HB.

Respiratory Event-related Physiological Biomarkers and Cognitive Performance in Obstructive Sleep Apnea.

Rationale: Individuals with obstructive sleep apnea (OSA) are at increased risk of cognitive impairment. However, the physiologic mechanisms that link OSA to this impairment are unclear. We assessed the association between novel physiologic biomarkers (, respiratory event-related electroencephalographic (EEG) activity and autonomic responses) and the risk of cognitive impairment.

Association Between a Recalled Positive Airway Pressure Device and Obstructive Lung Disease: A Province-Based Study.

Background: Limited real-world data exist on the health impacts of the Philips Respironics recall for positive airway pressure (PAP) devices.

Research Question: What is the relationship between PAP device manufacturer and obstructive lung disease (OLD) development and progression?

Study Design And Methods: A retrospective longitudinal study was conducted by using Ontario health administrative databases (Canada) on all new adult PAP users (2012-2018) with or without OLD. Individuals were followed up from PAP claim date to death or March 2023.

Continuous positive airway pressure and mandibular advancement splints: the CHOICE multicentre, open-label randomised clinical trial.

Background: Adherence to continuous positive airway pressure (CPAP) for obstructive sleep apnoea (OSA) continues to be low with high termination rates. Alternative therapies to CPAP are needed. Our objective was to compare objective adherence to CPAP and mandibular advancement splints (MAS) and to evaluate their effectiveness, and additionally to identify treatment usage patterns and the clinical effectiveness of having both therapies.

Delphi consensus recommendations for the management of chronic insomnia in Canada.

Objective: The lack of current Canadian practice guidelines for the management of insomnia poses a challenge for healthcare providers (HCP) in selecting the appropriate treatment options. This study aimed to establish expert consensus recommendations for the management of chronic insomnia in Canada.

Composition Of The Committee: Sixteen multidisciplinary experts in sleep medicine and insomnia across Canada developed consensus recommendations based on their knowledge of the literature and their practical experience.

Longer-term impacts of the COVID-19 pandemic on obstructive sleep apnoea (OSA)-related healthcare: a province-based study.

Rationale: Following marked reductions in sleep medicine care early in the COVID-19 pandemic, there is limited information about the recovery of these services. We explored long-term trends in obstructive sleep apnoea (OSA) health services and service backlogs during the pandemic compared with pre-pandemic levels in Ontario (the most populous province of Canada).

Methods: In this retrospective population-based study using Ontario (Canada) health administrative data on adults, we compared rates of polysomnograms (PSGs), outpatient visits and positive airway pressure (PAP) therapy purchase claims during the pandemic (March 2020 to December 2022) to pre-pandemic rates (2015-2019).

Air pollution, weather and positive airway pressure treatment adherence in adults with sleep apnea: a retrospective community-based repeated-measures longitudinal study.

We assessed the relation between air pollution, weather, and adherence to positive airway pressure (PAP) therapy in a retrospective community-based repeated-measures study of adults with obstructive sleep apnea who purchased PAP devices from a registered provider between 2013 and 2017 (Ottawa, Ontario, Canada) and had at least one day of data. Daily PAP-derived data, air pollution, and weather databases were linked using postal code. The exposures were mean nocturnal (8:00 p.

All Obstructive Sleep Apnea Events Are Not Created Equal: The Relationship between Event-related Hypoxemia and Physiologic Response.

Obstructive sleep apnea (OSA) severity is typically assessed by the apnea-hypopnea index (AHI), a frequency-based metric that allocates equal weight to all respiratory events. However, more severe events may have a greater physiologic impact. The purpose of this study was to determine whether the degree of event-related hypoxemia would be associated with the postevent physiologic response.

Causes, Consequences, and Treatments of Sleep and Circadian Disruption in the ICU: An Official American Thoracic Society Research Statement.

Sleep and circadian disruption (SCD) is common and severe in the ICU. On the basis of rigorous evidence in non-ICU populations and emerging evidence in ICU populations, SCD is likely to have a profound negative impact on patient outcomes. Thus, it is urgent that we establish research priorities to advance understanding of ICU SCD.

Moving toward Equitable Care for Sleep Apnea in the United States: Positive Airway Pressure Adherence Thresholds: An Official American Thoracic Society Policy Statement.

Positive airway pressure (PAP) is a highly effective treatment for obstructive sleep apnea (OSA), but adherence limits its efficacy. In addition, coverage of PAP by CMS (Centers for Medicare & Medicaid Services) and other insurers in the United States depends on adherence. This leaves many beneficiaries without PAP, disproportionally impacting non-white and low socioeconomic position patients with OSA and exacerbating sleep health disparities.

Association of clinically significant obstructive sleep apnoea with risks of contracting COVID-19 and serious COVID-19 complications: a retrospective population-based study of health administrative data.

Rationale/objectives: Despite plausible pathophysiological mechanisms, more research is needed to confirm the relationship between obstructive sleep apnoea (OSA) and the risk of COVID-19 infection or COVID-19-related serious complications.

Methods: We conducted a retrospective population-based cohort study using provincial health administrative data (Ontario, Canada). Adults with physician-diagnosed OSA who received positive airway pressure therapy in the 5 years prepandemic () were propensity score matched by baseline characteristics to individuals in the general population at low risk of OSA () using inverse probability of treatment weighting.

Contribution of obstructive sleep apnea to disrupted sleep in a large clinical cohort of patients with suspected obstructive sleep apnea.

Study Objectives: The response of sleep depth to CPAP in patients with OSA is unpredictable. The odds-ratio-product (ORP) is a continuous index of sleep depth and wake propensity that distinguishes different sleep depths within sleep stages, and different levels of vigilance during stage wake. When expressed as fractions of time spent in different ORP deciles, nine distinctive patterns are found.

Association of alternative polysomnographic features with patient outcomes in obstructive sleep apnea: a systematic review.

Study Objectives: Polysomnograms (PSGs) collect a plethora of physiologic signals across the night. However, few of these PSG data are incorporated into standard reports, and hence, ultimately, under-utilized in clinical decision making. Recently, there has been substantial interest regarding novel alternative PSG metrics that may help to predict obstructive sleep apnea (OSA)-related outcomes better than standard PSG metrics such as the apnea-hypopnea index.

Patient-reported Differences in Obstructive Sleep Apnea Care between Jurisdictions with and without Government Funding for Continuous Positive Airway Pressure.

Funding for obstructive sleep apnea (OSA) treatment may impact how patients access care, wait times, and costs of care. The aim of this study was to compare differences in diagnosis and treatment of OSA between Canadian jurisdictions with and without public funding for continuous positive airway pressure (CPAP). We administered an anonymous internet survey to Canadian adults reporting a physician diagnosis of OSA.

National strategy on the integration of sleep and circadian rhythms into public health research and policies: Report from the Canadian Sleep and Circadian Network.

Scientists in sleep and circadian rhythms, public health experts, healthcare providers, partners, and stakeholders convened in 2020 for a 2-day meeting organized by the Canadian Sleep and Circadian Network to develop a national strategy for integrating sleep and circadian rhythms into public health and policies in Canada. The objective of this paper is to present the national strategy that emerged from this meeting of 60 participants from across Canada. The meeting focused on 4 key target priorities: (1) atypical working schedules, (2) sleep and circadian rhythms of children and adolescents, (3) insomnia, and (4) impact of sleep apnea on health.

Circulating markers of oxidative stress and risk of incident cardiovascular events in obstructive sleep apnea.

Unlabelled: The identification of which patients with obstructive sleep apnea (OSA) are more likely to develop cardiovascular disease (CVD) remains a challenge. OSA causes oxidative stress (OS) which may contribute to CVD pathogenesis. Therefore, OS markers could be useful in risk-stratifying cardiovascular (CV) risk in OSA patients.

The rs579459 ABO gene polymorphism and risk of incident cardiovascular events in obstructive sleep apnea: a pilot study.

Purpose: We have previously shown that the TT genotype (rs579459 location of the ABO gene) is significantly associated with circulating levels of e-selectin in patients with suspected obstructive sleep apnea (OSA). We hypothesized that this genotype would be associated with incident cardiovascular disease (CVD).

Methods: Patients with suspected OSA who had a full diagnostic polysomnogram from 2003 to 2011 were recruited; CV events occurring within 8 years of polysomnography were identified by linkage to provincial health databases.

Symptom subtypes and risk of incident cardiovascular and cerebrovascular disease in a clinic-based obstructive sleep apnea cohort.

Study Objectives: Patients with obstructive sleep apnea (OSA) are at increased risk of cardiovascular and cerebrovascular disease, but predicting those at greatest risk is challenging. Using latent class analysis, patients with OSA can be placed into discrete symptom subtypes. The aim of this study was to determine whether symptom subtypes are associated with future cerebrovascular disease in patients with OSA in a clinic-based cohort.