Differential associations of hypoxia, sleep fragmentation, and depressive symptoms with cognitive dysfunction in obstructive sleep apnea

Obstructive sleep apnea (OSA) is characterized by recurrent episodes of partial or complete cessation of breathing during sleep and increased effort to breathe. This study examined patients who underwent overnight polysomnographic studies in a major sleep laboratory in Saudi Arabia. The study aimed to determine the extent to which intermittent hypoxia, sleep disruption, and depressive symptoms are independently associated with cognitive impairments in OSA. In the sample of 90 participants, 14 had no OSA, 30 mild OSA, 23 moderate OSA, and 23 severe OSA. The findings revealed that hypoxia and sleep fragmentation are independently associated with impairments of sustained attention and reaction time (RT). Sleep fragmentation, but not hypoxia, was independently associated with impairments in visuospatial deficits. Depressive symptoms were independently associated with impairments in the domains of sustained attention, RT, visuospatial ability, and semantic and episodic autobiographical memories. Since the depressive symptoms are independent of hypoxia and sleep fragmentation, effective reversal of cognitive impairment in OSA may require treatment interventions that target each of these factors. © Sleep Research Society 2020. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail [email protected]

Association between nocturnal activity of the sympathetic nervous system and cognitive dysfunction in obstructive sleep apnoea

Obstructive sleep apnoea (OSA) is associated with repetitive breathing obstructions during sleep. These episodes of hypoxia and associated arousals from sleep induce physiological stress and nocturnal over-activation of the sympathetic nervous system (SNS). One consequence of OSA is impairment in a range of cognitive domains. Previous research into cognitive impairment in OSA have focussed on intermittent hypoxia and disrupted sleep, but not nocturnal over-activation of the SNS. Therefore, we investigated whether nocturnal over-activity of the SNS was associated with cognitive impairments in OSA. The extent of nocturnal SNS activation was estimated from heart rate variability (HRV), pulse wave amplitude (PWA) and stress response biomarkers (cortisol and glucose levels). OSA severity was significantly associated with PWA indices and the HRV low frequency/ high frequency ratio (p < 0.05). Morning blood glucose levels were significantly associated with the duration of a blood oxygen saturation (SaO2) < 90% (p < 0.01). PWA and HRV were significantly associated with the time taken to perform a task involving visuospatial functioning (p < 0.05), but not with impairments in sustained attention, reaction time or autobiographical memory. These results suggest that the visuospatial dysfunction observed in people with OSA is associated with increased nocturnal activity of the SNS. © 2021, The Author(s)

Pro-inflammatory markers in patients with obstructive sleep apnea and the effect of Continuous Positive Airway Pressure therapy

Objectives: To evaluate the association of obstructive sleep apnea (OSA) with high-sensitivity C-reactive protein (CRP) and fibrinogen levels and to assess the effect of short-term therapy using continuous positive airway pressure (CPAP). Material and Methods: A prospective, open-label, controlled trial was conducted among clinically referred patients at risk for OSA undergoing diagnostic polysomnography (PSG). After PSG, the patients were divided into 3 groups: OSA treatment group (TG) (n=21), untreated OSA group (UOG) (n=19), and non-OSA healthy control group (HCG) (n=24). CRP and fibrinogen levels were measured at baseline and one month after treatment. Repeated-measures (RM) ANOVA and ANCOVA were used to compare changes in CRP and fibrinogen levels among the three groups by analyzing between-subject and within-subject effects as functions of time and adjusting for significant covariates. Results: At baseline, OSA subjects had significantly higher CRP [t(52.37)=-2.46, p=0.02)] and fibrinogen levels [t(57)=-2.00, p=0.05)] than HCG subjects. No significant differences in CRP levels [(F(2,58)=2.29, p=0.11)] or fibrinogen levels [(F(2, 58)=1.28, p=0.29)] emerged between TG and HCG subjects after adjusting for the pretest levels. Conclusion: CPAP therapy for one month does not affect CRP and fibrinogen levels among moderate-to-severe OSA patients. However, OSA is associated with elevated levels of these inflammatory biomarkers

Chronic obstructive pulmonary disease and associated healthcare resource consumption in the Middle East and North Africa: The BREATHE study

SummaryData on COPD-related healthcare resources use are rarely documented in developing countries. This article presents data on COPD-related healthcare resource consumption in the Middle East, North Africa and Pakistan and addresses the association of this variable with illness severity. A large survey of COPD was conducted in eleven countries of the region, namely Algeria, Egypt, Jordan, Lebanon, Morocco, Pakistan, Saudi-Arabia, Syria, Tunisia, Turkey and United Arab Emirates, using a standardised methodology. A total of 62,086 subjects were screened. This identified 2,187 subjects fulfilling the “epidemiological” definition of COPD. A detailed questionnaire was administered to document data on COPD-related healthcare consumption. Symptom severity was assessed using the COPD Assessment Test (CAT). 1,392 subjects were analysable. Physician consultations were the most frequently used healthcare resource, ranging from 43,118 [95% CI: 755–85,548] consultations in UAE to 4,276,800 [95% CI: 2,320,164–6,230,763] in Pakistan, followed by emergency room visits, ranging from 15,917 [95% CI: 0–34,807] visits in UAE to 683,697 [95% CI: 496,993–869,737] in Turkey and hospitalisations, ranging from 15,563 [95% CI: 7,911–23,215] in UAE to 476,674 [95% CI: 301,258–652,090] in Turkey. The use of each resource increased proportionally with the GOLD 2011 severity groups and was significantly (p < 0.0001) higher in subjects with more symptoms compared to those with lower symptoms and in subjects with exacerbations to those without exacerbations. The occurrence of exacerbations and the CAT score were independently associated with use of each healthcare resource. In conclusion, the BREATHE study revealed that physician consultation is the most frequently COPD-related healthcare resource used in the region. It showed that the deterioration of COPD symptoms and the frequency of exacerbations raised healthcare resource consumption

An update on the drainage of pyogenic lung abscesses

Most lung abscesses (80–90%) are now successfully treated with antibiotics; however, this conservative approach may occasionally fail. When medical treatment fails, pulmonary resection is usually advised. Alternatively, percutaneous transthoracic tube drainage or endoscopic drainage can be considered, though both remain controversial. In this communication, the medical literature focusing on percutaneous tube drainage efficacy, indications, techniques, complications, and mortality, as well as available data regarding endoscopic drainage are reviewed

Prevalence of restless legs syndrome and associated risk factors among middle-aged Saudi population

Background and Aim: The prevalence of restless legs syndrome (RLS) in the general population ranges from 5 to 15%; however, locally, such data are scarce. The aim of this study was to estimate the prevalence of RLS in the middle-aged Saudi population. Methods : This was a cross-sectional study that was conducted from February 2013 to June 2013 in Jeddah, Saudi Arabia. The target study population was Saudi school employees. Saudi employees aged 30-60 years were randomly selected and interviewed individually. Trained interviewers completed the Wisconsin Sleep Questionnaire, questions about demographics, the Epworth Sleepiness Scale to measure daytime sleepiness, and questions regarding symptoms of RLS based on the criteria defined by the International Restless Legs Syndrome Study Group (IRLSSG). Results: This survey revealed that 8.4% (95% confidence interval (CI): (7.35-9.45)) of the 2,682 participants (62.5% of them were males) had RLS. There was no age effect on the prevalence of RLS. RLS was found to be significantly associated with other sleep disorders, including excessive daytime sleepiness and habitual snoring. A univariate analysis revealed significant correlation of many factors with the RLS, including gender, consanguinity, snoring, diabetes, hypertension, asthma, chronic bronchitis, and smoking. However, when a multivariate logistic regression analysis performed, RLS continued to be associated with male gender, diabetes, asthma, and habitual snoring only. Conclusion: The prevalence of RLS is 8.4%, which is within the range reported by Western studies. However, unlike findings of most studies, RLS significantly affects males more than females. In addition, snoring, asthma, and consanguinity are potential new risk factors for RLS

Prevalence and risk factors of obstructive sleep apnea syndrome in a Saudi Arabian population

Background: Obstructive sleep apnea (OSA) is a common disorder worldwide; however, epidemiological studies on its prevalence lack in Saudi Arabia. This study aimed to determine the prevalence and risk factors of OSA in Saudi Arabia. Methods: The study was performed from 2013 to 2015 in two stages. The screening stage was first; a random sample of Saudi employees (n = 2682) 30–60 years of age completed a survey that included the Wisconsin questionnaire. According to these data, the subjects were categorized as habitual, moderate, or nonsnorers (NSs). The confirmatory second stage was a case–control study conducted on 346 individuals selected from each group using polysomnography (PSG). Results: In the first stage, the prevalence of habitual snoring was 23.5%, moderate snoring was16.6%, while 59.9% of the sample was NSs. Among the 346 individuals who underwent PSG, a total of 235 (67.9%) subjects had OSA with an apnea-hypopnea index (AHI) of ≥5; 76 (22.0%) had OSA syndrome (OSAS), defined by an AHI of ≥5 plus daytime sleepiness; and 227 (65.6%) had clinically diagnosed OSA syndrome (COSAS), as defined by the American Academy of Sleep Medicine. A conservative estimate of at least 8.8% (12.8% in men and 5.1% in women) was calculated for the overall prevalence of OSA. Similarly, the overall estimated prevalence of OSAS and COSAS was 2.8% (4.0% in men and 1.8% in women) and 8.5% (12.4% in men and 4.8% in women), respectively. A multivariate analysis revealed age, gender, obesity, and hypertension as independent risk factors of OSA. Conclusions: Our study demonstrated that the rate and risk factors of OSA in the Saudi population are similar to those observed in Western studies