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Sleep Apnea Syndromes: HELP
Articles by Jessie P. Bakker
Based on 35 articles published since 2008
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Between 2008 and 2019, J. Bakker wrote the following 35 articles about Sleep Apnea Syndromes.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Editorial Sleep apnea and diabetes: good friends or something more? 2014

Bakker, Jessie P / Patel, Sanjay R. ·1 Division of Sleep & Circadian Disorders Brigham & Women's Hospital and Harvard Medical School Boston, Massachusetts. ·Am J Respir Crit Care Med · Pubmed #25025353.

ABSTRACT: -- No abstract --

2 Editorial Evaluating behavioral weight loss programs for sleep apnea. 2013

Bakker, Jessie P / Patel, Sanjay R. ·Division of Sleep Medicine, Brigham and Women's Hospital, Boston, MA. ·Sleep · Pubmed #24082300.

ABSTRACT: -- No abstract --

3 Editorial Obstructive sleep apnea: the elephant in the cardiovascular room. 2012

Bakker, Jessie P / Sharma, Bhavneesh / Malhotra, Atul. ·Division of Sleep Medicine, Harvard Medical School, Brigham & Women's Hospital, Boston, MA. Electronic address: jpbakker@partners.org. · Division of Sleep Medicine, Harvard Medical School, Brigham & Women's Hospital, Boston, MA. ·Chest · Pubmed #22396556.

ABSTRACT: -- No abstract --

4 Review Obstructive Sleep Apnea and Vascular Diseases. 2016

Baltzis, Dimitrios / Bakker, Jessie P / Patel, Sanjay R / Veves, Aristidis. ·Microcirculation Lab and Joslin-Beth Israel Deaconess Foot Center, Harvard Medical School, Boston, USA. · Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Harvard Medical School, Boston, USA. ·Compr Physiol · Pubmed #27347900.

ABSTRACT: Obstructive sleep apnea (OSA) affects a large proportion of adults, and is as an independent risk factor for cerebrovascular and cardiovascular disease. The repetitive airway obstruction that characterizes OSA results in intermittent hypoxia, intrathoracic pressure swings, and sleep fragmentation, which in turn lead to sympathetic activation, oxidative stress, inflammation, and endothelial dysfunction. This review outlines the associations between OSA and vascular diseases and describes basic mechanisms that may be responsible for this association, in both the micro- and macrocirculation. It also reports on interventional studies that aim to ameliorate OSA and thereby reduce vascular disease burden. © 2016 American Physiological Society. Compr Physiol 6:1519-1528, 2016.

5 Review Patient Partnerships Transforming Sleep Medicine Research and Clinical Care: Perspectives from the Sleep Apnea Patient-Centered Outcomes Network. 2016

Redline, Susan / Baker-Goodwin, Si / Bakker, Jessie P / Epstein, Matthew / Hanes, Sherry / Hanson, Mark / Harrington, Zinta / Johnston, James C / Kapur, Vishesh K / Keepnews, David / Kontos, Emily / Lowe, Andy / Owens, Judith / Page, Kathy / Rothstein, Nancy / Anonymous5570867. ·Brigham and Women's Hospital, Harvard Medical School, Boston, MA. · Sleep Apnea Patient-Centered Outcomes Network. · Department of Respiratory and Sleep Medicine, Liverpool Hospital, Sydney, Australia. · University of Washington Medicine Sleep Center, Seattle, WA. · Hunter-Bellevue School of Nursing, Hunter College/CUNY, New York, NY. · Boston Children's Hospital, Harvard Medical School, Boston, MA. ·J Clin Sleep Med · Pubmed #27166300.

ABSTRACT: ABSTRACT: Due to an ongoing recent evolution in practice, sleep medicine as a discipline has been compelled to respond to the converging pressures to reduce costs, improve outcomes, and demonstrate value. Patient "researchers" are uniquely placed to participate in initiatives that address the specific needs and priorities of patients and facilitate the identification of interventions with high likelihood of acceptance by the "customer." To date, however, the "patient voice" largely has been lacking in processes affecting relevant policies and practice guidelines. In this Special Report, patient and research leaders of the Sleep Apnea Patient-Centered Outcomes Network (SAPCON), a national collaborative group of patients, researchers and clinicians working together to promote patient-centered comparative effectiveness research, discuss these interrelated challenges in the context of sleep apnea, and the role patients and patient-centered networks may play in informing evidence-based research designed to meet patient's needs. We first briefly discuss the challenges facing sleep medicine associated with costs, outcomes, and value. We then discuss the key role patients and patient-centered networks can play in efforts to design research to guide better sleep health care, and national support for such initiatives. Finally, we summarize some of the challenges in moving to a new paradigm of patient-researcher-clinician partnerships. By forging strong partnerships among patients, clinicians and researchers, networks such as SAPCON can serve as a living demonstration of how to achieve value in health care.

6 Review The effect of continuous positive airway pressure treatment on blood pressure: a systematic review and meta-analysis of randomized controlled trials. 2012

Montesi, Sydney B / Edwards, Bradley A / Malhotra, Atul / Bakker, Jessie P. ·Sleep Disorders Research Program, Brigham & Women's Hospital & Harvard Medical School, Boston, MA 02115, USA. ·J Clin Sleep Med · Pubmed #23066375.

ABSTRACT: STUDY OBJECTIVES: We sought to provide an updated systematic review and meta-analysis of studies investigating the effect of positive airway pressure (PAP) treatment for obstructive sleep apnea (OSA) on systolic and diastolic blood pressure (SBP, DBP). METHODS: Two independent investigators undertook a systematic search of the PubMed database (1980-2012) to identify randomized controlled trials comparing therapeutic PAP to sham-PAP, pill placebo, or standard care over at least one week in adult OSA patients without major comorbidities. The mean, variance, and sample size for diurnal and nocturnal SBP and DBP data were also extracted independently from each study. Random effects meta-analyses were conducted, followed by pre-specified subgroup and meta-regression analyses. RESULTS: 32 studies were identified, with data available from 28 studies representing n = 1,948 patients. The weighted mean difference in diurnal SBP (-2.58 mm Hg, 95% CI -3.57 to -1.59 mm Hg) and DBP (-2.01 mm Hg, 95% CI -2.84 to -1.18 mm Hg) both significantly favored PAP treatment over control arms, with similar results seen in nocturnal readings. Statistically significant reductions in BP were seen in studies whose patients were younger, sleepier, had more severe OSA, and exhibited greater PAP adherence. Meta-regression indicated that the reductions in DBP with PAP were predicted by mean baseline BP (β = -0.22, p = 0.02) and Epworth Sleepiness Scale scores (β = -0.27, p = 0.04). CONCLUSIONS: PAP treatment for OSA is associated with modest but significant reductions in diurnal and nocturnal SBP and DBP. Future research should be directed towards identifying subgroups likely to reap greater treatment benefits as well as other therapeutic benefits provided by PAP therapy.

7 Review Adaptive servoventilation for treatment of sleep-disordered breathing in heart failure: a systematic review and meta-analysis. 2012

Sharma, Bhavneesh K / Bakker, Jessie P / McSharry, David G / Desai, Akshay S / Javaheri, Shahrokh / Malhotra, Atul. ·Steward Health Care System, Boston, MA. · Sleep Disorders Research Program, Brigham and Women's Hospital and Harvard Medical School, Boston, MA. Electronic address: jpbakker@partners.org. · Sleep Disorders Research Program, Brigham and Women's Hospital and Harvard Medical School, Boston, MA. · Cardiovascular Division, Brigham and Women's Hospital, Boston, MA. · Sleepcare Diagnostics, Cincinnati, OH. ·Chest · Pubmed #22722232.

ABSTRACT: BACKGROUND: Adaptive servoventilation (ASV) has demonstrated efficacy in treating sleep-disordered breathing (SDB) in patients with heart failure (HF), but large randomized trials are lacking. We, therefore, sought to perform a systematic review and meta-analysis of existing data. METHODS: A systematic search of the PubMed database was undertaken in March 2012. Publications were independently assessed by two investigators to identify studies of ≥ 1-week duration that compared ASV to a control condition (ie, subtherapeutic ASV, continuous or bilevel pressure ventilation, oxygen therapy, or no treatment) in adult patients with SDB and HF. Mean, variability,and sample size data were extracted independently for the following outcomes: apneahypopnea index (AHI), left ventricular ejection fraction (LVEF), quality of life (SF-36 Health Survey; Medical Outcomes Trust), 6-min walk distance, peak oxygen consumption ( VO 2 ) % predicted, and ventilatory equivalent ratio for CO 2 ( VE / Vco 2 ) slope measured during exercise. Random effects meta-analysis models were applied. RESULTS: Fourteen studies were identified (N = 538). Comparing ASV to control conditions, the weighted mean difference in AHI ( -14.64 events/h; 95% CI, -21.03 to - 8.25) and LVEF (0.40;95% CI, 0.08-0.71) both significantly favored ASV. ASV also improved the 6-min walk distance,but not peak O 2 % predicted, VE / VCO 2 slope, or quality of life, compared with control conditions. CONCLUSIONS: In patients with HF and SDB, ASV was more effective than control conditions in reducing the AHI and improving cardiac function and exercise capacity. These data provide a compelling rationale for large-scale randomized controlled trials to assess the clinical impact of ASV on hard outcomes in these patients.

8 Review Flexible pressure delivery modification of continuous positive airway pressure for obstructive sleep apnea does not improve compliance with therapy: systematic review and meta-analysis. 2011

Bakker, Jessie P / Marshall, Nathaniel S. ·WellSleep Sleep Investigation Centre, Department of Medicine, University of Otago, Wellington, New Zealand. Electronic address: jessie.bakker@otago.ac.nz. · National Health and Medical Research Council (NHMRC) Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia. ·Chest · Pubmed #21193533.

ABSTRACT: BACKGROUND: Continuous positive airway pressure (CPAP) is the first-line therapy for obstructive sleep apnea (OSA), but patient compliance is a major barrier to long-term effectiveness. Flexible pressure delivery of PAP reduces pressure during early exhalation with the aim of improving comfort and, therefore, compliance, leading to subsequent symptoms improvement. METHODS: We undertook a systematic literature search of PubMed (January 1, 2000, to July 11, 2010) to identify all randomized trials comparing flexible and standard CPAP in adult patients with OSA with at least 1-week follow-up. Either we or the original trial investigators extracted means, SEs, and sample sizes for all relevant outcome measures. We then performed meta-analyses quantifying improvements in objective compliance and symptoms as measured by the Epworth Sleepiness Scale (ESS), the Maintenance of Wakefulness Test (MWT), and the Psychomotor Vigilance Task (PVT). RESULTS: We found 10 relevant trials (599 patients). Meta-analysis of the seven trials where we could extract compliance data (514 patients) indicated that flexible pressure did not improve compliance compared with CPAP in either the parallel (0.16 h; 95% CI, -0.09-0.42; P = .21) or the crossover trials (0.20 h; 95% CI, -0.26-0.66; P = .39). Flexible pressure caused no improvement over CPAP in any secondary outcome (ESS, MWT, PVT, and residual OSA, all P > .05). CONCLUSIONS: Flexible pressure modification neither significantly improves compliance with CPAP in patients with OSA nor significantly improves patient outcomes beyond the effects of CPAP. Unfortunately, we were unable to locate compliance data in the correct format for three out of the 10 suitable trials.

9 Clinical Trial Pilot study of the effects of bariatric surgery and continuous positive airway pressure treatment on vascular function in obese subjects with obstructive sleep apnoea. 2013

Bakker, J P / Balachandran, J S / Tecilazich, F / Deyoung, P N / Smales, E / Veves, A / Malhotra, A. ·Division of Sleep Medicine, Brigham and Women's Hospital, Boston, MA, USA. jpbakker@partners.org ·Intern Med J · Pubmed #23800096.

ABSTRACT: BACKGROUND: The mechanisms by which obesity and obstructive sleep apnoea (OSA) may contribute to endothelial dysfunction are unclear. AIMS: We sought to follow up a sample of obese subjects undergoing either bariatric surgery or continuous positive airway pressure (CPAP) therapy to treat OSA. We hypothesised improved vascular function with both therapeutic approaches, consistent with a reversible OSA effect on the circulation. METHODS: Twenty-seven obese (BMI ≥30 kg/m(2)) subjects with OSA underwent either bariatric surgery without CPAP (n = 12, median BMI 43.7 kg/m(2) IQR 9.4) or CPAP (n = 15, median BMI 33.8 kg/m(2) IQR 6.6). Polysomnography and vascular testing (flow-mediated dilation of the brachial artery measured with high-resolution ultrasound, endothelium-dependent change in skin blood flow measured with laser Doppler flowmetry, and arterial stiffness measured with applanation tonometry) took place at baseline and after 6 months. RESULTS: Both groups showed significant improvements in the apnoea-hypopnea index and overnight oxygen saturation. Endothelium-dependent microvascular reactivity was 45.6% (IQR 37.5) at baseline in the CPAP group, which increased to 69.1% (IQR 62.3) post-treatment (P < 0.05). No significant changes were observed in the surgery group, despite significant weight loss (post-surgery BMI 32.7 kg/m2 IQR 8.6 (P < 0.01); no change in BMI was observed in the CPAP group. There were no significant changes in brachial artery flow-mediated dilation in either group. CONCLUSIONS: This pilot study demonstrates that 6 months of CPAP may be sufficient to improve endothelium-dependent microvascular reactivity, while substantial surgically induced weight loss did not result in improvements. Further research should be directed towards comparative effectiveness trials using these novel surrogate outcomes, as well as hard cardiovascular outcomes.

10 Article The effectiveness of an obstructive sleep apnea screening and treatment program in patients with type 2 diabetes. 2017

Donovan, Lucas M / Rueschman, Michael / Weng, Jia / Basu, Nisha / Dudley, Katherine A / Bakker, Jessie P / Wang, Rui / Bertisch, Suzanne M / Patel, Sanjay R. ·University of Washington, 1959 NE Pacific St, Seattle, WA 98195, United States. Electronic address: ldonovan@uw.edu. · Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, United States. Electronic address: mrueschman@bwh.harvard.edu. · Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, United States. Electronic address: jweng2@partners.org. · Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02115, United States. Electronic address: nbasu@bidmc.harvard.edu. · Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02115, United States. Electronic address: kdudley@bidmc.harvard.edu. · Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, United States. Electronic address: jpbakker@bwh.harvard.edu. · Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, United States. Electronic address: rwang8@partners.org. · Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02115, United States. Electronic address: sbertisc@bidmc.harvard.edu. · University of Pittsburgh, UPMC Montefiore Hospital, NW628, 3459 Fifth Avenue, Pittsburgh, PA 15213, United States. Electronic address: patelsr2@upmc.edu. ·Diabetes Res Clin Pract · Pubmed #29054482.

ABSTRACT: AIMS: As recommended by current guidelines, we tested the acceptability and impact of screening patients with type 2 diabetes for obstructive sleep apnea (OSA). METHODS: In a large urban primary care practice, we instituted a telephone-based OSA screening program using a validated tool (STOP-BANG) in patients with type 2 diabetes. Patients identified as high risk were referred for diagnostic sleep testing, and those diagnosed with OSA were offered positive airway pressure (PAP) therapy. We evaluated the impact of PAP on sleep-related symptoms, glycemic control, and hospitalization rates. RESULTS: We identified 738 of 818 (90.1%) patients with type 2 diabetes as high risk for OSA. Only 29.2% (n = 213) of high risk patients were willing to undergo diagnostic sleep testing. The prevalence of OSA was 90.6% in this group, but only 66.0% of those with OSA initiated PAP. Patients with higher burden of sleep symptoms were more likely to pursue testing and initiate therapy. PAP use was associated with reduced sleep-related symptoms (mean Epworth sleepiness scale score declined from 8.8 to 7.3, p < .001), but did not impact hemoglobin A1c levels at one year (7.7-7.9%, p = .12). Changes in glycemic control and hospitalization rates did not differ from comparator groups. CONCLUSIONS: Despite a high prevalence of OSA, willingness to pursue diagnostic testing and treatment was low in an unselected type 2 diabetes population. Furthermore, glycemic control did not improve. Future screening programs should focus on patients with substantial sleep related symptoms as this group is most likely to derive benefit from treatment.

11 Article CPAP Use: Unmasking the Truth about Interface. 2016

Budhiraja, Rohit / Bakker, Jessie P. ·Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. · Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. ·J Clin Sleep Med · Pubmed #27568904.

ABSTRACT: -- No abstract --

12 Article Motivational Enhancement for Increasing Adherence to CPAP: A Randomized Controlled Trial. 2016

Bakker, Jessie P / Wang, Rui / Weng, Jia / Aloia, Mark S / Toth, Claudia / Morrical, Michael G / Gleason, Kevin J / Rueschman, Michael / Dorsey, Cynthia / Patel, Sanjay R / Ware, James H / Mittleman, Murray A / Redline, Susan. ·Division of Sleep & Circadian Disorders, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. Electronic address: jpbakker@bwh.harvard.edu. · Division of Sleep & Circadian Disorders, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, MA. · Division of Sleep & Circadian Disorders, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. · National Jewish Health, Denver, CO; Philips Respironics, Murrysville, PA. · McLean Hospital, Harvard Medical School, Boston, MA. · Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, MA. · Department of Epidemiology, Harvard TH Chan School of Public Health and Cardiovascular Epidemiology Research Unit, Beth Israel Deaconess Medical Center, Boston, MA. ·Chest · Pubmed #27018174.

ABSTRACT: BACKGROUND: Motivational enhancement (ME) shows promise as a means of increasing adherence to CPAP for OSA. METHODS: We performed an open-label, parallel-arm, randomized controlled trial of CPAP only or CPAP + ME, recruiting individuals 45 to 75 years with moderate or severe OSA without marked sleepiness and with either established cardiovascular disease (CVD) or at risk for CVD. All participants received standardized CPAP support from a sleep technologist; those randomly assigned to CPAP + ME also received standardized ME delivered by a psychologist during two appointments and six phone calls over 32 weeks. Mixed-effect models with subject-specific intercepts and slopes were fitted to compare objective CPAP adherence between arms, adjusting for follow-up duration, randomization factors, and device manufacturer. All analyses were intention-to-treat. RESULTS: Overall, 83 participants (n = 42 CPAP only; n = 41 CPAP + ME) contributed 14,273 nights of data for 6 months. Participants were predominantly male (67%) and had a mean ± SD age of 63.9 ± 7.4 years, a BMI of 31.1 ± 5.2 kg/m(2), and an apnea-hypopnea index of 26.2 ± 12.9 events/h. In our fully adjusted model, average nightly adherence for 6 months was 99.0 min/night higher with CPAP + ME compared with CPAP only (P = .003; primary analysis). A subset of 52 participants remained in the study for 12 months; modeling these data yielded a consistent difference in adherence between arms of 97 min/night (P = .006) favoring CPAP + ME. CONCLUSIONS: ME delivered during brief appointments and phone calls resulted in a clinically significant increase in CPAP adherence. This strategy may represent a feasible approach for optimizing management of OSA. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT01261390; URL: www.clinicaltrials.gov.

13 Article Associations between Obstructive Sleep Apnea, Sleep Duration, and Abnormal Fasting Glucose. The Multi-Ethnic Study of Atherosclerosis. 2015

Bakker, Jessie P / Weng, Jia / Wang, Rui / Redline, Susan / Punjabi, Naresh M / Patel, Sanjay R. ·1 Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; and. · 2 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland. ·Am J Respir Crit Care Med · Pubmed #26084035.

ABSTRACT: RATIONALE: No data exist as to the role of ethnicity in the associations between obstructive sleep apnea (OSA), sleep duration, and metabolic dysfunction. OBJECTIVES: To examine links between OSA, objectively measured habitual sleep duration, and fasting glucose in U.S. ethnic groups. METHODS: The Multi-Ethnic Study of Atherosclerosis is a multisite community-based study that conducted polysomnography and wrist actigraphy. In 2,151 subjects (1,839 in fully adjusted models), the apnea-hypopnea index was used to classify OSA as none (0-4.9/h), mild (5-14.9/h), or moderate to severe (≥15/h). Actigraphic sleep duration was classified as short (≤5 h/night), intermediate (>5 and <8 h/night), or long (≥8 h/night). Subjects were classified as having normal fasting glucose (<100 mg/dl and no hypoglycemic medication use) or abnormal fasting glucose (≥100 mg/dl and/or hypoglycemic medication use). MEASUREMENTS AND MAIN RESULTS: The sample was 45.8% male, age 68.5 ± 9.2 (mean ± SD) years, and 27.3% African American, 37.2% white, 11.8% Chinese, and 23.8% Hispanic. The prevalence of abnormal fasting glucose was 40.2%. Relative to subjects without apnea, moderate-to-severe OSA was significantly associated with abnormal fasting glucose in African Americans (odds ratio, 2.14; 95% confidence interval, 1.12-4.08) and white participants (odds ratio, 2.85; 95% confidence interval, 1.20-6.75), but not among Chinese or Hispanic subjects, after adjusting for site, age, sex, waist circumference, and sleep duration (P = 0.06 for ethnicity-by-OSA severity interaction). In contrast, sleep duration was not significantly associated with abnormal fasting glucose after considering the influence of OSA. CONCLUSIONS: This large multiethnic study confirmed previous reports of an independent association between OSA and metabolic dysfunction, and suggested that this association may vary by ethnicity.

14 Article Interest in bariatric surgery among obese patients with obstructive sleep apnea. 2015

Dudley, Katherine A / Tavakkoli, Ali / Andrews, Robert A / Seiger, Ashley N / Bakker, Jessie P / Patel, Sanjay R. ·Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, Massachusetts, United States. Electronic address: kdudley@partners.org. · Center for Weight Management and Metabolic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, United States. · Division of General, Minimally Invasive and Acute Care Surgery, North Shore-LIJ Lenox Hill Hospital, New York, New York, United States. · Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, Massachusetts, United States. ·Surg Obes Relat Dis · Pubmed #25892349.

ABSTRACT: BACKGROUND: Standard obstructive sleep apnea (OSA) therapies are poorly tolerated. Bariatric surgery is a potential alternative but the level of interest in this intervention among OSA patients is unknown. OBJECTIVES: Determine the proportion of OSA patients who would be interested in bariatric surgery. SETTING: Sleep clinics, United States. METHODS: Consecutive adult patients with untreated severe OSA and a body mass index of 35-45 kg/m(2) were approached. Patients at low perioperative risk and no urgent indication for OSA treatment were invited to a separate informational visit about bariatric surgery as primary treatment for OSA. RESULTS: Of 767 eligible patients, 230 (30.0%) were not at low perioperative risk, 49 (6.4%) had drowsy driving, and 16 (2.1%) had no insurance coverage for bariatric surgery. Of the remaining 482 patients, over one third (35.5%) were interested in bariatric surgery. Surgical interest was 47.2% in women versus 27.6% in men (P<0.01) and 67.3% in diabetics versus 31.0% in nondiabetics (P<0.01). In multivariable adjusted models, female gender (odds ratio 1.89, 95% CI [1.10-3.25]) and diabetes (odds ratio 3.97, 95% CI [1.97-8.01]) remained highly predictive of bariatric surgery interest. CONCLUSIONS: Nearly two thirds of obese patients with severe OSA are good candidates for bariatric surgery. Among candidates, over one third are interested in this treatment. Interest rates are highest among women and diabetics, indicating that metabolic improvements continue to be a major driver of surgery even in patients with severe OSA. Given patient interest, the role of bariatric surgery should be routinely discussed with obese OSA patients.

15 Article Obstructive sleep apnea is associated with impaired exercise capacity: a cross-sectional study. 2014

Beitler, Jeremy R / Awad, Karim M / Bakker, Jessie P / Edwards, Bradley A / DeYoung, Pam / Djonlagic, Ina / Forman, Daniel E / Quan, Stuart F / Malhotra, Atul. ·Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. · Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA. · Division of Sleep Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. · Division of Pulmonary and Critical Care Medicine, University of California, San Diego, San Diego, CA. · Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. · Division of Sleep Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA and Arizona Respiratory Center, University of Arizona College of Medicine, Tucson, AZ. ·J Clin Sleep Med · Pubmed #25325602.

ABSTRACT: OBJECTIVE: Obstructive sleep apnea (OSA) is associated with increased risk of adverse cardiovascular events. Because cardiopulmonary exercise testing (CPET) aids in prognostic assessment of heart disease, there is rising interest in its utility for cardiovascular risk stratification of patients with OSA. However, the relationship between OSA and exercise capacity is unclear. This study was conducted to test the hypothesis that OSA is associated with impaired exercise capacity. METHODS: Fifteen subjects with moderate-to-severe OSA (apnea-hypopnea index [AHI] ≥15 events/h) and 19 controls with mild or no OSA (AHI <15 events/h) were enrolled. Subjects underwent standard polysomnography to determine AHI and exclude other sleep disorders. Resting metabolic rate was measured via indirect calorimetry, followed by maximum, symptom-limited CPET. Subjects completed a sleep diary and physical activity questionnaire characterizing behaviors in the week prior to testing. RESULTS: Percent predicted peak oxygen uptake (V˙O2) was significantly lower in OSA subjects than controls (70.1%±17.5% vs 83.8%±13.9%; p = 0.02). Each 1-unit increase in log-transformed AHI was associated with a decrease in percent predicted peak V˙O2 of 3.20 (95% CI 0.53-5.88; p = 0.02). After adjusting for baseline differences, this association remained significant (p < 0.01). AHI alone explained 16.1% of the variability observed in percent predicted peak V˙O2 (p = 0.02). CONCLUSIONS: OSA is associated with impaired exercise capacity. Further study is needed to evaluate the utility of CPET for prognostic assessment of patients with OSA.

16 Article Clinical predictors of the respiratory arousal threshold in patients with obstructive sleep apnea. 2014

Edwards, Bradley A / Eckert, Danny J / McSharry, David G / Sands, Scott A / Desai, Amar / Kehlmann, Geoffrey / Bakker, Jessie P / Genta, Pedro R / Owens, Robert L / White, David P / Wellman, Andrew / Malhotra, Atul. ·1 Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham & Women's Hospital & Harvard Medical School, Boston, Massachusetts. ·Am J Respir Crit Care Med · Pubmed #25321848.

ABSTRACT: RATIONALE: A low respiratory arousal threshold (ArTH) is one of several traits involved in obstructive sleep apnea pathogenesis and may be a therapeutic target; however, there is no simple way to identify patients without invasive measurements. OBJECTIVES: To determine the physiologic determinates of the ArTH and develop a clinical tool that can identify patients with low ArTH. METHODS: Anthropometric data were collected in 146 participants who underwent overnight polysomnography with an epiglottic catheter to measure the ArTH (nadir epiglottic pressure before arousal). The ArTH was measured from up to 20 non-REM and REM respiratory events selected randomly. Multiple linear regression was used to determine the independent predictors of the ArTH. Logistic regression was used to develop a clinical scoring system. MEASUREMENTS AND MAIN RESULTS: Nadir oxygen saturation as measured by pulse oximetry, apnea-hypopnea index, and the fraction of events that were hypopneas (Fhypopneas) were independent predictors of the ArTH (r(2) = 0.59; P < 0.001). Using this information, we used receiver operating characteristic analysis and logistic regression to develop a clinical score to predict a low ArTH, which allocated a score of 1 to each criterion that was satisfied: (apnea-hypopnea index, <30 events per hour) + (nadir oxygen saturation as measured by pulse oximetry >82.5%) + (Fhypopneas >58.3%). A score of 2 or above correctly predicted a low arousal threshold in 84.1% of participants with a sensitivity of 80.4% and a specificity of 88.0%, a finding that was confirmed using leave-one-out cross-validation analysis. CONCLUSIONS: Our results demonstrate that individuals with a low ArTH can be identified from standard, clinically available variables. This finding could facilitate larger interventional studies targeting the ArTH.

17 Article Continuous positive airway pressure treatment for obstructive sleep apnoea: Maori, Pacific and New Zealand European experiences. 2014

Bakker, Jessie P / O'Keeffe, Karyn M / Neill, Alister M / Campbell, Angela J. ·WellSleep Sleep Investigation Centre, Department of Medicine, University of Otago, Wellington, New Zealand. · WellSleep Sleep Investigation Centre, University of Otago, Wellington, PO Box 7343, Wellington 6242, New Zealand. angela.campbell@otago.ac.nz. ·J Prim Health Care · Pubmed #25194249.

ABSTRACT: INTRODUCTION: Continuous positive airway pressure (CPAP) is an effective treatment of obstructive sleep apnoea (OSA), but can be limited by poor adherence. In New Zealand (NZ), ethnicity has been shown to be a predictor of CPAP adherence. This study aimed to explore Maori , Pacific and NZ European patients' experience of CPAP treatment. METHODS: Patients identifying as Maori , Pacific, or NZ European ethnicity referred for CPAP treatment for OSA attended separate, 1.5-hour group discussions facilitated by a health care worker of the same ethnic group, using an interview template. Thematic analysis was applied to the discussion transcripts independently by two investigators, following published guidelines. FINDINGS: Five Maori , five Pacific, and eight NZ Europeans participated (mean age 47, range 30-71 years, mean ± standard deviation CPAP adherence 6.32 ± 1.25 hours/night). Patients in all three groups reported that they had little knowledge of OSA or CPAP prior to treatment initiation. All groups identified barriers to treatment (both at the CPAP initiation phase and long term), reported feelings of being 'overwhelmed' with information during the initial CPAP education session, and discussed the importance of successful role models. Family and friends were generally reported as being supportive of CPAP therapy. CONCLUSION: The three groups all reported similar initial CPAP experiences, highlighting access barriers to publicly funded assessment and treatment pathways, and sleep health knowledge as key issues. Educational resources to improve access, enable self-management, and increase community awareness of OSA would help overcome some of the issues identified in this study.

18 Article Blood pressure improvement with continuous positive airway pressure is independent of obstructive sleep apnea severity. 2014

Bakker, Jessie P / Edwards, Bradley A / Gautam, Shiva P / Montesi, Sydney B / Durán-Cantolla, Joaquín / Aizpuru, Felipe / Barbé, Ferran / Sánchez-de-la-Torre, Manuel / Malhotra, Atul. ·Division of Sleep Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston MA. · Division of Translational Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston MA. · Pulmonary and Critical Care Unit, Massachusetts General Hospital, Boston MA. · Research Department, Sleep Division, Araba University, Basque Country University, Vitoria Spain. · Hospital Arnau de Vilanova, IRB Lleida, Respiratory Department, Lleida, Spain. CIBERes, Madrid, Spain. · Division of Sleep Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston MA ; Pulmonary and Critical Care Unit, Massachusetts General Hospital, Boston MA. ·J Clin Sleep Med · Pubmed #24733980.

ABSTRACT: STUDY OBJECTIVES: We sought to perform a patient-level meta-analysis using the individual patient data of the trials identified in our previous study-level meta-analysis investigating the effect of positive airway pressure (PAP) treatment for obstructive sleep apnea (OSA) on blood pressure (BP). DESIGN: Patient-level meta-analysis. SETTING: N/A. PARTICIPANTS: 968 adult OSA subjects without major comorbidities drawn from eight randomized controlled trials. INTERVENTIONS: Therapeutic PAP versus non-therapeutic control conditions (sham-PAP, pill placebo or standard care) over at least one week. MEASUREMENTS AND RESULTS: The mean reductions in BP between PAP and non-therapeutic control arms were -2.27 mm Hg (95% CI -4.01 to -0.54) for systolic BP and -1.78 mm Hg (95% CI -2.99 to -0.58) for diastolic BP. The presence of uncontrolled hypertension at baseline was significantly associated with a reduction in systolic BP of 7.1 mm Hg and diastolic BP of 4.3 mm Hg after controlling for OSA severity (apnea-hypopnea index, Epworth Sleepiness Scale score, PAP level), patient demographics (age, gender, body mass index, use of antihypertensive medication/s), and measures of PAP efficacy (PAP adherence and treatment duration). CONCLUSIONS: OSA patients with uncontrolled hypertension are likely to gain the largest benefit from PAP in terms of a substantial reduction in BP, even after controlling for disease severity.

19 Article Obesity and sleep apnea are independently associated with adverse left ventricular remodeling and clinical outcome in patients with atrial fibrillation and preserved ventricular function. 2014

Shah, Ravi V / Abbasi, Siddique A / Heydari, Bobak / Farhad, Hoshang / Dodson, John A / Bakker, Jessie P / John, Roy M / Veves, Aristidis / Malhotra, Atul / Blankstein, Ron / Jerosch-Herold, Michael / Kwong, Raymond Y / Neilan, Tomas G. ·Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA. · Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA. · Division of Aging, Department of Medicine, Brigham and Women's Hospital, Boston, MA. · Division of Sleep Medicine, Brigham and Women's Hospital, Boston, MA. · Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA. · Pulmonary and Critical Care Division, University of California San Diego, La Jolla, CA. · Department of Radiology, Brigham and Women's Hospital, Boston, MA. · Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA; Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Boston, MA. Electronic address: tneilan@partners.org. ·Am Heart J · Pubmed #24655713.

ABSTRACT: AIMS: Obesity is associated with the development of atrial fibrillation (AF), and both obesity and AF are independently associated with the development of heart failure with preserved ejection fraction. We tested the hypothesis that sleep apnea (SA) would have a body mass index (BMI) independent association with adverse left ventricular (LV) remodeling and clinical outcomes in patients with AF and preserved LV function. METHODS AND RESULTS: From 720 consecutive patients with AF, 403 patients without myocardial disease (preserved LV function) were identified and followed up for 3.3 ± 1.5 years. The primary outcome was a combination of all-cause mortality/heart failure hospitalization. Left ventricular mass and LV mass-to-volume ratio were higher in patients with SA and obesity (P < .0001 for all). Body mass index (β per log = .47; P < .0001) and SA (β = .05; P = .045) were independently associated with LV mass index. Patients with treated SA had a lower LV mass index (but not LV mass-to-volume ratio) compared with untreated (P = .002). In a best overall multivariable model, SA therapy (β = -.129; P = .001) and BMI (β per log = .373; P = .0007) had opposing associations with LV mass index. Sleep apnea (hazard ratio [HR] = 2.94; P = .0004) and BMI (HR per 1 kg/m(2) = 1.08; P = .004) were associated with clinical outcome in unadjusted analysis. Only SA was associated with clinical outcome in a best overall multivariable model (HR = 2.14; P = .02). CONCLUSION: Sleep apnea and obesity are independently associated with adverse LV remodeling and clinical outcomes in patients with preserved LV function, whereas continuous positive airway pressure therapy is associated with a beneficial effect on LV remodeling. Research investigating SA therapies in patients at high risk for LV remodeling and heart failure is warranted.

20 Article A pilot study investigating the effects of continuous positive airway pressure treatment and weight-loss surgery on autonomic activity in obese obstructive sleep apnea patients. 2014

Bakker, Jessie P / Campana, Lisa M / Montesi, Sydney B / Balachandran, Jayshankar / Deyoung, Pamela N / Smales, Erik / Patel, Sanjay R / Malhotra, Atul. ·Division of Sleep Medicine, Brigham & Women's Hospital & Harvard Medical School, Boston MA. Electronic address: jpbakker@partners.org. · Division of Sleep Medicine, Brigham & Women's Hospital & Harvard Medical School, Boston MA. · Division of Sleep Medicine, Brigham & Women's Hospital & Harvard Medical School, Boston MA; Pulmonary and Critical Care Unit, Massachusetts General Hospital, Boston MA. · Sleep Disorders Center, Section of Pulmonary & Critical Care, Department of Medicine, University of Chicago, Chicago IL. · Pulmonary & Critical Care Division, University of California San Diego, La Jolla CA. · Division of Sleep Medicine, Brigham & Women's Hospital & Harvard Medical School, Boston MA; Pulmonary & Critical Care Division, University of California San Diego, La Jolla CA. ·J Electrocardiol · Pubmed #24636793.

ABSTRACT: BACKGROUND: We have previously demonstrated that severity of obstructive sleep apnea (OSA) as measured by the apnea-hypopnea index (AHI) is a significant independent predictor of readily-computed time-domain metrics of short-term heart rate variability (HRV). METHODS: We aimed to assess time-domain HRV measured over 5-min while awake in a trial of obese subjects undergoing one of two OSA therapies: weight-loss surgery (n=12, 2 males, median and interquartile range (IQR) for BMI 43.7 [42.0, 51.4] kg/m2, and AHI 18.1 [16.3, 67.5] events/h) or continuous positive airway pressure (CPAP) (n=15, 11 males, median BMI 33.8 [31.3, 37.9] kg/m2, and AHI 36.5 [24.7, 77.3] events/h). Polysomnography was followed by electrocardiography during wakefulness; measurements were repeated at 6 and 12-18 months post-intervention. RESULTS: Despite similar measurements at baseline, subjects who underwent surgery exhibited greater improvement in short-term HRV than those who underwent CPAP (p=0.04). CONCLUSIONS: Our data suggest a possible divergence in autonomic function between the effects of weight loss resulting from bariatric surgery, and the amelioration of obstructive respiratory events resulting from CPAP treatment. Randomized studies are necessary before clinical recommendations can be made.

21 Article Effect of sleep apnea and continuous positive airway pressure on cardiac structure and recurrence of atrial fibrillation. 2013

Neilan, Tomas G / Farhad, Hoshang / Dodson, John A / Shah, Ravi V / Abbasi, Siddique A / Bakker, Jessie P / Michaud, Gregory F / van der Geest, Rob / Blankstein, Ron / Steigner, Michael / John, Roy M / Jerosch-Herold, Michael / Malhotra, Atul / Kwong, Raymond Y. ·Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA. ·J Am Heart Assoc · Pubmed #24275628.

ABSTRACT: BACKGROUND: Sleep apnea (SA) is associated with an increased risk of atrial fibrillation (AF). We sought to determine the effect of SA on cardiac structure in patients with AF, whether therapy for SA was associated with beneficial cardiac structural remodelling, and whether beneficial cardiac structural remodelling translated into a reduced risk of recurrence of AF after pulmonary venous isolation (PVI). METHODS AND RESULTS: A consecutive group of 720 patients underwent a cardiac magnetic resonance study before PVI. Patients with SA (n=142, 20%) were more likely to be male, diabetic, and hypertensive and have an increased pulmonary artery pressure, right ventricular volume, atrial dimensions, and left ventricular mass. Treated SA was defined as duration of continuous positive airway pressure therapy of >4 hours per night. Treated SA patients (n=71, 50%) were more likely to have paroxysmal AF, a lower blood pressure, lower ventricular mass, and smaller left atrium. During a follow-up of 42 months, AF recurred in 245 patients. The cumulative incidence of AF recurrence was 51% in patients with SA, 30% in patients without SA, 68% in patients with untreated SA, and 35% in patients with treated SA. In a multivariable model, the presence of SA (hazard ratio 2.79, CI 1.97 to 3.94, P<0.0001) and untreated SA (hazard ratio 1.61, CI 1.35 to 1.92, P<0.0001) were highly associated with AF recurrence. CONCLUSIONS: Patients with SA have an increased blood pressure, pulmonary artery pressure, right ventricular volume, left atrial size, and left ventricular mass. Therapy with continuous positive airway pressure is associated with lower blood pressure, atrial size, and ventricular mass, and a lower risk of AF recurrence after PVI.

22 Article Air leak during CPAP titration as a risk factor for central apnea. 2013

Montesi, Sydney B / Bakker, Jessie P / Macdonald, Mary / Hueser, Lauren / Pittman, Stephen / White, David P / Malhotra, Atul. ·Sleep Disorders Research Program, Brigham and Women's Hospital and Harvard Medical School, Boston, MA ; Pulmonary and Critical Care Unit, Massachusetts General Hospital, Boston, MA. ·J Clin Sleep Med · Pubmed #24235901.

ABSTRACT: OBJECTIVES: Emergence of central sleep apnea has been described in the setting of continuous positive airway pressure (CPAP) initiation. The underlying mechanism is unclear; however, we postulate that air leak washing out anatomical dead space is a contributing factor. DESIGN: Data were obtained from 310 patients with obstructive sleep apnea (OSA) who underwent either split-night or full-night CPAP titration during January to July of 2009. The majority (n = 245) underwent titration with a nasal mask. Average total leak and maximum total leak were measured at therapeutic CPAP level. Unintentional leak was calculated by subtracting manufacturer-defined intentional leak from maximum leak. RESULTS: SUBJECTS WERE DIVIDED INTO TWO GROUPS: central apnea index (CAI) during titration < 5/hour and ≥ 5/hour. The groups were similar in terms of gender, age, BMI, and AHI. The CAI < 5 group had a median average leak of 45.5 L/min (IQR 20.8 L/min) versus 51.0 L/min (IQR 21.0 L/min) with CAI ≥ 5 (p = 0.056). Maximum leak was 59.5 L/min (IQR 27.0 L/min) with CAI < 5 and 75.0 L/min (IQR 27.8 L/min) with CAI ≥ 5 (p = 0.003). In the subset of subjects titrated using a nasal mask, median average leak was 42.0 L/min (IQR 17.0) in the CAI < 5 group and 50.0 L/min (IQR 16.8) in the CAI ≥ 5 group (p = 0.001). In the CAI < 5 group, median maximum leak was 57.0 L/min (IQR 23.0) versus 74.5 L/min (IQR 24.3) in the CAI ≥ 5 group (p < 0.001). CONCLUSIONS: Leak during CPAP titration is associated with the development of acute central apnea; these data may have mechanistic and therapeutic implications for complex apnea. COMMENTARY: A commentary on this article appears in this issue on page 1193.

23 Article Acoustic pharyngometry measurement of minimal cross-sectional airway area is a significant independent predictor of moderate-to-severe obstructive sleep apnea. 2013

Deyoung, Pamela N / Bakker, Jessie P / Sands, Scott A / Batool-Anwar, Salma / Connolly, James G / Butler, James P / Malhotra, Atul. ·Division of Pulmonary and Critical Care, University of California San Diego, San Diego CA ; Division of Sleep Medicine, Brigham and Women's Hospital & Harvard Medical School, Boston, MA. ·J Clin Sleep Med · Pubmed #24235897.

ABSTRACT: STUDY OBJECTIVES: The current gold-standard method of diagnosing obstructive sleep apnea (OSA) is polysomnography, which can be inefficient. We therefore sought to determine a method to triage patients at risk of OSA, without using subjective data, which are prone to mis-reporting. We hypothesized that acoustic pharyngometry in combination with age, gender, and neck circumference would predict the presence of moderate-to-severe OSA. METHODS: Untreated subjects with suspected OSA were recruited from a local sleep clinic and underwent polysomnography. We also included a control group to verify differences. While seated in an upright position and breathing through the mouth, an acoustic pharyngometer was used to measure the minimal cross-sectional area (MCA) of the upper airway at end-exhalation. RESULTS: Sixty subjects were recruited (35 males, mean age 42 years, range 21-81 years; apnea-hypopnea index (AHI) 33 ± 30 events/h (mean ± standard deviation), Epworth Sleepiness Scale score 11 ± 6, body mass index 34 ± 8 kg/m(2)). In univariate logistic regression, MCA was a significant predictor of mild-no OSA (AHI < 15). A multivariate logistic regression model including MCA, age, gender, and neck circumference significantly predicted AHI < 15, explaining approximately one-third of the total variance (χ(2)(4) = 37, p < 0.01), with only MCA being a significant independent predictor (adjusted odds ratio 54, standard error 130; p < 0.01). CONCLUSIONS: These data suggest that independent of age, gender, and neck size, objective anatomical assessment can significantly differentiate those with mild versus moderate-to-severe OSA in a clinical setting, and may have utility as a component in stratifying risk of OSA.

24 Article Molecular biomarkers of vascular dysfunction in obstructive sleep apnea. 2013

Kaczmarek, Elzbieta / Bakker, Jessie P / Clarke, Douglas N / Csizmadia, Eva / Kocher, Olivier / Veves, Aristidis / Tecilazich, Francesco / O'Donnell, Christopher P / Ferran, Christiane / Malhotra, Atul. ·Center for Vascular Biology Research, Division of Vascular and Endovascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America. ekaczmar@bidmc.harvard.edu ·PLoS One · Pubmed #23923005.

ABSTRACT: Untreated and long-lasting obstructive sleep apnea (OSA) may lead to important vascular abnormalities, including endothelial cell (EC) dysfunction, hypertension, and atherosclerosis. We observed a correlation between microcirculatory reactivity and endothelium-dependent release of nitric oxide in OSA patients. Therefore, we hypothesized that OSA affects (micro)vasculature and we aimed to identify vascular gene targets of OSA that could possibly serve as reliable biomarkers of severity of the disease and possibly of vascular risk. Using quantitative RT-PCR, we evaluated gene expression in skin biopsies of OSA patients, mouse aortas from animals exposed to 4-week intermittent hypoxia (IH; rapid oscillations in oxygen desaturation and reoxygenation), and human dermal microvascular (HMVEC) and coronary artery endothelial cells (HCAEC) cultured under IH. We demonstrate a significant upregulation of endothelial nitric oxide synthase (eNOS), tumor necrosis factor-alpha-induced protein 3 (TNFAIP3; A20), hypoxia-inducible factor 1 alpha (HIF-1α?? and vascular endothelial growth factor (VEGF) expression in skin biopsies obtained from OSA patients with severe nocturnal hypoxemia (nadir saturated oxygen levels [SaO2]<75%) compared to mildly hypoxemic OSA patients (SaO2 75%-90%) and a significant upregulation of vascular cell adhesion molecule 1 (VCAM-1) expression compared to control subjects. Gene expression profile in aortas of mice exposed to IH demonstrated a significant upregulation of eNOS and VEGF. In an in vitro model of OSA, IH increased expression of A20 and decreased eNOS and HIF-1α expression in HMVEC, while increased A20, VCAM-1 and HIF-1αexpression in HCAEC, indicating that EC in culture originating from distinct vascular beds respond differently to IH stress. We conclude that gene expression profiles in skin of OSA patients may correlate with disease severity and, if validated by further studies, could possibly predict vascular risk in OSA patients.

25 Article Evaluation of right ventricular remodeling using cardiac magnetic resonance imaging in co-existent chronic obstructive pulmonary disease and obstructive sleep apnea. 2013

Sharma, Bhavneesh / Neilan, Tomas G / Kwong, Raymond Y / Mandry, Damien / Owens, Robert L / McSharry, David / Bakker, Jessie P / Malhotra, Atul. ·Division of Sleep Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. bhavn008@gmail.com ·COPD · Pubmed #23272670.

ABSTRACT: Untreated chronic obstructive pulmonary disease (COPD) co-existing with obstructive sleep apnea (OSA), also known as overlap syndrome, has higher cardiovascular mortality than COPD alone but its underlying mechanism remains unclear. We hypothesize that the presence of overlap syndrome is associated with more extensive right ventricular (RV) remodeling compared to patients with COPD alone. Adult COPD patients (GOLD stage 2 or higher) with at least 10 pack-years of smoking history were included. Overnight laboratory-based polysomnography was performed to test for OSA. Subjects with an apnea-hypopnea index (AHI) >10/h were classified as having overlap syndrome (n = 7), else classified as having COPD-only (n = 11). A cardiac MRI was performed to assess right and left cardiac chambers sizes, ventricular masses, and cine function. RV mass index (RVMI) was markedly higher in the overlap group than the COPD-only group (19 ± 6 versus 11 ± 6; p = 0.02). Overlap syndrome subjects had a reduced RV remodeling index (defined as the ratio between RVMI and RV end-diastolic volume index) compared to the COPD-only group (0.27 ± 0.06 versus 0.18 ± 0.08; p = 0.02). In the overlap syndrome subjects, the extent of RV remodeling was associated with severity of oxygen desaturation (R(2) = 0.65, p = 0.03). Our pilot results suggest that untreated overlap syndrome may cause more extensive RV remodeling than COPD alone.

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