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Sleep Apnea Syndromes: HELP
Articles by Thomas Penzel
Based on 68 articles published since 2008

Between 2008 and 2019, T. Penzel wrote the following 68 articles about Sleep Apnea Syndromes.
+ Citations + Abstracts
Pages: 1 · 2 · 3
1 Review Devices for home detection of obstructive sleep apnea: A review. 2018

Mendonça, Fábio / Mostafa, Sheikh Shanawaz / Ravelo-García, Antonio G / Morgado-Dias, Fernando / Penzel, Thomas. ·Madeira Interactive Technologies Institute, Portugal; Universidade de Lisboa, Instituto Superior Técnico, Portugal. · Universidad de Las Palmas de Gran Canaria, Institute for Technological Development and Innovation in Communications, Spain. Electronic address: antonio.ravelo@ulpgc.es. · Madeira Interactive Technologies Institute, Portugal; Universidade da Madeira, Portugal. · Charité Universitatsmedizin, Sleep Center, Germany; International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic. ·Sleep Med Rev · Pubmed #30149930.

ABSTRACT: One of the most common sleep-related disorders is obstructive sleep apnea, characterized by a reduction of airflow while breathing during sleep and cause significant health problems. This disorder is mainly diagnosed in sleep labs with polysomnography, involving high costs and stress for the patient. To address this situation multiple systems have been proposed to conduct the examination and analysis in the patient's home, using sensors to detect physiological signals that are examined by algorithms. The objective of this research is to review publications that show the performance of different devices for ambulatory diagnosis of sleep apnea. Commercial systems that were examined by an independent research group and validated research projects were selected. In total 117 articles were analysed, including a total of 50 commercial devices. Each article was evaluated according to diagnostic elements, level of automatisation implemented and the deducted level of evidence and quality rating. Each device was categorized using the SCOPER categorization system, including an additional proposed category, and a final comparison was performed to determine the sensors that provided the best results.

2 Review Opportunities for utilizing polysomnography signals to characterize obstructive sleep apnea subtypes and severity. 2018

Mazzotti, Diego R / Lim, Diane C / Sutherland, Kate / Bittencourt, Lia / Mindel, Jesse W / Magalang, Ulysses / Pack, Allan I / de Chazal, Philip / Penzel, Thomas. ·Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, United States of America. ·Physiol Meas · Pubmed #30047487.

ABSTRACT: BACKGROUND: Obstructive sleep apnea (OSA) is a heterogeneous sleep disorder with many pathophysiological pathways to disease. Currently, the diagnosis and classification of OSA is based on the apnea-hypopnea index, which poorly correlates to underlying pathology and clinical consequences. A large number of in-laboratory sleep studies are performed around the world every year, already collecting an enormous amount of physiological data within an individual. Clinically, we have not yet fully taken advantage of this data, but combined with existing analytical approaches, we have the potential to transform the way OSA is managed within an individual patient. Currently, respiratory signals are used to count apneas and hypopneas, but patterns such as inspiratory flow signals can be used to predict optimal OSA treatment. Electrocardiographic data can reveal arrhythmias, but patterns such as heart rate variability can also be used to detect and classify OSA. Electroencephalography is used to score sleep stages and arousals, but specific patterns such as the odds-ratio product can be used to classify how OSA patients responds differently to arousals. OBJECTIVE: In this review, we examine these and many other existing computer-aided polysomnography signal processing algorithms and how they can reflect an individual's manifestation of OSA. SIGNIFICANCE: Together with current technological advance, it is only a matter of time before advanced automatic signal processing and analysis is widely applied to precision medicine of OSA in the clinical setting.

3 Review Pre-operative screening for obstructive sleep apnoea. 2017

Verbraecken, Johan / Hedner, Jan / Penzel, Thomas. ·Dept of Pulmonary Medicine and Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium johan.verbraecken@uza.be. · Dept of Sleep Medicine, Pulmonary Medicine and Allergology, Sahlgrenska University Hospital, Gothenburg, Sweden. · Sleep Medicine Center, Dept of Cardiology CC11, Charité - Universitätsmedizin Berlin, Berlin, Germany. ·Eur Respir Rev · Pubmed #28049125.

ABSTRACT: Sleep disordered breathing, especially obstructive sleep apnoea (OSA), has a high and increasing prevalence. Depending on the apnoea and hypopnoea scoring criteria used, and depending on the sex and age of the subjects investigated, prevalence varies between 3% and 49% of the general population. These varying prevalences need to be reflected when considering screening for OSA. OSA is a cardiovascular risk factor and patients are at risk when undergoing medical interventions such as surgery. Screening for OSA before anaesthesia and surgical interventions is increasingly considered. Therefore, methods for screening and the rationale for screening for OSA are reviewed in this study.

4 Review Definition and Importance of Autonomic Arousal in Patients with Sleep Disordered Breathing. 2016

Bartels, Wibke / Buck, Dana / Glos, Martin / Fietze, Ingo / Penzel, Thomas. ·Interdisciplinary Center of Sleep Medicine, Department of Cardiology, Charité Universitätsmedizin Berlin, Charité Campus Mitte, Charitéplatz 1, Berlin 10117, Germany. · Interdisciplinary Center of Sleep Medicine, Department of Cardiology, Charité Universitätsmedizin Berlin, Charité Campus Mitte, Charitéplatz 1, Berlin 10117, Germany; Department of Oto-Rhino-Laryngology, Charité Universitätsmedizin Berlin, Charité Campus Mitte, Charitéplatz 1, Berlin 10117, Germany. · Interdisciplinary Center of Sleep Medicine, Department of Cardiology, Charité Universitätsmedizin Berlin, Charité Campus Mitte, Charitéplatz 1, Berlin 10117, Germany. Electronic address: thomas.penzel@charite.de. ·Sleep Med Clin · Pubmed #28118868.

ABSTRACT: Autonomic arousal at the end of sleep apnea events are not well-explored. We prospectively studied 20 patients with obstructive sleep apnea (OSA) and 24 healthy volunteers for 2 nights with cardiorespiratory polysomnography and continuous noninvasive blood pressure (Portapres). Recordings were scored visually for cortical and autonomic arousal. In the OSA group, 2151 cortical arousals and in the controls 1089 cortical arousals were scored. Respiratory arousal caused most frequently an increase of highest mean arterial blood pressure in patients and controls. A useful definition for autonomic arousal for OSA and controls based on blood pressure and heart rate analysis was developed.

5 Review [Sleep apnoea syndrome in the rehabilitation setting]. 2012

Penzel, T / Fietze, I / Schöbel, C / Baumann, G. ·Interdisziplinäres Schlafmedizinisches Zentrum, CharitéCentrum für Herz- Kreislauf- und Gefässmedizin, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland. thomas.penzel@charite.de ·Herz · Pubmed #22048328.

ABSTRACT: Sleep-related breathing disorders are a common finding in patients undergoing cardiological rehabilitation. Sleep apnoea is recognized as a major risk factor for cardiovascular disorders. The diagnosis of sleep-related breathing disorders begins with taking a thorough sleep medicine-related patient history and answering dedicated questionnaires. The second step involves portable monitoring to assess oxygen saturation, heart rate, respiratory flow and effort. Portable monitoring is able to detect the severity of the breathing disorder and forms the basis on which to refer the patient for further sleep laboratory diagnosis or, in the case of positive results, to initiate appropriate treatment. In order to exclude a sleep-related breathing disorder, to distinguish between obstructive and central sleep apnoea, or to diagnose other sleep disorders a cardiorespiratory polysomnography in a sleep laboratory is required. Polysomnography is also needed if comorbidities are present. Appropriate and prompt treatment of sleep-related breathing disorders can shorten cardiological rehabilitation and improve outcomes in this patient group.

6 Review [Central sleep apnea]. 2009

Schäfer, T / Schläfke, M E / Westhoff, M / Duchna, H-W / Penzel, T / Scholle, S / Orth, M. ·Ruhr-Universität Bochum, Medizinische Fakultät, Bochum. thorsten.schaefer@rub.de ·Pneumologie · Pubmed #19259893.

ABSTRACT: -- No abstract --

7 Clinical Trial Investigating relative respiratory effort signals during mixed sleep apnea using photoplethysmogram. 2013

Khandoker, A H / Karmakar, C K / Penzel, T / Glos, M / Palaniswami, M. ·Department of Electrical & Electronic Engineering, The University of Melbourne, Parkville, VIC 3010, Australia. ahsank@unimelb.edu.au ·Ann Biomed Eng · Pubmed #23695488.

ABSTRACT: Sleep disordered breathing does show different types of events. These are obstructive apnea events, central apnea events and mixed sleep apnea (MSA) which have a central component with a pause in airflow without respiratory effort followed by an obstructive component with respiratory effort. The esophageal pressure (Pes) is the accurate method to assess respiratory effort. The aim of the present study is to investigate whether the features extracted from photo-plethysmogram (PPG) could relate with the changes in Pes during MSA. Therefore, Pes and PPG signals during 65 pre-scored MSA events and 10 s preceding the events were collected from 8 patients. Pulse intervals (PPI), Pulse wave amplitudes (PWA) and wavelet decomposition (Wv) of PPG signals at level 8 (0.15-0.32 Hz) were derived from PPG signals. Results show that significant correlations (r = 0.63, p < 0.01; r = 0.42, p < 0.05; r = 0.8, p < 0.01 for OSA part) were found between reductions in Pes and that in PPG based surrogate respiratory signals PPI, PWA and Wv. Results suggest that PPG based relative respiratory effort signal can be considered as an alternative to Pes as a means of measuring changes in inspiratory effort when scoring OSA and CSA parts of MSA events.

8 Clinical Trial C-Flex technology: effects on breathing parameters and inspiratory flow limitation. 2009

Canisius, Sebastian / Kesper, Karl / Jerrentrup, Lukas / Ploch, Thomas / Vogelmeier, Claus / Penzel, Thomas / Jerrentrup, Andreas. ·Faculty of Medicine, Sleep Disorders Center, Philipps University, DE-35043 Marburg, Germany. canisius@staff.uni-marburg.de ·Respiration · Pubmed #19122451.

ABSTRACT: BACKGROUND: Expiratory pressure relief continuous positive airway pressure (pressure relief CPAP, C-Flex) is known to be as effective in the treatment of obstructive sleep apnea (OSA) as conventional CPAP while improving overall patients' adherence. However, the effects of C-Flex on ventilation during sleep have not been studied yet. OBJECTIVE: This study investigates the effects of pressure relief CPAP on respiratory parameters and possible inspiratory flow limitation with increased difference between inspiratory and expiratory pressure compared with conventional CPAP. METHODS: In total, 24 patients were investigated both during conventional CPAP and during three C-Flex pressure relief settings in randomized order during rapid-eye-movement (REM) and non-REM (NREM) sleep. Airflow was monitored with a pneumotachograph; inspiratory flow limitation was assessed by analyzing airflow and esophageal pressure swings. RESULTS: Using higher C-Flex gains, expiratory time decreased in favor of the inspiratory duty cycle while there was no significant change in tidal volume. Analysis of inspiratory flow limitation showed no significant difference between conventional CPAP and the C-Flex gains studied. CONCLUSIONS: The increase in the inspiratory duty cycle with C-Flex might either indicate an increase in the work of breathing or a decrease in the work of breathing due to a lower peak end-expiratory pressure and consecutive alleviation of passive expiration. Both treatments appeared equivalent regarding the occurrence of inspiratory flow limitation.

9 Article Feature relevance in physiological networks for classification of obstructive sleep apnea. 2018

Jansen, Christoph / Hodel, Stephan / Penzel, Thomas / Spott, Martin / Krefting, Dagmar. ·Center of Biomedical Image and Information Processing, HTW Berlin-University of Applied Sciences Berlin, Berlin, Germany. Sleep Medicine Center, Charité-Universitätsmedizin Berlin, Berlin, Germany. ·Physiol Meas · Pubmed #30524083.

ABSTRACT: OBJECTIVE: Physiological networks (PN) model couplings between organs in a high-dimensional parameter space. Machine learning methods, in particular artifical neural networks (ANNs), are powerful on high-dimensional classification tasks. However, lack of interpretability of the resulting models has been a drawback in research. We assess relevant PN topology changes in obstructive sleep apnea (OSA) by novel ANN interpretation techniques. APPROACH: ANNs are trained to classify OSA based on the PNs of 48 patients and 48 age and gender matched healthy controls. The PNs consisting of 2812 links are derived from overnight biosignal recordings. The interpretation technique DeepLift is applied to the resulting ANN models, enabling the determination of the relevant features for classification decisions on individual subjects. The mean relevance scores of the features are compared to other machine learning methods (decision tree and random forests) and statistical tests on group differences. MAIN RESULTS: The ANN interpretation results show good agreement with the compared methods and 87% of the samples could be correctly classified. OSA patients show a significantly higher coupling (p [Formula: see text] 0.001) in light sleep (N2) between breathing rate and EEG [Formula: see text] power in all electrode locations and to chin and leg muscular tone. In deep sleep (N3), OSA leads to significantly lower coupling (p [Formula: see text] 0.01) in lateral connections of EEG [Formula: see text] and [Formula: see text] power in central and frontal positions. Misclassified OSA patients had all mild/moderate AHIs and did not show PN topology changes. Both nights of these patients have been consistently misclassified as healthy. This may indicate, that the impact of respiratory events differs in subjects, thus forming different phenotypes. SIGNIFICANCE: The proposed PN analysis provides a powerful and robust method to quantify a broad range of physiological interactions. Interpretability of the ANN make them a promising tool to identify new diagnostic markers in data-driven approaches.

10 Article Is dynamic desaturation better than a static index to quantify the mortality risk in heart failure patients with Cheyne-Stokes respiration? 2018

Granitza, Philine / Kraemer, Jan F / Schoebel, Christoph / Penzel, Thomas / Kurths, Jürgen / Wessel, Niels. ·Department of Physics, Cardiovascular Physics, Humboldt-Universität zu Berlin, 10099 Berlin, Germany. · Interdisziplinäres Schlafmedizinisches Zentrum, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany. ·Chaos · Pubmed #30384661.

ABSTRACT: Cheyne-Stokes respiration (CSR) is a periodic, highly dynamic, respiratory pattern and a known comorbidity in congestive heart failure (CHF) patients. It is generally seen as an indicator for a negative prognosis, even if no distinction in degree is known or understood. This paper aims to improve on existing attempts by creating a quantification of the behavior of the dynamic desaturation process of oxygen in the blood. We performed this work on a cohort of

11 Article Improved follow-up by peripheral arterial tonometry in CPAP-treated patients with obstructive sleep apnea and persistent excessive daytime sleepiness. 2018

Schöbel, C / Knorre, S / Glos, M / Garcia, C / Fietze, I / Penzel, T. ·Interdiscplinary Center for Sleep Medicine, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany. christoph.schoebel@charite.de. · Interdiscplinary Center for Sleep Medicine, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany. ·Sleep Breath · Pubmed #29956104.

ABSTRACT: BACKGROUND: OSA-patients with persistent excessive daytime sleepiness (EDS) despite CPAP treatment are challenging in daily clinical life. To rule out residual sleep-disordered breathing (SDB), CPAP device-derived data are used in outpatient setting. In case of no pathological finding, a more intensive work-up with is necessary. 6-channel portable monitoring (6Ch-PM) is frequently used to exclude residual SDB. Peripheral arterial tonometry (PAT), as embodied in the WatchPAT device, represents an alternative technique for detecting SDB based on changes in autonomic tone. We wanted to investigate whether PAT might be a useful tool to improve diagnostic work-up in this specific patient group by better identifying residual SDB due to insufficient CPAP-adjustment. METHODS: Forty-nine OSA patients (39 male, 10 female) with sufficient CPAP treatment according to device-derived data were consecutively recruited. EDS was assessed by Epworth Sleepiness Scale (ESS). All patients underwent home-based CPAP therapy control by 6Ch-PM and portable monitoring using PAT technology on two consecutive nights. A sequence of both types of monitoring was randomized to prevent possible first night effect bias. RESULTS: Twelve out of 49 patients showed persistent EDS according to ESS (ESS > 10 points). 6Ch-PM showed a residually increased AHI under CPAP-treatment in 2 of those 12 subjects (positive predictive value, PPV = 16.7%). PAT-PM revealed 5 patients of those 12 with residual SDB (PPV = 41.7%). CONCLUSION: PAT could detect significantly more residual SDB under CPAP treatment than 6Ch-PM. Diagnostic work-up of CPAP-treated OSA patients with persistent EDS might be optimized, as insufficient pressure level adjustments could be recognized more precisely in time, possibly preventing more resource-consuming procedures, and potentially increased morbidity. CLINICAL TRIAL REGISTRATION: DRKS00007705.

12 Article Recognizable clinical subtypes of obstructive sleep apnea across international sleep centers: a cluster analysis. 2018

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 / Arnardottir, Erna Sif / Prochnow, Lisa Kristin / Penzel, Thomas / Sanner, Bernd / Schwab, Richard J / Shin, Chol / Sutherland, Kate / Tufik, Sergio / Maislin, Greg / Gislason, Thorarinn / Pack, Allan I. ·Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA. · School of Nursing, University of Pennsylvania, Philadelphia, PA. · Sir Charles Gairdner Hospital, Western Australian Sleep Disorders Research Institute, Nedlands, Western Australia, Australia. · Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil. · Division of Pulmonary, Critical Care, and Sleep Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan. · Royal North Shore Hospital, Northern Clinical School, and Charles Perkins Centre University of Sydney, Australia. · Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, The Ohio State University Wexner Medical Center, Columbus, OH. · Department of Sleep, Landspitali University Hospital, Reykjavik, Iceland. · Faculty of Medicine, University of Iceland, Reykjavik, Iceland. · Interdisciplinary Center of Sleep Medicine, Charité University Hospital, Berlin, Germany. · Department of Pulmonary Medicine, Agaplesion Bethesda Krankenhaus Wuppertal, Wuppertal, Germany. · Pulmonary, Critical Care and Sleep Disorder Center, Korea University Medical Center Ansan Hospital, Seoul, South Korea. ·Sleep · Pubmed #29315434.

ABSTRACT: 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.

13 Article Multiethnic Meta-Analysis Identifies RAI1 as a Possible Obstructive Sleep Apnea-related Quantitative Trait Locus in Men. 2018

Chen, Han / Cade, Brian E / Gleason, Kevin J / Bjonnes, Andrew C / Stilp, Adrienne M / Sofer, Tamar / Conomos, Matthew P / Ancoli-Israel, Sonia / Arens, Raanan / Azarbarzin, Ali / Bell, Graeme I / Below, Jennifer E / Chun, Sung / Evans, Daniel S / Ewert, Ralf / Frazier-Wood, Alexis C / Gharib, Sina A / Haba-Rubio, José / Hagen, Erika W / Heinzer, Raphael / Hillman, David R / Johnson, W Craig / Kutalik, Zoltan / Lane, Jacqueline M / Larkin, Emma K / Lee, Seung Ku / Liang, Jingjing / Loredo, Jose S / Mukherjee, Sutapa / Palmer, Lyle J / Papanicolaou, George J / Penzel, Thomas / Peppard, Paul E / Post, Wendy S / Ramos, Alberto R / Rice, Ken / Rotter, Jerome I / Sands, Scott A / Shah, Neomi A / Shin, Chol / Stone, Katie L / Stubbe, Beate / Sul, Jae Hoon / Tafti, Mehdi / Taylor, Kent D / Teumer, Alexander / Thornton, Timothy A / Tranah, Gregory J / Wang, Chaolong / Wang, Heming / Warby, Simon C / Wellman, D Andrew / Zee, Phyllis C / Hanis, Craig L / Laurie, Cathy C / Gottlieb, Daniel J / Patel, Sanjay R / Zhu, Xiaofeng / Sunyaev, Shamil R / Saxena, Richa / Lin, Xihong / Redline, Susan. ·1 Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts. · 2 Human Genetics Center, Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health and. · 3 Center for Precision Health, School of Public Health & School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, Texas. · 4 Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, Massachusetts. · 5 Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts. · 6 Department of Public Health Sciences, University of Chicago, Chicago, Illinois. · 7 Division of Genetics, Brigham and Women's Hospital, Boston, Massachusetts. · 8 Center for Genomic Medicine and Department of Anesthesia, Pain, and Critical Care Medicine, Massachusetts General Hospital, Boston, Massachusetts. · 9 Department of Biostatistics, University of Washington, Seattle, Washington. · 10 Departments of Medicine and Psychiatry, University of California, San Diego, California. · 11 the Children's Hospital at Montefiore, Division of Respiratory and Sleep Medicine, Albert Einstein College of Medicine, Bronx, New York. · 12 Section of Adult and Pediatric Endocrinology, Diabetes, and Metabolism, the University of Chicago, Chicago, Illinois. · 13 Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, Tennessee. · 14 Division of Medical Sciences, Harvard Medical School, Boston, Massachusetts. · 15 California Pacific Medical Center Research Institute, San Francisco, California. · 16 Internal Medicine B, University Medicine Greifswald, Greifswald, Germany. · 17 Children's Nutrition Research Center, Baylor College of Medicine, Houston, Texas. · 18 Computational Medicine Core, Center for Lung Biology, University of Washington Medicine Sleep Center, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington. · 19 Center of Investigation and Research on Sleep, Lausanne University Hospital, Lausanne, Switzerland. · 20 Department of Population Health Sciences, University of Wisconsin, Madison, Wisconsin. · 21 Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia. · 22 Institute of Social and Preventive Medicine, University Hospital of Lausanne, Lausanne, Switzerland. · 23 Swiss Institute of Bioinformatics, Lausanne, Switzerland. · 24 Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts. · 25 Department of Medicine, Division of Allergy, Pulmonary, and Critical Care, Vanderbilt University Medical Center, Nashville, Tennessee. · 26 Institute of Human Genomic Study, College of Medicine, Korea University Ansan Hospital, Jeokgum-ro, Danwon-gu, Ansan-si, Gyeonggi-Do, Republic of Korea. · 27 Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, Ohio. · 28 Division of Pulmonary Critical Care and Sleep Medicine, Department of Medicine, University of California San Diego School of Medicine, La Jolla, California. · 29 Adelaide Institute for Sleep Health, Flinders Centre of Research Excellence, Flinders University, Adelaide, South Australia, Australia. · 30 School of Public Health, University of Adelaide, Adelaide, South Australia, Australia. · 31 Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland. · 32 University Hospital Charité Berlin, Sleep Center, Berlin, Germany. · 33 Division of Cardiology, Johns Hopkins University, Baltimore, Maryland. · 34 Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida. · 35 Institute for Translational Genomics and Population Sciences, Los Angeles BioMedical Research Institute and Department of Pediatrics at Harbor-University of California Los Angeles Medical Center, Torrance, California. · 36 Division of Pulmonary, Critical Care, and Sleep, Icahn School of Medicine at Mount Sinai, New York, New York. · 37 Department of Pulmonary, Sleep, and Critical Care Medicine, College of Medicine, Korea University Ansan Hospital, Jeokgum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, Republic of Korea. · 38 Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, California. · 39 Department of Physiology, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland. · 40 Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany. · 41 Computational and Systems Biology, Genome Institute of Singapore, Singapore. · 42 Department of Psychiatry, University of Montreal, Montreal, Quebec, Canada. · 43 Department of Neurology and Sleep Medicine Center, Northwestern University, Chicago, Illinois. · 44 Veterans Affairs Boston Healthcare System, Boston, Massachusetts. · 45 Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. · 46 Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts; and. · 47 Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts. ·Am J Respir Cell Mol Biol · Pubmed #29077507.

ABSTRACT: Obstructive sleep apnea (OSA) is a common heritable disorder displaying marked sexual dimorphism in disease prevalence and progression. Previous genetic association studies have identified a few genetic loci associated with OSA and related quantitative traits, but they have only focused on single ethnic groups, and a large proportion of the heritability remains unexplained. The apnea-hypopnea index (AHI) is a commonly used quantitative measure characterizing OSA severity. Because OSA differs by sex, and the pathophysiology of obstructive events differ in rapid eye movement (REM) and non-REM (NREM) sleep, we hypothesized that additional genetic association signals would be identified by analyzing the NREM/REM-specific AHI and by conducting sex-specific analyses in multiethnic samples. We performed genome-wide association tests for up to 19,733 participants of African, Asian, European, and Hispanic/Latino American ancestry in 7 studies. We identified rs12936587 on chromosome 17 as a possible quantitative trait locus for NREM AHI in men (N = 6,737; P = 1.7 × 10

14 Article Development of methods for sleep disordered breathing to identify phenotypes. 2017

Penzel, Thomas / Schobel, Christoph / Glos, Martin / Schwarz, Lisa / Prochnow, Lisa / Fietze, Ingo. · ·Conf Proc IEEE Eng Med Biol Soc · Pubmed #29060229.

ABSTRACT: Sleep disordered breathing a very common disorder with prevalence rates of up to 49% in large epidemiological studies on subjects older than 40 years. A recent study showed that applying CPAP treatment to patients with sleep disordered breathing recruited by their number of apnea and hypopnea events alone, does improve sleepiness but does not improve overall cardiovascular mortality. Based on older large studies however it is knownthat sleep disordered breathing is a cardiovascular risk and that treatment lowers mortality and morbidity. These results appear to be contradictory. However, they might be explained if patient population investigated are carefully reviewed further, and if sleep apnea severity metrics are reconsidered. According to this, it appears that studies speak of different populations. Whereas epidemiological studies use sampled subjects willing to participate, earlier studies used patients contacting a sleep center with complaints and symptoms. In this paper two studies are presented with an assessment of anatomical metrics for upper airway morphology in order to derive parameters for better prediction. Different phenotypes can explain why some people benefit from treatment and others do not benefit equally. Therefore more than just counting apnea and hypopnea events is needed in order to identify patients at risk and patients who have a lower risk when treated. This will require large data set evaluations with hard outcome data.

15 Article On the difference of cardiorespiratory synchronisation and coordination. 2017

Krause, Harald / Kraemer, Jan F / Penzel, Thomas / Kurths, Jürgen / Wessel, Niels. ·AG NLD - Cardiovascular Physics, Humboldt-Universität zu Berlin, Berlin, Germany. ·Chaos · Pubmed #28964129.

ABSTRACT: Cardiorespiratory phase synchronisation (CRS) is a type of cardiorespiratory coupling that manifests through a prediliction for heart beats to occur at specific points relative to the phase of the respiratory cycle. It has been under investigation for nearly 20 years, and while it seems to be mostly occurring in relaxed states such as deep sleep and anesthesia, no clear clinical implications have been established. Cardiorespiratory coordination (CRC) is a recent development in this field where the relationship between the respiratory onset and heart beat is analysed in the time domain and the possible relationship of each heart beat is considered for both the previous and the next respiratory onset. This ostensibly closely related effect must not only show relevant information content but also do so independent of CRS in order to be relevant for future studies. In this paper, we investigate CRC and its relation to CRS mainly using graphical and statistical methods on two exemplary datasets: measurements from a pregnant woman participating in a preeclampsia study and those from a man suffering from sleep apnea. We show fundamental differences between the results of both approaches and are able to show a formerly unknown dependency between the heart activity and respiratory rate, potentially indicating heartbeat-initiated inspiration. Despite their differences, methods developed for the quantification of CRS can be adapted to CRC. Completing the comparison is an investigation into the relationship between CRC and respiratory sinus arrhythmia. Similar to previous results for CRS, the two effects are found to be orthogonal, meaning that they can be observed independently or in conjunction.

16 Article REM Sleep Imposes a Vascular Load in COPD Patients Independent of Sleep Apnea. 2017

Grote, Ludger / Sommermeyer, Dirk / Ficker, Joachim / Randerath, Winfried / Penzel, Thomas / Fietze, Ingo / Sanner, Bernd / Hedner, Jan / Schneider, Hartmut. ·a Center for Sleep and Wakefulness Disorders , Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden. · b Department of Respiratory and Critical Care Medicine , Johns Hopkins University , Baltimore , USA. · c ochschule Mannheim - University of Applied Sciences , Department of Information Technology , Mannheim , Germany. · d Department of Respiratory Medicine, Allergology and Sleep Medicine , Klinikum Nuremberg/ Paracelsus Medical University , Nuremberg , Germany. · e Department of Pulmonary Medicine, Bethanien Hospital , Solingen , Germany. · f Department of Cardiology , University Hospital Charité , Berlin , Germany. · g Department of Pulmonary Medicine , Bethesda Hospital , Wuppertal , Germany. ·COPD · Pubmed #28949781.

ABSTRACT: Arterial stiffness, a marker for cardiovascular risk, is increased in patients with Chronic Obstructive Pulmonary Disease (COPD) and Obstructive Sleep Apnea (OSA). The specific influence of both on arterial stiffness during sleep is unknown. Nocturnal arterial stiffness (Pulse Propagation Time (PPT) of the finger pulse wave) was calculated in 142 individuals evaluated for sleep apnea: 27 COPD patients (64.7 ± 11y, 31.2 ± 8 kg/m

17 Article Severity of individual obstruction events increases with age in patients with obstructive sleep apnea. 2017

Leppänen, Timo / Töyräs, Juha / Mervaala, Esa / Penzel, Thomas / Kulkas, Antti. ·Department of Clinical Neurophysiology, Seinäjoki Central Hospital, Seinäjoki, Finland; Department of Applied Physics, University of Eastern Finland, Kuopio, Finland. Electronic address: leppanen_timo@outlook.com. · Department of Applied Physics, University of Eastern Finland, Kuopio, Finland; Department of Clinical Neurophysiology, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland. · Department of Clinical Neurophysiology, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland; Department of Clinical Neurophysiology, Institute of Clinical Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland. · Interdisciplinary Sleep Center, Department of Cardiology, Charité - Universitätsmedizin Berlin, Berlin, Germany; International Clinical Research Center, St Anne's University Hospital Brno, Brno, Czech Republic. · Department of Clinical Neurophysiology, Seinäjoki Central Hospital, Seinäjoki, Finland; Department of Applied Physics, University of Eastern Finland, Kuopio, Finland. ·Sleep Med · Pubmed #28899537.

ABSTRACT: BACKGROUND: Age is a risk factor of obstructive sleep apnea (OSA). It has been shown that OSA progresses over time, although conflicting results have been reported. However, the effect of age on the severity of OSA and individual obstruction events has not been investigated within different OSA severity categories by taking the most prominent confounding factors (i.e., body mass index, gender, smoking, daytime sleepiness, snoring, hypertension, heart failure, and proportion of supine sleep) into account. METHODS: Polygraphic data of 1090 patients with apnea-hypopnea index (AHI) ≥5 were retrospectively reanalyzed. The effect of age on the severity of OSA and obstruction events was investigated in general, within different OSA severity categories, and in different age groups (age <40, 40≤ age <50, 50≤ age <60, and age ≥60 years). RESULTS: In the whole population, AHI and durations of apneas, hypopneas, and desaturations increased with increasing age (B ≥ 0.108, p ≤ 0.010). In more detailed analysis, AHI increased with age only in the moderate OSA category (B = 0.075, p = 0.022), although durations of apneas increased in mild and severe OSA categories (B ≥ 0.076, p ≤ 0.038). Furthermore, durations of hypopneas increased with age in mild and moderate OSA categories (B ≥ 0.105, p ≤ 0.038), and durations of desaturations (B ≥ 0.120, p ≤ 0.013) in all OSA severity categories. AHI was not statistically significantly different between the age groups, although durations of obstruction events tended to increase towards older age groups. CONCLUSION: As obstruction event severity was more strongly dependent on the age than it was dependent on AHI, considering the severity of obstruction events could be beneficial while estimating the long-term effects of the treatments and prognosticating the disease progression.

18 Article Independent associations between arterial bicarbonate, apnea severity and hypertension in obstructive sleep apnea. 2017

Eskandari, Davoud / Zou, Ding / Grote, Ludger / Schneider, Hartmut / Penzel, Thomas / Hedner, Jan. ·Center for Sleep and Vigilance Disorders, Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Medicinaregatan 8B, Box 421, SE-40530, Gothenburg, Sweden. · Center for Sleep and Vigilance Disorders, Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Medicinaregatan 8B, Box 421, SE-40530, Gothenburg, Sweden. zou.ding@lungall.gu.se. · Johns Hopkins Sleep Disorders Center, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA. · Interdisciplinary Center of Sleep Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany. · International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic. ·Respir Res · Pubmed #28659192.

ABSTRACT: BACKGROUND: Obstructive sleep apnea is characterized by intermittent hypoxia and hypercapnia. CO METHODS: A retrospective analysis of a sleep apnea cohort (n = 830) studied by ambulatory polygraphy. Office systolic/diastolic blood pressure, lung function, and arterial blood gases were assessed during daytime. RESULTS: Arterial standard bicarbonate was increased with apnea severity (mild/moderate/severe 24.1 ± 1.8, 24.4 ± 1.7 and 24.9 ± 2.9 mmol/l, respectively, Kruskal-Wallis test p < 0.001). Standard bicarbonate was independently associated with apnea hypopnea index after adjustment for sex, age, body mass index, smoking, alcohol, hypertension, pO CONCLUSIONS: There was an independent association between sleep apnea severity and arterial standard bicarbonate. The link between high standard bicarbonate and daytime hypertension suggests that carbonic anhydrase activity may constitute a novel mechanism for blood pressure regulation in sleep apnea.

19 Article [Positionpaper on Telemonitoring in Sleep-Related Breathing Disorders]. 2017

Randerath, W / Bögel, M / Franke, C / Hellmann, A / Jany, B / Nilius, G / Penzel, T / Voshaar, T / Wiater, A. ·Für die Deutsche Gesellschaft für Schlafforschung und Schlafmedizin. · Für den Bundesverband der Pneumologen, Schlaf- und Beatmungsmediziner. · Für die Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin. · Für den Verband Pneumologischer Kliniken. ·Pneumologie · Pubmed #28222476.

ABSTRACT: The use of telemonitoring in the care of patients with Sleep-related Breathing Disorders (SBD) can enhance medical support significantly. Telemonitoring aims at helping physicians to detect therapy problems early and thus improve patients' therapy adherence. Diagnostics and therapy decisions in the telemonitoring process nevertheless remain the responsibility of sleep specialists. The selection of data monitored, their evaluation and resulting consequences fall to the physician, who makes decisions and prescribes therapy in consultation with the patient. In light of professional legal and ethical requirements, it must be ensured that the extensive changes to the process flow in sleep medicine are designed in a way to guarantee high-quality patient care. In this position paper, the German Sleep Society, the German Respiratory Society, the Association of Pneumological Hospitals and the Federal Association of German Pneumologists comment on important aspects for implementation of telemonitoring for SRBD and describe the basic conditions required for its use.

20 Article Nocturnal heart rate variation in diabetic and non-diabetic patients with sleep apnea syndrome. 2017

Amra, Babak / Behjati, Mohaddeseh / Penzel, Thomas / Fietze, Ingo / Schoebel, Christoph / Sarrafzadegan, Nizal. ·Pulmonary Unit, Department of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran; Bamdad Respiratory Research Center, Isfahan, Iran. Electronic address: amra@med.mui.ac.ir. · Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Khorram Ave, PO Box 81465-1148 Isfahan, Iran. Electronic address: behjati@med.mui.ac.ir. · Center of Sleep Medicine, Charité - Universitätsmedizin Berlin, Charitéplatz 1, DE-10117 Berlin, Germany. Electronic address: thomas.penzel@charite.de. · Charité - Universitätsmedizin Berlin, Dept. of Cardiology and Pulmonology, Center of Sleep Medicine, Luisenstr. 13a, D-10117 Berlin, Germany. Electronic address: ingo.fietze@charite.de. · Charité - Universitätsmedizin Berlin, Dept. of Cardiology and Pulmonology, Center of Sleep Medicine, Luisenstr. 13a, D-10117 Berlin, Germany. Electronic address: Cristoph.Schoeble@charite.de. · Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Khorram Ave, PO Box 81465-1148 Isfahan, Iran. Electronic address: nsarrafzadegan@gmail.com. ·Sleep Med · Pubmed #28153217.

ABSTRACT: OBJECTIVES: Heart rate variability (HRV) analysis is used for the evaluation of autonomic function in the cardiovascular system. Decreased HRV is associated with disorders affecting the autonomous system such as diabetes mellitus (DM) and obstructive sleep apnea (OSA). Previous studies have shown an association between OSA and DM. However, the interrelationships of HRV with OSA and DM are not well known. The aim of this study was to assess nocturnal HRV in patients who suffered from OSA with and without DM. METHODS: Sixty patients with OSA (27 with DM and 33 non-DM) underwent polysomnography for eight hours starting at midnight. From electrocardiogram (ECG) recordings taken as a part of polysomnography, time-domain and frequency-domain HRV parameters were evaluated to compare patients with regard to nocturnal HRV components such as low frequency (LF) and high frequency (HF), apnea-hypopnea index (AHI) and sleep parameters. RESULTS: In the non-DM group, a direct relationship was observed between AHI and HRV rather than very low frequency (VLF) and LF/HF variables. This relationship was just significant between AHI and standard deviation of five-min average of normal R-R intervals and adjacent R-R intervals differing by 0.50 ms over 24 h (p < 0.05). In the DM group, the correlation between AHI and HRV parameters except HF and waking frequency was direct and non-significant. Intergroup comparison showed a significant difference between groups regarding AHI and HRV-index, LF and VLF (p < 0.05). CONCLUSIONS: DM can affect HRV; however, this is not the case in OSA patients. This means that in the presence of OSA, the DM effect on HRV disappears.

21 Article Clinical Phenotypes and Comorbidity in European Sleep Apnoea Patients. 2016

Saaresranta, Tarja / Hedner, Jan / Bonsignore, Maria R / Riha, Renata L / McNicholas, Walter T / Penzel, Thomas / Anttalainen, Ulla / Kvamme, John Arthur / Pretl, Martin / Sliwinski, Pawel / Verbraecken, Johan / Grote, Ludger / Anonymous1161049. ·Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, Turku, Finland. · Sleep Research Centre, Department of Physiology, University of Turku, Turku, Finland. · Department of Sleep Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden. · Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden. · Biomedical Department of Internal and Specialistic Medicine (DIBIMIS), University of Palermo, Palermo, Italy. · CNR Institute of Biomedicine and Molecular Immunology, Palermo, Italy. · Department of Sleep Medicine, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom. · Department of Respiratory and Sleep Medicine, St. Vincent´s University Hospital, Dublin, Ireland. · Conway Research Institute, University College Dublin, Dublin, Ireland. · Schlafmedizinisches Zentrum, Charité -Universitätsmedizin Berlin, Berlin, Germany. · International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic. · Department of ENT, Førde Central Hospital, Førde, Norway. · Centre for Sleep and Waking Disorders, Department of Neurology, First Faculty of Medicine, Charles University, Prague, Czech Republic. · Inspamed, Neurology and Sleep Laboratory, Prague, Czech Republic. · Institute of Tuberculosis and Lung Diseases, 4th Department of Respiratory Medicine, Warsaw, Poland. · Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Antwerp, Belgium. · University of Antwerp, Antwerp, Belgium. ·PLoS One · Pubmed #27701416.

ABSTRACT: BACKGROUND: Clinical presentation phenotypes of obstructive sleep apnoea (OSA) and their association with comorbidity as well as impact on adherence to continuous positive airway pressure (CPAP) treatment have not been established. METHODS: A prospective follow-up cohort of adult patients with OSA (apnoea-hypopnoea index (AHI) of ≥5/h) from 17 European countries and Israel (n = 6,555) was divided into four clinical presentation phenotypes based on daytime symptoms labelled as excessive daytime sleepiness ("EDS") and nocturnal sleep problems other than OSA (labelled as "insomnia"): 1) EDS (daytime+/nighttime-), 2) EDS/insomnia (daytime+/nighttime+), 3) non-EDS/non-insomnia (daytime-/nighttime-), 4) and insomnia (daytime-/nighttime+) phenotype. RESULTS: The EDS phenotype comprised 20.7%, the non-EDS/non-insomnia type 25.8%, the EDS/insomnia type 23.7%, and the insomnia phenotype 29.8% of the entire cohort. Thus, clinical presentation phenotypes with insomnia symptoms were dominant with 53.5%, but only 5.6% had physician diagnosed insomnia. Cardiovascular comorbidity was less prevalent in the EDS and most common in the insomnia phenotype (48.9% vs. 56.8%, p<0.001) despite more severe OSA in the EDS group (AHI 35.0±25.5/h vs. 27.9±22.5/h, p<0.001, respectively). Psychiatric comorbidity was associated with insomnia like OSA phenotypes independent of age, gender and body mass index (HR 1.5 (1.188-1.905), p<0.001). The EDS phenotype tended to associate with higher CPAP usage (22.7 min/d, p = 0.069) when controlled for age, gender, BMI and sleep apnoea severity. CONCLUSIONS: Phenotypes with insomnia symptoms comprised more than half of OSA patients and were more frequently linked with comorbidity than those with EDS, despite less severe OSA. CPAP usage was slightly higher in phenotypes with EDS.

22 Article Parameters of Overnight Pulse Wave under Treatment in Obstructive Sleep Apnea. 2016

Randerath, Winfried J / Treml, Marcel / Priegnitz, Christina / Hedner, Jan / Sommermeyer, Dirk / Zou, Ding / Ficker, Joachim H / Fietze, Ingo / Penzel, Thomas / Sanner, Bernd / Grote, Ludger. ·Sleep Disorders Center, Department of Pulmonary Medicine, Sahlgrenska University Hospital, Göteborg, Sweden. ·Respiration · Pubmed #27576684.

ABSTRACT: BACKGROUND: Sleep-related breathing disorders may promote cardiovascular (CV) diseases. A novel and differentiated approach to overnight photoplethysmographic pulse wave analysis, which includes risk assessment and measurement of various pulse wave characteristics, has been evaluated in obstructive sleep apnea (OSA). OBJECTIVES: The purpose of this study was to assess if and which of the differentiated pulse wave characteristics might be influenced by OSA treatment with positive airway pressure (PAP). METHODS: The study included two protocols. In the case-control study (group A), pulse wave-derived CV risk indices recorded during PAP therapy were compared with those obtained in age, body mass index, and CV risk class-matched patients with untreated OSA (n = 67/67). In the prospective PAP treatment study (group B), 17 unselected patients undergoing a full-night sleep test at baseline and after 23 ± 19 weeks of treatment were analyzed. RESULTS: In untreated OSA patients (group A), the overnight hypoxic load was increased (SpO2 index 38.7 ± 17.5 vs. 24.0 ± 11.1, p < 0.001) and the pulse wave attenuation index (PWA-I) was lower (29.4 ± 9.2 vs. 33.5 ± 11.8, p = 0.022) than in treated patients. In group B, PAP therapy reduced the hypoxic load and increased the PWA-I significantly. The composite CV risk index was slightly but not significantly reduced. CONCLUSIONS: PAP therapy modified the hypoxic load and pulse wave-derived markers. The PWA-I - associated with sympathetic vascular tone - was most prominently modified by PAP. This novel approach to markers of CV function should be further evaluated in prospective studies.

23 Article Sex Hormones and Sleep in Men and Women From the General Population: A Cross-Sectional Observational Study. 2016

Kische, Hanna / Ewert, Ralf / Fietze, Ingo / Gross, Stefan / Wallaschofski, Henri / Völzke, Henry / Dörr, Marcus / Nauck, Matthias / Obst, Anne / Stubbe, Beate / Penzel, Thomas / Haring, Robin. ·Institute of Clinical Chemistry and Laboratory Medicine (H.K., H.W., M.N., R.H.), Departments of Internal Medicine B (R.E., A.O., B.S.) and Cardiology (S.G., M.D.), and Institute for Community Medicine (H.V.), University Medicine Greifswald, D-17475 Greifswald, Germany · Interdisciplinary Sleep Center (I.F., T.P.), Charité, University Medicine, 10117 Berlin, Germany · German Centre for Cardiovascular Research (S.G., H.V., M.D., M.N.) and German Centre for Diabetes Research (H.V.), partner site Greifswald, 13092 Greifswald, Germany · and Faculty of Applied Public Health (R.H.), European University of Applied Sciences, 18051 Rostock, Germany. ·J Clin Endocrinol Metab · Pubmed #27403929.

ABSTRACT: CONTEXT AND OBJECTIVES: Associations between sex hormones and sleep habits originate mainly from small and selected patient-based samples. We examined data from a population-based sample with various sleep characteristics and the major part of sex hormones measured by mass spectrometry. DESIGN, SETTING, AND PARTICIPANTS: We used data from 204 men and 213 women of the cross-sectional Study of Health in Pomerania-TREND. MAIN OUTCOME AND MEASURES: Associations of total T (TT) and free T, androstenedione (ASD), estrone, estradiol (E2), dehydroepiandrosterone-sulphate, SHBG, and E2 to TT ratio with sleep measures (including total sleep time, sleep efficiency, wake after sleep onset, apnea-hypopnea index [AHI], Insomnia Severity Index, Epworth Sleepiness Scale, and Pittsburgh Sleep Quality Index) were assessed by sex-specific multivariable regression models. RESULTS: In men, age-adjusted associations of TT (odds ratio 0.62; 95% confidence interval (CI) 0.46-0.83), free T, and SHBG with AHI were rendered nonsignificant after multivariable adjustment. In multivariable analyses, ASD was associated with Epworth Sleepiness Scale (β-coefficient per SD increase in ASD: -0.71; 95% CI: -1.18 to -0.25). In women, multivariable analyses showed positive associations of dehydroepiandrosterone-sulphate with wake after sleep onset (β-coefficient: .16; 95% CI 0.03-0.28) and of E2 and E2 to TT ratio with Epworth Sleepiness Scale. Additionally, free T and SHBG were associated with AHI in multivariable models among premenopausal women. CONCLUSIONS: The present cross-sectional, population-based study observed sex-specific associations of androgens, E2, and SHBG with sleep apnea and daytime sleepiness. However, multivariable-adjusted analyses confirmed the impact of body composition and health-related lifestyle on the association between sex hormones and sleep.

24 Article Detection of cardiovascular risk from a photoplethysmographic signal using a matching pursuit algorithm. 2016

Sommermeyer, Dirk / Zou, Ding / Ficker, Joachim H / Randerath, Winfried / Fischer, Christoph / Penzel, Thomas / Sanner, Bernd / Hedner, Jan / Grote, Ludger. ·Department of Internal Medicine and Clinical Nutrition, Center for Sleep and Vigilance Disorders, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. dirk.sommermeyer@iaq-hd.de. · Institut für Assistenzsysteme und Qualifizierung e.V., Karlsruhe, Germany. dirk.sommermeyer@iaq-hd.de. · Department of Internal Medicine and Clinical Nutrition, Center for Sleep and Vigilance Disorders, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. · Department of Respiratory Medicine, Allergology and Sleep Medicine, Klinikum Nuernberg, Nuremberg, Germany. · Paracelsus Medical University, Nuremberg, Germany. · Department of Pulmonary Medicine, Bethanien Hospital, Solingen, Germany. · Interdisciplinary Center of Sleep Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany. · Roche Diabetes Care GmbH, Mannheim, Germany. · Department of Pulmonary Medicine, Agaplesion Bethesda Krankenhaus Wuppertal, Wuppertal, Germany. ·Med Biol Eng Comput · Pubmed #26538425.

ABSTRACT: Cardiovascular disease is the main cause of death in Europe, and early detection of increased cardiovascular risk (CR) is of clinical importance. Pulse wave analysis based on pulse oximetry has proven useful for the recognition of increased CR. The current study provides a detailed description of the pulse wave analysis technology and its clinical application. A novel matching pursuit-based feature extraction algorithm was applied for signal decomposition of the overnight photoplethysmographic pulse wave signals obtained by a single-pulse oximeter sensor. The algorithm computes nine parameters (pulse index, SpO2 index, pulse wave amplitude index, respiratory-related pulse oscillations, pulse propagation time, periodic and symmetric desaturations, time under 90 % SpO2, difference between pulse and SpO2 index, and arrhythmia). The technology was applied in 631 patients referred for a sleep study with suspected sleep apnea. The technical failure rate was 1.4 %. Anthropometric data like age and BMI correlated significantly with measures of vascular stiffness and pulse rate variability (PPT and age r = -0.54, p < 0.001, PR and age r = -0.36, p < 0.01). The composite biosignal risk score showed a dose-response relationship with the number of CR factors (p < 0.001) and was further elevated in patients with sleep apnea (AHI ≥ 15n/h; p < 0.001). The developed algorithm extracts meaningful parameters indicative of cardiorespiratory and autonomic nervous system function and dysfunction in patients suspected of SDB.

25 Article Comparison of effects of OSA treatment by MAD and by CPAP on cardiac autonomic function during daytime. 2016

Glos, Martin / Penzel, Thomas / Schoebel, Christoph / Nitzsche, Georg-Reiner / Zimmermann, Sandra / Rudolph, Christopher / Blau, Alexander / Baumann, Gert / Jost-Brinkmann, Paul-Georg / Rautengarten, Stefanie / Meier, Jan Christian / Peroz, Ingrid / Fietze, Ingo. ·Center for Sleep Medicine, Charité-Universitätsmedizin Berlin, CCM-CC11, Charitéplatz 1, 10117, Berlin, Germany. martin.glos@charite.de. · Center for Sleep Medicine, Charité-Universitätsmedizin Berlin, CCM-CC11, Charitéplatz 1, 10117, Berlin, Germany. · Department of Cardiology and Angiology, Charité-Universitätsmedizin Berlin, CCM-CC11, Berlin, Germany. · Department of Dentofacial Orthopedics, Orthodontics, and Pedodontics, Charité-Universitätsmedizin Berlin, CBF-CC3, Berlin, Germany. · Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Charité-Universitätsmedizin Berlin, CBF-CC3, Berlin, Germany. ·Sleep Breath · Pubmed #26463420.

ABSTRACT: PURPOSE: The present study compared the effects of mandibular advancement therapy (MAD) with continuous positive airway pressure therapy (CPAP) on daytime cardiac autonomic modulation in a wide range of obstructive sleep apnea (OSA) patients under controlled conditions in a randomized, two-period crossover trial. METHODS: Forty OSA patients underwent treatment with MAD and with CPAP for 12 weeks each. At baseline and after each treatment period, patients were assessed by polysomnography as well as by a daytime cardiac autonomic function test that measured heart rate variability (HRV), continuous blood pressure (BP), and baroreceptor sensitivity (BRS) under conditions of spontaneous breathing, with breathing at 6, 12, and 15/min. RESULTS: Both CPAP and MAD therapy substantially eliminated apneas and hypopneas. CPAP had a greater effect. During daytime with all four conditions of controlled breathing, three-minute mean values of continuous diastolic BP were significantly reduced for both MAD and CPAP therapy. At the same time, selective increases due to therapy with MAD were found for HRV high frequency (HF) values. No changes were observed for BRS in either therapy mode. CONCLUSIONS: These findings indicate that both MAD and CPAP result in similar beneficial changes in cardiac autonomic function during daytime, especially in blood pressure. CPAP is more effective than MAD in eliminating respiratory events.