SLEEP 2011 Abstract Supplement

B. Clinical Sleep Science VIII. Medical Disorders and Sleep
0656
IMPACT OF ABNORMAL LUNG FUNCTION ON SLEEP
ARCHITECTURE AND LONG TERM OUTCOMES IN
OBSTRUCTIVE SLEEP APNEA: A COHORT STUDY
Dave R 1 , McCarthy K 2 , Xu M 2 , Minai OA 1,2
1
Sleep Medicine, Cleveland Clinic, Cleveland, OH, USA, 2 Pulmonary,
Allergy and Critical Care Medicine, Cleveland Clinic, Cleveland, OH,
USA
Introduction: The impact of abnormal pulmonary function in patients
with OSA has not been adequately studied. We aimed to assess the impact
of abnormal pulmonary function on short and long-term outcomes
in patients with OSA.
Methods: Adult patients with polysomnographically (PSG) confirmed
OSA (defined as AHI >5) between July 2005 and August 2010 who underwent
pulmonary function testing (PFT) within 12 months of PSG
were identified using electronic medical records. Of these, 250 patient
charts [normal PFT (N=100), obstructive PFT (N=50), restrictive PFT
(N=50) and mixed PFT (N=50)] were reviewed to obtain demographic
and PSG variables. OSA patients with normal PFTs were compared to
patients with OSA and abnormal PFTs.
Results: We identified 823 patients who formed our study cohort: 440
(53%) females, 597 (72%) Caucasian and 182 (22%) African Americans.
Of these, 333 (43%) had mild OSA, 216 (32%) had moderate OSA
and 189 (25%) had severe OSA. Compared to patients with normal
PFTs, patients with abnormal PFTs had reduced survival at 1, 2, and
5 years (96.9%, 94.2%, and 85% versus 98.7%, 97.6%, and 90.2%; P
= 0.018). Compared to patients with normal PFTs, those with abnormal
PFTs had lower overall AHI (median 16 vs. 21.9, p=0.01), lower
NREM-AHI (median 13 vs. 22.1, p=0.003), and lower total number of
respiratory events (median 85.5 vs. 125). There were no significant differences
between the two groups in terms of BMI, Epworth Sleepiness
Scores, total sleep time (TST), sleep efficiency, total arousals, percentage
of TST in N1, N2, N3 and REM sleep stages, percentage of TST
spent with oxygen saturation below 90%, or percentage of TST with end
tidal CO2 (EtCO2) above 50%.
Conclusion: In patients with OSA, those with reduced measures of pulmonary
function have reduced survival compared to patients with normal
pulmonary function.
0657
QUALITY OF LIFE IN PATIENTS WITH OSA AND
ABNORMAL LUNG FUNCTION: A RETROSPECTIVE STUDY
Dave R 1 , McCarthy K 2 , Xu M 2 , Minai OA 2,1
1
Sleep Medicine, Cleveland Clinic, Cleveland, OH, USA, 2 Pulmonary,
Allergy & Critical Care Medicine, Cleveland Clinic, Cleveland, OH,
USA
Introduction: Sleep disordered breathing (SDB) is seen in variety of
patients with lung disorders. The impact of dual disease burden of OSA
and abnormal lung function on quality of life has not been adequately
studied. This study was undertaken to evaluate quality of life, fatigue,
and depression in patients with OSA and abnormal lung function based
on a self reported outpatient questionaire.
Methods: As part of their visit, all patients complete a Sleep clinic
questionaire consisting of validated tools for measuring quality of life,
subjective sleepiness, fatigue, and depression at our institution. Adult
patients with polysomnographically (PSG) confirmed OSA (defined as
AHI >5) between January 2008 and August 2010 who underwent pulmonary
function testing (PFT) within 12 months of PSG and completed
the Sleep clinic questionnaire were identified using electronic medical
records and the Sleep Center database. Data on demographics, PSG variables,
and Sleep clinic questionnaire [European Quality of life (EQ5D)
Index, PHQ-9 scores for depression, Total sleep time (hours), Epworth
sleepiness score (ESS), Fatigue Severity Score (FSS) and Functional
Outcomes of Sleep Questionaire (FOSQ) scores] were collected. OSA
patients with normal PFTs were compared to patients with OSA and
abnormal PFTs.
Results: We identified 154 patients who formed our study cohort
[90(58.44%) were females; 110(71%) Caucasians, and 39 (25%) African
Americans]. 55 (36%) had normal PFT and 99 (64%) had abnormal lung
function. Compared to patients with normal lung function, OSA patients
with abnormal lung function had lower EQ5D [median (25th, 75th) =
0.8 (0.7, 0.8) vs 0.8 (0.8, 0.8);p=0.028] and lower Intimate Relationships
and Sexual Activity FOSQ [1.3 (1.0, 3.3) vs 3.0 (1.0, 3.9); p=0.027]. No
significant differences were noted in terms of PHQ-9 Scores, Total Sleep
time in hours, ESS, FSS, and overall FOSQ scores.
Conclusion: In patients with OSA, abnormal lung function can result
in reduced quality of life (EQ5D) and FOSQ scores. Larger prospective
cohort studies are needed to understand the quality of life indicators in
OSA and abnormal lung function.
0658
ATRIAL FIBRILLATION IN PATIENTS WITH OBSTRUCTIVE
SLEEP APNEA AND ISCHEMIC STROKE - A CASE CONTROL
STUDY
Mansukhani MP 1 , Calvin A 2 , Lipford M 3 , Flemming K 3 , Somers VK 2 ,
Caples SM 1,4
1
Sleep Medicine, Mayo Clinic, Rochester, MN, USA, 2 Cardiovascular
Diseases, Mayo Clinic, Rochester, MN, USA, 3 Neurology, Mayo
Clinic, Rochester, MN, USA, 4 Pulmonary and Critical Care Medicine,
Mayo Clinic, Rochester, MN, USA
Introduction: Obstructive sleep apnea (OSA) has recently been shown
to be an independent risk factor for ischemic stroke. Atrial fibrillation
(AF), a strong risk factor for stroke, has also been linked to OSA.
Whether OSA plays an intermediary role in the relationship between AF
and stroke is unknown. To explore this, we aimed to study the association
between AF and first-time stroke in patients with OSA.
Methods: Olmsted county residents with a new diagnosis of OSA based
on polysomnography (PSG) between 1/1/2005-1/1/2010 (N=2980)
who suffered a first-time ischemic stroke during the same period were
identified as cases. Controls with no history of stroke were randomly
chosen from the same PSG database. Multiple logistic regression was
performed with age, gender, AF, BMI, smoking, hypertension, hyperlipidemia,
diabetes and CAD as co-variates with the diagnosis of OSA as
the variable of interest.
Results: A total of 108 subjects were analyzed. Mean age of cases
(n=34) was 73 years +/-12.3 years and 53% were men. Among controls
(n=74), mean age was 61 +/-15.5 years, 55% were men. After controlling
for confounders, AF was more common in the stroke cases than
among controls (50.0% vs 10.8%, corrected odds ratio 7.89, p