Sleep-disordered breathing is associated with major morbidity and mortality. However, its prevalence has mainly been selectively studied in populations at risk for sleep-disordered breathing or ...cardiovascular diseases. Taking into account improvements in recording techniques and new criteria used to define respiratory events, we aimed to assess the prevalence of sleep-disordered breathing and associated clinical features in a large population-based sample.
Between Sept 1, 2009, and June 30, 2013, we did a population-based study (HypnoLaus) in Lausanne, Switzerland. We invited a cohort of 3043 consecutive participants of the CoLaus/PsyCoLaus study to take part. Polysomnography data from 2121 people were included in the final analysis. 1024 (48%) participants were men, with a median age of 57 years (IQR 49-68, range 40-85) and mean body-mass index (BMI) of 25·6 kg/m(2) (SD 4·1). Participants underwent complete polysomnographic recordings at home and had extensive phenotyping for diabetes, hypertension, metabolic syndrome, and depression. The primary outcome was prevalence of sleep-disordered breathing, assessed by the apnoea-hypopnoea index.
The median apnoea-hypopnoea index was 6·9 events per h (IQR 2·7-14·1) in women and 14·9 per h (7·2-27·1) in men. The prevalence of moderate-to-severe sleep-disordered breathing (≥15 events per h) was 23·4% (95% CI 20·9-26·0) in women and 49·7% (46·6-52·8) in men. After multivariable adjustment, the upper quartile for the apnoea-hypopnoea index (>20·6 events per h) was associated independently with the presence of hypertension (odds ratio 1·60, 95% CI 1·14-2·26; p=0·0292 for trend across severity quartiles), diabetes (2·00, 1·05-3·99; p=0·0467), metabolic syndrome (2·80, 1·86-4·29; p<0·0001), and depression (1·92, 1·01-3·64; p=0·0292).
The high prevalence of sleep-disordered breathing recorded in our population-based sample might be attributable to the increased sensitivity of current recording techniques and scoring criteria. These results suggest that sleep-disordered breathing is highly prevalent, with important public health outcomes, and that the definition of the disorder should be revised.
Faculty of Biology and Medicine of Lausanne, Lausanne University Hospital, Swiss National Science Foundation, Leenaards Foundation, GlaxoSmithKline, Ligue Pulmonaire Vaudoise.
Introduction Background : Several questionnaires have been used to screen for sleep-disordered breathing (SDB). Most of them have been validated in selected clinical populations, and little is known ...about their predictive performance in the general population. Objectives To investigate the accuracy of four questionnaires used for SDB screening in the general population: the Berlin Questionnaire (BQ), the Epworth Sleepiness Scale (ESS), the STOP-Bang (SB) and the adjusted-neck circumference (neck+). Materials and methods 2115 subjects (50.4% women, 58.4 ± 11.0 years old, BMI 26.2 ± 4.4 kg/m2 ) participating in an ongoing population-based sleep cohort study (HypnoLaus, Lausanne, Switzerland) underwent complete polysomnographic recordings at home. Respiratory events were scored according to the AASM 2013 criteria. Prevalence of SDB was determined for apnea–hypopnea index (AHI) thresholds of ⩾15 and ⩾30. Interviewers administered the BQ and the ESS and calculated SB and neck+. SB includes the following items: snoring, daytime Tiredness, Observed apnea, high blood Pressure, Body-mass index ⩾35 kg/m2 , Age ⩾ 50 yr, Neck girth ⩾ 40 cm, and male Gender. Neck + is obtained by measuring the neck girth in cm and adding 3 cm for the presence of snoring, 3 cm for observed apnea and 4 cm for high blood pressure. Subjects were considered at increased risk for SDB if BQ is positive in ⩾2 categories, ESS score ⩾11, SB score ⩾3 and neck+ ⩾43 cm. Assessment of questionnaire included their sensitivity, specificity, positive-predicted value (PPV) and negative-predicted value (NPV). Results Prevalence of SDB with AHI thresholds of ⩾15 and ⩾30 were respectively 36.4% and 15.0%. Percentages of positive BQ was 25.3%, ESS:13.4%, SB: 41.3% and neck+:29.0%. For an AHI ⩾ 15, sensitivity, specificity, PPV and NPV were respectively: BQ (39.4%, 82.7%, 56.6% and 70.5%), ESS (13.5%, 86.7%, 35.8% and 64.5%), SB (67.3%, 72.8%, 57.3% and 80.4%) and neck+ (52.3%, 83.8%, 64.0% and 76.1%). For an AHI ⩾ 30, sensitivity, specificity, PPV and NPV were respectively: BQ (48.7%, 78.8%, 28.8% and 89.7%), ESS (13.1, 86.6%, 14.2% and 85.4%), SB (81.7%, 65.6%, 28.7% and 95.5%) and neck+ (69.8%, 77.9%, 34.6% and 93.9%). Conclusion Our population-based study suggests that questionnaires such as BQ, ESS, SB and neck+ could be used to rule out severe SDB considering their strong NPV. However they do not seem suitable to screen for moderate to severe SDB in the general population. Acknowledgements Funding : Ligue pulmonaire vaudoise, Fondation Leenaards, Fond national Suisse and GSK.
Introduction Background : Upper airway resistance syndrome (UARS) shares common clinical features with obstructive sleep apnea and hypopnea (OSAH). It is characterized by repetitive respiratory ...effort-related arousal (RERA), which may lead to daytime sleepiness and functional impairment. Little is known about the prevalence of UARS in the general population. Objectives : To determine the prevalence of UARS in the general population and to compare its characteristics to matched control subjects without UARS. Materials and methods 2020 subjects (50.0% women, 57.3 ± 10.7 years old, BMI 25.5 ± 4.3 kg/m2 ) participating in an ongoing population-based sleep cohort study (HypnoLaus, Lausanne, Switzerland) underwent complete polysomnographic recordings at home. Respiratory events were scored according to the AASM Chicago criteria. UARS was present if the RERA index was ⩾5/h and accounted for more than 50% of the respiratory disturbance index (RDI), which is defined by the sum of the apnea–hypopnea index (AHI) and RERA index. Characteristics of each subject with confirmed UARS were compared with 5 age and sex matched control subjects with similar AHI but no RERA. Results The prevalence of UARS was 0.84% of this general population sample. Median AHI and RDI were respectively 4.4/h (IQ range 3.5–6.8/h) and 10.7/h (IQ range 9.1–15.6/h). Mean Epworth Sleepiness Score was 6.6 ± 3.2; male-to-female ratio was 0.7. There were no significant differences between UARS subjects and the control subjects regarding BMI (24.7 ± 3.1 vs. 24.0 ± 3.3, p = 0.46) and the Epworth Sleepiness Score (6.6 ± 3.2 vs. 7.4 ± 2.5, p = 0.15). Also, the same prevalence of hypertension (29.4 ± 47.0% vs. 25.9 ± 19.7%, p = 0.77), diabetes (5.9 ± 24.2% vs. 5.9 ± 11.8%, p = 1.0) and metabolic syndrome (29.4 ± 47.0% vs. 12.9 ± 12.1%, p = 0.16) were found in UARS and control subjects. Conclusion In our middle-aged population-based cohort, the prevalence of UARS is lower than previously reported. There was no significant difference between UARS and control subjects in terms of BMI, daytime sleepiness, hypertension, diabetes and metabolic syndrome. Acknowledgement Funding: Ligue pulmonaire vaudoise, Fondation Leenaards, Fond national Suisse and GSK.
Introduction Historical studies suggest that there is an increased male/female ratio in the prevalence of sleep disordered breathing (SBD). Moreover, SDB was reported to increase in postmenopausal ...women. The aim of this study was to assess the prevalence and the characteristics of SDB in pre-menopausal and post-menopausal women. Materials and methods 2114 subjects (50.4% women, 58.5 ± 10.7 y.o, BMI 26.2 ± 4.4 kg/m2 ) participating in an ongoing population-based sleep cohort study (HypnoLaus, Lausanne, Switzerland) underwent full polysomnographic recordings at home. They also had a complete clinical workup including metabolic, cardiovascular, genetic and morphometric evaluation. Hormonal status was recorded in 981 women (30.6% pre-menopausal and 69.4% post-menopausal). Respiratory events were scored according to the AASM 2013 criteria. Results The prevalence of SDB in women with AHI thresholds of 5/h, 15/h and 30/h was 60.9%, 22.8% and 7.5%. Prevalence of an Epworth score > 10 and SDB with the same thresholds was 18.9% (AHI > 5/h), 11.5% (AHI > 15/h) and 5% (AHI > 30/h) with a male/female ratio of 1.75, 2.4 and 2.8 respectively. Male vs female prevalence was significantly different in each severity group ( p < 0.0001). Compared to men, women with an AHI > 15/h were older ( p < 0.0001), had a lower neck circumference ( p = 0.0001), a lower Mallampati score ( p = 0.0001), a lower waist/hip ratio ( p < 0.0001) but the BMI was not significantly different: 28.2 kg/m2 in women vs 28.1 kg/m2 in men ( p = 0.711). Women also reported less sleepiness at the wheel ( p < 0.0002), less witnessed sleep apnea ( p = 0.0006) but more morning fatigue ( p = 0.034), more sleeping pill intake ( p = 0.0003) but the same rate of snoring ( p = 0.55). Compared to post-menopausal, pre-menopausal women had a lower SDB prevalence. AHI > 5/h: 26.6% vs 42.5% ( p < 0.0001), AHI > 15/h: 7.2% vs 18.6% ( p < 0.0001), AHI > 30/h: 1.3% vs 10.2% ( p < 0.0001). Post-menopausal women had a larger neck ( p = 0.006) a higher waist-hip ratio ( p = 0.0001) and a higher Mallampati score ( p = 0.009) but the BMI was not significantly different( p = 0.5). Conclusion The prevalence of SDB is lower in women than in men with a male/female ratio increasing with SDB severity. Women with SDB tend to report more morning fatigue but less sleepiness at the wheel and less witnessed sleep apnea than men. Post-menopausal compared to premenopausal women have a higher SDB prevalence not due to an increased BMI but mainly because differences in fat distribution. Acknowledgements Funding: Fondation Leenaards, FNS, GSK, Ligue Pulmonnaire Vaudoise and CIRS.
Ventilator-associated tracheobronchitis (VAT) is associated with increased duration of mechanical ventilation. We hypothesized that, in patients with VAT, antibiotic treatment would be associated ...with reduced duration of mechanical ventilation.
We conducted a prospective, randomized, controlled, unblinded, multicenter study. Patients were randomly assigned (1:1) to receive or not receive intravenous antibiotics for 8 days. Patients with ventilator-associated pneumonia (VAP) prior to VAT and those with severe immunosuppression were not eligible. The trial was stopped early because a planned interim analysis found a significant difference in intensive care unit (ICU) mortality.
Fifty-eight patients were randomly assigned. Patient characteristics were similar in the antibiotic (n = 22) and no antibiotic (n = 36) groups. Pseudomonas aeruginosa was identified in 32% of VAT episodes. Although no difference was found in mechanical ventilation duration and length of ICU stay, mechanical ventilation-free days were significantly higher (median interquartile range, 12 8 to 24 versus 2 0 to 6 days, P < 0.001) in the antibiotic group than in the no antibiotic group. In addition, subsequent VAP (13% versus 47%, P = 0.011, odds ratio OR 0.17, 95% confidence interval CI 0.04 to 0.70) and ICU mortality (18% versus 47%, P = 0.047, OR 0.24, 95% CI 0.07 to 0.88) rates were significantly lower in the antibiotic group than in the no antibiotic group. Similar results were found after exclusion of patients with do-not-resuscitate orders and those randomly assigned to the no antibiotic group but who received antibiotics for infections other than VAT or subsequent VAP.
In patients with VAT, antimicrobial treatment is associated with a greater number of days free of mechanical ventilation and lower rates of VAP and ICU mortality. However, antibiotic treatment has no significant impact on total duration of mechanical ventilation.
ClinicalTrials.gov, number NCT00122057.
Obstructive sleep apnea (OSA) tends to worsen on the supine posture due to the effect of gravity on tongue position. In some cases, OSA is present exclusively on the supine posture (exclusive ...postural OSA). These patients may benefit from positional therapy (PT), which aim is to prevent sleep in the supine posture using different types of devices. Before opting for this therapeutic option, a sleep study with PT should be perform in order to confirm its efficacy and assess the patients' tolerance. Because the efficacy of PT is inferior to continuous positive airway pressure (CPAP), the latter treatment remains the first line of therapy. Also, the discomfort of the existing devices appears to limit the long term use of PT. Further studies assessing the long term effects of PT on metabolic and neurocognitive outcomes are needed.
To study the impact of neoadjuvant therapies on postoperative complications and mortality among non-small-cell lung cancer (NSCLC) patients subjected to anatomic lung resection and included in the ...Spanish cohort of the video-assisted thoracic surgery (GE-VATS) multicenter database.
The study included a total of 3085 patients from 33 centers between December 2016 and March 2018. We performed a comparative analysis of the complications and mortality in patients who received neoadjuvant therapies (n = 263) versus those who did not (n = 2822). A propensity score-matched analysis was used to adjust for potential confounders. Association between exposure in two groups and outcomes were estimated by logistic regression weighted by inverse of probability of receiving the treatment that actually received.
In the unadjusted analysis, the chemotherapy (CT) and chemoradiotherapy (CRT) group presented a higher frequency of ICU readmissions, reinterventions, empyema, cardiovascular complications, a greater frequency of atrial fibrillation, and an increased need for blood product transfusions. In the adjusted group, CT and CRT patients had a higher rate of cardiovascular complications (CT p = 0.002; OR 2.29; 95% CI 1.34–3.94 and CRT p = 0.001; OR 2.90; 95% CI 1.52-5-52), arrhythmias (CT p = 0.013; OR 2.23; 95% CI 1.18–4.20 and CRT p = 0.046; OR 2.22; 95% CI 1.01–4.90) and transfussions (CT p = 0.042; OR 2.95; 95% CI 1.04–8.35 and CRT p < 0.001; OR 7.74; 95% CI 3.01-19-92).
Based on our series, neoadjuvant CT and CRT were associated with a higher rate of cardiovascular complications, arrhythmias and transfussions in patients with NSCLC subjected to anatomic lung resection.
Although unexpected conversion during Video-Assisted Thoracic Surgery (VATS) lobectomy is up to 23%, the effects on postoperative outcomes remain debatable. This retrospective study aimed: (i) to ...identify potential preoperative risk factors of VATS conversion to standard thoracotomy; (ii) to assess the impact of surgical experience in VATS lobectomy on conversion rate and patient health-related quality of life.
We extracted detailed information on VATS lobectomy procedures performed consecutively (2014-2019). Predictors of conversion were assessed with univariable and multivariable logistic regressions. To assess the impact of VATS lobectomy experience, observations were divided according to surgeons' experiences with VATS lobectomy. The impact of VATS lobectomy experience on conversion and occurrence of postoperative complications was evaluated using logistic regressions. The impact of VATS lobectomy experience on EuroQoL-5D (EQ-5D) scores at discharge was assessed using Tobit regressions.
A total of 11,772 patients underwent planned VATS for non-small-cell lung cancer (NSCLC), with 1074 (9.1%) requiring conversion to thoracotomy. The independent predictors at multivariable analysis were: FEV1% (OR = 0.99; 95% CI: 0.98-0.99,
= 0.007), clinical nodal involvement (OR = 1.43; 95% CI: 1.08-1.90,
= 0.014). Experienced surgeons performed 4079 (34.7%) interventions. Experience in VATS lobectomy did not show a relevant impact on the risk of open surgery conversion (
= 0.13) and postoperative complications (
= 0.10), whereas it showed a significant positive impact (
= 0.012) on EQ-5D scores at discharge.
Clinical nodal involvement was confirmed as the most critical predictor of conversion. Greater experience in VATS lobectomy did not decrease conversion rate and postoperative complications but was positively associated with postoperative patient quality of life.
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