A scalable framework for population-level precision health: Insights from sleep disorders.

Individuals who have undergone long-term bariatric surgery may be at increased obstructive sleep apnea (OSA) risk. The purpose of this study was to estimate the frequency of OSA risk and its associations, via biochemical markers, in patients who have undergone long-term bariatric surgery. This cross-sectional study evaluated patients after 5years or more post Roux-en-Y gastric bypass. Biochemical markers, anthropometrics, and OSA risk, via the STOP-Bang score screening tool, were evaluated. Independent Student t, Pearson's chi-squared, or correlation tests were applied, according to total OSA risk score groups or its isolated components. Among the 77 patients evaluated (88.3% female; body mass index = 32.7 ± 5.8kg/ m2; postoperative time = 9.9 ± 3.1years), 36 were at risk for OSA. OSA risk score was positively correlated to high-sensitivity C-reactive protein levels (r2 = 0.270; p = 0.025), triglycerides (r2 = 0.338, p = 0.004), total cholesterol (r2 = 0,262; p = 0,028), and HbA1c (r2 = 0.332; p = 0.005). Compared to each counterpart, basal insulin and triglycerides were higher among those who self-reported witnessed apnea (12.8 ± 6.5 vs 8.1 ± 3.8, p = 0.013; 136.4 ± 41.1 vs 88.5 ± 34.8, p = 0.001, respectively), while levels of total cholesterol and LDL-C were higher in participants who reported tiredness (183.9 ± 27.0 vs 164.8 ± 33.4, p = 0.005; 105.9 ± 24.4 vs 92.0 ± 26.6, p = 0.018). Participants with snoring also had higher levels of triglycerides (107 ± 41.1 vs 83.7 ± 33.9, p = 0.010). OSA risk was highly prevalent among patients who had undergone long-term bariatric surgery, as noted via increased STOP-Bang scores, as were isolated components related to inflammatory markers and lipid and glycemic profile.

Sleep-related breathing disorders are a spectrum of condition among them obstructive sleep apnea (OSA) is the most severe and complex chronic clinical syndrome. This is characterized by repeated episode of upper airway occlusion, resulting in brief period of breathing cessation (apnea) or a significant reduction in airflow (hypopnea) during sleep. Person with OSA may experience loud snoring, oxygen desaturation, frequent arousal, and disruption of sleep. Disturb sleep also results in hypersomnolence, impaired concentration during daytime, and poor quality of life. OSA largely remains under-recognized and underdiagnosed entity. The global prevalence of OSA varies from 0.3% to 5.1% in general population.[1] In India, OSA varied from 4.4% to 13.7% (4.4%–19.7% in males and 2.5%–7.4% in females) in different studies.[2] Prevalence of OSA increases with age particularly in adults >60 years. The increasing rate of obesity also contributes to rise in OSA. Other contributing factors include male sex, anatomical factors, genetic and metabolic disorders, smoking, and postmenopausal female etc.[3] Recent studies have shown that there is a link between bronchial asthma and OSA and there is a bidirectional relationship where each disorder adversely influences the other one.[4] Patients of asthma appear to have an increased risk for OSA than general population. The first study that examines asthma and OSA was a case report by Hudgel and Shucard in 1979.[5] Since then, several studies have shown an increased prevalence of sleep disturbances among asthmatic patients.[67] Epidemiological studies demonstrate that asthma patients more frequently report snoring, excessive daytime sleepiness, and apnea. A recent population-based prospective epidemiological study showed that asthma is associated with an increased risk of new-onset OSA.[8] In this landmark study, the incidence of OSA over 4 years in patients with self-reported asthma was 27%, compared with 16% without asthma. The relative risk adjusted for risk factors such as body mass index, age, and gender was 1.39 (95% confidence interval: 15%–19%). Despite this well-described association between asthma and OSA, the mechanisms that link the duo still remain hypothetical. Some of the putative pathways that link OSA with asthma include increased parasympathetic tone during apnea, hypoxemia-related reflex bronchoconstriction, irritation of upper airway neural receptors, altered nocturnal neurohormonal secretion, increased inflammatory mediators (both local and systemic), gastroesophageal reflux, and obesity.[9] Corticosteroids may be a potential contributory factor through effect on upper airway caliber (increased adiposity) or dilator muscle function (steroid myopathy) as identified in a study on dose-dependent relationship with inhaled corticosteroids and risk of OSA.[10] Further, it is to be noted that OSA and asthma are often complicated by shared comorbidities and potential for multidirectional casual pathways, i.e., obstruction, inflammation, obesity, gastroesophageal reflux disorder, and rhinitis. The coexistence and hypothetical link between cough/asthma, obesity/OSA, rhinosinusitis, and esophageal reflux has also been coined as “CORE syndrome” to be specially considered among asthma patients refractory to the therapy.[11] On the other hand, OSA may adversely affect asthma-related outcomes. There is accumulating evidence to suggest that OSA is associated with the poor asthma control, more nocturnal symptoms, and frequent exacerbations in asthma patients.[4] OSA has been found to be associated with specific changes in airway inflammation that is predominantly neutrophilic with high levels of matrix metalloproteinase-9, interleukin-8, and low reticular basement membrane thickness in patients with severe asthma, suggesting changes in airway remodeling.[12] Interestingly, patients who are diagnosed with OSA and treated with continuous positive airway pressure (CPAP) seem to have better asthma control in terms of improved asthma symptoms as well as better morning peak expiratory flow rates and quality of life. It seems that CPAP has beneficial effects on mechanical and neuromechanical properties of lower airways apart from ameliorating gastroesophageal reflux and local as well as systemic inflammation. CPAP also restores sleep and further helps to control asthma.[13] It is, therefore, important to identify this dual, rather complex, association between asthma and OSA. There are more than enough evidences that OSA is not uncommon among asthma patients; however, it is poorly investigated. OSA is largely overlooked in patients having uncontrolled asthma. Patients with poor asthma control despite optimal recommended management need to be screened for possible OSA so as to reduce treatment cost, morbidity, and improved quality of life in such patients. Future research on this “alternate overlap syndrome” will further improve our understanding on this topic with some more useful insights for better management strategies.

This secondary data analysis aimed to determine the nature of the relationship between obstructive sleep apnea (OSA) risk, biological age acceleration, and nonspecific chronic low back pain (CLBP). In total, 199 adults aged 18-82 years who filled both STOPBANG and pain questionnaires subsetted for secondary analysis. Based on the STOPBANG questionnaire, 104 had a low OSA risk and 95 had an intermediate or high OSA risk. Dunedin Pace of Aging Computed from the Epigenome (DunedinPACE), Horvath's, Hannum's, PhenoAge, and GrimAge clocks were used to determine biological age and pace of biological aging. Individuals with low OSA risk reported increased DunedinPACE compared to those with intermediate/high OSA risk (p < 0.001). There was a significant correlation between the risk for OSA and biological age acceleration measured by PhenoAge as well as pace of biological aging (p < 0.05). Mediation analysis detected indirect effects of OSA risk on chronic pain outcomes through the pace of biological aging. Targeted interventions addressing OSA risk offers a promising therapeutic strategy. This could be particularly valuable for aging populations where both accelerated biological aging and chronic pain conditions are prevalent, offering a more holistic approach to improving nonspecific chronic pain outcomes through quality of sleep and restfulness.

Appropriate bmi criteria for Indian population: does it help stratify obstructive sleep apnea (OSA) patients better?

Background/Objectives: Current approaches to monitoring obstructive sleep apnea (OSA) risk primarily focus on structural or functional abnormalities, often neglecting systemic metabolic and physiological factors. Resource-intensive methods, such as polysomnography (PSG), limit their routine applicability. This study aimed to evaluate composite nutritional-inflammatory indices derived from routine blood markers to identify feasible indices for OSA management and explore their association with OSA risk. Methods: Data from 9622 adults in the NHANES (2015-2020) and GWAS datasets were analyzed using logistic regression, restricted cubic splines, machine learning, and Mendelian randomization (MR). These techniques were employed to identify nutritional-inflammatory indices associated with OSA risk. Random forest modeling identified body mass index (BMI) and albumin (ALB) as key components of the advanced lung cancer inflammation index (ALI). Causal relationships between ALI components and OSA were validated using MR. Results: ALI was significantly associated with OSA, with individuals in the highest ALI tertile exhibiting a 59% higher likelihood of OSA (OR = 1.59, 95% CI: 1.38-1.84; p < 0.001). BMI and ALB were identified as key contributors to ALI and confirmed as causal risk factors for OSA (BMI: OR = 1.91, 95% CI: 1.80-2.02; ALB: OR = 1.11, 95% CI: 1.04-1.19). Age, gender, and the neutrophil-to-lymphocyte ratio (NLR) were also significant predictors. Conclusions: This study identifies ALI as a potential composite index for assessing OSA risk. Integrating statistical modeling, machine learning, and causal inference techniques highlights the utility of nutritional-inflammatory indices in improving OSA monitoring and management in clinical practice.

While short-term weight changes are known to influence obstructive sleep apnoea (OSA), the impact of body mass index (BMI) changes over the life course has been poorly documented. We examined the association between BMI trajectories from childhood to middle age and adult OSA, 10 years later. Five BMI trajectories were previously identified in the population-based cohort Tasmanian Longitudinal Health Study (TAHS), using eight time-point BMI from age 5 to 43 years. The primary outcome was probable OSA at 53 years, defined using STOP-Bang questionnaire, with Berlin and OSA-50 questionnaires used to ensure consistency of findings. Clinically significant diagnosed OSA was defined as self-reported medical diagnosis or mild OSA with symptoms or moderate-to-severe OSA, using type-4 sleep studies. Associations were examined using multivariable logistic regression. Compared with the average BMI trajectory, the child average-increasing (aOR = 5.28, 95% CI 3.38-8.27) and persistently high trajectories (aOR = 3.73, 2.06-6.74) were associated with increased risk of probable OSA. These associations were consistent when using clinically significant diagnosed OSA (child average-increasing trajectory: aOR = 2.95, 1.30-6.72; high trajectory: aOR = 2.23, 0.82-6.09). Individuals belonging to the low trajectory were less likely than the average trajectory to have OSA. Notably, the child high-decreasing trajectory was not associated with OSA. Physicians and the public should be aware of the potential risk of OSA in middle-aged adults when BMI is high or continuously increasing from childhood to mid-40s. Obese children who subsequently lose weight were not at higher risk of OSA in middle age-a novel and key finding.

Repetitive airway occlusion during sleep in patients with obstructive sleep apnoea (OSA) results in the generation of negative intrathoracic pressures and ends in arousal, both of which may predispose to reflux during sleep (nocturnal reflux). We aimed to determine and compare the prevalence of nocturnal reflux symptoms and their sleep-associated risk factors in untreated OSA patients, OSA patients using continuous positive airway pressure (CPAP) therapy, and the general population. Gastro-oesophageal reflux and sleep questionnaires were completed by 1116 patients with polysomnography diagnosed OSA and by 1999 participants of the 2007 Busselton population health survey. Of the OSA patients, 137 completed the reflux questionnaire before and after treatment. Risk of OSA in the general population was assessed using the Berlin score. The prevalence of frequent (>weekly) nocturnal reflux symptoms was increased (P<0.001) in OSA patients (10.2%) versus the general population (5.5%), in individuals from the general population at high (8.7%) versus low risk (4.3%) of OSA and in patients with severe (13.9%) versus mild OSA (5.1%). Frequent nocturnal reflux symptoms were associated with high risk (general population) (OR 1.9, P<0.01) and severity of OSA (OSA population) OR 3.0, severe versus mild OSA, P<0.001) after correcting for age, gender and body mass index. Treatment with CPAP decreased the prevalence of reflux symptoms significantly. In conclusion, the prevalence of nocturnal reflux symptoms is increased in those with or suspected of having OSA. This association is independent of other risk factors including age, gender and body mass index, suggesting a causal relationship between OSA and nocturnal reflux.

Introduction Testosterone can impact factors such as neck circumference, fat distribution, and airway characteristics, potentially elevating the risk of obstructive sleep apnea (OSA). It may also affect respiratory control, raising the apneic threshold and contributing to central sleep apnea (CSA). While studies in cisgender men have produced inconclusive findings regarding the relationship between testosterone and sleep apnea (SA), research in premenopausal women with hyperandrogenic conditions indicates a higher SA prevalence. This study aims to investigate the association between testosterone therapy and the diagnosis of OSA and CSA in transmasculine individuals. Methods Data were sourced from TriNetX, a database with de-identified health records of over 120 million U.S. patients across 84 healthcare organizations. Transmasculine individuals were identified using ICD-10 codes for gender identity disorders and testosterone therapy, excluding those with a prior SA diagnosis. The index date was defined as three months post-testosterone initiation to account for physiological changes. Cisgender male and female cohorts were matched using propensity scores for BMI, smoking, and other SA risk factors. The primary outcome was SA incidence, identified through ICD-10 G47.3x codes. Kaplan–Meier analysis was used to estimate the probabilities of SA, with log-rank test group comparisons. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated using the Cox proportional hazards model, with significance set at p&amp;lt; 0.05. Results Among 22,745 transmasculine patients, the SA risk was significantly higher compared to matched cohorts of cisgender women (HR: 3.01, CI: 2.70–3.36, p&amp;lt; 0.0001) and men (HR: 1.64, CI: 1.49–1.81, p&amp;lt; 0.0001). The risk of OSA was elevated, with HRs of 3.25 (CI: 2.88–3.67, p&amp;lt; 0.0001) and 1.74 (CI: 1.57–1.95, p&amp;lt; 0.0001) compared to cisgender women and men, respectively. Moreover, there was an 18-fold increased risk of CSA compared to cisgender women (HR: 18.44, CI: 4.24–80.12, p&amp;lt; 0.0001). Conclusion Transmasculine individuals receiving testosterone therapy are at significantly higher risk of developing both OSA and CSA compared to cisgender individuals. These findings underscore the need for heightened clinical vigilance for SA in this population. Future studies should explore the underlying mechanisms and assess the impact of testosterone dose, duration, and patient-specific factors on SA risk. Support (if any)

A - 76 Association between Sleep Apnea Risk and Cognitive Performance in Individuals with Type 1 Diabetes (T1D): Evidence from the Glucog Study.

Disrupted sleep is an often intractable symptom of posttraumatic stress disorder (PTSD); however, non-PTSD-related causes of disrupted sleep are rarely considered in clinical practice. Study objectives were to determine obstructive sleep apnea (OSA) risk among veterans seeking PTSD treatment and to investigate the relationship between OSA risk and PTSD symptom severity. Veterans (N = 264; 25.8% female) completed measures of PTSD symptoms and OSA risk factors. The rate of OSA risk was 72.7% for the whole sample, 77.2% among men, and 59.7% among women. OSA risk was not significantly correlated with PTSD symptom severity. Detection and treatment of OSA in veterans with PTSD may result in decreased insomnia in affected individuals.

Agreement between stroke patients and family members for ascertaining pre-stroke risk for sleep apnea

Background: Recent studies have found a high prevalence of obstructive sleep apnea (OSA) among responders of the World Trade Center (WTC) disaster. Exposure to particulate matter (PM) causing upper airway inflammation is considered a significant contributing factor in the pathogenesis of OSA. The Berlin Questionnaire (BQ) is a widely used questionnaire to screen for OSA with published sensitivity up to 86% and specificity of 87% for OSA risk. We aim to investigate whether a relationship exists between OSA risk using the BQ and exposure to PM using the Wisnevsky exposure score. Methodology: We evaluated 808 participants in the WTC-CHEST Program from January 2011 to September 2013. High risk for OSA was identified as 2 or more positive categories in the BQ. The subjects were categorized into four exposure groups: very high, high, intermediate and low (Wisnevsky exposure score). Chi-square and Binary Logistic Regression analyses were performed to determine if there was a significant relationship between OSA risk and PM exposure. Results: High risk for OSA is associated with PM exposure in the study population (p=0.002). Using a binary logistic regression adjusting for gender and age, high risk for OSA was still found to be significantly associated with PM exposure (p = 0.022). Conclusion: Prior investigations have demonstrated a link between PM exposure and pulmonary disease, digestive disorders and PTSD. These results provide strong evidence for the association of PM exposure and OSA. In fact, PM exposure in this cohort of WTC first responders is one of the most significant contributors to increased OSA risk. Assessment of both OSA risk and exposure to PM are important as both have been linked to an increase in cardiovascular risk.

This study aimed to explore the association between serum steroid hormones (testosterone, estrogen), sex hormone-binding globulin (SHBG) levels, and the risk of obstructive sleep apnea (OSA) among adults in the United States, as well as to evaluate the potential utility of these biomarkers for OSA risk screening. Data were collected from the 2015 to 2016 National Health and Nutrition Examination Survey, including 3331 adults aged 20 years or older. OSA symptoms were assessed via self-reported questionnaires. Serum concentrations of testosterone, estrogen, and SHBG were measured. Sample-weighted logistic regression was used to investigate associations between hormone indicators and OSA risk, with restricted cubic spline models to check for nonlinear relationships. Subgroup analyses tested the robustness of the associations. Receiver operating characteristic curves and area under the curve were used to evaluate the screening utility of testosterone and SHBG. Among the 3331 participants, 1674 were classified as having OSA. Univariate analysis showed that higher testosterone was associated with increased OSA risk, but after adjusting for confounders, testosterone was inversely related to OSA risk (OR = 0.69, 95% confidence interval: 0.54–0.90), with a nonlinear threshold effect. Lower SHBG levels were significantly associated with a higher risk of OSA (OR = 0.71, 95% confidence interval: 0.59–0.85), a finding that remained robust across multiple models and subgroup analyses. Receiver operating characteristic analysis showed that ln(SHBG) had limited discriminatory power for OSA screening (area under the curve, AUC = 0.595). Estrogen levels were not significantly associated with OSA risk. Lower SHBG levels are significantly associated with increased OSA risk. While its standalone value is limited, SHBG may serve as a complementary biomarker in multifactor OSA risk assessment. The testosterone–OSA relationship appears complex, suggesting clinical use should account for multiple influencing factors. Future research should integrate multidimensional biomarkers to optimize early detection and risk assessment for OSA.

To estimate the rate of obstructive sleep apnea (OSA) and associated factors among Lebanese adults. A cross-sectional study was conducted in February-April 2022; 1,202 Lebanese adults were enrolled. The sample was collected among several Lebanese governorates through an anonymous online self-reported questionnaire. The STOP-BANG questionnaire was used as a screening tool to estimate the OSA risk. "Low OSA risk" is established with 0-2 positive answers, "Intermediate OSA risk" is established by 3-4 positive answers while "High OSA risk" is established by 5-8 positive answers. This study showed that 743 (62.4%) of the sample had low risk for OSA, 357 (30.0%) had moderate, and 90 (7.6%) had high risk for OSA. Older age (aOR = 1.05) and having hypertension (aOR = 7.80) were associated with higher odds of moderate OSA. Female sex (aOR = 0.04) was significantly associated with lower odds of moderate OSA compared to males. Older age (OR = 1.17), higher BMI (OR = 1.14), hypertension (OR = 18.55), and having severe COVID-19 infection compared to mild (OR = 4.30) were significantly associated with higher odds of high OSA, whereas female sex (OR = 0.002) and being married compared to single (aOR = 0.23) were associated with lower odds of high OSA. This study showed that most Lebanese adults have low risk for OSA. It also confirmed that sex, age, obesity, hypertension, and severe COVID-19 were associated with high OSA risk. These associated factors call for future research exploring the causes including the potential effect of social, economic, and political instability, local customs, and environmental factors. Moreover, future health campaigns should be assigned to increase awareness among Lebanese population regarding the prevention of OSA through lifestyle modifications.

Introduction Health consequences of co-occurring obstructive sleep apnea (OSA) and insomnia have been well documented. However, little is known about the mental and physical consequences of co-occurring OSA and insomnia among Blacks. We aimed to investigate the rate of OSA risk and insomnia symptoms and potential associations with physical and mental health in a community sample of Blacks. Methods Data were collected from an NIH-funded study ‘Peer-Enhanced Education to Reduce Sleep Ethnic Disparities, designed to navigate blacks at risk of OSA to receive timely diagnosis and treatment using peer-delivered linguistically and culturally tailored sleep health education. Blacks (n=878) were screened for OSA using the Apnea Risk Evaluation System Questionnaire; a score ≥6 denoted high OSA risk. The Sleep Disorders Questionnaire was used to assess insomnia based on three common insomnia symptoms: trouble falling asleep, difficulty staying asleep, and early morning awakening. Physical Health Composite Score (SF-12PCS) and Mental Health Composite Scores (SF-12MCS) were generated based on how the person answered the SF-12 questions. Scores range from 0 to 100, where 0 indicates the lowest level of health and 100, the highest. Logistic regression models were used to assess associations of physical and mental health among Blacks at risk for OSA, reporting insomnia symptoms, and co-occurring OSA risk and insomnia symptoms. All models adjusted for differences in age, sex, and BMI.#8232; Results The prevalence of OSA risk, insomnia symptoms, and co-occurring OSA risk and insomnia symptoms was 47.9%, 73.3%, and 40.2%, respectively. Logistic regression analyses showed lower physical score was positively associated with the odds of reporting insomnia symptoms (OR=1.03, p=0.007) and co-occurring OSA risk and insomnia symptoms (OR=1.02, p=0.001). Lower mental score was positively associated with the odds of OSA risk (OR=1.04, p=0.001), insomnia symptoms (OR=1.04, p=0.001), and co-occurring OSA risk and insomnia symptoms (OR=1.04, p=0.001). Individuals with OSA were less likely to report higher physical scores compared with those with co-occurring OSA risk and insomnia symptoms. Conclusion Results demonstrate that blacks with insomnia symptoms are more likely to endorse worse physical and mental health. Future research should investigate further the mechanism underlying co-occurring OSA and insomnia in this population using objective measurements. Support (If Any) Support: NIH R01MD007716