Samuel T. Kuna

Background: Short sleep duration has been widely linked to increased cardiovascular morbidity and mortality, although the underlying mechanisms for this relationship remain unclear. Maladaptive circadian variations in blood pressure (BP) may be an important mediator of adverse outcomes in people with short sleep duration. Our goal was to evaluate the association between sleep duration and 24-hour BP control. Methods: We performed a post-hoc analyses of 24-hour ambulatory BP monitoring in 219 non-hypertensive and pre-hypertensive adults in the Lifestyle Modification in BP Lowering Study (LIMBS) and Penn Icelandic Sleep Apnea (PISA) Study. Results: The 24-hour mean systolic BP was 12.7 mmHg higher in LIMBS (see Figure; pConclusions: Shorter sleep duration is strongly associated with higher systolic BP on 24-hour ambulatory BP monitoring; the association seems to be independent of nocturnal and in-office BP. Adults with shorter sleep duration may benefit from screening with 24-hour ambulatory BP monitoring to promote earlier detection of hypertension and potentially mitigate their increased risk for future cardiovascular disease.

To determine if the large and highly reproducible interindividual differences in arousal intensity and heart rate response to arousal (ΔHR) during non-REM sleep are heritable. Polysomnograms of 55 monozygotic (14 male and 41 female pairs) and 36 dizygotic (15 male and 21 female pairs) same-sex twin pairs were analyzed. Arousals were scored using the 2012 American Academy of Sleep Medicine criteria. Arousal intensity was scaled (between 0 and 9) using an automatic algorithm based on the change in electroencephalogram time and frequency characteristics. The ΔHR was determined at each arousal. We calculated average arousal duration, average arousal intensity, average overall ΔHR, average ΔHR at a given arousal intensity, slope of ΔHR per arousal intensity, and arousal intensity threshold of ΔHR. The intraclass correlations among monozygotic and dizygotic twin pairs were 0.663 and 0.146, respectively, for average arousal intensity, and 0.449 and 0, respectively, for arousal intensity threshold of ΔHR controlling for age, sex, and race. These values imply large broad sense heritability (H²) for these traits. This evidence was confirmed by a robust maximum likelihood-based variance components estimation approach, with an additive genetic heritability of 0.64 (95% confidence interval: 0.48 to 0.80) for average arousal intensity and a combined additive and dominance genetic heritability and of 0.46 (0.25 to 0.68) for arousal intensity threshold of ΔHR. Results also suggested significant additive genetic effects for average arousal duration, ΔHR at arousal intensity scale 4 and the overall average ΔHR. Genetic factors explain a significant fraction of the phenotypic variability for average arousal intensity and arousal intensity threshold of ΔHR. Results suggest that the duration of arousals and specific average ΔHR values may also be heritable traits. NCT02827461

S and full research articles published in SLEEP, the official journal of the APSS. Sleep and sleep disorder scientific findings.

Study Objectives:. To determine intersite agreement in respiratory event scoring of polysomnograms (PSGs) using different hypopnea definitions.Design:.

S and full research articles published in SLEEP, the official journal of the APSS. Sleep and sleep disorder scientific findings.

S and full research articles published in SLEEP, the official journal of the APSS. Sleep and sleep disorder scientific findings.

Portable-monitor testing is being used increasingly in ambulatory management pathways for the diagnosis and treatment of patients with obstructive sleep apnea. Wide varieties of portable monitors are commercially available and they range from single-channel recorders to units that record a full polysomnogram. Recent comparative effectiveness research studies have shown that clinical outcomes of patients with a high pretest probability for obstructive sleep apnea who receive ambulatory management using portable-monitor testing have similar functional outcomes and adherence to continuous positive airway pressure treatment, compared to patients managed with in-laboratory polysomnography. The cost-effectiveness of portable-monitor testing and its potential to improve patient access to diagnosis and treatment requires further investigation.

Obstructive sleep apnea (OSA) patients’ consistent use of continuous positive airway pressure (CPAP) therapy is critical to realizing improved functional outcomes and reducing untoward health risks associated with OSA. We conducted a mixed methods, concurrent, nested study to explore OSA patients’ beliefs and perceptions of the diagnosis and CPAP treatment that differentiate adherent from nonadherent patients prior to and after the first week of treatment, when the pattern of CPAP use is established. Guided by social cognitive theory, themes were derived from 30 interviews conducted postdiagnosis and after 1 week of CPAP use. Directed content analysis, followed by categorization of participants as adherent/nonadherent from objectively measured CPAP use, preceded across-case analysis among 15 participants with severe OSA. Beliefs and perceptions that differed between adherers and nonadherers included OSA risk perception, symptom recognition, self-efficacy, outcome expectations, treatment goals, and treatment facilitators/ barriers. Our findings suggest opportunities for developing and testing tailored interventions to promote CPAP use.