Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2018 May 15;14(5):809-817.
doi: 10.5664/jcsm.7112.

Prevalence, Associated Clinical Features, and Impact on Continuous Positive Airway Pressure Use of a Low Respiratory Arousal Threshold Among Male United States Veterans With Obstructive Sleep Apnea

Andrey Zinchuk  1 , Bradley A Edwards  2   3 , Sangchoon Jeon  4 , Brian B Koo  5 , John Concato  1   6 , Scott Sands  7 , Andrew Wellman  7 , Henry K Yaggi  1
Affiliations
Observational Study

Prevalence, Associated Clinical Features, and Impact on Continuous Positive Airway Pressure Use of a Low Respiratory Arousal Threshold Among Male United States Veterans With Obstructive Sleep Apnea

Andrey Zinchuk et al. J Clin Sleep Med. .

Abstract

Study objectives: Determine the prevalence of, and clinical features associated with, a low respiratory arousal threshold (ArTH) among patients with obstructive sleep apnea (OSA), and to assess whether a low ArTH is associated with reduced long-term CPAP use.

Methods: Cross-sectional and longitudinal analyses were performed in an observational study conducted among 940 male Veterans with OSA. Data for clinical characteristics, polysomnography characteristics, and long-term (5 ± 2 years) CPAP use were obtained from clinical records. Logistic regression was used to assess the associations between low ArTH and clinical features, including regular CPAP use.

Results: A low ArTH was observed in 38% of participants overall, and was more common among nonobese (body mass index < 30 kg/m2) patients (55%). In adjusted analyses, increasing body mass index (per 5 kg/m2) and antihypertensive medication use were negatively associated with low ArTH, with odds ratio (OR) (95% confidence interval [CI]) of 0.77 (0.69, 0.87) and 0.69 (0.49, 0.98), respectively. Conversely, increasing age (per 10 years) and antidepressant use-OR (95% CI) 1.15 (1.01,1.31) and 1.54 (1.14,1.98), respectively-were positively associated with low ArTH. Nonobese patients with low ArTH were less likely to be regular CPAP users-OR (95% CI) 0.38 (0.20, 0.72)-in an adjusted model.

Conclusions: Low ArTH is a common trait among Veterans with OSA and is more frequent among those who are older and nonobese and those taking antidepressants, but is less frequent among patients taking antihypertensive medications. A marked reduction of long-term CPAP use in nonobese patients with low ArTH highlights the importance of understanding a patient's physiologic phenotype for OSA management, and suggests potential targets to improve CPAP adherence.

Commentary: A commentary on this article appears in this issue on page 713.

Keywords: adherence; arousal threshold; continuous positive airway pressure; depression; hypertension; obesity; obstructive sleep apnea; race.

PubMed Disclaimer

Figures

Figure 1
Figure 1. Algorithm for analytic study sample selection from the source cohort.
AHI = apnea-hypopnea index, DREAM = Determining Risk of Vascular Events by Apnea Monitoring study, OSA = obstructive sleep apnea.
Figure 2
Figure 2. Predictors of low ArTH in multivariate model (n = 885).
AHI = apnea-hypopnea index, ArTH = arousal threshold, BMI = body mass index, CI = confidence interval. Low ArTH = being easily awakened from sleep in response to airway obstruction versus high ArTH = difficult to arouse from the same stimulus.
Figure 3
Figure 3. Regular CPAP use among male United States Veterans with low and high ArTH, stratified by obesity (n = 889).
51 patients missing either CPAP use or BMI data. Odds of regular CPAP use in Veterans with low versus high ArTH, stratified by obesity (n = 889), unadjusted. ArTH = arousal threshold, BMI = body mass index, CPAP = continuous positive airway pressure.
See this image and copyright information in PMC

Comment in

References

    1. Senaratna CV, Perret JL, Lodge CJ, et al. Prevalence of obstructive sleep apnea in the general population: a systematic review. Sleep Med Rev. 2017;34:70–81. - PubMed
    1. Redline S, Strauss ME, Adams N, et al. Neuropsychological function in mild sleep-disordered breathing. Sleep. 1997;20(2):160–167. - PubMed
    1. Findley LJ, Unverzagt ME, Suratt PM. Automobile accidents involving patients with obstructive sleep apnea. Am Rev Respir Dis. 1988;138(2):337–340. - PubMed
    1. Nieto FJ, Young TB, Lind BK, et al. Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep Heart Health Study. JAMA. 2000;283(14):1829–1836. - PubMed
    1. Kendzerska T, Gershon AS, Hawker G, Tomlinson G, Leung RS. Obstructive sleep apnea and incident diabetes. A historical cohort study. Am J Respir Crit Care Med. 2014;190(2):218–225. - PubMed

Publication types