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Biomedical subjects

Meir H Kryger

Publications and source records attributed to Meir H Kryger.

16 recordsLinked to original sources
PubMed2006

Healthcare utilization in women with obstructive sleep apnea syndrome 2 years after diagnosis and treatment.

UNLABELLED: SUBJECTIVE OBJECTIVES: To document healthcare utilization 2 years after diagnosis in women with obstructive sleep apnea syndrome (OSAS). DESIGN: Retrospective observational cohort study. SETTING: Tertiary university-based medical center. PATIENTS AND CONTROLS: Four hundred and fourteen women with OSAS were matched with 1404 women from the general population who served as controls. INTERVENTIONS: Patients were treated with continuous positive airway pressure (CPAP) or were recommended weight loss alone. MEASUREMENTS AND RESULTS: There were 231 treatment compliant (TC) patients, 91 patients not using CPAP (NCU), and 92 patients who were only recommended weight loss (WL). In the entire group, there was increase in fees of $123.43+/-$25.01 in the 2 years before diagnosis and a reduction of fees of $37.96+/-$21.35 in the 2 years after diagnosis (p < .0001). Physician claims increased in the 2 years before diagnosis by $111.22+/-31.35 in TC and by $152.77+/-59.55 in the NCU groups and then decreased in TC by $20.96+/-$26.60 (p < .01) and NCU by $72.20 +/-45.91 in the 2 years after diagnosis (p < .01). The fees in WL group did not change significantly. The number of clinic visits of the entire group increased in the 2 years before diagnosis by 2.32+/-0.43 and decreased over the next 2 years by 1.48+/-0.42 visits (p < .0001). There was an increase of clinic visits in the 3 subgroups in the 2 years before diagnosis (2.30+/-0.57 in TC, 2.55+/-0.99 in NCU, and 2.18+/-0.82 in WL groups) followed by a reduction of clinic visits over the next 2 years (1.56+/-0.55 fewer visits in TC [p < .0001], 1.70+/-0.90 in NCU [p < .01], and 1.04+/-0.90 in the WL group [p < .05] ). CONCLUSIONS: Healthcare utilization in women with OSAS increased in the years before sleep-clinic evaluation and then decreased in the following 2 years.

Body Mass Index↗
PubMed2005

Long-term treatment of sleep breathing disorder in a patient with Huntington's disease.

Huntington's disease (HD) is an autosomal dominant neurodegenerative disorder. An association with sleep breathing disorder has not previously been established in the literature. We report the case of a 45-year-old woman with HD, presenting with snoring and observed apnea. Polysomnography showed obstructive sleep apnea with an apnea-hypopnea index (AHI) of 6.6 per hour including events up to 57 s long during rapid eye movement (REM) sleep. A trial of continuous positive airway pressure (CPAP) resulted in significant improvement in sleep structure, nocturnal respiration, daytime alertness, and subjective memory. Snoring, apneas, and respiratory arousals were abolished on CPAP. HD patients may suffer from sleep breathing disorder, and in spite of potential chorea, CPAP is feasible and may significantly improve their quality of life.

Continuous Positive Airway Pressure↗
PubMed2005

Experience in using split-day studies for suspected obstructive sleep apnea syndrome.

BACKGROUND: Because in many locations the demand for sleep studies exceeds resources, we evaluated the utility of split-day in-laboratory studies (SDS) in highly selected patients. METHODS: We studied 100 eligible cases: 68 males (age 48.6+/-1.3 [standard error, se] years, body mass index (BMI): 32.6+/-0.8 kg/m(2)) and 32 females (age 50.9+/-2.4 years, BMI: 36.3+/-1.3 kg/m(2)) with severe subjective sleepiness (Epworth sleepiness scale: ESS 16) and suspected obstructive sleep apnea syndrome (OSAS). RESULTS: There were 86 conclusive studies that yielded both a diagnosis and sufficient information for management (86.0%) and 14 inconclusive studies that did not yield sufficient information for management (14.0%). In six cases (6.0%) with an inconclusive study a diagnosis was made, however, no titration data was obtained. Thus a definitive diagnosis was obtained in 92.0% of all cases. Those with inconclusive studies had additional assessment, and eight of them ultimately had a final diagnosis of a sleep breathing disorder (SBD) and six had another sleep disorder: four had narcolepsy, one had a movement disorder, one had sleep deprivation. Thus there were six patients (6.0%) in whom SDS yielded only an SBD diagnosis but there was insufficient data for titration; two patients (2.0%) who ultimately had severe OSAS who were not diagnosed on SDS. CONCLUSIONS: SDS was found to be useful in the evaluation and treatment of highly selected patients with severe daytime sleepiness (ESS 16) and suspected OSAS.

Delivery of Health Care↗
PubMed2005

Utilization of healthcare resources in obstructive sleep apnea syndrome: a 5-year follow-up study in men using CPAP.

STUDY OBJECTIVES: Patients with untreated obstructive sleep apnea syndrome (OSAS) have higher healthcare utilization than matched controls. However, the long-term impact of continuous positive airway pressure (CPAP) use on healthcare utilization is unknown. DESIGN: Retrospective observational cohort study. SUBJECTS: There were 342 eligible men with OSAS and matched controls on whom there were utilization data for 5 years prior to initial OSAS diagnosis and for the 5 years on CPAP treatment of the cases. INTERVENTIONS: Patients were treated with CPAP. RESULTS: Patients with OSAS were typical cases (mean +/- SD): age, 48.2 +/- 0.6 years; body mass index, 35.6 +/- 0.4 kg/m2; Epworth Sleepiness Scale score, 14.2 +/- 0.3; apnea-hypopnea index, 47.1 +/- 1.8 events per hour. The number of physician visits were higher by 3.46 +/- 0.2 (95% confidence interval [CI]: 2.57 to 4.36) in cases in the year before diagnosis, compared with the fifth year before diagnosis, then decreased over the next 5 years by 1.03 +/- 0.49 (95% CI: -1.99 to -0.07)(P<.0001). Physician fees, in Canadian dollars, were higher by dollars 148.65 +/- dollars 27.27 (95% CI: 95.12 to 202.10) in cases in the year before diagnosis, compared with the fifth year before diagnosis, and then decreased over the next 5 years by dollars 13.92 +/- dollars 27.94(95%CI: -68.68 to 40.83)(P=.0009). Preexisting ischemic heart disease at the time of OSAS diagnosis predicted about a 5-fold increase in healthcare utilization between the second and fifth year of treatment. CONCLUSIONS: Treatment of OSAS reversed the trend of increasing healthcare utilization seen prior to diagnosis. Preexisting ischemic heart disease results in a negative impact on healthcare utilization. CPAP results in a long-term health benefit, as measured by the use of healthcare services.

Adult↗
PubMed2005

Differences between men and women in the clinical presentation of patients diagnosed with obstructive sleep apnea syndrome.

STUDY OBJECTIVES: Obstructive sleep apnea syndrome (OSAS) results from recurrent episodes of breathing cessation during sleep. Epidemiologic studies have shown that OSAS is more prevalent in men than women (4% vs 2%). Previous studies have explored gender-related differences in upper airway anatomy and function, hormone physiology, and polysomnographic findings. The aim of this study is to assess differences in clinical presentation between women and men with OSAS. DESIGN: Retrospective chart review analysis. SETTING: Tertiary university-based medical center PARTICIPANTS: 130 randomly selected women with OSAS matched individually with 130 men with OSAS for age, body mass index, apnea-hypopnea index, and Epworth Sleepiness Scale score. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: Data were obtained from questionnaires and in-laboratory polysomnographic studies. There were no differences between the genders for age (48.0 +/- 1.1 years [mean +/- SEM] for women vs 47.6 +/- 1.0 years for men), body mass index (40.4 +/- 0.7 kg/m2 for women vs 40.0 +/- 0.6 kg/m2 for men), apnea-hypopnea index (36.8 +/- 3.3/hour for women vs 36.0 +/- 3.0/hour for men), or Epworth Sleepiness Scale score (12.45 +/- 0.53 for women vs 12.84 +/- 0.47 for men). Although snoring and sleepiness were similarly common in women and men, women more often described their main presenting symptoms as insomnia (odds ratio: 4.20; 95% confidence interval: 1.54-14.26) and were much more likely to have a history of depression (odds ratio: 4.60; 95% confidence interval: 1.71-15.49) and hypothyroid disease (odds ratio: 5.60; 95% confidence interval: 2.14-18.57). Women presented less often with a primary complaint of witnessed apnea (odds ratio: 0.66; 95% confidence interval: 0.38-1.12), consumed less caffeine per day (3.3 cups in women vs 5.2 cups in men; P = .0001), and admitted to less alcohol consumption (odds ratio: 0.36; 95% confidence interval: 0.18-0.70). CONCLUSIONS: At the time of OSAS diagnosis, women with OSAS are more likely to be treated for depression, to have insomnia, and to have hypothyroidism than are men with the same degree of OSAS.

Adult↗
PubMed2003

Sleep disorders in a military population.

INTRODUCTION: Sleep disorders are common in the civilian population, but little is known about which sleep disorders are common in members of the military. This article compares a group of military personnel referred to our sleep disorders center with a group of civilian controls also referred to our sleep disorders center. METHODS: We analyzed the data of 70 Canadian military personnel and 70 civilian controls matched for age and gender. All subjects had full polysomnography. We compared reasons for referral and final sleep diagnoses for both groups. RESULTS: The mean age of each group was 40.8 +/- 7.0 SD (military) and 40.8 +/- 7.3 SD (civilians), and there were 61 men and 9 women in each group. Both groups were obese (body mass index, 30.2 +/- 5.3 (military) versus 32.5 +/- 6.9 (civilian)). Both groups were also pathologically sleepy during the day (Epworth Sleepiness Score, 10.4 +/- 4.6 (military) versus 11.3 +/- 5.4 (civilian)). The majority of referrals in each group were to rule out a sleep breathing disorder (SBD) (66% military versus 79% civilian, p = not significant). Only military patients were referred to rule out a movement disorder (17.1% military versus 0% civilian; 95% confidence interval of the difference = 8.4%-27.6%, p < 0.05). Fewer military were referred because of excessive daytime sleepiness or insomnia (7.1% military versus 20.0% civilian, 95% confidence interval of the difference = -24.4% to -1.4%, p < 0.05). The most common diagnosis confirmed in both groups was a SBD (53% military, 66% civilian, p = not significant). CONCLUSIONS: The range and distribution of sleep disorders seen in the military population is similar to that in the civilian population. Both groups were overweight and sleepy and were found to have SBD and movement disorders. These findings underscore the importance of diagnosing and treating sleep disorders in both groups. The neurocognitive impairment associated with SBD and movement disorders impacts highly on the ability of these groups to safely perform their jobs.

Adult↗
PubMed2002

Gender and obstructive sleep apnea syndrome, part 2: mechanisms.

Epidemiologic studies have reported that obstructive sleep apnea syndrome (OSAS) is a common disorder affecting about four percent of adult males and two percent of adult females. This difference in OSAS prevalence suggests that the female gender may reduce the risk of sleep breathing disorders in adults. We review several interrelated factors that may explain the differences in risk related to gender. These include differences in obesity and the distribution of adipose tissue, upper-airway anatomy, upper-airway muscle function, control of ventilation, the effect of sex hormones and leptin. The gender related protective effect decreases in females who are postmenopausal and not on hormone replacement therapy.

Adipose Tissue↗
PubMed2002

Gender and obstructive sleep apnea syndrome, part 1: Clinical features.

In the two decades after obstructive sleep apnea syndrome (OSAS) was described, it was considered a disease primarily of males. As a result, for many years, epidemiologic studies of the general population examining the prevalence of OSAS included only males and investigators examined almost exclusively males in their pathophysiologic studies. It has been widely recognized that OSAS in women is not as rare as it was originally believed. Whereas early studies of clinic populations suggested that females made up about 10% or less of OSAS cases, later studies of the general population suggest that about a third of all cases are females. This suggests that there may be clinical under-recognition of OSAS in females. We explore the reasons for the male predominance of OSAS, and the clinical under-recognition in females by examining differences in clinical presentation and polysomnography findings between male and female patients.

Adolescent↗
PubMed2002

Low body stores of iron and restless legs syndrome: a correctable cause of insomnia in adolescents and teenagers.

BACKGROUND: It has been shown that restless legs syndrome (RLS) in adults may be linked to abnormalities in iron stores. Whether reduced iron stores play a role in children is not clear. METHODS: We evaluated the status of iron stores and sleep in three teenagers who presented with severe sleep onset insomnia, subjective sleep latency exceeding 60 min and excessive daytime sleepiness. RESULTS: The three teenagers were found to have RLS and laboratory evaluation confirmed reduced body stores of iron with a low percent iron saturation (mean value 9.7%) and a low serum ferritin level (mean value 17 microg/l). None had marked anemia. The three patients were treated with oral iron for 4-5 months. As a group they had an increase in percent iron saturation (from a mean of 9.7 to 22.7%) and serum ferritin (from a mean of 17 to 27 microg/l) and a marked reduction of the symptoms of RLS, with mean subjective sleep latency decreasing from 143 to 23 min, sleep efficiency increasing from 75.7 to 84.0% and the number of periodic movements per hour of sleep decreasing from 20.5 to 10.5. INTERPRETATION: These findings support the hypothesis that abnormal iron stores or metabolism may result in RLS causing insomnia in teenagers. We recommend evaluation of iron status including serum iron, total iron binding capacity and ferritin levels in teenagers with chronic insomnia of unexplained origin even when anemia is mild or absent.

Journal Article↗
PubMed2002

What are obstructive sleep apnea patients being treated for prior to this diagnosis?

BACKGROUND: Patients with obstructive sleep apnea syndrome (OSAS) use health-care resources at higher rates than control subjects for years prior to diagnosis. Although obesity and certain cardiovascular disorders are more common in OSAS patients, the precise cause of increased health-care utilization is unclear. OBJECTIVES: To examine the causes of increased utilization, and what patients with OSAS were being treated for prior to this diagnosis. METHODS: We compared the records of 773 patients with OSAS to those of age-, gender-, geographic-, and physician-matched control subjects from the general population. RESULTS: We found that sleep apnea patients used 23 to 50% more resources (defined by physician fees, physician visits, and hospital nights) in the 5 years prior to diagnosis than did control subjects. We examined the diagnoses made and found that apnea patients are at higher risk for hypertension (odds ratio [OR], 2.5; 95% confidence interval [CI], 2.0 to 3.3), congestive heart failure (OR, 3.9; 95% CI, 1.7 to 8.9), cardiac arrhythmias (OR, 2.2; 95% CI, 1.2 to 4.0), cardiovascular disease (OR, 2.6; 95% CI, 2.0 to 3.3), chronic obstructive airways disease (OR, 1.6; 95% CI, 1.2 to 2.0), and depression (OR, 1.4; 95% CI, 1.0 to 1.9). To control for the confounding effects of obesity and to determine the independent effects of body mass index (BMI), gender, age, degree of hypoxemia, apnea-hypopnea index, and sleepiness in the 773 patients, we performed a logistic regression analysis with the dependent variable being diagnosis, and a linear regression analysis with the dependent variable being measures of health-care utilization. Age and BMI were significant independent predictors of most cardiovascular diagnoses and arthropathy. Male gender predicted ischemic heart disease (OR, 2.98; 95% CI, 1.36 to 6.54), and female gender was predictive of chronic obstructive airways disease (OR, 2.63; 95% CI, 1.85 to 3.72) and depression (OR, 2.24; 95% CI, 1.45 to 3.44). The best model predicting health-care utilization measures was comprised of age, gender, and BMI, and explained 9%, 14%, and 8% of the variability in physician fees, number of physician claims, and number of physician visits, respectively. CONCLUSION: Of all comorbid diagnoses, significantly increased utilization was found for cardiovascular disease and especially hypertension in the OSAS patients.

Adult↗