Farrell Historical Landmarks

Dr. Peter Farrell, ResMed Founder and Chairman, identifies key research findings that are shaping the field of sleep medicine today.

Dr. Peter C. Farrell PhD, DSc, AM is a graduate of the University of Sydney, the Massachusetts Institute of Technology, the University of Washington, Seattle, and the University of New South Wales. More about Peter.

Historical landmarks

• Unexpectedly high prevalence of sleep disordered breathing in a population
  
  Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. New Engl J Med 1993;328(17):1230-5

• Foundation of a sleep disorders clinic at Stanford University with recognition of sleep apnoea syndromes as a medical disorder
  
  Guilleminault C, Tilkian A, and Dement W. The sleep apnea syndromes. Annual Reviews 1976 465-484

• Invention of nasal CPAP to treat obstructive sleep apnoea
  
  Sullivan C, Issa F, Berthon-Jones M, Eves L Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares. Lancet 1981;18;1(8225):862-5

• Confirmation of the clinical effectiveness of nasal CPAP after reports of failure
  
  Rapoport D, Sorkin B, Gary S, Goldring R. Reversal of the “Pickwickian Syndrome” by long-term use of nocturnal nasal –airway pressure. New Eng J Med 1982;307(15)931-3

• Acknowledgement by a group of clinical specialists that CPAP effectively treats obstructive sleep apnoea
  
  Block A, Faulkner J, Hughes R, Remmers J, Thach B. Clinical conference in pulmonary disease: Factors influencing upper airway closure. Chest 1984;86:114-122

• Commercial production of CPAP
  
  Barnes C. ResMed Origins: A brief history of a company manufacturing devices for the diagnosis and treatment of sleep disordered breathing. ResMed 2007

• Sleep apnoea recognised as a major health problem in:
  • The medical literature
    • Phillipson EA. Sleep apnea--a major public health problem. New Engl J Med 1993;328(17):1271-1273
    • Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med 2002;165:1217–1239
  • A Report to Congress
    • Dement W (Chairman). Wake up America: A National Sleep Alert: Report of the National Commission on Sleep Disorders Research Submitted to the United States Congress. January 1993
• AutoSet feasibility
  
  Berthon-Jones M. Feasibility of a self-setting CPAP machine. Sleep 1993 16 S120-123

• Future developments
  
  Farrell P. The future of sleep medicine and the business of Sleep. Sleep Breath 2006;10:111-114

Diagnosis

Screening by questionnaire

• Berlin questionnaire and ASA checklist demonstrate a moderately high level of sensitivity for OSA screening
  • Chung F, Yegneswaran B, Liao P, Chung SA, Vairavanathan S, Islam S, Khajehdehi A, Shapiro CM. Validation of the Berlin questionnaire and American Society of Anesthesiologists checklist as screening tools for obstructive sleep apnea in surgical patients. Anesthesiology 2008;108(5):822-30
• The STOP questionnaire is short and can be easily incorporated into routine screening of general or surgical patients
  • Chung F, Elsaid H. Screening for obstructive sleep apnea before surgery: why is it important? The STOP questionnaire. Curr Opin Anaesthesiol 2009;22(3):405-11

Home Diagnosis

• Functional outcome in patients evaluated according to a home testing is not clinically inferior to that in patients receiving standard in-lab PSG
  • Kuna S, Gurubhagavatula I, Maislin G, Hin S, Hartwig K, McCloskey S, Hachadoorian R, Hurley S, Gupta R, Staley B, Atwood C. Noninferiority of functional outcome in ambulatory management of obstructive sleep apnea. Am J Respir Crit Care Med 2011;183(9):1238-44
• Home testing found to be equally clinically effective as attended testing
  • Domingo C, Vigil L. Effectiveness of unattended ambulatory sleep studies for the diagnosis and treatment of OSAS. J Eval Clin Pract 2011;17(1):26-31
  • Mulgrew A, Fox N, Ayas N, Ryan C. Diagnosis and initial management of obstructive sleep apnea without polysomnography: A randomized validation study. Ann Intern Med 2007;146(3):157-66
• No difference in PAP adherence for patients who underwent home testing vs. in-lab testing
  • Lettieri C, Lettieri C, Carter K. Does home sleep testing impair CPAP adherence in patients with obstructive sleep apnea? Chest 2011; DOI 10.1378/chest.10-1060
• ResMed's ApneaLink a clinically accurate screening tool
  • Ragette R, Wang Y, Weinreich G, Teschler H. Diagnostic performance of single airflow channel recording (ApneaLink) in home diagnosis of sleep apnea. Sleep Breath 2010;14(2):109-14
  • Erman M, Stewart D, Einhorn D, Gordon N, Casal E. Validation of the ApneaLink for the screening of sleep apnea: a novel and simple single-channel recording device. J Clin Sleep Med 2007;3(4):387-392
  • Oktay B, Rice T, Atwood C, Passero M, Gupta N, Givelber R, Drumheller O, Houck P, Godrdon N, Strollo P. Evaluation of a Single-Channel Portable Monitor for the Diagnosis of Obstructive Sleep Apnea. J Clin Sleep Med 2011;7(4):384-390. doi:10.5664/jcsm.1196
• ApneaLink is highly sensitive and specific in quantifying the AHI when compared against PSG
  • Ng SS, Chan T, To K, Ngai J, Tung A, Ko F, Hui D. Validation of a portable recording device (ApneaLink) for identifying patients with suspected obstructive sleep apnoea syndrome. Intern Med J 2009;39:757-762
• ApneaLink Plus shows strong correlation in detecting and differentiating apnoea event types compared to manual apnoea scoring with PSG
  • D2231-127: ApneaLink Plus White Paper. ResMed Ltd. Bella Vista, NSW Australia 2009
• ApneaLink shown to detect Cheyne-Stokes respiration with a high degree of diagnostic accuracy
  • Weinreich G, Armitstead J, Topfer V, Wang Y, Teschler H. Validation of ApneaLink as screening device for Cheyne-Stokes respiration. Sleep 2009;32(4):553-557

All-cause mortality

• ApneaLink shown to detect Cheyne-Stokes respiration with a high degree of diagnostic accuracy
  • Rich J, Raviv A, Raviv N, Brietzke S. An Epidemiologic Study of Snoring and All-Cause Mortality.Otolaryngol Head Neck Surg 2011 Mar 18 [Epub ahead of print]
• EDS associated with heightened mortality risk in elderly population, independent of other risk factors
  • Gooneratne N, Richards K, Joffe M, Lam R, Pack F, Staley B, Dinges D, Pack AI. Sleep disordered breathing with excessive daytime sleepiness is a risk factor for mortality in older adults. Sleep2011;34(4):435-442
• SDB associated with increased risk of all-cause mortality, especially with relation to coronary artery disease and in men aged 40 to 70
  • Punjabi N, Caffo B, Goodwin J, Gottlieb D, Newman A, O'Connor G, Rapoport D, Redline S, Resnick H, Robbins J, Shahar E, Unruh M, Samet J. Sleep-disordered breathing and mortality: a prospective cohort study. PLoS Medicine 2009;6(8):e1000132. Comment in Postgrad Med 2009;121(6):197-9
• Findings from Wisconsin Sleep Cohort Study underscore need for greater clinical recognition and strategies to address sleep apnoea impact
  • Young T, Palta M, Dempsey J, Peppard P, Nieto FJ, Hla K. Burden of sleep apnea: rationale, design, and major findings of the Wisconsin Sleep Cohort study. Wis Med J 2009;108(5):246-9
• Findings from Wisconsin Sleep Cohort Study underscore need for greater clinical recognition and strategies to address sleep apnoea impact
  • Young T, Finn L, Peppard PE, Szklo-Coxe M, Austin D, Nieto FJ, Stubbs R, Hla KM. Sleep disordered breathing and mortality: Eighteen-year follow-up of the Wisconsin sleep cohort. Sleep 2008;31(8):1071-1078
• Busselton Health Study finds sleep apnoea an independent risk factor for all-cause mortality in a community-based sample free from clinical referral bias
  • Marshall NS, Wong KK, Liu PY, Cullen SR, Knuiman MW, Grunstein RR. Sleep apnea as an independent risk factor for all-cause mortality: The Busselton Health Study. Sleep 2008;31(8): 1079-1085
• Sleep apnoea associated with increased risk of sudden death mortality from cardiac causes during sleep
  • Gami AS, Howard DE, Olson EJ, Somers VK. Day-night pattern of sudden death in obstructive sleep apnea. New Engl J Med 2005;352:1206-14

Cardiovascular disease

General

• On the use of CPAP versus oxygen supplementation in the management of patients with Obstructive Sleep Apnoea (OSA)
  • Gottlieb DJ, Punjabi NM, Mehra R, Patel SR, Quan SF, M.D., Babineau DC, Tracy RP, Rueschman M, Blumenthal RS, Eldrin F. Lewis EF, Bhatt DL, Redline S. CPAP versus Oxygen in Obstructive Sleep Apnea. N Engl J Med 2014; 370:2276–2285 June 12, 2014
• CPAP therapy can reverse systolic and diastolic abnormalities in OSA sufferers as early as 3 months into therapy
  • Colish J, Walker J, Elmayergi N, Almutairi S, Alharbi F, Lytwyn M, Francis A, Bohonis S, Zeglinski M, Kirkpatrick I, Sharma S, Jassal D. Obstructive sleep apnea: Effects of continuous positive airway pressure on cardiac remodeling as assessed by cardiac biomarkers, echocardiography, and cardiac MRI. Chest 2012 141(3):674–81
• Comorbidity of OSA and cardiovascular disease suggest OSA as a novel target for risk reduction
  • Monahan K and Redline S. Role of obstructive sleep apnea in cardiovascular disease. Curr Opin Cardiol2011;26(6):541-7

 Mortality

• OSA associated with increased risk of sudden cardiac death
  • Gami AS, Olson EJ, Shen WK, Wright RS, Ballman KV, Hodge DO, Herges RM, Howard DE, Somers VK. Obstructive sleep apnea and the risk of sudden cardiac death: a longitudinal study of 10,701 adults. J Am Coll Cardiol 2013; doi:10.1016/j.jacc.2013.04.080
• Obstructive sleep apnoea increases the risk of death from cardiovascular causes
  • Shah N, Yaggi H, Concato J, Mohsenin V. Obstructive sleep apnea as a risk factor for coronary events or cardiovascular death. Sleep Breath 2010;14(2):131-6

 Hypertension

• Obstructive sleep apnoea increases the risk of death from cardiovascular causes
  • Durán-Cantolla J, Aizpuru F, Montserrat JM, Ballester E, Terán-Santos J, Aguirregomoscorta JI, Gonzalez M, Lloberes P, Masa JF, De La Peña M, Carrizo S, Mayos M, Barbé F; Spanish Sleep and Breathing Group. Collaborators: López-Picado A, Miranda-Serrano E, Martinez-Null C, Rubio R, Alonso ML, Cordero J, Esteban C, Jiménez A, Carpizo MR, Sanpol G, Corral J, Rubio M, Barceló A, Piérola J, Marín JM. Continuous positive airway pressure as treatment for systemic hypertension in people with obstructive sleep apnoea: randomised controlled trial. Br Med J;2010;341:c5991. doi: 10.1136/bmj.c5991
  • Aihara K, Chin K, Oga T, Takahashi K, Hitomi T, Takegami M, Handa T, Niimi A, Tsuboi T, Mishima M. Long-term nasal continuous positive airway pressure treatment lowers blood pressure in patients with obstructive sleep apnea regardless of age. Hypertens Res 2010;33(10):1025-31
• Obstructive sleep apnoea increases the risk of death from cardiovascular causes
  • Albuquerque FN, Kuniyoshi FH, Calvin AD, Sierra-Johnson J, Romero-Corral A, Lopez-Jimenez F, George CF, Rapoport DM, Vogel RA, Khandheria B, Goldman ME, Roberts A, Somers VK. Sleep-disordered breathing, hypertension, and obesity in retired National Football League players. J Am Coll Cardiol 2010;56(17):1432-3
• An examination of the impacts of OSA on non-dipping hypertension and impacts of treatment on cardiovascular outcomes
  • Wolf J, Hering D, Narkiewicz K. Non-dipping pattern of hypertension and obstructive sleep apnea syndrome. Hypertens Res 2010;33(9):867-71
• Effective CPAP treatment in non-sleepy hypertensive OSA patients associated with blood pressure decrease
  • Barbé F, Durán-Cantolla J, Capote F, de la Peña M, Chiner E, Masa JF, Gonzalez M, Marín JM, Garcia-Rio F, de Atauri JD, Terán J, Mayos M, Monasterio C, del Campo F, Gomez S, de la Torre MS, Martinez M, Montserrat JM; Spanish Sleep and Breathing Group. Long-term effect of continuous positive airway pressure in hypertensive patients with sleep apnea. Am J Respir Crit Care Med 2010;181(7):718-26
• Difference in diurnal variation in the onset of myocardial infarction (MI) in OSA patients vs non-OSA patients suggests that OSA may be a trigger for MI
  • Somers VK, White DP, Amin R, Abraham WT, Costa F, Culebras A, Daniels S, Floras JS, Hunt CE, Olson LJ, Pickering TG, Russell R, Woo M, Young T. Sleep apnea and cardiovascular disease: an American Heart Association/American College of Cardiology Foundation Scientific Statement from the American Heart Association Council for High Blood Pressure Research Professional Education Committee,Council on Clinical Cardiology, Stroke Council, and Council on Cardiovascular Nursing. J Am Coll Cardiol2008;52(8):686-717. PubMed PMID: 18702977.

 Drug Resistant Hypertension

• Fluid redistribution during sleep may account for the high prevalence of OSA in drug-resistant hypertension
  • Friedman O, Bradley TD, Chan CT, Parkes R, Logan AG. Relationship between overnight rostral fluid shift and obstructive sleep apnea in drug-resistant hypertension. Hypertension 2010;56(6):1077-82.
• Fluid redistribution during sleep may account for the high prevalence of OSA in drug-resistant hypertension
  • Lloberes P, Lozano L, Sampol G, Romero O, Jurado MJ, Ríos J, Untoria MD, Tovar JL. Obstructive sleep apnoea and 24-h blood pressure in patients with resistant hypertension. J Sleep Res 2010;19(4):597-602. doi: 10.1111/j.1365-2869.2010.00839.x
• Fluid redistribution during sleep may account for the high prevalence of OSA in drug-resistant hypertension
  • Lozano L, Tovar JL, Sampol G, Romero O, Jurado MJ, Segarra A, Espinel E, Ríos J, Untoria MD, Lloberes P Continuous positive airway pressure treatment in sleep apnea patients with resistant hypertension: a randomized, controlled trial. J Hypertens 2010;28(10):2161-8
  • Martinez-Garcia MA, Gomez-Aldaravi R, Soler-Cataluna JJ, Martinez TG, Bernacer-Alpera B, Roman-Sanchez P. Positive effect of CPAP treatment on the control of difficult-to-treat hypertension. Eur Respir J 2007;29(5):951-7
• Hyperaldosteronism correlates to greater severity of OSA in drug-resistant hypertension
  • Gonzaga CC, Gaddam KK, Ahmed MI, Pimenta E, Thomas SJ, Harding SM, Oparil S, Cofield SS, Calhoun DA. Severity of obstructive sleep apnea is related to aldosterone status in subjects with resistant hypertension. J Clin Sleep Med2010;6(4):363-8

 Arteries

• CPAP withdrawal leads to rapid recurrence of OSA, subjective sleepiness, impaired endothelial function and cardiovascular impacts
  • Kohler M, Stoewhas A, Ayers L, Senn O, Bloch K, Russi E, Stradling J. The effects of CPAP therapy withdrawal in patients with obstructive sleep apnea: a randomised controlled trial. Am J Respir Crit Care Med 2011 doi:10.1164/rccm.201106-0964OC.
• High prevalence of OSA in AAA patients suggest OSA may be a causal factor for faster AAA expansion
  • Mason R, Ruegg G, Perkins J, Hardinge M, Amann-Vesti B, Senn O, Stradling J, Kohler M. Obstructive Sleep Apnea in Patients with Abdominal Aortic Aneurysms: highly prevalent and associated with aneurysm expansion. Am J Respir Crit Care Med 2011;183(5):668-74
• Concomitant endothelial dysfunction and impaired myocardial perfusion present in subjects with moderate-to-severe obstructive sleep apnea, and effective CPAP treatment reverses many of these macrovascular/microvascular abnormalities
  • Butt M, Khair O, Dwivedi G, Shantsila A, Shantsila E, Lip G. Myocardial perfusion by myocardial contrast echocardiography and endothelial dysfunction in obstructive sleep apnea. Hypertension2011;doi:10.1161/HYPERTENSIONAHA.111.170910
• CPAP improves endothelial function in OSA patients
  • Büchner N, Quack I, Woznowski M, Stähle C, Wenzel U, Rump L. Microvascular Endothelial Dysfunction in Obstructive Sleep Apnea Is Caused by Oxidative Stress and Improved by Continuous Positive Airway Pressure Therapy. Respiration (DOI: 10.1159/000323266)
  • Patt B, Jarjoura D, Haddad D, Sen C, Roy S, Flavahan N, Khayat R. Endothelial dysfunction in the microcirculation of patients with obstructive sleep apnea. Am J Respir Crit Care Med2010;182(12):1540-5
  • Bayram N, Ciftci B, Keles T, Durmaz T, Turhan S, Bozkurt E, Peker Y. Endothelial function in normotensive men with obstructive sleep apnea before and 6 months after CPAP treatment. Sleep2009;32(10):1257-63
• OSA may be associated with functional impairment on the endothelium and on arterial stiffness
  • Yim-Yeh S, Rahangdale S, Nguyen A, Jordan A, Novack V, Veves A, Malhotra A. Obstructive sleep apnea and aging effects on macrovascular and microcirculatory function. Sleep 2010;33(9):1177-83
• OSA may initiate atherogenic processes in patients with endothelial dysfunction
  • Priou P, Gagnadoux F, Tesse A, Mastronardi M, Agouni A, Meslier N, Racineux J, Martinez MC, Trzepizur W, Andriantsitohaina R. Endothelial dysfunction and circulating microparticles from patients with obstructive sleep apnea. Am J Pathol 2010;177(2):974-83
• Editorial calls for further exploration of effects of OSA and its treatment on AIx and peripheral and central BP
  • Phillips C, Avolio A, Grunstein R. Endothelial function and arterial stiffness in OSA using pulse wave analysis. Am J Respir Crit Care Med 2009;179(10):968
• Endothelial dysfunction in OSA may be independent of metabolic syndrome
  • Amra B, Karbasi E, Hashemi M, Hoffmann-Castendiek B, Golshan M. Endothelial dysfunction in patients with obstructive sleep apnoea independent of metabolic syndrome. Ann Acad Med Singapore2009;38(5):461-4

Arrhythmia

• CPAP in OSA improves arrhythmia-free survival in patients undergoing pulmonary vein isolation (PVI), while PVI offers limited value in OSA patients not treated with CPAP
  • Fein AS, Shvilkin A, Shah D, Haffajee CI, Das S, Kumar K, Kramer DB, Zimetbaum PJ, Buxton AE, Josephson ME, Anter E. Treatment of obstructive sleep apnea reduces the risk of atrial fibrillation recurrence following catheter ablation. J Am Coll Cardiol 2013 doi: 10.1016/j.jacc.2013.03.052
• Untreated OSA associated with higher recurrence of AF after ablation
  • Naruse Y, Tada H, Satoh M, Yanagihara M, Tsuneoka H, Hirata Y, Ito Y, Kuroki K, Machino T, Yamasaki H, Igarashi M, Sekiguchi Y, Sato A, Aonuma K. Concomitant obstructive sleep apnea increases the recurrence of atrial fibrillation following radiofrequency catheter ablation of atrial fibrillation: clinical impact of continuous positive airway pressure therapy. Heart Rhythm 2012 doi: 10.1016/j.hrthm.2012.11.015
• Patients with implantable cardioverter-defibrillators and SDB have a striking increase in the onset of life-threatening ventricular arrhythmic events during sleeping hours
  • Zeidan-Shwiri T, Aronson D, Atalla K, Blich M, Suleiman M, Marai I, Gepstein L, Lavie L, Lavie P, Boulos M. Circadian pattern of life-threatening ventricular arrhythmia in patients with sleep-disordered breathing and implantable cardioverter-defibrillators. Heart Rhythm 2011;8(5):657-662
• Evidence of direct temporal link between SDB events and development of nocturnal arrhythmias
  • Monahan K, Storfer-Isser A, Mehra R, Shahar E, Mittleman M, Rottman J, Punjabi N, Sanders M, Quan SF, Resnick H, Redline S. Triggering of nocturnal arrhythmias by sleep-disordered breathing events. J Am Coll Cardiol 2009;54(19):1797-804
• Presence and severity of SDB may be an important and potentially modifiable cause of morbidity and mortality in atrial fibrillation patients with HC
  • Konecny T, Brady PA, Orban M, Lin G, Pressman GS, Lehar F, Tomas K, Gersh BJ, Tajik AJ, Ommen SR, Somers VK. Interactions between sleep disordered breathing and atrial fibrillation in patients with hypertrophic cardiomyopathy. Am J Cardiol 2010;105(11):1597-602
• Moderate/severe OSA is associated with high prevalence of concentric LV geometry
  • Cioffi G, Russo TE, Stefenelli C, Selmi A, Furlanello F, Cramariuc D, Gerdts E, de Simone G. Severe obstructive sleep apnea elicits concentric left ventricular geometry. J Hypertens 2010;28(5):1074-82
• Ventricular arrhythmia patients with sleep apnoea have high recurrence of arrhythmias after successful catheter ablation
  • Koshino Y, Satoh M, Katayose Y, Kuroki K, Sekiguchi Y, Yamasaki H, Yoshida K, Yasuda K, Tanigawa T, Kuga K, Aonuma K. Sleep apnea and ventricular arrhythmias: Clinical outcome, electrophysiologic characteristics, and follow-up after catheter ablation. J Cardiol 2010;55(2):211-6
• CPAP treatment is effective in preventing OSA-associated arrhythmias
  • Abe H, Takahashi M, Yaegashi H, Eda S, Tsunemoto H, Kamikozawa M, Koyama J, Yamazaki K, Ikeda U. Efficacy of continuous positive airway pressure on arrhythmias in obstructive sleep apnea patient.Heart Vessels 2010;25(1):63-9
• CSA detection may help identify asymptomatic patients at increased risk of cerebrovascular or cardiovascular events
  • Rupprecht S, Hoyer D, Hagemann G, Witte OW, Schwab M. Central sleep apnea indicates autonomic dysfunction in asymptomatic carotid stenosis: a potential marker of cerebrovascular and cardiovascular risk. Sleep 2010;33(3):327-33

 Stroke

• CPAP therapy initiated in the first night after stroke seems to be feasible and was not associated with neurological deterioration.
  • Minnerup J, Ritter M, Wersching H, Kemmling A, Okegwo A, Schmidt A, Schilling M, Ringelstein B, Schābitz W, Young P, Dziewas R. Continuous Positive Airway Pressure Ventilation for Acute Ischemic Stroke: A Randomized Feasibility Study. Stroke 2011 Dec 22. [Epub ahead of print]
• Treatment of OSA by CPAP in stroke patients undergoing rehabilitation improved functional and motor outcomes
  • Ryan C, Bayley M, Green R, Murray B, Bradley T. Influence of Continuous Positive Airway Pressure on Outcomes of Rehabilitation in Stroke Patients With Obstructive Sleep Apnea. Stroke 2011;42:1062 - 1067
• Sleep Heart Health Study: Strong association between ischemic stroke and OAHI in community-dwelling men with mild to moderate sleep apnoea suggests appropriate target for future stroke prevention trials
  • Redline S, Yenokyan G, Gottlieb DJ, Shahar E, O'Connor GT, Resnick HE, Diener-West M, Sanders MH, Wolf PA, Geraghty EM, Ali T, Lebowitz M, Punjabi NM. Obstructive sleep apnea-hypopnea and incident stroke: the sleep heart health study. Am J Respir Crit Care Med 2010;182(2):269-77
• ECG-derived spectrographic marker related to low frequency cardiopulmonary coupling is associated with greater sleep apnoea severity and higher prevalence of hypertension and stroke
  • Thomas R, Weiss M, Mietus J, Peng C, Goldberger A, Gottlieb D. Prevalent hypertension and stroke in the Sleep Heart Health Study: association with an ECG-derived spectrographic marker of cardiopulmonary coupling. Sleep 2009;32(7):897-904
• Patients with stroke may have less daytime sleepiness and lower body mass index than subjects without stroke, making detection more difficult
  • Arzt M, Young T, Peppard PE, Finn L, Ryan CM, Bayley M, Bradley TD. Dissociation of obstructive sleep apnea from hypersomnolence and obesity in patients with stroke Stroke 2010;41(3):e129-34
• Treating OSA with CPAP reduces stroke mortality
  • Martínez-García MA, Soler-Cataluña JJ, Ejarque-Martínez L, Soriano Y,Román-Sánchez P, Illa FB, Canal JM, Durán-Cantolla J. Continuous positive airway pressure treatment reduces mortality in patients with ischemic stroke and obstructive sleep apnea: a 5-year follow-up study. Am J Respir Crit Care Med2009;180(1):36-41
• Treating OSA with CPAP reduces stroke mortality
  • Scala R, Turkington PM, Wanklyn P, Bamford J, Elliott MW. Acceptance,effectiveness and safety of continuous positive airway pressure in acute stroke: a pilot study. Respir Med 2009;103(1):59-66

Women and OSA

• Severe OSA is associated with cardiovascular death in women, and adequate CPAP treatment may reduce this risk.
  • Campos-Rodriguez F, Martinez-Garcia MA, de la Cruz-Moron I, Almeida-Gonzalez C, Catalan-Serra P, Montserrat J. Cardiovascular Mortality in Women With Obstructive Sleep Apnea With or Without Continuous Positive Airway Pressure Treatment: A Cohort Study. Ann Intern Med 2012;156(2):115-22
• Pregnancies complicated by OSA are at increased risk for preeclampsia, medical complications, and indicated pre-term birth
  • Louis J, Auckley D, Sokol R, Mercer B. Maternal and neonatal morbidities associated with obstructive sleep apnea complicating pregnancy. Am J Obstet Gynecol 2010;202(3):261.e1-5
• Low association between OSA, growth restriction and hypertension
  • Yin TT, Williams N, Burton C, Ong SS, Loughna P, Britton JR, Thornton JG. Hypertension, fetal growth restriction and obstructive sleep apnoea in pregnancy. Eur J Obstet Gynecol Reprod Biol. 2008;141(1):35-8
• Strong association between OSA and pre-eclampsia
  • Champagne K, Schwartzman K, Opatrny L, Barriga P, Morin L, Mallozzi A, Benjamin A, Kimoff RJ. Obstructive sleep apnoea and its association with gestational hypertension. Eur Respir J2009;33(3):559-65
• CPAP treatment for OSA with pre-clampsia may decrease severity of negative pregnancy outcomes
  • Guilleminault C, Palombini L, Poyares D, Takaoka S, Huynh NT, El-Sayed Y. Pre-eclampsia and nasal CPAP: part 1. Early intervention with nasal CPAP in pregnant women with risk-factors for pre-eclampsia: preliminary findings. Sleep Med 2007;9(1):9-14
• SDB, inadequate waking respiration and insufficient cardiopulmonary synchronization may initiate pre-eclampsia
  • Jerath R, Barnes V, Fadel H. Mechanism of development of pre-eclampsia linking breathing disorders to endothelial dysfunction. Med Hypotheses 2009;73(2):163-6
• SDB associated with increased risk of cognitive impairment in older women
  • Yaffe K, Laffan A, Harrison S, Redline S, Spira A, Ensrud K, Ancoli-Israel S, Stone K. Sleep-Disordered Breathing, Hypoxia, and Risk of Mild Cognitive Impairment and Dementia in Older Women. J Am Med Assoc 2011;306(6):613-619.

Metabolic syndrome

• OSA may contribute to metabolic dysregulation and systemic inflammation in patients with MetS, regardless of daytime sleepiness
  • Drager LF, Lopes HF, Maki-Nunes C, Trombetta IC, Toschi-Dias E, Alves MJ, Fraga RF, Jun JC, Negrão CE, Krieger EM, Polotsky VY, Lorenzi-Filho G. The impact of obstructive sleep apnea on metabolic and inflammatory markers in consecutive patients with metabolic syndrome. PLoS One 2010;5(8):e12065
• High prevalence of OSA among patients suspected of metabolic disorders suggests a strong bidirectional association between OSAS and MS
  • Angelico F, del Ben M, Augelletti T, de Vita R, Roma R, Violi F, Fabiani M. Obstructive sleep apnoea syndrome and the metabolic syndrome in an internal medicine setting. Eur J Intern Med2010;21(3):191-5
• Nocturnal intermittent hypoxia may be associated with the accumulation of metabolic risk factors, especially among non-overweight individuals
  • Muraki I, Tanigawa T, Yamagishi K, Sakurai S, Ohira T, Imano H, Kiyama M, Kitamura A, Sato S, Shimamoto T, Konishi M, Iso H; CIRCS Investigators. Nocturnal intermittent hypoxia and metabolic syndrome; the effect of being overweight: the CIRCS study. J Atheroscler Thromb 2010;17(4):369-77
• BMI could have an independent role in MS, OSA and syndrome Z
  • Sharma SK, Sreenivas V. Are metabolic syndrome, obstructive sleep apnoea & syndrome Z sequential?--a hypothesis. Indian J Med Res 2010;131:455-8
• OSA may increase risk of metabolic syndrome in young pre-clinical patients
  • Guill S, Hargens T, Nickols-Richardson S, Bassaganya-Riera J, Miller L, Zedalis D, Gregg J, Gwazdauskas F, Herbert W. Early evidence of increased risk for metabolic syndrome in young men with latent obstructive sleep apnea. Metab Syndr Relat Disord 2010;8(1):33-8
• Impacts of CPAP treatment on metabolic disorders
  • Murri M, Alcázar-Ramírez J, Garrido-Sánchez L, Linde F, Alcaide J, Cardona F, Tinahones FJ. Oxidative stress and metabolic changes after continuous positive airway pressure treatment according to previous metabolic disorders in sleep apnea-hypopnea syndrome patients. Transl Res 2009;154(3):111-21

Diabetes

• OSA associated with increased risk of incident cardiovascular disease in diabetic population
  • Seicean S, Strohl KP, Seicean A, Gibby C, Marwick TH. Sleep disordered breathing as a risk of cardiac events in subjects with diabetes mellitus and normal exercise echocardiographic findings. Am J Cardiol2013;111(8):1214-20
• AACE Guidelines for Diabetes Care
  • Handelsman Y, Mechanick J, Blonde L, Grunberger G, Bloomgarden Z, Bray G, Dagogo-Jack S, Davidson J, Einhorn D, Ganda O, Garber A, Hirsch I, Horton E, Ismail-Beigi F, Jellinger P, Jones K, Jovanovič L, Lebovitz H, Levy P, Moghissi E, Orzeck E, Vinik A, Wyne K. American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for Developing a Diabetes Mellitus Comprehensive Care Plan. Endocr Pract 2011;17(2)1-53
• Treatment of OSA may improve macrovascular outcomes in type 2 diabetes patients
  • Yim-Yeh S, Rahangdale S, Nguyen AT, Stevenson KE, Novack V, Veves A, Malhotra A. Vascular dysfunction in obstructive sleep apnea and type 2 diabetes mellitus. Obesity (Silver Spring)2011;19(1):17-22
• Sleep apnoea associated with microvascular complications even in well-controlled DM-2 veterans
  • Kosseifi S, Bailey B, Price R, Roy TM, Byrd RP Jr, Peiris AN. The association between obstructive sleep apnea syndrome and microvascular complications in well-controlled diabetic patients. Mil Med2010;175(11):913-6
• Sleep apnoea as predictor of impaired glucose metabolism and type 2 diabetes
  • Pallayova M, Steele KE, Magnuson TH, Schweitzer MA, Hill NR, Bevans-Fonti S, Schwartz AR. Sleep apnea predicts distinct alterations in glucose homeostasis and biomarkers in obese adults with normal and impaired glucose metabolism. Cardiovasc Diabetol 2010;9:83
  • Botros N, Concato J, Mohsenin V, Selim B, Doctor K, Yaggi HK. Obstructive sleep apnea as a risk factor for type 2 diabetes. Am J Med 2009;122(12):1122-7
• High prevalence of retinopathy in comorbid type 2 diabetes and OSA
  • West S, Groves D, Lipinski H, Nicoll D, Mason R, Scanlon P, Stradling J. The prevalence of retinopathy in men with Type 2 diabetes and obstructive sleep apnoea. Diabet Med 2010;27(4):423-30
• Increasing severity of OSA associated with poor glucose control in type 2 diabetes, independent of adiposity and other confounders
  • Aronsohn R, Whitmore H, Van Cauter E, Tasali E. Impact of untreated obstructive sleep apnea on glucose control in type 2 diabetes. Am J Respir Crit Care Med 2010;181(5):507-13
• Nocturnal intermittent hypoxia associated with increased risk of developing type 2 diabetes
  • Muraki I, Tanigawa T, Yamagishi K, Sakurai S, Ohira T, Imano H, Kitamura A, Kiyama M, Sato S, Shimamoto T, Konishi M, Iso H; CIRCS Investigators. Nocturnal intermittent hypoxia and the development of type 2 diabetes: the Circulatory Risk in Communities Study (CIRCS). Diabetologia2010;53(3):481-8
• High prevalence of OSA in type 2 diabetes
  • Lam DC, Lui MM, Lam JC, Ong LH, Lam KS, Ip MS. Prevalence and recognition of obstructive sleep apnea in Chinese patients with type 2 diabetes mellitus. Chest 2010;138(5):1101-7
• High prevalence of OSA in type 2 diabetic patients with poor diabetic control calls for systematic OSA screening
  • Laaban JP, Daenen S, Léger D, Pascal S, Bayon V, Slama G, Elgrably F. Prevalence and predictive factors of sleep apnoea syndrome in type 2 diabetic patients. Diabetes Metab 2009;35(5):372-7
• Severe OSA independently associated with DM in patients who report excessive daytime sleepiness
  • Ronksley PE, Hemmelgarn BR, Heitman SJ, Hanly PJ, Faris PD, Quan H, Tsai WH. Obstructive sleep apnoea is associated with diabetes in sleepy subjects. Thorax 2009;64(10):834-9
• OSA prevalence in type 2 diabetes ethnically inconsistent, though association with REM sleep may be statistically significant
  • Mahmood K, Akhter N, Eldeirawi K, Onal E, Christman JW, Carley DW, Herdegen JJ. Prevalence of type 2 diabetes in patients with obstructive sleep apnea in a multi-ethnic sample. J Clin Sleep Med2009;5(3):215-21

Perioperative management

• Patients with OSA at higher risk of postoperative hypoxemia, ICU transfers, and longer hospital stays
  • Kaw R, Pasupuleti V, Walker E, Ramaswamy A, Foldvary-Schafer N. Postoperative complications in patients with obstructive sleep apnea. Chest 2012;141(2):436-41
• Discussion of ambulatory surgery in patients with OSA with a suggested algorithm to guide perioperative management
  • Adesanya AO, Lee W, Greilich NB, Joshi GP. Perioperative management of obstructive sleep apnea.Chest 2010;138(6):1489-98
• Sleep apnoea an independent risk factor for perioperative pulmonary complications
  • Memtsoudis S, Liu SS, Ma Y, Chiu YL, Walz JM, Gaber-Baylis LK, Mazumdar M. Perioperative pulmonary outcomes in patients with sleep apnea after noncardiac surgery. Anesth Analg2011;112(1):113-21
• OSA and perioperative/post-operative complications
  • Weingarten TN, Flores AS, McKenzie JA, Nguyen LT, Robinson WB, Kinney TM, Siems. Obstructive sleep apnoea and perioperative complications in bariatric patients. Br J Anaesth 2011;106(1):131-9
• STOP-BANG questionnaire useful for preoperative identification of patients at higher than normal risk for surgical complications
  • Vasu TS, Doghramji K, Cavallazzi R, Grewal R, Hirani A, Leiby B, Markov D, Reiter D, Kraft WK, Witkowski T. Obstructive sleep apnea syndrome and postoperative complications: clinical use of the STOP-BANG questionnaire. Arch Otolaryngol Head Neck Surg 2010;136(10):1020-4
• Automated OSA alert and perioperative RT system helped prevent sudden-onset acute respiratory compromise in postoperative patients with OSA or at risk of OSA
  • Ramachandran SK, Kheterpal S, Haas CF, Saran KA, Tremper KK. Automated notification of suspected obstructive sleep apnea patients to the perioperative respiratory therapist: a pilot study. Respir Care2010;55(4):414-8
• P-SAP score predicts diagnosis of OSA with dependable accuracy across mild to severe disease
  • Ramachandran SK, Kheterpal S, Consens F, Shanks A, Doherty TM, Morris M, Tremper KK. Derivation and validation of a simple perioperative sleep apnea prediction score. Anesth Analg 2010;110(4):1007-15

Cancer

• Sleep apnoea associated with increased cancer mortality
  • Javier Nieto F, Peppard P, Young T, Finn L, Mae Hla K, Farré R. Sleep disordered breathing and cancer mortality: results from the Wisconsin Sleep Cohort Study. Am J Respir Crit Care Med 2012 doi:10.1164/rccm.201201-0130OC

Chronic obstructive pulmonary disease (COPD)

• Overlap syndrome is associated with increased risk of hospitalization and death due to COPD exacerbation. CPAP treatment may improve survival and decrease hospitalizations in overlap syndrome patients
  • Marin J, Soriano J, Carrizo S, Boldova A, Celli B. Outcomes in patients with chronic obstructive pulmonary disease and obstructive sleep apnea: the overlap syndrome. Am J Respir Crit Care Med2010;182(3):325-31

Nocturia

• Nocturia with prostatic enlargement may indicate OSA
  • Tandeter H, Gendler S, Dreiher J, Tarasiuk A. Nocturic episodes in patients with benign prostatic enlargement may suggest the presence of obstructive sleep apnea. J Am Board Fam Med2011;24(2):146-51
• Nocturia as independent indicator of OSA in Stroke
  • Chen CY, Hsu CC, Pei YC, Yu CC, Chen YS, Chen CL. Nocturia is an independent predictor of severe obstructive sleep apnea in patients with ischemic Stroke J Neurol 2011;258(2):189-94
• Urgency and nocturia independently affect sleep and are affected by sleep quality
  • Tsujimura A, Takao T, Miyagawa Y, Yamamoto K, Fukuhara S, Nakayama J, Kiuchi H, Suganuma N, Nakamura T, Kumano-Go T, Sugita Y, Nonomura N, Okuyama A. Urgency is an independent factor for sleep disturbance in men with obstructive sleep apnea. Urology 2010;76(4):967-70
• Associations between nocturia and sleep disorder
  • Yoshimura K, Oka Y, Kamoto T, Yoshimura K, Ogawa O. Differences and associations between nocturnal voiding/nocturia and sleep disorders. BJU Int 2010;106(2):232-7
  • Moriyama Y, Miwa K, Tanaka H, Fujihiro S, Nishino Y, Deguchi T. Nocturia in men less than 50 years of age may be associated with obstructive sleep apnea syndrome. Urology 2008;71(6):1096-8
• Nocturia comparable to snoring as a screening tool for OSA
  • Romero E, Krakow B, Haynes P, Ulibarri V. Nocturia and snoring: predictive symptoms for obstructive sleep apnea. Sleep Breath 2010;14(4):337-43
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• Nocturia associated with sleep disorders in perimenopause
  • Gopal M, Sammel MD, Pien G, Gracia C, Freeman EW, Lin H, Arya L. Investigating the associations between nocturia and sleep disorders in perimenopausal women. J Urol 2008;180(5):2063-7

Miscellaneous

• High prevalence of OSA in patients with chronic wounds not detected by standard screening questionnaires
  • Patt B, Jarjoura D, Lambert L, Roy S, Gordillo G, Schlanger R, Sen C, Khayat R. Prevalence of obstructive sleep apnea in patients with chronic wounds. J Clin Sleep Med 2010;6(6):541-4