Associations Between Sleep Quality, Sleep Architecture and Sleep Disordered Breathing and Memory After Continuous Positive Airway Pressure in Patients with Obstructive Sleep Apnea in the Apnea Positive Pressure Long-term Efficacy Study (APPLES)
AffiliationUniv Arizona, Asthma & Airways Res Ctr
MetadataShow full item record
PublisherBRAZILIAN ASSOC SLEEP
CitationQuan SF, Budhiraja R, Kushida CA. Associations Between Sleep Quality, Sleep Architecture and Sleep Disordered Breathing and Memory After Continuous Positive Airway Pressure in Patients with Obstructive Sleep Apnea in the Apnea Positive Pressure Long-term Efficacy Study (APPLES). Sleep Sci.2018;11(4):231-238
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AbstractSleep architecture, sleep quality and SDB improved in the CPAP group at 6 months; performance on the Buschke and DSST improved equally in both CPAP and Sham CPAP groups. There also were no significant correlations between changes in the amount or percentage of sleep stages between baseline and the 6 months, and corresponding changes in either the Buschke or the DSST. However, when stratified by the upper quartile and lower 3 quartiles, greater changes in the Buschke occurred over 6 months in the top quartile of total sleep time (5.7±7.3 vs. 4.0±6.8, p≤0.01) and amount of N3 sleep (55.9±7.7 vs. 53.6±8.9 min, p≤0.01). Those with more %N3 at 6 months scored better on the Buschke as well (55.9±7.8 vs. 53.6±8.9, p≤0.01). Borderline improvement in the DSST over 6 months was observed in the top quartiles of amount of N3 and %N3. Those in the top quartile of the amount of REM and %REM also showed greater improvement in the Buschke after 6 months. No differences were observed for the AHI, but those in the top quartile of oxygen desaturation had worse scores on the Buschke at 6 months. CPAP/Sham CPAP adherence did not impact 6 month Buschke or DSST performance.
NoteOpen access journal
VersionFinal published version
SponsorsNational Heart, Lung and Blood Institute [5UO1-HL-068060]; American Academy of Sleep Medicine; Sleep Medicine Education and Research Foundation; National Institute of Neurological Disorders and Stroke [N44-NS-002394]
- Effects of continuous positive airway pressure on neurocognitive function in obstructive sleep apnea patients: The Apnea Positive Pressure Long-term Efficacy Study (APPLES).
- Authors: Kushida CA, Nichols DA, Holmes TH, Quan SF, Walsh JK, Gottlieb DJ, Simon RD Jr, Guilleminault C, White DP, Goodwin JL, Schweitzer PK, Leary EB, Hyde PR, Hirshkowitz M, Green S, McEvoy LK, Chan C, Gevins A, Kay GG, Bloch DA, Crabtree T, Dement WC
- Issue date: 2012 Dec 1
- [Effects of continuous positive airway pressure on daytime sleepiness in patients with severe obstructive sleep apnea syndrome].
- Authors: Pan H, Ren R, Li Y, Yang L, Huang G, Lei F, Du L, Tang X
- Issue date: 2014 Feb 18
- Impact of treatment with continuous positive airway pressure (CPAP) on weight in obstructive sleep apnea.
- Authors: Quan SF, Budhiraja R, Clarke DP, Goodwin JL, Gottlieb DJ, Nichols DA, Simon RD, Smith TW, Walsh JK, Kushida CA
- Issue date: 2013 Oct 15
- Sleep quality, short-term and long-term CPAP adherence.
- Authors: Somiah M, Taxin Z, Keating J, Mooney AM, Norman RG, Rapoport DM, Ayappa I
- Issue date: 2012 Oct 15
- Obesity hypoventilation syndrome: hypoxemia during continuous positive airway pressure.
- Authors: Banerjee D, Yee BJ, Piper AJ, Zwillich CW, Grunstein RR
- Issue date: 2007 Jun
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HEALTHCARE FINANCIAL HARDSHIP AND HABITUAL SLEEP DURATION, IMPACT ON SLEEP DISPARITIES, AND IMPACT ON THE SLEEP-OBESITY RELATIONSHIPGrandner, Michael A.; Liang, Olivia (The University of Arizona., 2019-05)Introduction: Sleep is related to socioeconomics and can impact health. This study evaluated whether foregoing medical care due to cost impacts sleep and plays a role in sleep disparities and the sleep-obesity relationship. Methods: Data were obtained from the 2017 Behavioral Risk Factor Surveillance System (N=39,267 from 7 states provided complete data on all variables). Sleep duration was assessed as hours/day. Participants were asked, “Was there a time in the past 12 months when you needed to see a doctor but could not because of cost?” They were also asked for information about age, sex, race/ethnicity, education, income, employment, overall health, and access to health insurance. They were also asked for height/weight, which was used to compute body mass index (BMI). Results: Access to health insurance was not associated with habitual sleep duration. However, foregoing medical care was associated with less sleep on average (B=-0.26,95%CI[-0.35, 0.17],p<0.0005). There was an interaction with race/ethnicity, such that compared to non Hispanic Whites, the effect was 115% larger among Blacks/African-Americans, 13% larger in Hispanics/Latinos, 101% larger and in the opposite direction for Asians, and non-significant for Multiracial. Race/ethnicity relationships to sleep duration were stratified by foregoing care. Among those who did not (90%), typical relationships were seen, with both high and low sleep duration being more likely among Blacks/African-Americans and other minority groups. Among those who did forego care (10%), these effects were dramatically reduced. Further, when sleep duration was evaluated as a predictor of obesity, this relationship was only seen among those who did not forego care. Conclusion: Foregoing medical care due to cost is an independent risk factor for insufficient sleep, irrespective of income, employment, and access to insurance. It disproportionately affects Blacks/African-Americans and may represent part of the reason why these disparities exist even after adjustment for most socioeconomic indices. Further, foregoing medical care may present such health risks that this subsumes the relationship between sleep and obesity.
Rx Free Sleep: Improving Sleep Through Behavioral and Environmental Interventions and Pharmacy Driven Taper Recommendation of Hypnotic Sleep Medications for Assisted Living ResidentsLee, Jeannie; Lee, Sandy; Kaitschuck, Angela; Sassenrath, Kimberly; Weng, Cindy; College of Pharmacy, The University of Arizona (The University of Arizona., 2018)Specific Aims: To safely reduce the use of potentially dangerous sleep medications in geriatric patients while simultaneously providing sleep hygiene techniques to improve sleep in a natural way without medications. Methods: Study participants enrolled in either sleep hygiene only or sleep hygiene and sleep medication taper track. All participants completed a Sleep Survey and IOWA Fatigue Scale (IFS) pre- and post-intervention. Student pharmacists provided an initial one-on-one educational session on sleep hygiene techniques and set individualized goals with each elder. Those enrolled in the medication taper track had a personalized taper schedule sent to their provider. Follow-up sessions were conducted 3 and 6 weeks after the initial session. Main Results: Among eight participants (mean age 74.8 years, 63% female), those with fatigue per the IFS was reduced from 6 to 3 post-intervention (p=0.375). Sleep questionnaire showed time-to-sleep was shortened by 8.3 minutes, nightly sleep increased by 0.69 hours, and coffee/tea consumption was reduced by 0.38 and 0.13 cups, respectively. While the results demonstrate no statistical improvement in the proportions of participants with fatigue, many participants subjectively reported that they noticed sleep improvements and plan to continue the behavioral changes after the study. Conclusions: Providing proper sleep hygiene education and reducing the use of sleep medications is beneficial in older assisted-living residents. This study showed no negative impacts on Elders’ quality of life and is a simple program that can be implemented at other facilities.
Sleep to Feel Better: An Investigation of the Role of Sleep in the Internalizing Symptoms of Youth with Type 1 Diabetes MellitusPerfect, Michelle M.; Frye, Sara S.; Perfect, Michelle M.; Sulkowski, Michael; Silva Torres, Graciela E. (The University of Arizona., 2017)Background and Objective: Type 1 diabetes mellitus (T1DM) is one of the most common pediatric chronic illnesses. Youth with T1DM have been shown to be at risk for internalizing problems and obtaining insufficient sleep. An emerging body of literature has demonstrated the feasibility and potential benefit of increasing sleep duration as a strategy to improve psychological outcomes in nondiabetic school age populations. The current study seeks to investigate the relationship between sleep and internalizing symptoms and empirically examine the effect of a sleep extension intervention on internalizing symptoms in youth with T1DM. Methods: The sample consisted of 106 youth with T1DM (mean age = 13.5 ± 2.1 years) who were part of a larger study recruited over a three-year period. Participants were 52.8% male and 50.9% identified as non-white. The primary outcome measure was the Behavior Assessment System for Children, Second Edition (BASC-2), both parent and self-report. Other behavioral and sleep measures included actigraphy, sleep diary, the School Sleep Habits Survey (SSHS), Pediatric Symptoms Checklist (PSC), and the Child Sleep Habits Questionnaire (CSHQ). Participants were randomly assigned to either the Sleep Extension condition (n = 50), in which they were asked to extend their sleep duration, or the Fixed Sleep Duration condition (n = 56), in which they were asked to maintain the same amount of sleep as their baseline. Results: Average sleep durations varied across measures, with all values falling in the lower range or below national recommendations. More than a third (34.5%) of the sample had elevated scores for internalizing problems based on parent report, and 17.7% were elevated based on self-report. Pearson correlations indicated that parent reported sleep duration was negatively related to self-reported anxiety, r(106) = -0.237, p = 0.018, as well as parent-reported depression, r(106) = -0.218, p = 0.028, and emotional self-control, r(106) = -0.232, p = 0.018. No other measure of sleep duration was significantly correlated with internalizing symptoms. Secondary analyses of measures of sleep quality including sleep efficiency (SE), wake after sleep onset (WASO), and sleepiness, were significantly related to internalizing problems based on both parent and self-report (all p < 0.05), whereas more variability in sleep duration (CV) was related to higher self-reported depression, r(106) = 0.210, p = 0.033. Following the sleep intervention, participants in the Sleep Extension condition increased their average sleep duration by 26.71 minutes based on actigraphy, while participants in the Fixed Sleep duration decreased by 0.14 minutes from pre- to post-intervention. Participants in the Sleep Extension condition had significantly lower scores on the BASC-2 Internalizing Problems Composite than participants in the Fixed Sleep Duration condition following the intervention, after controlling for sex and baseline internalizing symptoms, F(1, 98) = 4.18, p = 0.044. On average, the Internalizing Problems Composite score of participants in the Sleep Extension condition decreased by almost half a standard deviation (4.65 ± 6.41 points), compared to a decrease of 2.31 ± 6.59 points for participants in the Fixed Sleep Duration condition. There were no significant effects for self-report. Conclusions: Youth with T1DM obtained insufficient sleep and experienced high rates of internalizing symptoms. The results also suggest that relations between sleep and internalizing symptoms exist; however, these associations may be more driven by other aspects of sleep rather than actual sleep loss, such as nighttime sleep disturbance, daytime sleepiness, and variability of the sleep schedule. The findings further indicated that a sleep extension intervention was effective in increasing sleep duration, as well as reducing parent-reported internalizing symptoms in a sample of children and adolescents with T1DM. This intervention has the potential to be utilized as a cost effective, and relatively easy to implement method for reducing internalizing symptoms in youth with T1DM.