Association Of The Arousal Threshold With Inflammation And Sleepiness In Men With Obstructive Sleep Apnea

Sarah Appleton; Danny Eckert; Andrew Vakulin; Peter Catcheside; Doug McEvoy; Sean Martin; Gary Wittert; Robert J Adams

doi:10.1093/sleep/zsy061.450

Abstract

Introduction

Waking up too easily to minor airway narrowing (low respiratory arousal threshold: ArTH) is a key non-anatomical contributor to obstructive sleep apnea (OSA) pathophysiology. However, the extent to which a low ArTH phenotype contributes to daytime sleepiness and inflammation-related clinical sequelae in OSA is unclear. Accordingly, we determined relationships between ArTH, inflammation and sleepiness in a cohort of community dwelling men with OSA.

Methods

The Men Androgen Inflammation Lifestyle Environment and Stress (MAILES) Study is a biomedical cohort of men aged ≥ 35y in Adelaide, South Australia. In 2008–10, men underwent biomedical assessment (including anthropometry, inflammatory markers) and in 2010–12, 837 men underwent home-based full unattended polysomnography (Embletta X100) and completed the Epworth Sleepiness Scale (ESS). ArTH was estimated using a 2014 published equation: -65.391 + 0.0636*age + 3.692*1 (male sex) - 0.0314*BMI - 0.108*apnea hypopnea index + 0.533*oxygen saturation nadir + 0.0906*hypopnea fraction. Low arousal threshold was also identified as two or more of: apnea hypopnea index<30; oxygen saturation nadir >82.5%; hypopnea fraction >58.3%. Inflammatory markers were log-transformed.

Results

In 423 men with OSA (AHI≥10/hr), mean (SD) ArTH was -17.8cmH₂O (6.5). ArTh was significantly correlated with C-reactive protein (CRP, Pearson r= -0.118, p=0.018), and e-Selectin (e-SEL, r= -0.152, p=0.003) but not with myeloperoxidase (r= -0.01, p=0.84), tumor necrosis factor-alpha (r= -0.018, p=0.72), interleukin-6 (r= -0.096, p=0.057) or ESS scores (r= -0.091, p=0.065). In multiple regression models adjusted for age, BMI, and smoking, significant associations of ArTH with CRP (p=0.27) and eSEL (p=0.093) were confounded by age and obesity and did not persist. BMI and depression but not ArTH (unstandardized B coefficient p=0.28) explained ESS scores. The findings did not alter when ArTH was entered as a dichotomous variable (low vs high) into models. The null finding for sleepiness was also observed men with low-moderate OSA, i.e. AHI 10–30/hr (ArTH unstandardized B coefficient p=0.28).

Conclusion

The ArTH is not independently associated with inflammation or excessive sleepiness in OSA.

Original language	English
Article number	0451
Pages (from-to)	A171
Number of pages	1
Journal	SLEEP
Volume	41
Issue number	suppl_1
DOIs	https://doi.org/10.1093/sleep/zsy061.450
Publication status	Published - 27 Apr 2018
Event	Clinical Sleep Science and Practice - Duration: 1 Jan 2018 → …

Keywords

low respiratory arousal threshold
Obstructive Sleep Apnea

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This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1093/sleep/zsy061.450Licence: In Copyright

Cite this

@article{4539a8d904764241b28d60b714c45416,

title = "Association Of The Arousal Threshold With Inflammation And Sleepiness In Men With Obstructive Sleep Apnea",

abstract = "IntroductionWaking up too easily to minor airway narrowing (low respiratory arousal threshold: ArTH) is a key non-anatomical contributor to obstructive sleep apnea (OSA) pathophysiology. However, the extent to which a low ArTH phenotype contributes to daytime sleepiness and inflammation-related clinical sequelae in OSA is unclear. Accordingly, we determined relationships between ArTH, inflammation and sleepiness in a cohort of community dwelling men with OSA.MethodsThe Men Androgen Inflammation Lifestyle Environment and Stress (MAILES) Study is a biomedical cohort of men aged ≥ 35y in Adelaide, South Australia. In 2008–10, men underwent biomedical assessment (including anthropometry, inflammatory markers) and in 2010–12, 837 men underwent home-based full unattended polysomnography (Embletta X100) and completed the Epworth Sleepiness Scale (ESS). ArTH was estimated using a 2014 published equation: -65.391 + 0.0636*age + 3.692*1 (male sex) - 0.0314*BMI - 0.108*apnea hypopnea index + 0.533*oxygen saturation nadir + 0.0906*hypopnea fraction. Low arousal threshold was also identified as two or more of: apnea hypopnea index<30; oxygen saturation nadir >82.5%; hypopnea fraction >58.3%. Inflammatory markers were log-transformed.ResultsIn 423 men with OSA (AHI≥10/hr), mean (SD) ArTH was -17.8cmH2O (6.5). ArTh was significantly correlated with C-reactive protein (CRP, Pearson r= -0.118, p=0.018), and e-Selectin (e-SEL, r= -0.152, p=0.003) but not with myeloperoxidase (r= -0.01, p=0.84), tumor necrosis factor-alpha (r= -0.018, p=0.72), interleukin-6 (r= -0.096, p=0.057) or ESS scores (r= -0.091, p=0.065). In multiple regression models adjusted for age, BMI, and smoking, significant associations of ArTH with CRP (p=0.27) and eSEL (p=0.093) were confounded by age and obesity and did not persist. BMI and depression but not ArTH (unstandardized B coefficient p=0.28) explained ESS scores. The findings did not alter when ArTH was entered as a dichotomous variable (low vs high) into models. The null finding for sleepiness was also observed men with low-moderate OSA, i.e. AHI 10–30/hr (ArTH unstandardized B coefficient p=0.28).ConclusionThe ArTH is not independently associated with inflammation or excessive sleepiness in OSA.",

keywords = "low respiratory arousal threshold, Obstructive Sleep Apnea",

author = "Sarah Appleton and Danny Eckert and Andrew Vakulin and Peter Catcheside and Doug McEvoy and Sean Martin and Gary Wittert and Adams, {Robert J}",

year = "2018",

month = apr,

day = "27",

doi = "10.1093/sleep/zsy061.450",

language = "English",

volume = "41",

pages = "A171",

journal = "SLEEP",

issn = "0161-8105",

publisher = "American Academy of Sleep Medicine Sleep Research Society",

number = "suppl_1",

note = "Clinical Sleep Science and Practice ; Conference date: 01-01-2018",

}

TY - JOUR

T1 - Association Of The Arousal Threshold With Inflammation And Sleepiness In Men With Obstructive Sleep Apnea

AU - Appleton, Sarah

AU - Eckert, Danny

AU - Vakulin, Andrew

AU - Catcheside, Peter

AU - McEvoy, Doug

AU - Martin, Sean

AU - Wittert, Gary

AU - Adams, Robert J

PY - 2018/4/27

Y1 - 2018/4/27

N2 - IntroductionWaking up too easily to minor airway narrowing (low respiratory arousal threshold: ArTH) is a key non-anatomical contributor to obstructive sleep apnea (OSA) pathophysiology. However, the extent to which a low ArTH phenotype contributes to daytime sleepiness and inflammation-related clinical sequelae in OSA is unclear. Accordingly, we determined relationships between ArTH, inflammation and sleepiness in a cohort of community dwelling men with OSA.MethodsThe Men Androgen Inflammation Lifestyle Environment and Stress (MAILES) Study is a biomedical cohort of men aged ≥ 35y in Adelaide, South Australia. In 2008–10, men underwent biomedical assessment (including anthropometry, inflammatory markers) and in 2010–12, 837 men underwent home-based full unattended polysomnography (Embletta X100) and completed the Epworth Sleepiness Scale (ESS). ArTH was estimated using a 2014 published equation: -65.391 + 0.0636*age + 3.692*1 (male sex) - 0.0314*BMI - 0.108*apnea hypopnea index + 0.533*oxygen saturation nadir + 0.0906*hypopnea fraction. Low arousal threshold was also identified as two or more of: apnea hypopnea index<30; oxygen saturation nadir >82.5%; hypopnea fraction >58.3%. Inflammatory markers were log-transformed.ResultsIn 423 men with OSA (AHI≥10/hr), mean (SD) ArTH was -17.8cmH2O (6.5). ArTh was significantly correlated with C-reactive protein (CRP, Pearson r= -0.118, p=0.018), and e-Selectin (e-SEL, r= -0.152, p=0.003) but not with myeloperoxidase (r= -0.01, p=0.84), tumor necrosis factor-alpha (r= -0.018, p=0.72), interleukin-6 (r= -0.096, p=0.057) or ESS scores (r= -0.091, p=0.065). In multiple regression models adjusted for age, BMI, and smoking, significant associations of ArTH with CRP (p=0.27) and eSEL (p=0.093) were confounded by age and obesity and did not persist. BMI and depression but not ArTH (unstandardized B coefficient p=0.28) explained ESS scores. The findings did not alter when ArTH was entered as a dichotomous variable (low vs high) into models. The null finding for sleepiness was also observed men with low-moderate OSA, i.e. AHI 10–30/hr (ArTH unstandardized B coefficient p=0.28).ConclusionThe ArTH is not independently associated with inflammation or excessive sleepiness in OSA.

AB - IntroductionWaking up too easily to minor airway narrowing (low respiratory arousal threshold: ArTH) is a key non-anatomical contributor to obstructive sleep apnea (OSA) pathophysiology. However, the extent to which a low ArTH phenotype contributes to daytime sleepiness and inflammation-related clinical sequelae in OSA is unclear. Accordingly, we determined relationships between ArTH, inflammation and sleepiness in a cohort of community dwelling men with OSA.MethodsThe Men Androgen Inflammation Lifestyle Environment and Stress (MAILES) Study is a biomedical cohort of men aged ≥ 35y in Adelaide, South Australia. In 2008–10, men underwent biomedical assessment (including anthropometry, inflammatory markers) and in 2010–12, 837 men underwent home-based full unattended polysomnography (Embletta X100) and completed the Epworth Sleepiness Scale (ESS). ArTH was estimated using a 2014 published equation: -65.391 + 0.0636*age + 3.692*1 (male sex) - 0.0314*BMI - 0.108*apnea hypopnea index + 0.533*oxygen saturation nadir + 0.0906*hypopnea fraction. Low arousal threshold was also identified as two or more of: apnea hypopnea index<30; oxygen saturation nadir >82.5%; hypopnea fraction >58.3%. Inflammatory markers were log-transformed.ResultsIn 423 men with OSA (AHI≥10/hr), mean (SD) ArTH was -17.8cmH2O (6.5). ArTh was significantly correlated with C-reactive protein (CRP, Pearson r= -0.118, p=0.018), and e-Selectin (e-SEL, r= -0.152, p=0.003) but not with myeloperoxidase (r= -0.01, p=0.84), tumor necrosis factor-alpha (r= -0.018, p=0.72), interleukin-6 (r= -0.096, p=0.057) or ESS scores (r= -0.091, p=0.065). In multiple regression models adjusted for age, BMI, and smoking, significant associations of ArTH with CRP (p=0.27) and eSEL (p=0.093) were confounded by age and obesity and did not persist. BMI and depression but not ArTH (unstandardized B coefficient p=0.28) explained ESS scores. The findings did not alter when ArTH was entered as a dichotomous variable (low vs high) into models. The null finding for sleepiness was also observed men with low-moderate OSA, i.e. AHI 10–30/hr (ArTH unstandardized B coefficient p=0.28).ConclusionThe ArTH is not independently associated with inflammation or excessive sleepiness in OSA.

KW - low respiratory arousal threshold

KW - Obstructive Sleep Apnea

U2 - 10.1093/sleep/zsy061.450

DO - 10.1093/sleep/zsy061.450

M3 - Meeting Abstract

SN - 0161-8105

VL - 41

SP - A171

JO - SLEEP

JF - SLEEP

IS - suppl_1

M1 - 0451

T2 - Clinical Sleep Science and Practice

Y2 - 1 January 2018