Person: Budhiraja, Rohit
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Budhiraja
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Rohit
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Budhiraja, Rohit
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Publication Prevalence and correlates of periodic limb movements in OSA and the effect of CPAP therapy(Ovid Technologies (Wolters Kluwer Health), 2019-12-27) Budhiraja, Rohit; Javaheri, Sogol; Epstein, Lawrence; Omobomi, Olabimpe; Pavlova, Milena; Quan, StuartObjective We sought to assess the prevalence, correlates, and consequences of periodic limb movements of sleep (PLMS) in persons with obstructive sleep apnea (OSA) and the effect (worsening or improvement) of continuous positive airway pressure (CPAP) therapy on PLMS in a large prospective multicenter randomized controlled trial. Methods We performed retrospective analyses of data from the Apnea Positive Pressure Long-term Efficacy Study, a prospective multicenter randomized controlled trial. A total of 1,105 persons with OSA enrolled in this study underwent a polysomnographic investigation at baseline, another one for CPAP titration, and another study 6 months after randomization to either active CPAP or sham CPAP. Results Of all participants, 19.7% had PLM index (PLMI) ≥10/hour, 14.8% had PLMI ≥15/hour, 12.1% had PLMI ≥20/hour, 9.3% had PLMI ≥25/hour, and 7.5% had PLMI ≥30/hour. The odds of having a PLMI ≥10 were higher in older participants (odds ratio [OR] 1.03, p < 0.001), men (OR 1.63. p = 0.007), those using antidepressants (OR 1.48. p = 0.048), and those with higher caffeine use (OR 1.01, p = 0.04). After controlling for OSA and depression, PLMS were associated with increased sleep latency, reduced sleep efficiency, and reduced total sleep time. No significant relationships were noted between PLMS frequency and subjective sleepiness (Epworth Sleepiness Scale score) or objective sleepiness (Maintenance of Wakefulness Test). There was no differential effect of CPAP in comparison to sham CPAP on PLMS after 6 months of therapy. Conclusions PLMS are common in patients with OSA and are associated with a significant reduction in sleep quality over and above that conferred by OSA. Treatment with CPAP does not affect the severity of PLMS.Publication The Association Between Obstructive Sleep Apnea Characterized by a Minimum 3 Percent Oxygen Desaturation or Arousal Hypopnea Definition and Hypertension(American Academy of Sleep Medicine (AASM), 2019-09-15) Budhiraja, Rohit; Javaheri, Sogol; Parthasarathy, Sairam; Berry, Richard B.; Quan, StuartStudy Objectives: The association between obstructive sleep apnea (OSA) and hypertension in prior studies has been determined using a definition of hypopnea requiring a 4% O2 desaturation. However, the American Academy of Sleep Medicine (AASM) recommends using a 3% O2 desaturation or an arousal. This analysis assesses the relationship between OSA and hypertension utilizing the AASM recommended definition and the 2018 American College of Cardiology/American Heart Association hypertension guidelines. Methods: Data from 6113 participants from the Sleep Heart Health Study were analyzed. The AASM recommended apnea-hypopnea index (AHI) was classified into 4 categories of OSA severity: < 5, 5 to < 15, 15 to < 30 and ≥ 30 events/h. Three definitions of hypertension were used: elevated (> 120/< 80 or use of hypertension medications [meds]), stage 1/stage 2 (> 130/80 or meds), stage 2 (> 140/90 or meds). Data were analyzed using logistic regression controlling for demographics, smoking and body mass index. Multiple linear regression analysis assessed the relationship between natural log AHI, and systolic and diastolic blood pressure controlling for the same covariates. Results: For all definitions of blood pressure elevation, increasing OSA severity was associated with greater likelihood of an elevated or hypertensive status in fully adjusted models (odds ratio [95% confidence interval]): elevated 1.30 (1.09–1.54), 1.39 (1.13–1.70) 1.69 (1.29–2.13); stage 1/2: 1.25 (1.06–1.47), 1.32 (1.10–1.59), 1.53 (1.23–1.91); stage 2: 1.07 (0.91–1.25), 1.21 (1.01–1.44), 1.37 (1.11–1.69) for AHI 5 to < 15, 15 to < 30 and > 30 events/h (< 5 events/h reference). Linear regression found that AHI was associated with both systolic and diastolic blood pressure in fully adjusted models. Conclusions: Use of the AASM recommended definition of hypopnea as a component of the AHI is associated with the presence of hypertension.Publication Use of blood biomarkers to screen for obstructive sleep apnea(Dove Medical Press, 2018) Fleming, Wesley Elon; Holty, Jon-Erik C; Bogan, Richard K; Hwang, Dennis; Ferouz-Colborn, Aliya S; Budhiraja, Rohit; Redline, Susan; Mensah-Osman, Edith; Osman, Nadir Ishag; Li, Qing; Azad, Armaghan; Podolak, Susann; Samoszuk, Michael K; Cruz, Amabelle B; Bai, Yang; Lu, Jiuliu; Riley, John S; Southwick, Paula CPurpose Obstructive sleep apnea (OSA) is a highly prevalent disorder associated with increased risk for cardiovascular disease, diabetes, and other chronic conditions. Unfortunately, up to 90% of individuals with OSA remain without a diagnosis or therapy. We assess the relationship between OSA and blood biomarkers, and test the hypothesis that combinations of markers provide a characteristic OSA signature with diagnostic screening value. This validation study was conducted in an independent cohort in order to replicate findings from a prior feasibility study. Patients and methods This multicenter prospective study consecutively enrolled adult male subjects with clinically suspected OSA. All subjects underwent overnight sleep studies. An asymptomatic control group was also obtained. Five biomarkers were tested: glycated hemoglobin (HbA1c), C-reactive protein (CRP), uric acid, erythropoietin (EPO), and interleukin-6 (IL-6). Results: The study enrolled 264 subjects. The combination of HbA1c+CRP+EPO (area under the curve 0.78) was superior to the Epworth Sleepiness Scale (ESS; 0.53) and STOP-Bang (0.70) questionnaires. In non-obese subjects, the combination of biomarkers (0.75) was superior to body mass index (BMI; 0.61). Sensitivity and specificity results, respectively, were: HbA1c+CRP+EPO (81% and 60%), ESS (78% and 19%), STOP-Bang (75% and 52%), BMI (81% and 56%), and BMI in non-obese patients (81% and 38%). Conclusion: We verify our hypothesis and replicate our prior feasibility findings that OSA is associated with a characteristic signature cluster of biomarker changes in men. Concurrent elevations of HbA1c, CRP, and EPO levels should generate a high suspicion of OSA and may have utility as an OSA screening tool. Biomarker combinations correlate with OSA severity and, therefore, may assist sleep centers in identifying and triaging higher risk patients for sleep study diagnosis and treatment.Publication Predictors of sleepiness in obstructive sleep apnoea at baseline and after 6 months of continuous positive airway pressure therapy(European Respiratory Society (ERS), 2017) Budhiraja, Rohit; Kushida, Clete A.; Nichols, Deborah A.; Walsh, James K.; Simon, Richard D.; Gottlieb, Daniel; Quan, StuartWe evaluated factors associated with subjective and objective sleepiness at baseline and after 6 months of continuous positive airway pressure (CPAP) therapy in patients with obstructive sleep apnoea (OSA).We analysed data from the Apnoea Positive Pressure Long-term Efficacy Study (APPLES), a prospective 6-month multicentre randomised controlled trial with 1105 subjects with OSA, 558 of who were randomised to active CPAP. Epworth sleepiness scale (ESS) scores and the mean sleep latency (MSL) on the maintenance of wakefulness test at baseline and after 6 months of CPAP therapy were recorded.Excessive sleepiness (ESS score >10) was present in 543 (49.1%) participants. Younger age, presence of depression and higher apnoea-hypopnoea index were all associated with higher ESS scores and lower MSL. Randomisation to the CPAP group was associated with lower odds of sleepiness at 6 months. The prevalence of sleepiness was significantly lower in those using CPAP >4 h·night-1versus using CPAP ≤4 h·night-1 Among those with good CPAP adherence, those with ESS >10 at baseline had significantly higher odds (OR 8.2, p<0.001) of persistent subjective sleepiness.Lower average nightly CPAP use and presence of sleepiness at baseline were independently associated with excessive subjective and objective sleepiness after 6 months of CPAP therapy.Publication Outcomes from the Tucson Children's Assessment of Sleep Apnea Study(Elsevier BV, 2009-03-01) Budhiraja, Rohit; Quan, StuartSleep disordered breathing (SDB) is increasingly recognized as an important clinical problem in children. However, the clinical, anatomic and physiologic correlates of SDB have not been extensively studied in a general population sample using polysomnography to document the presence of SDB. The Tucson Children's Assessment of Sleep Apnea Study (TuCASA) is a longitudinal cohort study of 503 6-12 year old Caucasian and Hispanic children who underwent polysomnography and neurocognitive testing at the time of recruitment. Subsets of the cohort had additional MRI imaging and pulmonary physiologic testing. Initial cross-sectional analyses indicate that SDB is associated with behavioral abnormalities, hypertension, learning problems and clinical symptoms such as snoring and excessive daytime sleepiness. Future follow-up of the cohort will assess the impact of SDB on subsequent childhood development.Publication Weighing the Impact of CPAP Therapy on Body Mass in Persons With OSA(Elsevier BV, 2019-04) Budhiraja, Rohit; Quan, StuartSeveral studies have demonstrated that when used adequately, CPAP therapy mitigates several negative consequences of OSA, including excessive sleepiness and hypertension, and improves quality of life.1,2 However, concerning is the observation by several researchers that use of CPAP has been associated with weight gain.3,4 This is a bothersome finding because increased weight is generally associated with the development or worsening of OSA and adverse health outcomes. Furthermore, a fear of weight gain might negatively influence the decision of patients with OSA to accept or be adherent to CPAP therapy.Publication Measurement of the severity of sleep-disordered breathing: a moving target(American Academy of Sleep Medicine (AASM), 2020-02-15) Quan, Stuart; Javaheri, Sogol; Budhiraja, RohitPublication Predictors of sleepiness in obstructive sleep apnoea at baseline and after 6 months of continuous positive airway pressure therapy(European Respiratory Society (ERS), 2017) Budhiraja, Rohit; Kushida, Clete A.; Nichols, Deborah A.; Walsh, James K.; Simon, Richard D.; Gottlieb, Daniel; Quan, Stuart