Person: Quan, Stuart
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Quan
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Quan, Stuart
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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 contribution of sleep problems to academic and psychosocial functioning(Wiley, 2014-01-28) Perfect, Michelle M.; Levine-Donnerstein, Deborah; Archbold, Kristen; Goodwin, James L.; Quan, StuartThe current study examined the concurrent and longitudinal relations among sleep problems with academic and psychosocial functioning in a prospective cohort study, the Tucson Children’s Assessment of Sleep Apnea study (TuCASA). Children were assessed between the ages of 6 and 11 years and again approximately five years later. Sleep disordered breathing was assessed via polysomnography and sleep duration, sleep consistency, excessive daytime sleepiness (EDS), and insomnia symptoms were evaluated via parental and self-report. Although regression models for sleep problems yielded minimum effect sizes in predicting standardized achievement scores, they jointly related to lower parent-reported grades and adolescent-reported school problems. Additionally, hierarchical multiple regression revealed that sleep parameters significantly predicted measures of psychosocial functioning with medium (Behavior Assessment Scales (BASC-2) Parent Report Form (PRF)-Behavioral Symptoms Index, Internalizing Symptoms Composite, Self-Report (SRP) Emotional Symptoms Index, Internalizing Composite, Personal Adjustment) to small-medium effect sizes (BASC-2 PRF Externalizing, Adaptive Composites, BASC-2 SRP Inattention/Hyperactivity Composite) above and beyond sociodemographics and IQ. Similar findings occurred for BASC-2 subscales. Parent- reported current EDS and youth-reported insomnia symptoms were the most consistent contributors. School psychologists should screen for and treat or make referrals for sleep problems, taking into account chronicity and multiple informants’ perspectives, to maximize academic intervention benefits.Publication The Impact of an Online Prematriculation Sleep Course (Sleep 101) on Sleep Knowledge and Behaviors in College Freshmen: A Pilot Study(Southwest Journal of Pulmonary and Critical Care, 2017-04-06) Quan, Stuart; Ziporyn, PallasCollege students have a high prevalence of poor sleep quality and sleep deficiency which negatively impacts their academic, mental and physical performance. A prematriculation course focused on improving sleep knowledge and behaviors may reduce sleep problems. “Sleep 101” is an online prematriculation course developed to educate incoming college freshmen about the importance of sleep in their lives and to recommend behaviors that will improve their sleep health. In a pilot program, “Sleep 101” was administered to freshman at four universities. The results of a voluntary survey after completion of the course indicated that there was an improvement in knowledge about sleep and the effects of caffeine use, and that students were less likely to drive drowsy and pull “all-nighters,” These pilot data suggest that an internet administered prematriculation course on the importance of sleep and the adoption of healthy sleep behaviors will be effective in reducing sleep problems among college students.Publication The effect of CPAP on HRQOL as Measured by the quality of Well-Being Self-Administered Questionnaire (QWB-SA)(Southwest Journal of Pulmonary and Critical Care, 2020-01-14) Batool-Anwar, Salma; Omobomi, Olabimpe; Quan, StuartBackground: To examine the effect of continuous positive airway pressure (CPAP) on Health-related quality of life (HRQoL) as measured by the Quality of Well Being Self-Administered questionnaire (QWB-SA). Methods: Participants from The Apnea Positive Pressure Long-term Efficacy Study (APPLES); a 6-month multicenter randomized, double-blinded intention to treat study, were included in this analysis. The participants with an apnea-hypopnea index >10 events/hour initially randomized to CPAP or Sham group were asked to complete QWB-SA at baseline, 2, 4, and 6-month visits. Results: There were no group differences among either the CPAP or Sham groups. “Mean age was 52±12 [SD] years, AHI 40±25 events/hr, BMI 32±7.1 kg/m2, and Epworth Sleepiness Score (ESS) 10±4 of 24 points.” QWB-SA scores were available at baseline, and 2, 4 & 6 months after treatment in CPAP (n 558) and Sham CPAP (n 547) groups. There were no significant differences in QWB scores among mild, moderate or severe OSA participants at baseline. Modest improvement in QWB scores was noted at 2, 4 and 6- months among both Sham and CPAP groups (P <0.05). However, no differences were observed between Sham CPAP and CPAP at any time point. Comparison of the QWB-SA data from the current study with published data in populations with chronic illnesses demonstrated that the impact of OSA is no different than the effect of AIDS and arthritis. Conclusion: Although the QoL measured by the QWB-SA was impaired in OSA it did not have direct proportionality to OSA severity.Publication Clinical and Polysomnographic Correlates of Subjective Sleepiness in Mild Obstructive Sleep Apnea(Springer Science and Business Media LLC, 2019-06-19) Omobomi, Olabimpe; Batool-Anwar, Salma; Quan, StuartPurpose: The decision to treat mild obstructive sleep apnea (OSA) often hinges on the presence of subjective daytime sleepiness. This study was done to identify clinical and polysomnographic features which correlate with subjective sleepiness in mild OSA. Methods: Utilizing data from the Apnea Positive Pressure Long-term Efficacy Study, 199 participants with mild OSA were identified. Participants were grouped as “sleepy” or “non-sleepy” based on their responses to a question regarding excessive daytime sleepiness, and Epworth Sleepiness Scores. We compared demographic, clinical and baseline polysomnographic data between the groups. Results: The prevalence of subjective sleepiness was 74.4%. The sleepy group was younger (46.1 ± 12.6 vs. 53.3 ± 13.1 years, p=0.001), reported lower quality of life (4.5 ± 0.69 vs. 4.9 ± 0.61, p=0.0002), had higher depression scores (5.4 ± 4.7 vs. 3.1 ± 3.5, p=0.003) and reported more naps per week (2.6 ± 2.9 vs. 1.3 ± 1.9, p=0.01). Total sleep time and sleep efficiency were notably higher in the sleepy (254.2 ± 106 vs. 220.4 ± 114 min, p=0.08) and (80.2 ± 12.6 vs. 75.7 ± 14.9 %, p=0.06), approaching statistical significance. The non-sleepy group had slightly higher apnea hypopnea index (AHI: 12.2 ± 1.5 vs. 11.2 ± 2.4 events/hour, p=0.01) and worse desaturation indices. Conclusions: Subjective sleepiness in mild OSA is associated with younger age, worsened mood and quality of life. This study suggests that evidence of increased sleep drive on polysomnography may correlate with subjective sleepiness in mild OSA.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 Sleep apnea learning module(Division of Slepp Medicine, Harvard Medical School, 2018) Quan, StuartPublication Minimizing Bias in Systematic Reviews: Comment on Kunisaki et al, Provider types and Outcomes in Obstructive Sleep Apnea Case Finding and Treatment: A Systematic Review(American College of Physicians, 2018) Parthasarathy, Sairam; Combs, Daniel; Patel, Sarah; Poongkunran, Chitra; Quan, StuartPublication The Role of Dentists in the Diagnosis and Treatment of Obstructive Sleep Apnea: Consensus and Controversy(American Academy of Sleep Medicine (AASM), 2017) Quan, Stuart; Schmidt-Nowara, WolfgangPublication Sleep-disordered breathing in hospitalized patients with congestive heart failure: a concise review and proposed algorithm(Springer Nature, 2018) Gupta, Ankit; Quan, Stuart; Oldenburg, Olaf; Malhotra, Atul; Sharma, SunilCongestive heart failure (CHF) is the most common cause of hospital admission in the USA costing the taxpayers billions of dollars. Sleep-disordered breathing (SDB) is a common co-morbid condition associated with CHF with prevalence estimated to be 60-70%. Despite substantial evidence supporting the negative impact of SDB on CHF, the condition is underrecognized and undertreated. Patients admitted to the hospital with CHF and SDB are prime candidates for intervention with positive airway pressure (PAP) therapy as they form a "captive audience," and timely intervention and education may mitigate sub-optimal outcomes. In conclusion, this review explores emerging data on the cost effectiveness and outcome of early intervention with PAP in hospitalized CHF patients.