Esa Rauhala

Breathing during sleep in menopause: A randomized, controlled, crossover trial with estrogen therapy

OBJECTIVE To evaluate the prevalence of different types of nocturnal breathing abnormalities in postmenopausal women and the effect of estrogen replacement therapy (ERT) on nocturnal breathing. METHODS A prospective, randomized, placebo-controlled, double-blind, crossover study was completed by 62 of 71 recruited healthy women. The first 3-month treatment period with either estrogen or placebo was followed by placebo washout for a month and then by a second treatment period with crossover to either estrogen or placebo. On a night after each treatment period, sleep was monitored with polysomnography, and breathing was assessed with a static-charge-sensitive bed and oximeter. For the respiratory variables, a sample size of 48 subjects was sufficient to give statistical power of 85% with a significance level of P < .05. RESULTS The occurrence of obstructive sleep apnea in all women was low (1.6%), but partial upper airway obstruction, manifesting as an increased respiratory resistance pattern, was more common (17.7%). Estrogen replacement therapy decreased the occurrence (P = .047) and frequency (P = .049) of sleep apnea but had no effect on partial upper airway obstruction or arterial oxyhemoglobin saturation. CONCLUSION Partial upper airway obstruction is the most prevalent form of sleep-disordered breathing, occurring ten times more frequently than sleep apnea in postmenopausal women. Unopposed estrogen replacement therapy has only a minor effect on sleep apnea and has no effect on partial airway obstruction.

Upper airway obstruction in hypothyroidism

Abstract. Objectives. To determine the occurrence and frequency of nocturnal upper airway obstruction in hypothyroidism.

Estrogen replacement therapy and nocturnal periodic limb movements : A randomized controlled trial

Objective To evaluate the effect of estrogen replacement therapy on nocturnal periodic limb movements in a randomized, double-masked, placebo-controlled, crossover trial. Methods Seventy-one healthy postmenopausal women volunteered in answer to a newspaper announcement; 62 women completed the follow-up. Frequency of nocturnal body movements was measured with the static-charge-sensitive bed and all-night polysomnographic recordings. Serum estradiol (E2) and FSH concentrations were also measured at baseline and after each treatment period. The power of the study setup was 94%. Results Nearly half the women presented with episodes of periodic limb movements (30 of 62 women, or 48%, during placebo and 27, or 44%, during estrogen therapy). In 17 (27%) during placebo and 19 (31%) during estrogen therapy, frequency of periodic limb movements exceeded index level 5 per hour while subjects were in bed. Incidence or intensity of movements, movement durations, and movement intervals did not change with estrogen therapy. The arousal index was similar during the two treatments (medians = 1.7 for placebo and 1.3 for estrogen, P = .758). Variations in serum E2 concentration, age, and body mass index did not explain variations in movement activity. Conclusion Estrogen replacement therapy in doses used to control climacteric symptoms does not alter the incidence or intensity of nocturnal periodic limb movements.

Sleep quality in preeclampsia

OBJECTIVE Our goal was to study the sleep quality in women with preeclampsia with a special reference to nocturnal body movement activity. STUDY DESIGN Sleep quality was evaluated in nine women with preeclampsia and eight women with normal term pregnancy by means of questionnaires and by recording the nocturnal body movement activity with the static charge-sensitive bed. RESULTS Subjective sleep complaints were similar in both groups. The total movement time and the total frequency of body movements in bed were, however, significantly increased in the preeclamptic group. CONCLUSION The study suggests that sleep is impaired in preeclamptic subjects.

Detection of periodic leg movements with a static‐charge‐sensitive bed

SUMMARY We evaluated the performance of the static‐charge‐sensitive bed (SCSB), a non‐ invasive movement sensor, in detecting nocturnal periodic movement activity using simultaneous bilateral anterior tibialis electromyography (EMG,) as a reference. Two different study setups were used, one with 500 random record extracts, another with 10 continuous recordings. The inter‐rater reliability between two independent scorers was 0.92 in scoring EMG, and 0.91 in scoring SCSB. In an epoch based analysis, depending on the study setup and scorer, the sensitivity of the SCSB to detect periodic leg movements was 0.81‐0.94 whereas the specificity was 0.84‐0.89. In a movement‐by‐movement analysis, despite incomplete concordance between the two methods the total number of movements per hour were comparable. Our findings support the use of the SCSB as a non‐invasive alternative to anterior tibialis EMG recordings to reveal the presence of nocturnal periodic movement activity and estimate its frequency.

Comparison of autonomic withdrawal in men with obstructive sleep apnea syndrome, systemic hypertension, and neither condition

Obstructive sleep apnea syndrome is characterized by obesity, nocturnal breathing abnormalities, arterial hypertension, and an increased number of cardiovascular events. Sympathetic activity is increased during nocturnal apneic episodes, which may mediate the cardiovascular complications of sleep apnea. We studied 15 male subjects with obstructive sleep apnea syndrome and associated hypertension, 54 subjects with mild to moderate essential hypertension, and 25 healthy normotensive men. Cardiovascular autonomic control was assessed using frequency domain measures of heart rate variability (HRV) during a controlled breathing test and during orthostatic maneuver. Compared with normotensive and hypertensive groups, total power and low- and high-frequency components of HRV during controlled breathing were significantly (analysis of variance, p<0.0001) lower in the obstructive sleep apnea syndrome. During the orthostatic maneuver, the change in total power of HRV was different between the 3 groups (analysis of variance, p = 0.004). The total power of HRV tended to increase in the normotensive (4.11+/-12.29 ms2) and in hypertensive (2.31+/-12.65 ms2) groups, but decreased (1.13+/-1.23 ms2) in the hypertensive group with obstructive sleep apnea syndrome. According to multivariate regression analysis, age and sleep apnea were the major independent determinants of HRV. This study found that an abnormal response to autonomic nervous tests characterizes hypertension in overweight subjects with obstructive sleep apnea syndrome. This could be due to autonomic withdrawal or supersaturation of the end-organ receptors by excessive and prolonged sympathetic stimulation. Our results also show the reduced response of orthostatic maneuver and controlled breathing in the hypertensive group compared with the normotensive group.

Emfit movement sensor in evaluating nocturnal breathing.

Obstructive sleep apnea (OSA) diagnostics by the movement sensors static charge-sensitive bed (SCSB) and electromechanical film transducer (Emfit) is based on dividing the signal into different breathing patterns. The usage of non-invasive mattress sensors in diagnosing OSA is particularly tempting if patient has many other non sleep-related monitoring sensors. However, a systematic comparison of the apnea-hypopnea index (AHI) with Emfit-parameters is lacking. In addition to periodic breathing, SCSB and Emfit visualize episodes of sustained negative increases in intrathoracic pressure (increased respiratory resistance, IRR), of which relevance is still ambiguous. Our aim is to compare Emfit-parameters with the AHI and to provide a description of the patients suffering from IRR. Time percentage with all obstructive periodic Emfit breathing patterns (OPTotal%) showed the best correlation with the AHI. The OPTotal percentage of 21 yielded to excellent accuracy in detecting subjects with an AHI of 15/h or more. Patients with IRR received high scores in GHQ-12-questionnaire. An Emfit movement sensor might offer additional information in OSA diagnostics especially if nasal pressure transducer cannot be used.

Climacteric vasomotor symptoms do not predict nocturnal breathing abnormalities in postmenopausal women

OBJECTIVE To study the association of climacteric vasomotor symptoms and nocturnal breathing abnormalities in a sample of healthy postmenopausal women. METHODS Out of 71 postmenopausal women who took part in a large sleep study, 65 women were included into the present study. Sleep was monitored with polysomnography and nocturnal breathing with a static-charge sensitive bed and a pulse oximeter. Climacteric vasomotor symptoms were scored daily for 14 days and levels of oestradiol and FSH were measured in the serum. RESULTS Altogether 21 (32.3%) women had some degree of breathing abnormalities during the study night. The occurrence of clinically significant sleep apnoea was low (1.5%) and of moderate type (OP-2). In contrast, increased respiratory resistance pattern, typical for partial upper airway obstruction, was frequent (16.9%). Seventy-eight per cent of the women had arterial oxyhaemoglobin desaturation events, but only in 4.6% of the women these events occurred more than 5 times/h of time in bed. Older women had more simple periodic breathing (P-1) and lower mean arterial oxyhaemoglobin saturation (SaO(2)). Body mass index (BMI) correlated with the apnoea frequency (OP-2) and inversely with the mean SaO(2). The severity of climacteric vasomotor symptoms or serum oestradiol concentration did not correlate with nocturnal breathing abnormalities. CONCLUSIONS Nocturnal breathing abnormalities, especially partial upper airway obstruction, are common in postmenopausal women, but climacteric vasomotor symptoms do not predict their occurrence or severity. Increasing age and high BMI are important determinants of nocturnal breathing abnormalities.

Subjective Sleep Quality during Treatment with Two Different Antihypertensive Medications

AbstractObjective: Only a few studies have addressed the effect of antihypertensive medication on the quality of sleep and sleep apnoea. Therefore, we evaluated the subjective sleep quality of hypertensive patients using self-administered questionnaires (in particular factors reflecting sleep apnoea and snoring) when treated with either metoprolol, a β-blocking agent, or isradipine, a calcium antagonist. Design and Patients: Seven hundred and ninety-seven men and women with diastolic blood pressure (DBP) of 95 to 114mm Hg were randomised to receive either isradipine 1.25mg twice daily or metoprolol 50mg twice daily after a 4-week placebo washout period. The dosages were titrated at 4-week intervals to maintain normotension (DBP ≤90mm Hg). If normotension was not achieved by monotherapy, add-on therapy (combining isradipine and metoprolol) was started. The patients completed a sleep questionnaire at the end of the placebo period and at 8 and 24 weeks on active treatment to evaluate the effect of these two medications on sleep. Results: After 8 weeks of monotherapy, isradipine showed a more favourable change in the number of naps taken (p < 0.05), the tendency to fall asleep during leisure time (p < 0.01) and the frequency of nocturnal sweating (p < 0.001) compared with metoprolol. However, most of the differences between the study drugs were reduced after 24 weeks of monotherapy; only nocturnal sweating (p < 0.05) still exhibited the same difference as that seen at 8 weeks. With regard to the frequency of snoring, a more favourable change was observed with metoprolol (p < 0.05). Combining isradipine with metoprolol clearly decreased nocturnal sweating (p < 0.001). Conclusions: According to our study there were only small clinically nonsignificant long-lasting differences between isradipine and metoprolol with regard to their effect on sleep. Significant differences were seen at the beginning of the treatment but they lessened during the course of the study.