Simmons 1 Kayla Simmons Professor S.

Annette Shelton Biology 1615 21 August 2014 Sleep-Disordered Breathing and Mortality: A Prospective Cohort Study A Summary Paper Approximately 9% of women and 24% of men in the general population have sleepdisordered breathing and a majority of those go undiagnosed. Data collected by the Sleep Heart Health Study, a study of the cardiovascular consequences of sleep-disordered breathing, and examine whether this chronic condition is independently associated with mortality and evaluate the possible effects of sex and age (PLOS). Sleep-disordered breathing is an illness that, in recent years, has gained recognition as a large cause of mortality. Sleep-disordered breathing is characterized by recurrent collapse of the upper airway, and is associated with recurrent episodes of arousal from sleep (PLOS). One of the biggest mortality factors is known as sleep apnea, or a pause/cessation of breathing in ones sleep. Additionally, many of those suffering from sleep-disordered breathing have a host of other medical complications that contribute to their mortality risk; such as, hypertension, coronary artery disease, congestive heart failure, and stroke. Such complications make it difficult to gather accurate statistical analysis of sleep disorder related mortality, due to a lack of separation and a bias of data. In the past, many studies have been conducted but have failed to gain merit as a result of improper data collection and separation, but also any prior treatment for the condition. However, between the years of 1995 and 1998 the Sleep Heart Health Study was able to gather 6,441 participants aged 40 years or older whom had never received treatment for sleep-disorder breathing. Prior treatment was defined as anyone who had received positive airway pressure, an oral appliance, supplemental oxygen, or a tracheostomy and anyone who had received such treatments were not eligible for participation. To obtain an accurate sample each participant was given a baseline exam that consisted of an overall health screening, home polysomnogram (a sleep study), vital sign monitoring, and a list of prescription drug use. Any outside factors, such as tobacco use, were obtained via selfreport. The overall hypothesis was older aged, male sex, minority race, and central adiposity would associate with increased severity of sleep-disordered breathing (PLOS). The experiment was conducted using a portable monitor to track participants sleep patterns from home. Signals such as ECGs (both bilateral and single bipolar), oxygen saturations, pulse oximetry, body positioning, and airflow through a specially designed mask were monitored and scored by researchers. A 10 second or greater pause in breathing defined an apnea, and hypopneas (abnormally low respiratory rates) were identified as a decrease of 30% in saturation levels. These results were combined to create an AHI, or apnea-hypopnea index, and were used as the primary measurement for statistical analysis. Participants were monitored for one night, and follow-up procedures were conducted over an 8 year period. Follow-up methodology was done through a cohort using approaches such as interviews, annual questionnaires, phone calls, as well as community monitoring through hospital records, and obituaries. In the follow up period, it was obtained that 147 participants sought out medical treatment for their condition, and were

Simmons 2 removed from the study. However, 1, 047 participants were identified as having died from sleepdisordered breathing. Upon the end of the follow up period, scientists gathered the data into a statistical representation. The AHI level were arranged into clinical cutoff points. Events less than 5 were classified as normal, 5.0-14.9 were mild, 15.0-29.9 moderate, and greater than 30 were considered severe. A Kaplan Meier plot was created to evaluate the results and is included below.

As hypothesized, those adults with older age, male sex, minority race, and central adiposity were associated with increasing severity of sleep-disordered breathing (PLOS). The data was further broken down to conclude that 42.9% of the men did not have sleep-disordered breathing, 33.2% had mild disease, 15.7% had moderate disease, and 8.2% had severe disease. Women had corresponding percentages of 64.7%, 24.5%, 7.9%, and 3.0%. Thus, it was determined the greatest association between sleep-disorder breathing and mortality was found in men aged 40-70 years with severe disease. Furthermore, those participants who also suffered from CAD were at twice the risk of mortality. Though this study cannot make a definitive claim that sleep-disorder breathing is a direct cause of death, simply because correlation doesnt prove causation, it does establish a relationship between the two, and indicates the need for further study. As previously stated, the majority of those suffering from sleep-disorder breathing go undiagnosed and are unaware of its health risk especially when associated with other adverse health conditions. This study is highly indicative of a need for further clinical study on a larger scale and over a length of time. This

Simmons 3 study was limited in that the observation was only done over one night of analysis, and some information was left up to self-report, which creates room for inaccurate representation. Though, it is unlikely such errors in reporting would affect abnormalities in the study. This research gains credibility in that it is the largest study conducted to date and represents an association between sleep-disorder breathing and mortality. Furthermore, it has significant strengths due to the separation of participants by age, sex, and preexisting medical conditions. Unfortunately, study without existing cardiovascular disease is not possible, meaning sleep-disorder breathing cannot be studied independently and must be an associated science. Researchers are working to study sleep-disorder in a more category specific way, such that, younger adults will be studied more in depth and independently from older aged adults. In conclusion, the experiment conducted by the Sleep Heart Health Study indicates sleep-disorder breathing is a cause of mortality and is directly related to age, obesity, and preexisting, chronic conditions and need further experimentation due to a rising prevalence within the general populous.

Simmons 4 Works Cited Punjabi, Naresh M., Brian S. Caffo, James L. Goodwin, Daniel J. Gottlieb, Anne B. Newman, George T. O'Connor, David M. Rapoport, Susan Redline, Helaine E. Resnick, John A. Robbins, Eyal Shahar, Mark L. Unruh, and Jonathan M. Samet. "Sleep-Disordered Breathing and Mortality: A Prospective Cohort Study." PLOS Medicine:. N.p., 18 Aug. 2009. Web. 23 Apr. 2014. "What Is Sleep Apnea?" - NHLBI, NIH. N.p., 10 July 2012. Web. 22 Apr. 2014. "What Causes Hypoxemia?" What Causes Hypoxemia? N.p., n.d. Web. 23 Apr. 2014 "Polysomnography." Wikipedia. Wikimedia Foundation, 21 Apr. 2014. Web. 23 Apr. 2014 "Hypopnea." Wikipedia. Wikimedia Foundation, 18 Apr. 2014. Web. 23 Apr. 2014.

Link to research article: http://www.plosmedicine.org/article/fetchObject.action?uri=info%3Adoi%2F10.1371%2 Fjournal.pmed.1000132&representation=PDF