Suchergebnisse

Background: Obstructive sleep apnea (OSA) is a modifiable risk factor of atrial fibrillation (AF) but is underdiagnosed in these patients due to absence of good OSA screening pathways. Polysomnography (PSG) is the gold standard for diagnosing OSA but too resource-intensive as a screening tool. We explored whether cardiorespiratory polygraphy (PG) devices using an automated algorithm for Apnea-Hypopnea Index (AHI) determination can meet the requirements of a good screening tool in AF patients.Methods: This prospective study validated the performance of three PGs [ApneaLink Air (ALA), SOMNOtouch RESP (STR) and SpiderSAS (SpS)] in consecutive AF patients who were referred for PSG evaluation. Patients wore one of the three PGs simultaneously with PSG, and a different PG during each of three consecutive nights at home. Severity of OSA was classified according to the AHI during PSG (30 = severe).Results: Of the 100 included AF patients, PSG diagnosed at least moderate in 69% and severe OSA in 33%. Successful PG execution at home was obtained in 79.1, 80.2 and 86.8% of patients with the ALA, STR and SpS, respectively. For the detection of clinically relevant OSA (AHI >= 15), an area under the curve of 0.802, 0.772 and 0.803 was calculated for the ALA, STR and SpS, respectively.Conclusions: This study indicates that home-worn PGs with an automated AHI algorithm can be used as OSA screening tools in AF patients. Based on an appropriate AHI cut-off value for each PG, the device can guide referral for definite PSG diagnosis. ; This study was supported by the Antwerp University Hospital Cardiology Research Fund, and is part of the Limburg Clinical Research Center, supported by the foundation Limburg Sterk Merk, province of Limburg, Flemish government, Hasselt University, Ziekenhuis Oost-Limburg and Jessa Hospital. We like to thank ResMED, SOMNOmedics and Microport for their education and the unconditional provision of the respective PGs for this study.

Purpose Breathing sounds during sleep are altered and characterized by various acoustic specificities in patients with sleep disordered breathing (SDB). This study aimed to identify acoustic biomarkers indicative of the severity of SDB by analyzing the breathing sounds collected from a large number of subjects during entire overnight sleep. Methods The participants were patients who presented at a sleep center with snoring or cessation of breathing during sleep. They were subjected to full-night polysomnography (PSG) during which the breathing sound was recorded using a microphone. Then, audio features were extracted and a group of features differing significantly between different SDB severity groups was selected as a potential acoustic biomarker. To assess the validity of the acoustic biomarker, classification tasks were performed using several machine learning techniques. Based on the apnea–hypopnea index of the subjects, four-group classification and binary classification were performed. Results Using tenfold cross validation, we achieved an accuracy of 88.3% in the four-group classification and an accuracy of 92.5% in the binary classification. Experimental evaluation demonstrated that the models trained on the proposed acoustic biomarkers can be used to estimate the severity of SDB. Conclusions Acoustic biomarkers may be useful to accurately predict the severity of SDB based on the patient's breathing sounds during sleep, without conducting attended full-night PSG. This study implies that any device with a microphone, such as a smartphone, could be potentially utilized outside specialized facilities as a screening tool for detecting SDB. ; The work was partly supported by the SNUBH Grant #06-2014-157 and the Bio and Medical Technology Development Program of the National Research Foundation (NRF) funded by the Korean government, Ministry of Science, ICT & Future Planning (MSIP) (NRF-2015M3A9D7066972, NRF-2015M3A9D7066980).

Índex d'apnea-hipopnea; Circadià; Hemoglobina glicada ; Índice de apnea-hipopnea; Circadiano; Hemoglobina glicada ; Apnea-hypoapnea index; Circadian; Glycated hemoglobin ; Sleep apnea, a condition that modifies sleep and circadian rhythms, is highly prevalent in patients with diabetes. However, it is not known if there is an association between sleep apnea, circadian alterations and glycemic regulation in this type of patient. Here, a polysomnographic study was carried out on 21 women and 25 men (mean age = 64.3 ± 1.46 years) with diagnoses of type 2 diabetes to detect the presence of sleep apnea. Moreover, patients wore an actigraph and a temperature sensor on the wrist for one week, to study the manifestation of the circadian rhythms. The correlations of circadian and polysomnographic variables with the severity of apnea, measured by the apnea-hypopnea index, and with glycemic dysregulation, measured by the percentage of glycated hemoglobin, were analyzed. The mean apnea-hypoapnea index of all the participants was 39.6 ± 4.3. Apnea-hypoapnea index correlated with % N1, negatively with % N3, and also the stability of the active circadian rhythm. However, no significant correlation was found between the apnea-hypopnea index and wrist temperature rhythm and glycated hemoglobin. Glycated hemoglobin levels were negatively associated with the percentage of variance explained by the wrist temperature circadian rhythm (calculated via 24 and 12 h rhythms). This association was independent of body mass index and was strongest in patients with severe apnea. In conclusion, patients with diabetes showed altered circadian rhythms associated with a poor glycemic control and this association could partially be related to the coexistence of sleep apnea. ; This research was supported by grants from de Instituto de Salud Carlos III ISCIII (Fondo de Investigación Sanitaria PI12/00803 and PI15/00260). European Union (European Regional Development Fund. Fondo Europeo de Desarrollo Regional. FEDER. "Una manera de hacer Europa"). CIBER de Diabetes y Enfermedades Metabólicas Asociadas and CIBER de Enfermedades Respiratorias are initiatives of the Instituto de Salud Carlos III.

Type 2 diabetes leads to severe nocturnal hypoxemia, with an increase in apnea events and daytime sleepiness. Hence, we assessed sleep breathing parameters in the prediabetes stage. A cross-sectional study conducted on 966 middle-aged subjects without known pulmonary disease (311 patients with prediabetes and 655 controls with normal glucose metabolism) was conducted. Prediabetes was defined by glycated hemoglobin (HbA1c), and a nonattended overnight home sleep study was performed. Participants with prediabetes (n = 311) displayed a higher apnea-hypopnea index (AHI: 12.7 (6.1;24.3) vs. 9.5 (4.2;19.6) events/h, p < 0.001) and hypopnea index (HI: 8.4 (4.0;14.9) vs. 6.0 (2.7;12.6) events/h, p < 0.001) than controls, without differences in the apnea index. Altogether, the prevalence of obstructive sleep apnea was higher in subjects with prediabetes than in controls (78.1 vs. 69.9%, p = 0.007). Additionally, subjects with prediabetes presented impaired measurements of the median and minimum nocturnal oxygen saturation, the percentage of time spent with oxygen saturations below 90%, and the 4% oxygen desaturation index in comparison with individuals without prediabetes (p < 0.001 for all). After adjusting for age, sex, and the presence of obesity, HbA1c correlated with the HI in the entire population (r = 0.141, p < 0.001), and the presence of prediabetes was independently associated with the AHI (B = 2.20 (0.10 to 4.31), p = 0.040) as well as the HI (B = 1.87 (0.61 to 3.14), p = 0.004) in the multiple linear regression model. We conclude that prediabetes is an independent risk factor for an increased AHI after adjusting for age, sex, and obesity. The enhanced AHI is mainly associated with increments in the hypopnea events. ; This work was supported by grants from the Lleida Provincial Council, AutonomousGovernment of Catalonia (2017SGR696 and SLT0021600250), Instituto de Salud Carlos III (Fondo deInvestigación Sanitaria PI12/00803, PI15/00260 and PI18/00964), and European Union (EuropeanRegional ...

Sleep apnea, a condition that modifies sleep and circadian rhythms, is highly prevalent in patients with diabetes. However, it is not known if there is an association between sleep apnea, circadian alterations and glycemic regulation in this type of patient. Here, a polysomnographic study was carried out on 21 women and 25 men (mean age = 64.3 1.46 years) with diagnoses of type 2 diabetes to detect the presence of sleep apnea. Moreover, patients wore an actigraph and a temperature sensor on the wrist for one week, to study the manifestation of the circadian rhythms. The correlations of circadian and polysomnographic variables with the severity of apnea, measured by the apnea-hypopnea index, and with glycemic dysregulation, measured by the percentage of glycated hemoglobin, were analyzed. The mean apnea-hypoapnea index of all the participants was 39.6 4.3. Apnea-hypoapnea index correlated with % N1, negatively with %N3, and also the stability of the active circadian rhythm. However, no significant correlation was found between the apneahypopnea index and wrist temperature rhythm and glycated hemoglobin. Glycated hemoglobin levels were negatively associated with the percentage of variance explained by the wrist temperature circadian rhythm (calculated via 24 and 12 h rhythms). ThisSleep apnea, a condition that modifies sleep and circadian rhythms, is highly prevalent in patients with diabetes. However, it is not known if there is an association between sleep apnea, circadian alterations and glycemic regulation in this type of patient. Here, a polysomnographic study was carried out on 21 women and 25 men (mean age = 64.3 1.46 years) with diagnoses of type 2 diabetes to detect the presence of sleep apnea. Moreover, patients wore an actigraph and a temperature sensor on the wrist for one week, to study the manifestation of the circadian rhythms. The correlations of circadian and polysomnographic variables with the severity of apnea, measured by the apnea-hypopnea index, and with glycemic dysregulation, measured by the percentage of glycated hemoglobin, were analyzed. The mean apnea-hypoapnea index of all the participants was 39.6 4.3. Apnea-hypoapnea index correlated with % N1, negatively with %N3, and also the stability of the active circadian rhythm. However, no significant correlation was found between the apneahypopnea index and wrist temperature rhythm and glycated hemoglobin. Glycated hemoglobin levels were negatively associated with the percentage of variance explained by the wrist temperature circadian rhythm (calculated via 24 and 12 h rhythms). This association was independent of body mass index and was strongest in patients with severe apnea. In conclusion, patients with diabetes showed altered circadian rhythms associated with a poor glycemic control and this association could partially be related to the coexistence of sleep apnea. association was independent of body mass index and was strongest in patients with severe apnea. In conclusion, patients with diabetes showed altered circadian rhythms associated with a poor glycemic control and this association could partially be related to the coexistence of sleep apnea. ; This research was supported by grants from de Instituto de Salud Carlos III ISCIII (Fondo de Investigación Sanitaria PI12/00803 and PI15/00260). European Union (European Regional Development Fund. Fondo Europeo de Desarrollo Regional. FEDER. "Una manera de hacer Europa"). CIBER de Diabetes y Enfermedades Metabólicas Asociadas and CIBER de Enfermedades Respiratorias are initiatives of the Instituto de Salud Carlos III.

STUDY OBJECTIVES: Centers for Medicare and Medicaid Services (CMS) reimbursement for positive airway pressure (PAP) devices for obstructive sleep apnea treatment is dependent on patients meeting adherence expectations within the first 3 months on therapy. Adherence is defined as usage of the device for at least 4 hours per night on 70% of nights during a consecutive 30-day period. We hypothesize that the adherence pattern may be established beyond this initial period, which may limit the opportunity to treat many patients. METHODS: Treatment and adherence data from PAP devices were monitored via wireless modems for 42 consecutive PAP-naïve military veterans who completed 1 year of nightly monitoring. Their baseline characteristics were as follows: age (mean ± standard deviation) 58.5 ± 12.5 years; body mass index 33.7 ± 5.7 kg/m(2); diagnostic apnea-hypopnea index (pretreatment) 28.1 ± 18.5 events/h; apnea-hypopnea index on PAP: 4.3 ± 3.3 events/h. We examined daily, monthly, quarterly, semiannual, and annual reports, and the best 30-day adherence report for each quarter. RESULTS: In the first 3 months, 19 of 42 participants were adherent by CMS criteria, and 23 of 42 participants were not. Of the 19 adherent participants, 13 remained adherent and 6 became nonadherent or stopped PAP treatment for the remainder of the year. In the 23 initially nonadherent participants, 16 stopped PAP treatment, and 7 participants (30.4%) became adherent (using CMS criteria) during the rest of the year. Thus, PAP adherence during the first 3 months was predictive for the rest of the year in only 68.4%. PAP nonadherence during the first 3 months was predictive for further nonadherence in only 69.6% of the cases. Overall, this led to a 65% sensitivity and 72% specificity of using adherence at 3 months in predicting adherence at 1 year. CONCLUSIONS: CMS adherence criteria affecting PAP coverage are restrictive and can result in the withholding of therapy in many patients who otherwise might become adherent. CLINICAL TRIAL ...

Obstructive Sleep Apnea Syndrome (OSAS) is defined as a sleep related breathing disorder that causes the body to stop breathing for about 10 seconds and mostly ends with a loud sound due to the opening of the airway. OSAS is traditionally diagnosed using polysomnography, which requires a whole night stay at the sleep laboratory of a hospital, with multiple electrodes attached to the patient's body. Snoring is a symptom which may indicate the presence of OSAS; thus investigation of snoring sounds, which can be recorded in the patient's own sleeping environment, has become popular in recent years to diagnose OSAS. In this study, we aim to develop a new method to detect post-apnea snoring episodes with the goal of diagnosing apnea or creating new criteria similar to apnea / hypopnea index. Emphasis is placed on detecting post apnea episodes, hence the apnea periods. In this method, first segmentation is done to eliminate the silence parts. Then, these episodes are represented by distinctive features; some of these features are available in literature but some of them are novel. Finally, episodes are classified using supervised methods. False alarm rates are reduced by adding additional constraints into the detection algorithm. These methods are applied to snoring sound signals of OSAS patients, recorded in Gulhane Military Medical Academy, to verify the success of our algorithms.

Introduction: Many studies on the impact of type 2 diabetes mellitus (T2DM) on sleep breathing have shown a higher prevalence and severity of sleep apnea-hypopnea syndrome (SAHS) in those with T2DM. Moreover, an increased activity of the sympathetic nervous system has been described in both pathologies. This cross-sectional study aimed to assess sympathetic activity in patients with T2DM, and to investigate the relationship between sympathetic activity and polysomnographic parameters. Materials and Methods: Thirty-six patients with T2DM without known clinical macrovascularnorpulmonarydiseaseand11controlsunderwentrespiratorypolygraphy, and their cardiac variability and 24-h urine total metanephrines were measured. Results: SAHS was highly prevalent with a mean apnea-hypopnea index (AHI) in the range of moderate SAHS. In patients with T2DM, the nocturnal concentration of total metanephrines in urine were higher than diurnal levels [247.0 (120.0–1375.0) vs. 210.0 (92.0–670.0), p = 0.039]. The nocturnal total metanephrine concentration was positively and significantly associatedwith the percentage of sleeping time spent with oxygen saturation <90%(CT90). In the entire population and in subjects with T2DM, the multivariate regression analysis showed a direct interaction between the nocturnal concentration of urine metanephrines and the CT90. Conclusion: These findings suggest that the increase in sympathetic activity previously described in patients with T2DM could be mediated through nocturnal breathing disturbances. The diagnosis and treatment of SAHS may influence sympathetic activity disorders and may contribute to an improvement in T2DM and cardiovascular risk. ; This study was supported by grants from the Instituto de Salud Carlos III (Fondo de Investigación Sanitaria, PI12/00803 and PI15/00260), European Union (European Regional Development Fund, Fondo Europeo de Desarrollo Regional, Una manera de hacer Europa), the Fundación Sociedad Española Endocrinología y Nutrición, and Menarini Spain S.A. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

AbstractBackgroundObstructive sleep apnea (OSA) was estimated to affect 15% to 30% of males and 5% to 15% of females with prevalence increasing with progressive tooth loss and its early identification can reduce the sequalae of OSA. Apnea‐hypopnea index is confirmatory but unsuitable for clinical settings to detect OSA and concise screening tools are required to detect OSA in edentulous patients.AimTo evaluate the impact of soft palate visibility and tongue position on incidence of OSA among edentulous patients.MethodologyThirty two edentulous participants aged between 30 and 65 years were grouped as partially edentulous (PE) and completely edentulous (CE). STOP‐BANG Questionnaire (SBQ) was used to assess the scores in OSA risk factors. Mallampati score assessed soft palate visibility. Wright's Classification graded tongue position. Spearmann test evaluated the correlation between the soft palate visibility and tongue position on the OSA scores. Mann–Whitney U test evaluated influence of tooth loss and gender on OSA scores.ResultsPositive correlation existed between Mallampati scores, Wright's classification and OSA scores (p < .05). CE participants and male participants had more OSA scores at (p < .05) and (p < .01).ConclusionsSBQ and Mallampati score can assist in chairside screening of OSA. Early screening for OSA in edentulous patients will direct for early intervention and prevent unforeseen sequalae.

บทนำ: โรคหยุดหายใจขณะหลับเป็นอันตรายต่อสุขภาพ ปัจจุบันรักษาโดยใช้เครื่องอัดอากาศแรงดันบวกชนิดต่อเนื่อง แต่พบว่าผู้ป่วยมีอัตราการยอมรับและใช้เครื่องอย่างต่อเนื่องต่ำ หากมีการปรับความรู้และพฤติกรรมของผู้ป่วยเมื่อเริ่มต้นใช้เครื่อง จะสามารถเพิ่มอัตราการใช้เครื่องได้ วัตถุประสงค์: เพื่อศึกษาอัตราการยอมรับเครื่องอัดอากาศแรงดันบวกชนิดต่อเนื่อง และปัจจัยการทำนายของผู้ป่วยโรคหยุดหายใจขณะหลับ ภายหลังได้รับการปรับความรู้และพฤติกรรมในรูปแบบกลุ่มในสถานการณ์การรักษาในเวชปฏิบัติ วิธีการศึกษา: การวิจัยแบบดำเนินการไปข้างหน้าในกลุ่มตัวอย่างผู้ป่วยโรคหยุดหายใจขณะหลับ ณ ศูนย์โรคการนอนหลับ โรงพยาบาลรามาธิบดี ระหว่างเดือนกุมภาพันธ์ถึงเดือนกรกฎาคม พ.ศ. 2558 จำนวน 247 คน ที่มีข้อบ่งชี้ในการใช้เครื่องอัดอากาศแรงดันบวกชนิดต่อเนื่องและร่วมโครงการปรับความรู้และพฤติกรรมซึ่งประกอบไปด้วย การให้ความรู้ สร้างแรงจูงใจ สาธิตวิธี ทดลองเครื่อง ประเมินผล ทุกสัปดาห์เป็นเวลา 3 สัปดาห์ ผลการศึกษา: กลุ่มตัวอย่างผู้ป่วย จำนวน 247 คน ส่วนใหญ่เป็นเพศชาย คิดเป็นร้อยละ 62 ดัชนีการหยุดหายใจโดยมีค่ามัธยฐาน (ค่าพิสัยควอไทล์) เท่ากับ 41.5 (46.4) ครั้งต่อชั่วโมง และมีอัตราการยอมรับการใช้เครื่องอัดอากาศแรงดันบวกชนิดต่อเนื่องคิดเป็นร้อยละ 85 ปัจจัยส่งเสริมการตัดสินใจใช้เครื่องคือ มีระดับของโรครุนแรงมาก (OR, 4.1; 95% CI, 1.2 - 13.9) จำนวนการทดลองเครื่อง 3 ครั้ง (OR, 8.6; 95% CI, 2.1 - 35.4) และสิทธิการเบิกค่ารักษาพยาบาล (OR, 8.1; 95% CI, 2.9 - 22.4) สรุป: ภายหลังการปรับความรู้และพฤติกรรมของผู้ป่วยโรคหยุดหายใจขณะหลับพบว่ามีการยอมรับในการใช้เครื่องสูงในบริบทของผู้ป่วยคนไทย จึงควรส่งเสริมโครงการนี้ให้แพร่หลายมากขึ้น ; Background:Continuous positive airway pressure (CPAP) device therapy is the standard treatment for obstructive sleep apnea (OSA) to date. However, acceptance and adherence rate remained low. Recent study showed that educational and behavioral modification program can improve the efficacy of CPAP use. Objectives: To study rate of acceptance and its predictor factors of in patients with obstructive sleep apnea after participant in group modification behavior program. Methods: This prospective cohort study was conducted in 247 obstructive sleep apnea patients at Ramathibodi Sleep Disorders Center, Ramathibodi Hospital from February to July 2015. There were indicated for CPAP. Participating states spanning included awareness, motivating, demonstration, and trials of CPAP evaluated every week for 3 weeks. Results: Of 247 obstructive sleep apnea patients (62% male) were included with apnea-hypopnea index (AIH) (median [interquartile range], 41.5 [46.4]), and acceptance CPAP (85%). Factors influencing decision to use CPAP wereseverity of diseases (OR, 4.1; 95% CI, 1.2 - 13.9), triple trials (OR, 8.6; 95% CI, 2.1 - 35.4), and government reimbursement (OR, 8.1; 95% CI, 2.9 - 22.4). Conclusions: After educational and behavioral intervention, the CPAP acceptance rate were high among Thai patients with obstructive sleep apnea. This program should be encouraged for more widespread clinical practice.

Funding Information: Fjola D. Sigurdardottir was funded by a PhD fellowship from the South‐Eastern Norway Regional Health Authority. Caroline Tonje Øverby was funded by NordForsk (NordSleep project 90458) via the Norwegian Research Council (Norsk Forskningsråd 298845). Tuomas Karhu was funded by the Research Committee of the Kuopio University Hospital Catchment Area for the State Research Funding (5041787) and Tampere Tuberculosis Foundation. Timo Leppänen was funded by the European Union's Horizon 2020 research and innovation programme (grant agreement no. 965417), NordForsk (NordSleep project 90458) via Business Finland (5133/31/2018), the Academy of Finland (323536), the Research Committee of the Kuopio University Hospital Catchment Area for the State Research Funding (5041767 and 5041794), the Finnish Cultural Foundation ‐ North Savo Regional Fund, and Tampere Tuberculosis Foundation. Abbott Diagnostics has provided the reagents for cTnI analysis. Torbjørn Omland has received consultant and/or speaker honoraria from Abbott Diagnostics, Bayer, Roche Diagnostics, Novartis, and CardiNor and has received research support from AstraZeneca, Abbott Diagnostics, Roche Diagnostics and SomaLogic via Akershus University Hospital. Publisher Copyright: © 2022 The Authors. Journal of Sleep Research published by John Wiley & Sons Ltd on behalf of European Sleep Research Society. ; Novel diagnostic markers for obstructive sleep apnea beyond the apnea–hypopnea index (AHI) have been introduced. There are no studies on their association with markers of subclinical myocardial injury. We assessed the association between novel desaturation parameters and elevated cardiac troponin I and T. Participants with polysomnography (498) from the Akershus Sleep Apnea study were divided into normal and elevated biomarker groups based on sex-specific concentration thresholds (cardiac troponin I: ≥4 ng/L for women, ≥6 ng/L for men; and cardiac troponin T: ≥7 ng/L for women, ≥8 ng/L for men). Severity of obstructive sleep apnea was ...

STUDY OBJECTIVES: Studies of older and less active patients with obstructive sleep apnea (OSA) have reported decreased exercise capacity as measured by peak oxygen uptake (VO(2) max) during cardiopulmonary exercise testing (CPET). We looked to determine whether VO(2) max was decreased in younger patients with OSA who regularly exercise as would be encountered in the military. METHODS: We evaluated military personnel who had undergone pulmonary function testing (PFT), CPET, and polysomnography (PSG) as part of the larger STAMPEDE III study for comprehensive evaluation of exertional dyspnea. For analysis, patients were classified into two groups, the OSA group with an apnea-hypopnea index (AHI) ≥ 15 events/h and a control group with an AHI < 15 events/h. RESULTS: Mean AHI was 32.7 in the OSA group (n = 40) versus 5.8 in the control group (n = 58) with no significant difference in age (40.7 years versus 39.4 years) or body mass index (30.4 kg/m(2) versus 29.9 kg/m(2)). PFT was normal in both groups including diffusing capacity (100.7% versus 96.5%) and FEV(1) (89.2% versus 86.2%). VO(2) max was not significantly different in the OSA group compared to the control group (101.3% versus 102.8%; P = .60) with both groups having normal exercise capacity. Exercise blood pressure response was normal and peak heart rate trended toward a blunted response in the OSA group (166.0 bpm versus 171.6 bpm, P = .09). CONCLUSIONS: Younger military personnel with moderate to severe OSA do not have decreased exercise capacity. The effect of OSA on exercise tolerance may be influenced by additional factors and is likely too small to be noted in this population. COMMENTARY: A commentary on this article appears in this issue on page 819. CITATION: Powell TA, Mysliwiec V, Aden JK, Morris MJ. Moderate to severe obstructive sleep apnea in military personnel is not associated with decreased exercise capacity. J Clin Sleep Med. 2019;15(6):823–829.

Obstructive sleep apnea (OSA) is a common sleep disorder characterized by recurring breathing pauses during sleep caused by a blockage of the upper airway (UA). OSA is generally diagnosed through a costly procedure requiring an overnight stay of the patient at the hospital. This has led to proposing less costly procedures based on the analysis of patients' facial images and voice recordings to help in OSA detection and severity assessment. In this paper we investigate the use of both image and speech processing to estimate the apnea-hypopnea index, AHI (which describes the severity of the condition), over a population of 285 male Spanish subjects suspected to suffer from OSA and referred to a Sleep Disorders Unit. Photographs and voice recordings were collected in a supervised but not highly controlled way trying to test a scenario close to an OSA assessment application running on a mobile device (i.e., smartphones or tablets). Spectral information in speech utterances is modeled by a state-of-the-art low-dimensional acoustic representation, called i-vector. A set of local craniofacial features related to OSA are extracted from images after detecting facial landmarks using Active Appearance Models (AAMs). Support vector regression (SVR) is applied on facial features and i-vectors to estimate the AHI. ; The activities in this paper were funded by the Spanish Ministry of Economy and Competitiveness and the European Union (FEDER) as part of the TEC2012-37585-C02 (CMC-V2) project. Authors also thank Sonia Martinez Diaz for her effort in collecting the OSA database that is used in this study.

Diabetis tipus 2; Hiperactivitat simpàtica; Risc cardiovascular ; Diabetes tipo 2; Hiperactividad simpática; Riesgo cardiovascular ; Type 2 diabetes; Sympathetic hyperactivity; Cardiovascular risk ; Introduction: Many studies on the impact of type 2 diabetes mellitus (T2DM) on sleep breathing have shown a higher prevalence and severity of sleep apnea-hypopnea syndrome (SAHS) in those with T2DM. Moreover, an increased activity of the sympathetic nervous system has been described in both pathologies. This cross-sectional study aimed to assess sympathetic activity in patients with T2DM, and to investigate the relationship between sympathetic activity and polysomnographic parameters. Materials and Methods: Thirty-six patients with T2DM without known clinical macrovascular nor pulmonary disease and 11 controls underwent respiratory polygraphy, and their cardiac variability and 24-h urine total metanephrines were measured. Results: SAHS was highly prevalent with a mean apnea-hypopnea index (AHI) in the range of moderate SAHS. In patients with T2DM, the nocturnal concentration of total metanephrines in urine were higher than diurnal levels [247.0 (120.0–1375.0) vs. 210.0 (92.0–670.0), p = 0.039]. The nocturnal total metanephrine concentration was positively and significantly associatedwith the percentage of sleeping time spent with oxygen saturation <90%(CT90). In the entire population and in subjects with T2DM, the multivariate regression analysis showed a direct interaction between the nocturnal concentration of urine metanephrines and the CT90. Conclusion: These findings suggest that the increase in sympathetic activity previously described in patients with T2DM could be mediated through nocturnal breathing disturbances. The diagnosis and treatment of SAHS may influence sympathetic activity disorders and may contribute to an improvement in T2DM and cardiovascular risk. ; This study was supported by grants from the Instituto de Salud Carlos III (Fondo de Investigación Sanitaria, PI12/00803 and PI15/00260), European Union (European Regional Development Fund, Fondo Europeo de Desarrollo Regional, Una manera de hacer Europa), the Fundación Sociedad Española Endocrinología y Nutrición, and Menarini Spain S.A. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.