case_images: PMC10983785_01
case_images: Key Findings of the Los Angeles Metropolitan Area Study. (A) This was one of the first epidemiological studies to systematically report on the prevalence of sleep disturbances, their age of onset, chronicity as well as sex and age differences. (B) The study also first reported on the prevalence of the same sleep disturbances as a function of the presence of chronic physical health problems, hospitalizations, and mental health problems, including the association of depression with insomnia symptoms in a non-clinical, general population sample. Taken with permission from Bixler et al.
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case_images: F4
case_images: As shown in Figure 4, Dr. Also, he reported that insomnia was more frequent in older people, particularly older women, and in people of lower educational socioeconomic status (Figure 4A); incipient data for the current revolution in sleep health disparities research. In addition, he confirmed in a general population sample, that insomnia, nightmares, and hypersomnia were more prevalent in individuals with frequent physical and mental health problems, particularly anxiety and depression (Figure 4B).
case_images: PMC10983785_02
case_images: Prevalence of SDB in the Penn State Adult Cohort. (A) Prevalence of different types and levels of SDB as a function of age in men (N = 741). Taken with permission from Bixler et al. (B) Prevalence of different types and levels of SDB in men (N = 741) and women (N = 1000) as well as a function of age, obesity, and menopausal and HRT status. Taken with permission from Bixler et al.
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case_images: F5
case_images: As shown in Figure 5, Dr. AHI >= 10 and daytime symptoms or comorbidities such as excessive daytime sleepiness, hypertension, or other cardiovascular complication) was 3.3% in men (Figure 5A), while 1.2% in women (Figure 5B). AHI, was greater in younger men than older men (Figure 6B). As it pertained to women, they were indeed less likely to have any type of SDB, regardless of menopausal status, compared to men (Figure 5B). Taken together, the data presented in Figures 5-7 supported early on the hypothesis that SDB in older adults is less severe in terms of its degree of associated hypoxemia and impact on cardiovascular health, while SDB in young and middle-aged adults is more severe in terms of both health dimensions.
case_images: Effect of Age and Gender on SDB in the Penn State Adult Cohort. (A) The prevalence of OSA, defined as an OA/HI >= 10 plus the presence of daytime symptoms or comorbidities increases up to the fifth decade of life in men (N = 741). (B) The severity of OSA, as measured by the slope of minimum SaO2 and defined across four different levels of the AHI, was greater in younger men than older men (N = 741). Taken with permission from Bixler et al. (C) Women, regardless of menopausal status, were significantly less likely to have any type of SDB compared to men (N = 1741); however, postmenopausal women not taking HRT were 4-times significantly more likely to have an OA/HI >= 15 compared to premenopausal women (N = 1000). Taken with permission from Bixler et al..
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case_images: F6
case_images: As shown in Figure 6A, the highest prevalence of clinically defined OSA in men was in the middle-age group 45 to 64 years old, with a peak at the fifth decade of life. AHI, was greater in younger men than older men (Figure 6B). As it pertained to women, they were indeed less likely to have any type of SDB, regardless of menopausal status, compared to men (Figure 5B). However, as shown in Figure 6C, the odds of SDB in women in any of the three categories of menopausal status were significantly lower compared to men, but less so in postmenopausal women not taking HRT. Taken together, the data presented in Figures 5-7 supported early on the hypothesis that SDB in older adults is less severe in terms of its degree of associated hypoxemia and impact on cardiovascular health, while SDB in young and middle-aged adults is more severe in terms of both health dimensions.
case_images: Association of SDB with Hypertension in the Penn State Adult Cohort. (A) Surface plots representing men without SDB [A], snoring [B], mild SDB [C], and moderate-to-severe SDB [D]. The shape of the distribution of the prevalence of hypertension in women alone (N = 1000) or in men and women combined (N = 1741) was almost identical to the distribution of the men alone shown in the surface plots above that depict the probability of having hypertension across age and BMI levels in men (N = 741). (B) The odds of hypertension associated with an OA/HI >= 15 (vs. no SDB) in men and women (N = 1741) were significantly increased in the second through fifth decade of life in those with overweight (BMI = 28) [A], while greatly diminished in those with obesity (BMI = 32) [B]; asterisks indicate p-value < 0.05. Taken with permission from Bixler et al.
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case_images: F7
case_images: SDB and hypertension was strongest in young and middle-aged adults, especially those of normal weight. Specifically, the odds of hypertension associated with moderate-to-severe OSA were greatly increased in the second through fifth decade of life in men and women who were overweight, while diminished in those who were obese, as shown in Figure 7B. Taken together, the data presented in Figures 5-7 supported early on the hypothesis that SDB in older adults is less severe in terms of its degree of associated hypoxemia and impact on cardiovascular health, while SDB in young and middle-aged adults is more severe in terms of both health dimensions.
case_images: Prevalence of Insomnia and Hypersomnia in the Penn State Adult Cohort. (A) The prevalence of chronic insomnia, defined as a report of having insomnia lasting a year or longer, was 7.5% and was significantly higher in women and racial/ethnic minorities and in those with depression, colitis, hypertension or anemia, while the prevalence of sleep difficulty, defined as moderate-to-severe insomnia symptoms (i.e. difficulty initiating sleep, difficulty maintaining sleep, early morning awakening, and/or nonrestorative sleep) was 29.9% and was significantly higher in women and in those with depression, marital problems, ulcer or cancer/tumor. Taken with permission from Bixler et al. (B) The prevalence of EDS, defined as moderate-to-severe complaints of feeling drowsy or sleepy most of the day but managing to stay awake and/or having any irresistible sleep attacks during the day, was 8.7% and was significantly higher in younger adults and in those with depression, obesity, diabetes or those reporting shorter sleep duration or being a smoker. Taken with permission from Bixler et al. .
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case_images: F8
case_images: As shown in Figure 8A, Dr. The prevalence of EDS was 8.7% and, as shown in Figure 8B, it was significantly higher in younger and older adults (U-shape) and in those with depression, obesity, diabetes or those reporting shorter sleep duration or smoking.
case_images: Prevalence of SDB, Risk Factors and Association with Hypertension in the Penn State Child Cohort. (A) The prevalence of primary snoring was 15.5%, that of mild SDB was 25.0%, and that of moderate-to-severe SDB was 1.2% in school-aged children (N = 700), and was significantly higher in those with overweight (85 <= BMI < 95) and/or with obesity (BMI >= 95); data are prevalence, 95% confidence interval (CI), and (sample size). (B) While different demographic, constitutional, and upper-airway anatomic risk factors emerged for different types and levels of SDB in children, central obesity, as measured by waist circumference, was consistently associated with SDB at all levels of severity; data are regression coefficient (beta) odds ratio (OR), 95% CI, and p-value (P). Taken with permission from Bixler et al. (C) Systolic blood pressure, diastolic blood pressure and mean arterial pressure (MAP)levels adjusted for age, sex, and height percentile in 700 school-aged children with different levels of SDB (i.e. AHI thresholds ranging from 1 through 5) compared to children without SDB (i.e. AHI < 1); a = p-value < 0.001, b = p-value < 0.05, c = p-value < 0.10); sample size for each subgroup presented in parenthesis. Taken with permission from Bixler et al.
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case_images: F9
case_images: As shown in Figure 9A, Dr. AHI < 5 to be 25.0% and that of AHI >= 5 to be 1.2% in the PSCC. As shown in Figure 9B, risk factors for SDB in these school-aged children included a higher waist circumference, having nasal abnormalities (e.g. chronic sinusitis/rhinitis), and identifying as a racial/ethnic minority per parent report, particularly Black/African American. As shown in Figure 9C, Dr.
case_images: Natural history of SDB in the Penn State Child Cohort. (A) Persistence, remission, and incidence rates of SDB in school-aged children transitioning to adolescence (N = 421); data are n/N (%). (B) Risk factors independently associated with different levels of SDB in adolescence; data are odds ratio (OR), and 95% confidence intervals (CI). C) Systematic assessment of detailed body fat distribution and composition variables with different levels of SDB in adolescence; data are OR (95% CI); z, z-transformed; AWP, android/whole-body fat-mass proportion; GWP, gynoid/whole-body fat-mass proportion; VAT, visceral adipose tissue; SAT, subcutaneous adipose tissue. Taken with permission from Bixler et al..
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case_images: F10
case_images: As shown in Figure 10A, Dr. As shown in Figure 10B, the key risk factors for adolescent SDB, particularly incident moderate-to-severe OSA, were similar to those found in adults; namely, male sex, older age, and obesity. Moreover, the study reported novel cross-sectional findings that the amount of DEXA-measured visceral adipose tissue was strongly associated with SDB in adolescence (Figure 10C), a finding consistent with studies in adults.
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