September 2024 Condition Watch: Sleep

Homocysteine Concentration Levels Could Predict Risk, Severity of Obstructive Sleep Apnea

According to study findings published in the European Archives of Oto-Rhino-Laryngology, measuring the levels of a certain amino acid in the blood, homocysteine, may help predict an individual’s risk of developing obstructive sleep apnea. Prior evidence shows that unusually high levels of homocysteine in the blood (>15 μmol/L) can cause alterations in the blood vessel walls and potentially lead to the development of coronary disease, thrombosis, myocardial infarction, and stroke.

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The investigators aimed to assess the potential association between sleep apnea and blood levels of homocysteine. A total of 1042 participants aged 20 to 80 years were enrolled in an initial study in 2007, which included polysomnographic evaluations to measure participants’ apnea-hypopnea index, questionnaires on participants’ sleep and general health, and biochemical analyses. After an 8-year period, 715 participants from the initial population were invited to participate in a follow-up assessment, which commenced in 2015. In this subgroup, a rise of 1 μmol/L in the 2007 level of homocysteine represented a rise of 0.98% in the risk of a diagnosis of apnea in 2015.

The findings demonstrate that increased plasma homocysteine concentrations may be considered a risk factor for the development of obstructive sleep apnea. The data, according to the investigators, demonstrate that elevations in levels may be able to predict the severity of patients’ apnea, emphasizing the believed association between homocysteine and sleep apnea. In addition, the investigators note their desire to conduct further research to gain more extensive data.

“It’s a low risk, but it exists,” said study author Monica Andersen, in a news release. “The fact is that we presented a novel factor which is easy to measure and has clinical and practical applicability.”—Gillian McGovern, Assistant Editor

REFERENCE

Cavalcante-Silva V, Morelhão PK, Fernandes GL, D’Almeida V, Tufik S, Andersen ML. Homocysteine as a predictor of apnea-hypopnea index in obstructive sleep apnea: a longitudinal epidemiological study (EPISONO). Eur Arch Otorhinolaryngol. 2024;281(6):3237-3243. doi:10.1007/s00405-024-08614-z

Mood and Sleep Disorders Negatively Affect Asthma Control

According to recent study findings published in the Journal of Asthma, there is an association between insomnia, depression, and obstructive sleep apnea in individuals with asthma. Poor sleep quality, according to the investigators, was previously reported by individuals with asthma, and notably those with poor control over their condition.

A total of 659 adult patients with asthma were enrolled in a retrospective study. Participants were evaluated based on the presence of concurrent obstructive sleep disorder, mood disorders, asthma exacerbation frequency, and asthma control test scores.

The study findings demonstrate that compared with patients who did not have insomnia, patients with difficulty sleeping were more likely to have a simultaneous diagnosis of obstructive sleep apnea (57.3% vs 18%, respectively; P < .001).

Additionally, these patients were also more likely to be diagnosed with depression or anxiety (68.5% vs 11.4%, respectively; P < .001). Furthermore, the investigators observed that patients with insomnia had an average of 0.93 asthma exacerbations per year compared with those without insomnia, who had less frequent exacerbations (average, 0.59; P = .039).—Gillian McGovern, Assistant Editor

REFERENCE

Rhoads SL, Edinger J, Khatiwada A, Zimmer J, Zelarney P, Wechsler ME. The impact of insomnia and depression on asthma control. J Asthma. 2024;61(8):1-4.doi:10.1080/02770903.2024.2335367

Data Show Tirzepatide Can Reduce Dependence on CPAP

Treatment with tirzepatide, both with and without a continuous positive airway pressure (CPAP) machine, showed improvements in apnea-hypopnea index (AHI) from baseline to week 52 for individuals with obstructive sleep apnea (OSA) and obesity, according to results from the phase 3 SURMOUNT-OSA (NCT05412004) trial. Based on these results, tirzepatide could be the first medication approved for treatment of OSA in patients with obesity.¹

In the SURMOUNT-OSA trial, investigators conducted 2 separate trials: one that included patients who were not on PAP (study 1) and patients who were on PAP (study 2). Furthermore, investigators restricted enrollment to 70% men so that more women could be included in the study. Individuals were included if they were 18 years or older, had moderate to severe OSA, and had a body mass index greater than 30. Individuals with diabetes or those planning for surgery related to sleep apnea or obesity were excluded.^1,2

In study 1 findings, the change in AHI at week 52 was approximately –25.3 events per hour with tirzepatide and –5.3 events per hour with the placebo. In study 2 findings, the primary end point result was –29.3 events and –5.5 events, respectively. When examining the efficacy of treatment, the changes were –27.4 events with tirzepatide and –4.8 events with placebo in study 1 findings and –30.4 events and –6 events, respectively, in study 2 findings.^1,2

Furthermore, in study 1 findings, the percentage of participants who had severe or moderate OSA at baseline (99%) decreased to 42% at 52 weeks. Additionally, 20% of patients had AHI scores that no longer qualified for OSA. In study 2 findings, the percentage of individuals with severe or moderate OSA at baseline (99%) decreased to 40%. Furthermore, 31% of patients no longer qualified for OSA.¹ —Ashley Gallagher, Associate Editor

REFERENCES

1. Jastreboff AM, Malhotra A, Tasali E, Kundel V, Schwab RJ, Aronne LJ. SURMOUNT-OSA trial results and potential role of tirzepatide in treating obesity-related obstructive sleep apnea. Presented at: American Diabetes Association 84th Scientific Sessions; June 21-24, 2024; Orlando, FL.

2. Malhotra A, Grunstein RR, Fietze I, et al; SURMOUNT-OSA Investigators. Tirzepatide for the treatment of obstructive sleep apnea and obesity. N Eng J Med. Published online June 21, 2024. doi:10.1056/NEJMoa2404881