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Sample records for apnea list mode

  1. APNEA list mode data acquisition and real-time event processing

    SciTech Connect

    Hogle, R.A.; Miller, P.; Bramblett, R.L.

    1997-11-01

    The LMSC Active Passive Neutron Examinations and Assay (APNEA) Data Logger is a VME-based data acquisition system using commercial-off-the-shelf hardware with the application-specific software. It receives TTL inputs from eighty-eight {sup 3}He detector tubes and eight timing signals. Two data sets are generated concurrently for each acquisition session: (1) List Mode recording of all detector and timing signals, timestamped to 3 microsecond resolution; (2) Event Accumulations generated in real-time by counting events into short (tens of microseconds) and long (seconds) time bins following repetitive triggers. List Mode data sets can be post-processed to: (1) determine the optimum time bins for TRU assay of waste drums, (2) analyze a given data set in several ways to match different assay requirements and conditions and (3) confirm assay results by examining details of the raw data. Data Logger events are processed and timestamped by an array of 15 TMS320C40 DSPs and delivered to an embedded controller (PowerPC604) for interim disk storage. Three acquisition modes, corresponding to different trigger sources are provided. A standard network interface to a remote host system (Windows NT or SunOS) provides for system control, status, and transfer of previously acquired data. 6 figs.

  2. List mode multichannel analyzer

    DOEpatents

    Archer, Daniel E.; Luke, S. John; Mauger, G. Joseph; Riot, Vincent J.; Knapp, David A.

    2007-08-07

    A digital list mode multichannel analyzer (MCA) built around a programmable FPGA device for onboard data analysis and on-the-fly modification of system detection/operating parameters, and capable of collecting and processing data in very small time bins (<1 millisecond) when used in histogramming mode, or in list mode as a list mode MCA.

  3. A Prescription for List-Mode Data Processing Conventions

    SciTech Connect

    Beddingfield, David H.; Swinhoe, Martyn Thomas; Huszti, Jozsef; Newell, Matthew R.

    2015-10-08

    There are a variety of algorithmic approaches available to process list-mode pulse streams to produce multiplicity histograms for subsequent analysis. In the development of the INCC v6.0 code to include the processing of this data format, we have noted inconsistencies in the “processed time” between the various approaches. The processed time, tp, is the time interval over which the recorded pulses are analyzed to construct multiplicity histograms. This is the time interval that is used to convert measured counts into count rates. The observed inconsistencies in tp impact the reported count rate information and the determination of the error-values associated with the derived singles, doubles, and triples counting rates. This issue is particularly important in low count-rate environments. In this report we will present a prescription for the processing of list-mode counting data that produces values that are both correct and consistent with traditional shift-register technologies. It is our objective to define conventions for list mode data processing to ensure that the results are physically valid and numerically aligned with the results from shift-register electronics.

  4. Sleep Apnea

    MedlinePlus

    Sleep apnea is a common disorder that causes your breathing to stop or get very shallow. Breathing ... an hour. The most common type is obstructive sleep apnea. It causes your airway to collapse or ...

  5. Sleep Apnea

    MedlinePlus

    Sleep apnea is a common disorder that causes your breathing to stop or get very shallow. Breathing pauses ... an hour. The most common type is obstructive sleep apnea. It causes your airway to collapse or become ...

  6. List mode with the ORTEC digiBASE-E.

    PubMed

    Hearn, Gentry; Marianno, Craig; Khatri, Sunil; Grypp, Matt

    2014-02-01

    The ORTEC digiBASE-E (ORTEC, 801 S. Illinos Ave., Oak Ridge TN 37831) is a compact photomultiplier tube endcap designed to handle all of the necessary power and signal processing requirements of a scintillation gamma-ray detector. The list mode feature of this device was used by a custom software package (CraneWow, Department of Nuclear Engineering, Texas A&M University, College Station, TX 77843) to gather data during seaport operations unloading cargo containers. A number of difficulties were encountered in creating the software and are catalogued here to aid future users of the device. PMID:24378557

  7. Spatiotemporal reconstruction of list-mode PET data

    SciTech Connect

    Nichols, Thomas E.; Qi, Jinyi; Asma, Evren; Leahy, Richard M.

    2002-03-01

    We describe a method for computing a continuous time estimate of tracer density using list-mode positron emission tomography data. The rate function in each voxel is modeled as an inhomogeneous Poisson process whose rate function can be represented using a cubic B-spline basis. The rate functions are estimated by maximizing the likelihood of the arrival times of detected photon pairs over the control vertices of the spline, modified by quadratic spatial and temporal smoothness penalties and a penalty term to enforce nonnegativity. Randoms rate functions are estimated by assuming independence between the spatial and temporal randoms distributions. Similarly, scatter rate functions are estimated by assuming spatiotemporal independence and that the temporal distribution of the scatter is proportional to the temporal distribution of the trues. A quantitative evaluation was performed using simulated data and the method is also demonstrated in a human study using 11C-raclopride.

  8. Abnormal resting-state functional connectivity within the default mode network subregions in male patients with obstructive sleep apnea

    PubMed Central

    Li, Hai-Jun; Nie, Xiao; Gong, Hong-Han; Zhang, Wei; Nie, Si; Peng, De-Chang

    2016-01-01

    Background and objective Abnormal resting-state functional connectivity (rs-FC) between the central executive network and the default mode network (DMN) in patients with obstructive sleep apnea (OSA) has been reported. However, the effect of OSA on rs-FC within the DMN subregions remains uncertain. This study was designed to investigate whether the rs-FC within the DMN subregions was disrupted and determine its relationship with clinical symptoms in patients with OSA. Methods Forty male patients newly diagnosed with severe OSA and 40 male education- and age-matched good sleepers (GSs) underwent functional magnetic resonance imaging (fMRI) examinations and clinical and neuropsychologic assessments. Seed-based region of interest rs-FC method was used to analyze the connectivity between each pair of subregions within the DMN, including the medial prefrontal cortex (MPFC), posterior cingulate cortex (PCC), hippocampus formation (HF), inferior parietal cortices (IPC), and medial temporal lobe (MTL). The abnormal rs-FC strength within the DMN subregions was correlated with clinical and neuropsychologic assessments using Pearson correlation analysis in patients with OSA. Results Compared with GSs, patients with OSA had significantly decreased rs-FC between the right HF and the PCC, MPFC, and left MTL. However, patients with OSA had significantly increased rs-FC between the MPFC and left and right IPC, and between the left IPC and right IPC. The rs-FC between the right HF and left MTL was positively correlated with rapid eye movement (r=0.335, P=0.035). The rs-FC between the PCC and right HF was negatively correlated with delayed memory (r=-0.338, P=0.033). Conclusion OSA selectively impairs the rs-FC between right HF and PCC, MPFC, and left MTL within the DMN subregions, and provides an imaging indicator for assessment of cognitive dysfunction in OSA patients. PMID:26855576

  9. Obstructive sleep apnea - adults

    MedlinePlus

    Sleep apnea - obstructive - adults; Apnea - obstructive sleep apnea syndrome - adults; Sleep-disordered breathing - adults; OSA - adults ... the upper airway for obstructive sleep apnea in adults. Sleep . 2010;33:1408-1413. PMID: 21061864 www. ...

  10. Pediatric sleep apnea

    MedlinePlus

    Sleep apnea - pediatric; Apnea - pediatric sleep apnea syndrome; Sleep-disordered breathing - pediatric ... Untreated pediatric sleep apnea may lead to: High blood pressure Heart or lung problems Slow growth and development

  11. Sleep Apnea Facts

    MedlinePlus

    ... Apnea Facts Sleep Apnea Links Sleep Apnea Facts Sleep apnea affects up to 18 million Americans The condition was ... member is the first to notice signs of sleep apnea in someone with the ... diagnosed. The condition affects about 4 percent of middle-aged men and ...

  12. Pediatric sleep apnea

    MedlinePlus

    Sleep apnea - pediatric; Apnea - pediatric sleep apnea syndrome; Sleep-disordered breathing - pediatric ... During sleep, all of the muscles in the body become more relaxed. This includes the muscles that help keep ...

  13. Obstructive sleep apnea - adults

    MedlinePlus

    Sleep apnea - obstructive - adults; Apnea - obstructive sleep apnea syndrome - adults; Sleep-disordered breathing - adults; OSA - adults ... When you sleep, all of the muscles in your body become more relaxed. This includes the muscles that help keep your ...

  14. Snoring and Sleep Apnea

    MedlinePlus

    ... Find an ENT Doctor Near You Snoring and Sleep Apnea Snoring and Sleep Apnea Patient Health Information ... newsroom@entnet.org . Insight into sleeping disorders and sleep apnea Forty-five percent of normal adults snore ...

  15. Sleep Apnea Information Page

    MedlinePlus

    ... is Sleep Apnea? Sleep apnea is a common sleep disorder characterized by brief interruptions of breathing during sleep. ... better ways to prevent, treat, and ultimately cure sleep disorders, such as sleep apnea. NIH Patient Recruitment for ...

  16. Apnea of prematurity

    MedlinePlus

    Apnea - newborns; AOP; As and Bs; A/B/D; Blue spell - newborns; Dusky spell - newborns; Spell - newborns; Apnea - neonatal ... the airway open are weak Other stresses in a sick or premature baby may worsen apnea, including: ...

  17. A method for synchronizing an external respiratory signal with a list-mode PET acquisition

    SciTech Connect

    Bruyant, P. P.; Cheze Le Rest, C.; Turzo, A.; Jarritt, P.; Carson, K.; Visvikis, D.

    2007-11-15

    A method is proposed to synchronize positron emission tomography (PET) list-mode data with an externally recorded respiratory signal in the absence of a master clock. When the respiratory signal reaches a user-defined threshold, a trigger mark is stored in the list-mode file. After the acquisition, synchronization is achieved when the stored trigger marks are superimposed on the respiratory curve to form a horizontal line over time at the user-defined threshold. Synchronization was possible and unequivocal for ten out of ten clinical studies. The list-mode acquisition actually started approximately 40 and 4 s after acquisition initiation at the user interface of the Philips Gemini and the GE DLS PET-CT systems, respectively.

  18. Objective assessment of image quality. V. Photon-counting detectors and list-mode data

    PubMed Central

    Caucci, Luca; Barrett, Harrison H.

    2012-01-01

    A theoretical framework for detection or discrimination tasks with list-mode data is developed. The object and imaging system are rigorously modeled via three random mechanisms: randomness of the object being imaged, randomness in the attribute vectors, and, finally, randomness in the attribute vector estimates due to noise in the detector outputs. By considering the list-mode data themselves, the theory developed in this paper yields a manageable expression for the likelihood of the list-mode data given the object being imaged. This, in turn, leads to an expression for the optimal Bayesian discriminant. Figures of merit for detection tasks via the ideal and optimal linear observers are derived. A concrete example discusses detection performance of the optimal linear observer for the case of a known signal buried in a random lumpy background. PMID:22673432

  19. Statistical list-mode image reconstruction for the high resolution research tomograph

    NASA Astrophysics Data System (ADS)

    Rahmim, A.; Lenox, M.; Reader, A. J.; Michel, C.; Burbar, Z.; Ruth, T. J.; Sossi, V.

    2004-09-01

    We have investigated statistical list-mode reconstruction applicable to a depth-encoding high resolution research tomograph. An image non-negativity constraint has been employed in the reconstructions and is shown to effectively remove the overestimation bias introduced by the sinogram non-negativity constraint. We have furthermore implemented a convergent subsetized (CS) list-mode reconstruction algorithm, based on previous work (Hsiao et al 2002 Conf. Rec. SPIE Med. Imaging 4684 10-19 Hsiao et al 2002 Conf. Rec. IEEE Int. Symp. Biomed. Imaging 409-12) on convergent histogram OSEM reconstruction. We have demonstrated that the first step of the convergent algorithm is exactly equivalent (unlike the histogram-mode case) to the regular subsetized list-mode EM algorithm, while the second and final step takes the form of additive updates in image space. We have shown that in terms of contrast, noise as well as FWHM width behaviour, the CS algorithm is robust and does not result in limit cycles. A hybrid algorithm based on the ordinary and the convergent algorithms is also proposed, and is shown to combine the advantages of the two algorithms (i.e. it is able to reach a higher image quality in fewer iterations while maintaining the convergent behaviour), making the hybrid approach a good alternative to the ordinary subsetized list-mode EM algorithm.

  20. Sensitivity estimation in time-of-flight list-mode positron emission tomography

    SciTech Connect

    Herraiz, J. L.; Sitek, A.

    2015-11-15

    Purpose: An accurate quantification of the images in positron emission tomography (PET) requires knowing the actual sensitivity at each voxel, which represents the probability that a positron emitted in that voxel is finally detected as a coincidence of two gamma rays in a pair of detectors in the PET scanner. This sensitivity depends on the characteristics of the acquisition, as it is affected by the attenuation of the annihilation gamma rays in the body, and possible variations of the sensitivity of the scanner detectors. In this work, the authors propose a new approach to handle time-of-flight (TOF) list-mode PET data, which allows performing either or both, a self-attenuation correction, and self-normalization correction based on emission data only. Methods: The authors derive the theory using a fully Bayesian statistical model of complete data. The authors perform an initial evaluation of algorithms derived from that theory and proposed in this work using numerical 2D list-mode simulations with different TOF resolutions and total number of detected coincidences. Effects of randoms and scatter are not simulated. Results: The authors found that proposed algorithms successfully correct for unknown attenuation and scanner normalization for simulated 2D list-mode TOF-PET data. Conclusions: A new method is presented that can be used for corrections for attenuation and normalization (sensitivity) using TOF list-mode data.

  1. American Sleep Apnea Association

    MedlinePlus

    American Sleep Apnea Association Learn About the CPAP Assistance Program About ASAA News about ASAA Who we are Leadership Team Supporting the ASAA Financials Learn Healthy sleep Sleep apnea Other sleep disorders Personal stories Treat Test Yourself ...

  2. What Is Sleep Apnea?

    MedlinePlus

    ... page from the NHLBI on Twitter. What Is Sleep Apnea? Español Sleep apnea (AP-ne-ah) is ... many people. Rate This Content: NEXT >> Featured Video Sleep Apnea Research: The HeartBeat Study 06/07/2012 ...

  3. Image properties of list mode likelihood reconstruction for a rectangular positron emission mammography with DOI measurements

    SciTech Connect

    Qi, Jinyi; Klein, Gregory J.; Huesman, Ronald H.

    2000-10-01

    A positron emission mammography scanner is under development at our Laboratory. The tomograph has a rectangular geometry consisting of four banks of detector modules. For each detector, the system can measure the depth of interaction information inside the crystal. The rectangular geometry leads to irregular radial and angular sampling and spatially variant sensitivity that are different from conventional PET systems. Therefore, it is of importance to study the image properties of the reconstructions. We adapted the theoretical analysis that we had developed for conventional PET systems to the list mode likelihood reconstruction for this tomograph. The local impulse response and covariance of the reconstruction can be easily computed using FFT. These theoretical results are also used with computer observer models to compute the signal-to-noise ratio for lesion detection. The analysis reveals the spatially variant resolution and noise properties of the list mode likelihood reconstruction. The theoretical predictions are in good agreement with Monte Carlo results.

  4. Spatially Variant Resolution Modelling for Iterative List-Mode PET Reconstruction.

    PubMed

    Bickell, Matthew G; Zhou, Lin; Nuyts, Johan

    2016-07-01

    A spatially variant resolution modelling technique is presented which estimates the system matrix on-the-fly during iterative list-mode reconstruction. This is achieved by redistributing the endpoints of each list-mode event according to derived probability density functions describing the detector response function and photon acollinearity, at each iteration during the reconstruction. Positron range is modelled using an image-based convolution. When applying this technique it is shown that the maximum-likelihood expectation maximisation (MLEM) algorithm is not compatible with an obvious acceleration strategy. The image space reconstruction algorithm (ISRA), however, after being adapted to a list-mode based implementation, is well-suited to the implementation of the model. A comparison of ISRA and MLEM is made to confirm that ISRA is a suitable alternative to MLEM. We demonstrate that this model agrees with measured point spread functions and we present results showing an improvement in resolution recovery, particularly for off-centre objects, as compared to commercially available software, as well as the standard technique of using a stationary Gaussian convolution to model the resolution, for equal iterations and only slightly higher computation time. PMID:26886967

  5. Pathophysiology of Sleep Apnea

    PubMed Central

    Veasey, Sigrid C.; Morgan, Barbara J.; O'Donnell, Christopher P.

    2010-01-01

    Sleep-induced apnea and disordered breathing refers to intermittent, cyclical cessations or reductions of airflow, with or without obstructions of the upper airway (OSA). In the presence of an anatomically compromised, collapsible airway, the sleep-induced loss of compensatory tonic input to the upper airway dilator muscle motor neurons leads to collapse of the pharyngeal airway. In turn, the ability of the sleeping subject to compensate for this airway obstruction will determine the degree of cycling of these events. Several of the classic neurotransmitters and a growing list of neuromodulators have now been identified that contribute to neurochemical regulation of pharyngeal motor neuron activity and airway patency. Limited progress has been made in developing pharmacotherapies with acceptable specificity for the treatment of sleep-induced airway obstruction. We review three types of major long-term sequelae to severe OSA that have been assessed in humans through use of continuous positive airway pressure (CPAP) treatment and in animal models via long-term intermittent hypoxemia (IH): 1) cardiovascular. The evidence is strongest to support daytime systemic hypertension as a consequence of severe OSA, with less conclusive effects on pulmonary hypertension, stroke, coronary artery disease, and cardiac arrhythmias. The underlying mechanisms mediating hypertension include enhanced chemoreceptor sensitivity causing excessive daytime sympathetic vasoconstrictor activity, combined with overproduction of superoxide ion and inflammatory effects on resistance vessels. 2) Insulin sensitivity and homeostasis of glucose regulation are negatively impacted by both intermittent hypoxemia and sleep disruption, but whether these influences of OSA are sufficient, independent of obesity, to contribute significantly to the “metabolic syndrome” remains unsettled. 3) Neurocognitive effects include daytime sleepiness and impaired memory and concentration. These effects reflect

  6. Performance evaluation and optimization for a newly developed digital list-mode data acquisition Compton suppression spectrometer.

    PubMed

    Zhang, Weihua; Keeshan, Benjamin; Mekarski, Pawel; Yi, Jing; Ungar, Kurt

    2013-11-01

    A comparative study was carried out between an analog timing and a digital list-mode data acquisition system for a Compton suppression spectrometer. The performance of both Compton suppression systems has been evaluated using the conventional, coincidence and anticoincidence spectra measured by (60)Co and (137)Cs point sources. The present study focuses on improving and optimizing the energy peak resolution and peak-to-Compton background ratios of the digital list-mode system. PMID:23497957

  7. Novel scatter compensation of list-mode PET data using spatial and energy dependent corrections

    PubMed Central

    Guérin, Bastien

    2011-01-01

    With the widespread use of PET crystals with greatly improved energy resolution (e.g., 11.5% with LYSO as compared to 20% with BGO) and of list-mode acquisitions, the use of the energy of individual events in scatter correction schemes becomes feasible. We propose a novel scatter approach that incorporates the energy of individual photons in the scatter correction and reconstruction of list-mode PET data in addition to the spatial information presently used in clinical scanners. First, we rewrite the Poisson likelihood function of list-mode PET data including the energy distributions of primary and scatter coincidences and show that this expression yields an MLEM reconstruction algorithm containing both energy and spatial dependent corrections. To estimate the spatial distribution of scatter coincidences we use the single scatter simulation (SSS). Next, we derive two new formulae which allow estimation of the 2D (coincidences) energy probability density functions (E-PDF) of primary and scatter coincidences from the 1D (photons) E-PDFs associated with each photon. We also describe an accurate and robust object-specific method for estimating these 1D E-PDFs based on a decomposition of the total energy spectra detected across the scanner into primary and scattered components. Finally, we show that the energy information can be used to accurately normalize the scatter sinogram to the data. We compared the performance of this novel scatter correction incorporating both the position and energy of detected coincidences to that of the traditional approach modeling only the spatial distribution of scatter coincidences in 3D Monte Carlo simulations of a medium cylindrical phantom and a large, non uniform NCAT phantom. Incorporating the energy information in the scatter correction decreased bias in the activity distribution estimation by ~20% and ~40% in the cold regions of the large NCAT phantom at energy resolutions 11.5 and 20% at 511 keV, respectively, compared to when

  8. Rapid processing of PET list-mode data for efficient uncertainty estimation and data analysis

    NASA Astrophysics Data System (ADS)

    Markiewicz, P. J.; Thielemans, K.; Schott, J. M.; Atkinson, D.; Arridge, S. R.; Hutton, B. F.; Ourselin, S.

    2016-07-01

    In this technical note we propose a rapid and scalable software solution for the processing of PET list-mode data, which allows the efficient integration of list mode data processing into the workflow of image reconstruction and analysis. All processing is performed on the graphics processing unit (GPU), making use of streamed and concurrent kernel execution together with data transfers between disk and CPU memory as well as CPU and GPU memory. This approach leads to fast generation of multiple bootstrap realisations, and when combined with fast image reconstruction and analysis, it enables assessment of uncertainties of any image statistic and of any component of the image generation process (e.g. random correction, image processing) within reasonable time frames (e.g. within five minutes per realisation). This is of particular value when handling complex chains of image generation and processing. The software outputs the following: (1) estimate of expected random event data for noise reduction; (2) dynamic prompt and random sinograms of span-1 and span-11 and (3) variance estimates based on multiple bootstrap realisations of (1) and (2) assuming reasonable count levels for acceptable accuracy. In addition, the software produces statistics and visualisations for immediate quality control and crude motion detection, such as: (1) count rate curves; (2) centre of mass plots of the radiodistribution for motion detection; (3) video of dynamic projection views for fast visual list-mode skimming and inspection; (4) full normalisation factor sinograms. To demonstrate the software, we present an example of the above processing for fast uncertainty estimation of regional SUVR (standard uptake value ratio) calculation for a single PET scan of 18F-florbetapir using the Siemens Biograph mMR scanner.

  9. Rapid processing of PET list-mode data for efficient uncertainty estimation and data analysis.

    PubMed

    Markiewicz, P J; Thielemans, K; Schott, J M; Atkinson, D; Arridge, S R; Hutton, B F; Ourselin, S

    2016-07-01

    In this technical note we propose a rapid and scalable software solution for the processing of PET list-mode data, which allows the efficient integration of list mode data processing into the workflow of image reconstruction and analysis. All processing is performed on the graphics processing unit (GPU), making use of streamed and concurrent kernel execution together with data transfers between disk and CPU memory as well as CPU and GPU memory. This approach leads to fast generation of multiple bootstrap realisations, and when combined with fast image reconstruction and analysis, it enables assessment of uncertainties of any image statistic and of any component of the image generation process (e.g. random correction, image processing) within reasonable time frames (e.g. within five minutes per realisation). This is of particular value when handling complex chains of image generation and processing. The software outputs the following: (1) estimate of expected random event data for noise reduction; (2) dynamic prompt and random sinograms of span-1 and span-11 and (3) variance estimates based on multiple bootstrap realisations of (1) and (2) assuming reasonable count levels for acceptable accuracy. In addition, the software produces statistics and visualisations for immediate quality control and crude motion detection, such as: (1) count rate curves; (2) centre of mass plots of the radiodistribution for motion detection; (3) video of dynamic projection views for fast visual list-mode skimming and inspection; (4) full normalisation factor sinograms. To demonstrate the software, we present an example of the above processing for fast uncertainty estimation of regional SUVR (standard uptake value ratio) calculation for a single PET scan of (18)F-florbetapir using the Siemens Biograph mMR scanner. PMID:27280456

  10. Sleep apnea and stroke.

    PubMed

    Culebras, Antonio

    2015-01-01

    Clinical evidence has established that sleep apnea is a risk factor for stroke. Patients with stroke have a high prevalence of sleep apnea that may have preceded or developed as a result of the stroke. Well-established concurrent stroke risk factors for stroke like hypertension and atrial fibrillation respond favorably to the successful treatment of sleep apnea. The gold standard diagnosis of sleep apnea is obtained in the sleep laboratory, but unattended polysomnography is gaining acceptance. Positive airway pressure (PAP) (continuous positive airway pressure [CPAP] or bilevel positive airway pressure [BiPAP]) applications are the gold-standard treatment of sleep apnea. Suggestive evidence indicates that stroke occurrence or recurrence may be reduced with treatment of sleep apnea. PMID:25407131

  11. Propagation of errors from the sensitivity image in list mode reconstruction

    SciTech Connect

    Qi, Jinyi; Huesman, Ronald H.

    2003-11-15

    List mode image reconstruction is attracting renewed attention. It eliminates the storage of empty sinogram bins. However, a single back projection of all LORs is still necessary for the pre-calculation of a sensitivity image. Since the detection sensitivity is dependent on the object attenuation and detector efficiency, it must be computed for each study. Exact computation of the sensitivity image can be a daunting task for modern scanners with huge numbers of LORs. Thus, some fast approximate calculation may be desirable. In this paper, we theoretically analyze the error propagation from the sensitivity image into the reconstructed image. The theoretical analysis is based on the fixed point condition of the list mode reconstruction. The non-negativity constraint is modeled using the Kuhn-Tucker condition. With certain assumptions and the first order Taylor series approximation, we derive a closed form expression for the error in the reconstructed image as a function of the error in the sensitivity image. The result provides insights on what kind of error might be allowable in the sensitivity image. Computer simulations show that the theoretical results are in good agreement with the measured results.

  12. List-Mode Likelihood: EM Algorithm and Image Quality Estimation Demonstrated on 2-D PET

    PubMed Central

    Barrett, Harrison H.

    2010-01-01

    Using a theory of list-mode maximum-likelihood (ML) source reconstruction presented recently by Barrett et al. [1], this paper formulates a corresponding expectation-maximization (EM) algorithm, as well as a method for estimating noise properties at the ML estimate. List-mode ML is of interest in cases where the dimensionality of the measurement space impedes a binning of the measurement data. It can be advantageous in cases where a better forward model can be obtained by including more measurement coordinates provided by a given detector. Different figures of merit for the detector performance can be computed from the Fisher information matrix (FIM). This paper uses the observed FIM, which requires a single data set, thus, avoiding costly ensemble statistics. The proposed techniques are demonstrated for an idealized two-dimensional (2-D) positron emission tomography (PET) [2-D PET] detector. We compute from simulation data the improved image quality obtained by including the time of flight of the coincident quanta. PMID:9688154

  13. Apnea of Prematurity.

    PubMed

    Eichenwald, Eric C

    2016-01-01

    Apnea of prematurity is one of the most common diagnoses in the NICU. Despite the frequency of apnea of prematurity, it is unknown whether recurrent apnea, bradycardia, and hypoxemia in preterm infants are harmful. Research into the development of respiratory control in immature animals and preterm infants has facilitated our understanding of the pathogenesis and treatment of apnea of prematurity. However, the lack of consistent definitions, monitoring practices, and consensus about clinical significance leads to significant variation in practice. The purpose of this clinical report is to review the evidence basis for the definition, epidemiology, and treatment of apnea of prematurity as well as discharge recommendations for preterm infants diagnosed with recurrent apneic events. PMID:26628729

  14. Development of an ideal observer that incorporates nuisance parameters and processes list-mode data

    DOE PAGESBeta

    MacGahan, Christopher Jonathan; Kupinski, Matthew Alan; Hilton, Nathan R.; Brubaker, Erik M.; Johnson, William C.

    2016-02-01

    Observer models were developed to process data in list-mode format in order to perform binary discrimination tasks for use in an arms-control-treaty context. Data used in this study was generated using GEANT4 Monte Carlo simulations for photons using custom models of plutonium inspection objects and a radiation imaging system. We evaluated observer model performance and then presented using the area under the receiver operating characteristic curve. Lastly, we studied the ideal observer under both signal-known-exactly conditions and in the presence of unknowns such as object orientation and absolute count-rate variability; when these additional sources of randomness were present, their incorporationmore » into the observer yielded superior performance.« less

  15. Development of an ideal observer that incorporates nuisance parameters and processes list-mode data.

    PubMed

    MacGahan, Christopher J; Kupinski, Matthew A; Hilton, Nathan R; Brubaker, Erik M; Johnson, William C

    2016-04-01

    Observer models were developed to process data in list-mode format in order to perform binary discrimination tasks for use in an arms-control-treaty context. Data used in this study was generated using GEANT4 Monte Carlo simulations for photons using custom models of plutonium inspection objects and a radiation imaging system. Observer model performance was evaluated and presented using the area under the receiver operating characteristic curve. The ideal observer was studied under both signal-known-exactly conditions and in the presence of unknowns such as object orientation and absolute count-rate variability; when these additional sources of randomness were present, their incorporation into the observer yielded superior performance. PMID:27140781

  16. Fourier-processed images of dynamic lung function from list-mode data

    SciTech Connect

    Zubal, I.G.; Rowe, R.W.; Bizais, Y.; Susskind, H.; Bennett, G.W.; Brill, A.B.

    1983-01-01

    Time and volume correlated amplitude and phase images are computed from nuclear medical ventilation studies and for dynamic transmission scans of the lungs. This is made possible by a hardware interface and data acquisition system, developed in-house, allowing camera events and multiple ancillary physiological signals (including lung volume) to be acquired simultaneously in list mode. The first harmonic amplitude and phase images are constructed on an event by event basis. These are computed for both equal time and equal lung volume increments. Time and volume correlated Fourier images for ventilation studies have shown details and functional structures not usually seen in conventional imaging techniques. Processed transmission scans show similar results compared to ventilation images.

  17. List mode reconstruction for PET with motion compensation: A simulation study

    SciTech Connect

    Qi, Jinyi; Huesman, Ronald H.

    2002-07-03

    Motion artifacts can be a significant factor that limits the image quality in high-resolution PET. Surveillance systems have been developed to track the movements of the subject during a scan. Development of reconstruction algorithms that are able to compensate for the subject motion will increase the potential of PET. In this paper we present a list mode likelihood reconstruction algorithm with the ability of motion compensation. The subject moti is explicitly modeled in the likelihood function. The detections of each detector pair are modeled as a Poisson process with time vary ingrate function. The proposed method has several advantages over the existing methods. It uses all detected events and does not introduce any interpolation error. Computer simulations show that the proposed method can compensate simulated subject movements and that the reconstructed images have no visible motion artifacts.

  18. List mode reconstruction for PET with motion compensation: A simulation study

    SciTech Connect

    Qi, Jinyi; Huesman, Ronald H.

    2002-07-01

    Motion artifacts can be a significant factor that limits the image quality in high-resolution PET. Surveillance systems have been developed to track the movements of the subject during a scan. Development of reconstruction algorithms that are able to compensate for the subject motion will increase the potential of PET. In this paper we present a list mode likelihood reconstruction algorithm with the ability of motion compensation. The subject motion is explicitly modeled in the likelihood function. The detections of each detector pair are modeled as a Poisson process with time-varying rate function. The proposed method has several advantages over the existing methods. It uses all detected events and does not introduce any interpolation error. Computer simulations show that the proposed method can compensate simulated subject movements and that the reconstructed images have no visible motion artifacts.

  19. A regularized relaxed ordered subset list-mode reconstruction algorithm and its preliminary application to undersampling PET imaging

    NASA Astrophysics Data System (ADS)

    Cao, Xiaoqing; Xie, Qingguo; Xiao, Peng

    2015-01-01

    List mode format is commonly used in modern positron emission tomography (PET) for image reconstruction due to certain special advantages. In this work, we proposed a list mode based regularized relaxed ordered subset (LMROS) algorithm for static PET imaging. LMROS is able to work with regularization terms which can be formulated as twice differentiable convex functions. Such a versatility would make LMROS a convenient and general framework for fulfilling different regularized list mode reconstruction methods. LMROS was applied to two simulated undersampling PET imaging scenarios to verify its effectiveness. Convex quadratic function, total variation constraint, non-local means and dictionary learning based regularization methods were successfully realized for different cases. The results showed that the LMROS algorithm was effective and some regularization methods greatly reduced the distortions and artifacts caused by undersampling.

  20. Obstructive Sleep Apnea and Depression

    PubMed Central

    Ejaz, Shakir M.; Bhatia, Subhash; Hurwitz, Thomas D.

    2011-01-01

    Obstructive sleep apnea is a common sleep disorder associated with several medical conditions, increased risk of motor vehicle accidents, and overall healthcare expenditure. There is higher prevalence of depression in people with obstructive sleep apnea in both clinical and community samples. Many symptoms of depression and obstructive sleep apnea overlap causing under-diagnosis of obstructive sleep apnea in depressed patients. Sleep problems, including obstructive sleep apnea, are rarely assessed on a regular basis in patients with depressive disorders, but they may be responsible for antidepressant treatment failure. The mechanism of the relationship between obstructive sleep apnea and depression is complex and remains unclear. Though some studies suggest a mutual relationship, the relationship remains unclear. Several possible pathophysiological mechanisms could explain how obstructive sleep apnea can cause or worsen depression. Increased knowledge of the relationship between obstructive sleep apnea and depression might significantly improve diagnostic accuracy as well as treatment outcomes for both obstructive sleep apnea and depression. PMID:21922066

  1. Sleep Apnea Detection

    MedlinePlus

    ... Prenatal Baby Bathing & Skin Care Breastfeeding Crying & Colic Diapers & Clothing Feeding & Nutrition Preemie Sleep Teething & Tooth Care Toddler Preschool Gradeschool Teen Young Adult Healthy Children > Ages & Stages > Baby > Sleep > Sleep Apnea ...

  2. Obstructive Sleep Apnea

    MedlinePlus

    ... daytime drowsiness that can result in accidents, lost productivity and relationship problems. The National Sleep Foundation estimates ... the person just enough to restart the breathing process. Sleep apnea is generally defined as the presence ...

  3. Central sleep apnea

    MedlinePlus

    ... pressure (CPAP) , bilevel positive airway pressure (BiPAP) or adaptive servo-ventilation (ASV). Some types of central sleep ... et al. The treatment of central sleep apnea syndromes in adults: practice parameters with an evidence-based ...

  4. Evaluation of Bias and Variance in Low-count OSEM List Mode Reconstruction

    PubMed Central

    Jian, Y; Planeta, B; Carson, R E

    2016-01-01

    Statistical algorithms have been widely used in PET image reconstruction. The maximum likelihood expectation maximization (MLEM) reconstruction has been shown to produce bias in applications where images are reconstructed from a relatively small number of counts. In this study, image bias and variability in low-count OSEM reconstruction are investigated on images reconstructed with MOLAR (motion-compensation OSEM list-mode algorithm for resolution-recovery reconstruction) platform. A human brain ([11C]AFM) and a NEMA phantom are used in the simulation and real experiments respectively, for the HRRT and Biograph mCT. Image reconstructions were repeated with different combination of subsets and iterations. Regions of interest (ROIs) were defined on low-activity and high-activity regions to evaluate the bias and noise at matched effective iteration numbers (iterations x subsets). Minimal negative biases and no positive biases were found at moderate count levels and less than 5% negative bias was found using extremely low levels of counts (0.2 M NEC). At any given count level, other factors, such as subset numbers and frame-based scatter correction may introduce small biases (1–5%) in the reconstructed images. The observed bias was substantially lower than that reported in the literature, perhaps due to the use of point spread function and/or other implementation methods in MOLAR. PMID:25479254

  5. Evaluation of bias and variance in low-count OSEM list mode reconstruction.

    PubMed

    Jian, Y; Planeta, B; Carson, R E

    2015-01-01

    Statistical algorithms have been widely used in PET image reconstruction. The maximum likelihood expectation maximization reconstruction has been shown to produce bias in applications where images are reconstructed from a relatively small number of counts. In this study, image bias and variability in low-count OSEM reconstruction are investigated on images reconstructed with MOLAR (motion-compensation OSEM list-mode algorithm for resolution-recovery reconstruction) platform. A human brain ([(11)C]AFM) and a NEMA phantom are used in the simulation and real experiments respectively, for the HRRT and Biograph mCT. Image reconstructions were repeated with different combinations of subsets and iterations. Regions of interest were defined on low-activity and high-activity regions to evaluate the bias and noise at matched effective iteration numbers (iterations × subsets). Minimal negative biases and no positive biases were found at moderate count levels and less than 5% negative bias was found using extremely low levels of counts (0.2 M NEC). At any given count level, other factors, such as subset numbers and frame-based scatter correction may introduce small biases (1-5%) in the reconstructed images. The observed bias was substantially lower than that reported in the literature, perhaps due to the use of point spread function and/or other implementation methods in MOLAR. PMID:25479254

  6. Home apnea monitor use - infants

    MedlinePlus

    ... ency/patientinstructions/000755.htm Home apnea monitor use - infants To use the sharing features on this page, ... oxygen or a breathing machine How Does my Baby get Started on an Apnea Monitor? A home ...

  7. [Sleep apneas in children].

    PubMed

    Ghelfi, D

    2000-07-01

    There are many causes leading to breathing disorders in children. In the newborn period the immature central regulation of breathing can result in a pattern with apneas and bradycardias most commonly seen in the very premature infant. Therefore, during hospital stay many of these very tiny preterms and some of the very ill term infants do have severe apneas and do need medication and or mechanical support (nasal CPAP, positive pressure ventilation). In the first two to three months of life central dysmaturity can persist in some infants and apneas of infancy can occur further on. Infants with prolonged apneas and symptoms like paleness, cyanosis, stiffness or limpness are often investigated, treated or monitored. At the age of two to six, every tenth child is a loud snorer. Every fifth snorer at this age suffers from a severe upper airway obstruction. Factors that decrease pharyngeal size or increase pharyngeal compliance may lead to obstruction. Adenotonsillar hypertrophy is the most common associated condition, craniofacial disorders, central nervous system and neuromuscular problems and less obesity are disposing factors. Children may present nocturnal symptoms like snoring, difficult breathing or disturbed sleep, but most of them have daytime problems as initial complaint such as hyperactivity, behavioral problems, growth failure, poor school performance. Excessive daytime sleepiness is not so common in young children. The childhood obstructive sleep apnea syndrome is a common and serious problem. Children with symptoms suggesting severe obstruction should be evaluated and treated. Most children are cured by adenotonsillectomy whilst some require further therapy. PMID:10953655

  8. Central Sleep Apnea

    PubMed Central

    Eckert, Danny J.; Jordan, Amy S.; Merchia, Pankaj; Malhotra, Atul

    2008-01-01

    Central sleep apnea (CSA) is characterized by a lack of drive to breathe during sleep, resulting in repetitive periods of insufficient ventilation and compromised gas exchange. These nighttime breathing disturbances can lead to important comorbidity and increased risk of adverse cardiovascular outcomes. There are several manifestations of CSA, including high altitude-induced periodic breathing, idiopathic CSA, narcotic-induced central apnea, obesity hypoventilation syndrome, and Cheyne-Stokes breathing. While unstable ventilatory control during sleep is the hallmark of CSA, the pathophysiology and the prevalence of the various forms of CSA vary greatly. This brief review summarizes the underlying physiology and modulating components influencing ventilatory control in CSA, describes the etiology of each of the various forms of CSA, and examines the key factors that may exacerbate apnea severity. The clinical implications of improved CSA pathophysiology knowledge and the potential for novel therapeutic treatment approaches are also discussed. PMID:17296668

  9. An updated list of AGILE bright γ-ray sources and their variability in pointing mode

    NASA Astrophysics Data System (ADS)

    Verrecchia, F.; Pittori, C.; Chen, A. W.; Bulgarelli, A.; Tavani, M.; Lucarelli, F.; Giommi, P.; Vercellone, S.; Pellizzoni, A.; Giuliani, A.; Longo, F.; Barbiellini, G.; Trifoglio, M.; Gianotti, F.; Argan, A.; Antonelli, L. A.; Caraveo, P.; Cardillo, M.; Cattaneo, P. W.; Cocco, V.; Colafrancesco, S.; Contessi, T.; Costa, E.; Del Monte, E.; De Paris, G.; Di Cocco, G.; Di Persio, G.; Donnarumma, I.; Evangelista, Y.; Fanari, G.; Feroci, M.; Ferrari, A.; Fiorini, M.; Fornari, F.; Fuschino, F.; Froysland, T.; Frutti, M.; Galli, M.; Labanti, C.; Lapshov, I.; Lazzarotto, F.; Liello, F.; Lipari, P.; Mattaini, E.; Marisaldi, M.; Mastropietro, M.; Mauri, A.; Mauri, F.; Mereghetti, S.; Morelli, E.; Moretti, E.; Morselli, A.; Pacciani, L.; Perotti, F.; Piano, G.; Picozza, P.; Pilia, M.; Pontoni, C.; Porrovecchio, G.; Prest, M.; Primavera, R.; Pucella, G.; Rapisarda, M.; Rappoldi, A.; Rossi, E.; Rubini, A.; Sabatini, S.; Santolamazza, P.; Soffitta, P.; Stellato, S.; Striani, E.; Tamburelli, F.; Traci, A.; Trois, A.; Vallazza, E.; Vittorini, V.; Zanello, D.; Salotti, L.; Valentini, G.

    2013-10-01

    Aims: We present a variability study of a sample of bright γ-ray(30 Mev-50 Gev) sources. This sample is an extension of the first AGILE catalogue of γ-ray sources (1AGL), obtained using the complete set of AGILE observations in pointing mode performed during a 2.3 year period from July 9, 2007 until October 30, 2009. Methods: The dataset of AGILE pointed observations covers a long time interval and its γ-ray data archive is useful for monitoring studies of medium-to-high brightness γ-ray sources. In the analysis reported here, we used data obtained with an improved event filter that covers a wider field of view, on a much larger (about 27.5 months) dataset, integrating data on observation block time scales, which mostly range from a few days to thirty days. Results: The data processing resulted in a better characterized source list than 1AGL was, and includes 54 sources, 7 of which are new high galactic latitude (|BII| ≥ 5) sources, 8 are new sources on the galactic plane, and 20 sources from the previous catalogue with revised positions. Eight 1AGL sources (2 high-latitude and 6 on the galactic plane) were not detected in the final processing either because of low OB exposure and/or due to their position in complex galactic regions. We report the results in a catalogue of all the detections obtained in each single OB, including the variability results for each of these sources. In particular, we found that 12 sources out of 42 or 11 out of 53 are variable, depending on the variability index used, where 42 and 53 are the number of sources for which these indices could be calculated. Seven of the 11 variable sources are blazars, the others are Crab pulsar+nebula, LS I +61°303, Cyg X-3, and 1AGLR J2021+4030. Table 5 is only available at the CDS via anonymous ftp to http://cdsarc.u-strasbg.fr (ftp://130.79.128.5) or via http://cdsarc.u-strasbg.fr/viz-bin/qcat?J/A+A/558/A137

  10. Hypoxic apnea and gasping.

    PubMed Central

    Guntheroth, W G; Kawabori, I

    1975-01-01

    We have tested the hypothesis that severe lypoxia causes apnea, regardless of the arterial CO2 and pH, and that extreme hypoxia causes gasping. Acute experiments with airway occlusion and with low inspired oxygen (FIo2) were performed on anesthetized adult dogs and monkeys. Arterial oxygen saturation was recorded continuously with fiberoptic oximetry, and Pco2 by an electrode catheter. In addition, blood samples were obtained for Po2, Pco2, and pH. Apnea was induced regularly when the Pao2 fell below 10 torr, whether the Paco2 was high with asphyxia (63 torr) or low (26 torr) with low FIo2. Similarly, the Pao2 at apnea was the same whether the pH was 7.17 with asphyxic hypoxia or 7.46 with hypoxic hypoxia. Gasping occurred at even lower Pao2 (below 5 torr) after 1 or 2 min of apnea. Gasping promptly restored the Pao2 to levels of moderate hypoxia (over 30 torr) which permitted resumption of regular respiration, with gradual elimination of the gasping. Fetal monkeys at term were studied in a similar manner from the moment of cord clamping. Their blood gases with apnea were quite similar to adult values in the narrow range of Pao2 and the wide range of Paco2 and pH. In the fetus, gasping was less immediately effective in improving arterial oxygen, but more persistent than in the adult. Regular respirations would not develop in the absence of oxygen in either the fetus or adult animal. Images PMID:811688

  11. Alternative approaches to treatment of Central Sleep Apnea

    PubMed Central

    2013-01-01

    Synopsis Divergent approaches to treatment of hypocapnic central sleep apnea syndromes reflect the difficulties in taming a hyperactive respiratory chemoreflex. As both sleep fragmentation and a narrow CO2 reserve or increased loop gain drive the disease, sedatives (to induce longer periods of stable non-rapid eye movement (NREM) sleep and reduce the destabilizing effects of arousals in NREM sleep) and CO2-based stabilization approaches are logical. Adaptive ventilation reduces mean hyperventilation yet can induce ventilator-patient dyssynchrony, while enhanced expiratory rebreathing space (EERS, dead space during positive pressure therapy) and CO2 manipulation directly stabilize respiratory control by moving CO2 above the apnea threshold. Carbonic anhydrase inhibition can provide further adjunctive benefits. Provent and Winx may be less likely to trigger central apneas or periodic breathing in those with a narrow CO2 reserve. An oral appliance can meaningfully reduce positive pressure requirements and thus enable treatment of complex apnea. Novel pharmacological approaches may target mediators of carotid body glomus cell excitation, such as the balance between gas neurotransmitters. In complex apnea patients, single mode therapy is not always successful, and multi-modality therapy might need to be considered. Phenotyping of sleep apnea beyond conventional scoring approaches is the key to optimal management. PMID:24772053

  12. List-mode PET image reconstruction for motion correction using the Intel XEON PHI co-processor

    NASA Astrophysics Data System (ADS)

    Ryder, W. J.; Angelis, G. I.; Bashar, R.; Gillam, J. E.; Fulton, R.; Meikle, S.

    2014-03-01

    List-mode image reconstruction with motion correction is computationally expensive, as it requires projection of hundreds of millions of rays through a 3D array. To decrease reconstruction time it is possible to use symmetric multiprocessing computers or graphics processing units. The former can have high financial costs, while the latter can require refactoring of algorithms. The Xeon Phi is a new co-processor card with a Many Integrated Core architecture that can run 4 multiple-instruction, multiple data threads per core with each thread having a 512-bit single instruction, multiple data vector register. Thus, it is possible to run in the region of 220 threads simultaneously. The aim of this study was to investigate whether the Xeon Phi co-processor card is a viable alternative to an x86 Linux server for accelerating List-mode PET image reconstruction for motion correction. An existing list-mode image reconstruction algorithm with motion correction was ported to run on the Xeon Phi coprocessor with the multi-threading implemented using pthreads. There were no differences between images reconstructed using the Phi co-processor card and images reconstructed using the same algorithm run on a Linux server. However, it was found that the reconstruction runtimes were 3 times greater for the Phi than the server. A new version of the image reconstruction algorithm was developed in C++ using OpenMP for mutli-threading and the Phi runtimes decreased to 1.67 times that of the host Linux server. Data transfer from the host to co-processor card was found to be a rate-limiting step; this needs to be carefully considered in order to maximize runtime speeds. When considering the purchase price of a Linux workstation with Xeon Phi co-processor card and top of the range Linux server, the former is a cost-effective computation resource for list-mode image reconstruction. A multi-Phi workstation could be a viable alternative to cluster computers at a lower cost for medical imaging

  13. System for controlling apnea

    SciTech Connect

    Holzrichter, John F

    2015-05-05

    An implanted stimulation device or air control device are activated by an external radar-like sensor for controlling apnea. The radar-like sensor senses the closure of the air flow cavity, and associated control circuitry signals (1) a stimulator to cause muscles to open the air passage way that is closing or closed or (2) an air control device to open the air passage way that is closing or closed.

  14. Simulated one-pass list-mode: an approach to on-the-fly system matrix calculation

    NASA Astrophysics Data System (ADS)

    Gillam, J. E.; Solevi, P.; Oliver, J. F.; Rafecas, M.

    2013-04-01

    In the development of prototype systems for positron emission tomography a valid and robust image reconstruction algorithm is required. However, prototypes often employ novel detector and system geometries which may change rapidly under optimization. In addition, developing systems generally produce highly granular, or possibly continuous detection domains which require some level of on-the-fly calculation for retention of measurement precision. In this investigation a new method of on-the-fly system matrix calculation is proposed that provides advantages in application to such list-mode systems in terms of flexibility in system modeling. The new method is easily adaptable to complicated system geometries and available computational resources. Detection uncertainty models are used as random number generators to produce ensembles of possible photon trajectories at image reconstruction time for each datum in the measurement list. However, the result of this approach is that the system matrix elements change at each iteration in a non-repetitive manner. The resulting algorithm is considered the simulation of a one-pass list (SOPL) which is generated and the list traversed during image reconstruction. SOPL alters the system matrix in use at each iteration and so behavior within the maximum likelihood-expectation maximization algorithm was investigated. A two-pixel system and a small two dimensional imaging model are used to illustrate the process and quantify aspects of the algorithm. The two-dimensional imaging system showed that, while incurring a penalty in image resolution, in comparison to a non-random equal-computation counterpart, SOPL provides much enhanced noise properties. In addition, enhancement in system matrix quality is straightforward (by increasing the number of samples in the ensemble) so that the resolution penalty can be recovered when desired while retaining improvement in noise properties. Finally the approach is tested and validated against a

  15. Event-by-event PET image reconstruction using list-mode origin ensembles algorithm

    NASA Astrophysics Data System (ADS)

    Andreyev, Andriy

    2016-03-01

    There is a great demand for real time or event-by-event (EBE) image reconstruction in emission tomography. Ideally, as soon as event has been detected by the acquisition electronics, it needs to be used in the image reconstruction software. This would greatly speed up the image reconstruction since most of the data will be processed and reconstructed while the patient is still undergoing the scan. Unfortunately, the current industry standard is that the reconstruction of the image would not start until all the data for the current image frame would be acquired. Implementing an EBE reconstruction for MLEM family of algorithms is possible, but not straightforward as multiple (computationally expensive) updates to the image estimate are required. In this work an alternative Origin Ensembles (OE) image reconstruction algorithm for PET imaging is converted to EBE mode and is investigated whether it is viable alternative for real-time image reconstruction. In OE algorithm all acquired events are seen as points that are located somewhere along the corresponding line-of-responses (LORs), together forming a point cloud. Iteratively, with a multitude of quasi-random shifts following the likelihood function the point cloud converges to a reflection of an actual radiotracer distribution with the degree of accuracy that is similar to MLEM. New data can be naturally added into the point cloud. Preliminary results with simulated data show little difference between regular reconstruction and EBE mode, proving the feasibility of the proposed approach.

  16. A cluster analysis method for identification of subpopulations of cells in flow cytometric list-mode arrays

    NASA Technical Reports Server (NTRS)

    Li, Z. K.

    1985-01-01

    A specialized program was developed for flow cytometric list-mode data using an heirarchical tree method for identifying and enumerating individual subpopulations, the method of principal components for a two-dimensional display of 6-parameter data array, and a standard sorting algorithm for characterizing subpopulations. The program was tested against a published data set subjected to cluster analysis and experimental data sets from controlled flow cytometry experiments using a Coulter Electronics EPICS V Cell Sorter. A version of the program in compiled BASIC is usable on a 16-bit microcomputer with the MS-DOS operating system. It is specialized for 6 parameters and up to 20,000 cells. Its two-dimensional display of Euclidean distances reveals clusters clearly, as does its 1-dimensional display. The identified subpopulations can, in suitable experiments, be related to functional subpopulations of cells.

  17. The shareholding similarity of the shareholders of the worldwide listed energy companies based on a two-mode primitive network and a one-mode derivative holding-based network

    NASA Astrophysics Data System (ADS)

    Li, Huajiao; Fang, Wei; An, Haizhong; Yan, LiLi

    2014-12-01

    Two-mode and multi-mode networks represent new directions of simulating a complex network that can simulate the relationships among the entities more precisely. In this paper, we constructed two different levels of networks: one is the two-mode primitive networks of the energy listed companies and their shareholders on the basis of the two-mode method of complex theory, and the other is the derivative one-mode holding-based network based on the equivalence network theory. We calculated two different topological characteristics of the two networks, that is, the out-degree of the actor nodes of the two-mode network (9003 nodes) and the weights of the edges of the one-mode network (619,766 edges), and we analyzed the distribution features of both of the two topological characteristics. In this paper, we define both the weighted and un-weighted Shareholding Similarity Coefficient, and using the data of the worldwide listed energy companies and their shareholders as empirical study subjects, we calculated and compared both the weighted and un-weighted shareholding similarity coefficient of the worldwide listed energy companies. The result of the analysis indicates that (1) both the out-degree of the actor nodes of the two-mode network and the weights of the edges of the one-mode network follow a power-law distribution; (2) there are significant differences between the weighted and un-weighted shareholding similarity coefficient of the worldwide listed energy companies, and the weighted shareholding similarity coefficient is of greater regularity than the un-weighted one; (3) there are a vast majority of shareholders who hold stock in only one or a few of the listed energy companies; and (4) the shareholders hold stock in the same listed energy companies when the value of the un-weighted shareholding similarity coefficient is between 0.4 and 0.8. The study will be a helpful tool to analyze the relationships of the nodes of the one-mode network, which is constructed based

  18. What Can You Do About Sleep Apnea?

    MedlinePlus

    ... seem to stop breathing, they may have a sleep disturbance known as obstructive sleep apnea. It's estimated that more than 15 million ... men. But only one in 10 people with sleep apnea is actually diagnosed. Barbara Peck: When John ...

  19. 21 CFR 868.2377 - Apnea monitor.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... breath. The apnea monitor also includes indirect methods of apnea detection such as monitoring of heart rate and other physiological parameters linked to the presence or absence of adequate respiration....

  20. 21 CFR 868.2377 - Apnea monitor.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... breath. The apnea monitor also includes indirect methods of apnea detection such as monitoring of heart rate and other physiological parameters linked to the presence or absence of adequate respiration....

  1. 21 CFR 868.2377 - Apnea monitor.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... breath. The apnea monitor also includes indirect methods of apnea detection such as monitoring of heart rate and other physiological parameters linked to the presence or absence of adequate respiration....

  2. 21 CFR 868.2377 - Apnea monitor.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... breath. The apnea monitor also includes indirect methods of apnea detection such as monitoring of heart rate and other physiological parameters linked to the presence or absence of adequate respiration....

  3. Sleep Apnea Tied to Complications After Angioplasty

    MedlinePlus

    ... page: https://medlineplus.gov/news/fullstory_159391.html Sleep Apnea Tied to Complications After Angioplasty Nightly breathing ... 15, 2016 WEDNESDAY, June 15, 2016 (HealthDay News) -- Sleep apnea may increase the risk of serious complications ...

  4. Getting a Diagnosis for Sleep Apnea

    MedlinePlus

    American Sleep Apnea Association Learn About the CPAP Assistance Program About ASAA News about ASAA Who we are Leadership Team Supporting the ASAA Financials Learn Healthy sleep Sleep apnea Other sleep disorders Personal stories Treat Test Yourself ...

  5. Sleep Apnea Tied to Complications After Angioplasty

    MedlinePlus

    ... nlm.nih.gov/medlineplus/news/fullstory_159391.html Sleep Apnea Tied to Complications After Angioplasty Nightly breathing ... 15, 2016 WEDNESDAY, June 15, 2016 (HealthDay News) -- Sleep apnea may increase the risk of serious complications ...

  6. A scatter-corrected list-mode reconstruction and a practical scatter/random approximation technique for dynamic PET imaging

    NASA Astrophysics Data System (ADS)

    Cheng, Ju-Chieh Kevin; Rahmim, Arman; Blinder, Stephan; Camborde, Marie-Laure; Raywood, Kelvin; Sossi, Vesna

    2007-04-01

    We describe an ordinary Poisson list-mode expectation maximization (OP-LMEM) algorithm with a sinogram-based scatter correction method based on the single scatter simulation (SSS) technique and a random correction method based on the variance-reduced delayed-coincidence technique. We also describe a practical approximate scatter and random-estimation approach for dynamic PET studies based on a time-averaged scatter and random estimate followed by scaling according to the global numbers of true coincidences and randoms for each temporal frame. The quantitative accuracy achieved using OP-LMEM was compared to that obtained using the histogram-mode 3D ordinary Poisson ordered subset expectation maximization (3D-OP) algorithm with similar scatter and random correction methods, and they showed excellent agreement. The accuracy of the approximated scatter and random estimates was tested by comparing time activity curves (TACs) as well as the spatial scatter distribution from dynamic non-human primate studies obtained from the conventional (frame-based) approach and those obtained from the approximate approach. An excellent agreement was found, and the time required for the calculation of scatter and random estimates in the dynamic studies became much less dependent on the number of frames (we achieved a nearly four times faster performance on the scatter and random estimates by applying the proposed method). The precision of the scatter fraction was also demonstrated for the conventional and the approximate approach using phantom studies. This work was supported by the Canadian Institute of Health Research, a TRIUMF Life Science Grant, the Natural Sciences and Engineering Research Council of Canada UFA (V Sossi) and the Michael Smith Foundation for Health Research Scholarship (V Sossi).

  7. Obstructive Sleep Apnea

    PubMed Central

    Drager, Luciano F.; Polotsky, Vsevolod Y.

    2011-01-01

    Obstructive sleep apnea (OSA) is independently associated with death from cardiovascular diseases, including myocardial infarction and stroke. Myocardial infarction and stroke are complications of atherosclerosis; therefore, over the last decade investigators have tried to unravel relationships between OSA and atherosclerosis. OSA may accelerate atherosclerosis by exacerbating key atherogenic risk factors. For instance, OSA is a recognized secondary cause of hypertension and may contribute to insulin resistance, diabetes, and dyslipidemia. In addition, clinical data and experimental evidence in animal models suggest that OSA can have direct proatherogenic effects inducing systemic inflammation, oxidative stress, vascular smooth cell activation, increased adhesion molecule expression, monocyte/lymphocyte activation, increased lipid loading in macrophages, lipid peroxidation, and endothelial dysfunction. Several cross-sectional studies have shown consistently that OSA is independently associated with surrogate markers of premature atherosclerosis, most of them in the carotid bed. Moreover, OSA treatment with continuous positive airway pressure may attenuate carotid atherosclerosis, as has been shown in a randomized clinical trial. This review provides an update on the role of OSA in atherogenesis and highlights future perspectives in this important research area. PMID:21813534

  8. [Sleep apnea syndrome and obesity].

    PubMed

    Laaban, J P

    2002-04-01

    Obesity is a main risk factor for sleep apnea syndrome (SAS). The prevalence of SAS is especially high in massive obesity and in visceral obesity. The mechanisms of obstructive apneas in obesity are poorly known, but an increase in upper airway collapsibility probably plays an important role. Several cardiorespiratory complications of SAS, especially systemic arterial hypertension, diurnal alveolar hypoventilation and pulmonary arterial hypertension, are more frequent and more severe in obese patients. An important weight loss resulting from surgical treatment of obesity is often associated with a dramatic decrease in apnea-hypopnea index in patients with massive obesity. In patients with moderate obesity, dietary weight loss is associated with varying degrees of improvement in SAS. Pharyngoplasty and anterior mandibular positioning devices have a low success rate in patients with massive obesity. Nasal continuous positive airway pressure is often the only effective treatment in obese SAS patients. PMID:12082447

  9. Home ventilation therapy in obstructive sleep apnea-hypopnea syndrome.

    PubMed

    González Mangado, Nicolás; Troncoso Acevedo, María Fernanda; Gómez García, Teresa

    2014-12-01

    Obstructive sleep apnea-hypopnea is a highly prevalent disease that is often underdiagnosed at present. It has a significant economic and social welfare impact, accounting for a large part of the resources assigned to home respiratory therapies. As part of the 2014 SEPAR Year of the Chronic Patient and Domiciliary Respiratory Care sponsored by the Spanish Society of Pulmonology and Thoracic Surgery, this article reviews the most recent publications on the indications and controversial issues in the treatment of sleep apnea, the latest evidence for indication of various positive pressure devices, and adjustment modes, ranging from the use of empirical formulae or mathematical estimations to modern auto-CPAP equipment, while not forgetting the gold standard of manual titration. Emphasis is placed on the need for monitoring required by patients to ensure treatment adherence and compliance. Finally, other therapies that are not the object of this article are briefly reviewed. PMID:25059585

  10. Erroneous cardiac ECG-gated PET list-mode trigger events can be retrospectively identified and replaced by an offline reprocessing approach: first results in rodents

    NASA Astrophysics Data System (ADS)

    Böning, Guido; Todica, Andrei; Vai, Alessandro; Lehner, Sebastian; Xiong, Guoming; Mille, Erik; Ilhan, Harun; la Fougère, Christian; Bartenstein, Peter; Hacker, Marcus

    2013-11-01

    The assessment of left ventricular function, wall motion and myocardial viability using electrocardiogram (ECG)-gated [18F]-FDG positron emission tomography (PET) is widely accepted in human and in preclinical small animal studies. The nonterminal and noninvasive approach permits repeated in vivo evaluations of the same animal, facilitating the assessment of temporal changes in disease or therapy response. Although well established, gated small animal PET studies can contain erroneous gating information, which may yield to blurred images and false estimation of functional parameters. In this work, we present quantitative and visual quality control (QC) methods to evaluate the accuracy of trigger events in PET list-mode and physiological data. Left ventricular functional analysis is performed to quantify the effect of gating errors on the end-systolic and end-diastolic volumes, and on the ejection fraction (EF). We aim to recover the cardiac functional parameters by the application of the commonly established heart rate filter approach using fixed ranges based on a standardized population. In addition, we propose a fully reprocessing approach which retrospectively replaces the gating information of the PET list-mode file with appropriate list-mode decoding and encoding software. The signal of a simultaneously acquired ECG is processed using standard MATLAB vector functions, which can be individually adapted to reliably detect the R-peaks. Finally, the new trigger events are inserted into the PET list-mode file. A population of 30 mice with various health statuses was analyzed and standard cardiac parameters such as mean heart rate (119 ms ± 11.8 ms) and mean heart rate variability (1.7 ms ± 3.4 ms) derived. These standard parameter ranges were taken into account in the QC methods to select a group of nine optimal gated and a group of eight sub-optimal gated [18F]-FDG PET scans of mice from our archive. From the list-mode files of the optimal gated group, we

  11. Apnea: a new training method in sport?

    PubMed

    Lemaître, Frédéric; Joulia, Fabrice; Chollet, Didier

    2010-03-01

    The physiological responses to apnea training exhibited by elite breath-hold divers may contribute to improving sports performance. Breath-hold divers have shown reduced blood acidosis, oxidative stress and basal metabolic rate, and increased hematocrit, erythropoietin concentration, hemoglobin mass and lung volumes. We hypothesise that these adaptations contributed to long apnea durations and improve performance. These results suggest that apnea training may be an effective alternative to hypobaric or normobaric hypoxia to increase aerobic and/or anaerobic performance. PMID:19850416

  12. Physiological and clinical aspects of apnea diving.

    PubMed

    Muth, Claus-Martin; Ehrmann, Ulrich; Radermacher, Peter

    2005-09-01

    Apnea diving is a fascinating example of applied physiology. The record for apnea diving as an extreme sport is 171 meters, 8:58 minutes. The short time beneath the surface induces profound cardiovascular and respiratory effects. Variations of blood-gas tensions result from the interaction of metabolism and the rapid sequence of compression and decompression. Decompression sickness is possible. Apnea divers can reach depths beyond the theoretic physiologic limit by using the lung-packing maneuver. Apnea divers exhibit a fall in heart rate, which can be trained and is an oxygen-conserving effect, but increases the incidence of ventricular arrhythmia. PMID:16140133

  13. Sleep Apnea and Risk of Panic Disorder

    PubMed Central

    Su, Vincent Yi-Fong; Chen, Yung-Tai; Lin, Wei-Chen; Wu, Li-An; Chang, Shi-Chuan; Perng, Diahn-Warng; Su, Wei-Juin; Chen, Yuh-Min; Chen, Tzeng-Ji; Lee, Yu-Chin; Chou, Kun-Ta

    2015-01-01

    PURPOSE Epidemiological studies have identified a trend in the development of depressive and anxiety disorders following a diagnosis of sleep apnea. The relationship between sleep apnea and subsequent panic disorder, however, remains unclear. METHODS Using a nationwide database, the Taiwan National Health Insurance Research Database, patients with sleep apnea and age-, sex-, income-, and urbanization-matched control patients who did not have sleep apnea were enrolled between 2000 and 2010. Patients with a prior diagnosis of panic disorder before enrollment were excluded. The 2 cohorts were observed until December 31, 2010. The primary endpoint was occurrence of newly diagnosed panic disorder. RESULTS A total of 8,704 sleep apnea patients and 34,792 control patients were enrolled. Of the 43,496 patients, 263 (0.60%) suffered from panic disorder during a mean follow-up period of 3.92 years, including 117 (1.34%) from the sleep apnea cohort and 146 (0.42%) from the control group. The Kaplan-Meier analysis revealed a predisposition of patients with sleep apnea to develop panic disorder (log-rank test, P <.001). After multivariate adjustment, the hazard ratio for subsequent panic disorder among the sleep apnea patients was 2.17 (95% confidence interval, 1.68–2.81; P <.001). CONCLUSIONS Sleep apnea appears to confer a higher risk for future development of panic disorder. PMID:26195676

  14. Obstructive sleep apnea and asthma*

    PubMed Central

    Salles, Cristina; Terse-Ramos, Regina; Souza-Machado, Adelmir; Cruz, Álvaro A

    2013-01-01

    Symptoms of sleep-disordered breathing, especially obstructive sleep apnea syndrome (OSAS), are common in asthma patients and have been associated with asthma severity. It is known that asthma symptoms tend to be more severe at night and that asthma-related deaths are most likely to occur during the night or early morning. Nocturnal symptoms occur in 60-74% of asthma patients and are markers of inadequate control of the disease. Various pathophysiological mechanisms are related to the worsening of asthma symptoms, OSAS being one of the most important factors. In patients with asthma, OSAS should be investigated whenever there is inadequate control of symptoms of nocturnal asthma despite the treatment recommended by guidelines having been administered. There is evidence in the literature that the use of continuous positive airway pressure contributes to asthma control in asthma patients with obstructive sleep apnea and uncontrolled asthma. PMID:24310634

  15. Pathophysiology of central sleep apneas.

    PubMed

    Hernandez, Adam B; Patil, Susheel P

    2016-05-01

    The transition from wake to sleep is accompanied by a host of physiologic changes, which result in major alterations in respiratory control and may result in sleep-related breathing disorders. The central sleep apneas are a group of sleep-related breathing disorders that are characterized by recurrent episodes of airflow reduction or cessation due to a temporary reduction or absence of central respiratory drive. The fundamental hallmark of central sleep apnea (CSA) disorders is the presence of ventilatory control instability; however, additional mechanisms play a role in one or more specific manifestations of CSA. CSA may manifest during conditions of eucapnia/hypocapnia or chronic hypercapnia, which is a useful clinical classification that lends understanding to the underlying pathophysiology and potential therapies. In this review, an overview of normal breathing physiology is provided, followed by a discussion of pathophysiologic mechanisms that promote CSA and the mechanisms that are specific to different manifestations of CSA. PMID:26782104

  16. Holding-based network of nations based on listed energy companies: An empirical study on two-mode affiliation network of two sets of actors

    NASA Astrophysics Data System (ADS)

    Li, Huajiao; Fang, Wei; An, Haizhong; Gao, Xiangyun; Yan, Lili

    2016-05-01

    Economic networks in the real world are not homogeneous; therefore, it is important to study economic networks with heterogeneous nodes and edges to simulate a real network more precisely. In this paper, we present an empirical study of the one-mode derivative holding-based network constructed by the two-mode affiliation network of two sets of actors using the data of worldwide listed energy companies and their shareholders. First, we identify the primitive relationship in the two-mode affiliation network of the two sets of actors. Then, we present the method used to construct the derivative network based on the shareholding relationship between two sets of actors and the affiliation relationship between actors and events. After constructing the derivative network, we analyze different topological features on the node level, edge level and entire network level and explain the meanings of the different values of the topological features combining the empirical data. This study is helpful for expanding the usage of complex networks to heterogeneous economic networks. For empirical research on the worldwide listed energy stock market, this study is useful for discovering the inner relationships between the nations and regions from a new perspective.

  17. A method to synchronize signals from multiple patient monitoring devices through a single input channel for inclusion in list-mode acquisitions

    SciTech Connect

    O’Connor, J. Michael; Pretorius, P. Hendrik; Johnson, Karen; King, Michael A.

    2013-12-15

    Purpose: This technical note documents a method that the authors developed for combining a signal to synchronize a patient-monitoring device with a second physiological signal for inclusion into list-mode acquisition. Our specific application requires synchronizing an external patient motion-tracking system with a medical imaging system by multiplexing the tracking input with the ECG input. The authors believe that their methodology can be adapted for use in a variety of medical imaging modalities including single photon emission computed tomography (SPECT) and positron emission tomography (PET). Methods: The authors insert a unique pulse sequence into a single physiological input channel. This sequence is then recorded in the list-mode acquisition along with the R-wave pulse used for ECG gating. The specific form of our pulse sequence allows for recognition of the time point being synchronized even when portions of the pulse sequence are lost due to collisions with R-wave pulses. This was achieved by altering our software used in binning the list-mode data to recognize even a portion of our pulse sequence. Limitations on heart rates at which our pulse sequence could be reliably detected were investigated by simulating the mixing of the two signals as a function of heart rate and time point during the cardiac cycle at which our pulse sequence is mixed with the cardiac signal. Results: The authors have successfully achieved accurate temporal synchronization of our motion-tracking system with acquisition of SPECT projections used in 17 recent clinical research cases. In our simulation analysis the authors determined that synchronization to enable compensation for body and respiratory motion could be achieved for heart rates up to 125 beats-per-minute (bpm). Conclusions: Synchronization of list-mode acquisition with external patient monitoring devices such as those employed in motion-tracking can reliably be achieved using a simple method that can be implemented using

  18. Sleep Apnea and Heart Disease, Stroke

    MedlinePlus

    ... Pressure High Blood Pressure Tools & Resources Stroke More Sleep Apnea and Heart Disease, Stroke Updated:Sep 16,2015 Plain old snoring ... evidence is very strong for the relationship between sleep apnea and hypertension and cardiovascular disease generally, so people really need to know that,” ...

  19. 21 CFR 868.2377 - Apnea monitor.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Apnea monitor. 868.2377 Section 868.2377 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES... entitled “Class II Special Controls Guidance Document: Apnea Monitors; Guidance for Industry and FDA.”...

  20. Obstructive sleep apnea in atrial fibrillation patients.

    PubMed

    Arias, Miguel A; Alonso-Fernández, Alberto; García-Río, Francisco; Sánchez, Ana; López, Juana M; Pagola, Carlos

    2006-06-28

    A high prevalence of obstructive sleep apnea has been demonstrated in patients with atrial fibrillation. Our comments want to emphasize the importance of identifying and treating a large proportion of patients with atrial fibrillation who have undiagnosed obstructive sleep apnea as an additional preventive strategy for atrial fibrillation patients. PMID:16309764

  1. Clinical manifestations of sleep apnea

    PubMed Central

    2015-01-01

    Obstructive sleep apnea (OSA) may manifest in a number of ways from subtle intrusion into daily life to profound sleepiness, snoring, witnessed apneas and other classic symptoms. Although there is increasing evidence suggesting OSA can adversely affect health in a variety of ways, this disorder remains underdiagnosed. The most well-escribed health consequences of OSA relate to the cardiovascular system. Hypertension and arrhythmias have a strong association with OSA, and evidence suggests that treatment of OSA in patients with refractory hypertension and in patients planning cardioversion for atrial fibrillation may be of particularly importance. Significant associations between heart failure and OSA as well as complex sleep apnea have also been well-described. Cerebrovascular insult, impaired neurocognition, and poorly controlled mood disorder are also associated with in OSA. Therapy for OSA may ameliorate atherosclerotic progression and improve outcomes post-cerebrovascular accident (CVA). OSA should be considered in patients complaining of poor concentration at work, actual or near-miss motor vehicle accidents, and patients with severe sleepiness as a component of their co-morbid mood disorders. The metabolic impact of OSA has also been studied, particularly in relation to glucose homeostasis. Also of interest is the potential impact OSA has on lipid metabolism. The adverse effect untreated OSA has on glucose tolerance and lipid levels has led to the suggestion that OSA is yet another constituent of the metabolic syndrome. Some of these metabolic derangements may be related to the adverse effects untreated OSA has on hepatic health. The cardiovascular, neurocognitive, and metabolic manifestations of OSA can have a significant impact on patient health and quality of life. In many instances, evidence exists that therapy not only improves outcomes in general, but also modifies the severity of co-morbid disease. To mitigate the long-term sequela of this disease

  2. Severe Central Sleep Apnea in Vici Syndrome.

    PubMed

    El-Kersh, Karim; Jungbluth, Heinz; Gringras, Paul; Senthilvel, Egambaram

    2015-11-01

    Vici syndrome is a rare congenital multisystem disorder due to recessive mutations in the key autophagy regulator EPG5. Vici syndrome is characterized by agenesis of the corpus callosum, hypopigmentation, immunodeficiency, cataracts, and cardiomyopathy, with variable additional multisystem involvement. Here we report on a 5-year-old girl who presented with global developmental delay, seizures, callosal agenesis, cataracts, sensorineural hearing loss, hypopigmentation, and immunodeficiency with a low CD4 count and recurrent infections. EPG5 sequencing (prompted by suggestive clinical features) revealed a homozygous missense mutation, c.1007A>G (p.Gln336Arg). The patient was referred to our center for evaluation of nocturnal apnea. Overnight polysomnography showed severe central sleep apnea (CSA) with an overall apnea-hypopnea index of 100.5 events per hour of sleep (central apnea index of 97.5, mixed apnea index of 2, and obstructive hypopnea index of 1). The patient responded to bilevel positive airway pressure therapy with a backup rate with normalization of the apnea-hypopnea index and maintenance of oxygen saturation >90%. Despite successful control of the severe CSA, the patient was eventually started on nocturnal oxygen therapy due to excessive upper airway secretions and the high risk of possible aspiration with positive airway pressure therapy. This is the first report of EPG5-related Vici syndrome associated with CSA. We discuss the polysomnographic findings in our patient in the context of a brief literature review of the reported sleep abnormalities in Vici syndrome. PMID:26482670

  3. Hematological response and diving response during apnea and apnea with face immersion.

    PubMed

    Schagatay, Erika; Andersson, Johan P A; Nielsen, Bodil

    2007-09-01

    Increased hematocrit (Hct) attributable to splenic contraction accompanies human apneic diving or apnea with face immersion. Apnea also causes heart rate reduction and peripheral vasoconstriction, i.e., a cardiovascular diving response, which is augmented by face immersion. The aim was to study the role of apnea and facial immersion in the initiation of the hematological response and to relate this to the cardiovascular diving response and its oxygen conservation during repeated apneas. Seven male volunteers performed two series of five apneas of fixed near-maximal duration: one series in air (A) and the other with facial immersion in 10 degrees C water (FIA). Apneas were spaced by 2 min and series by 20 min of rest. Venous blood samples, taken before and after each apnea, were analysed for Hct, hemoglobin concentration (Hb), lactic acid, blood gases and pH. Heart rate, skin capillary blood flow and arterial oxygen saturation were continuously measured non-invasively. A transient increase of Hct and Hb by approximately 4% developed progressively across both series. As no increase of the response resulted with face immersion, we concluded that the apnea, or its consequences, is the major stimulus evoking splenic contraction. An augmented cardiovascular diving response occurred during FIA compared to A. Arterial oxygen saturation remained higher, venous oxygen stores were more depleted and lactic acid accumulation was higher across the FIA series, indicating oxygen conservation with the more powerful diving response. This study shows that the hematological response is not involved in causing the difference in oxygen saturation between apnea and apnea with face immersion. PMID:17541787

  4. Sleep Apnea May Take Toll on Your Mood, Thinking Skills

    MedlinePlus

    ... nlm.nih.gov/medlineplus/news/fullstory_157515.html Sleep Apnea May Take Toll on Your Mood, Thinking ... 29, 2016 MONDAY, Feb. 29, 2016 (HealthDay News) -- Sleep apnea may have an impact on brain function, ...

  5. Sleep Apnea May Raise Heart Risks in People with Pacemakers

    MedlinePlus

    ... nlm.nih.gov/medlineplus/news/fullstory_158688.html Sleep Apnea May Raise Heart Risks in People With ... 2016 (HealthDay News) -- People with heart pacemakers and sleep apnea are at much greater risk for a ...

  6. Very long apnea events in preterm infants.

    PubMed

    Mohr, Mary A; Vergales, Brooke D; Lee, Hoshik; Clark, Matthew T; Lake, Douglas E; Mennen, Anne C; Kattwinkel, John; Sinkin, Robert A; Moorman, J Randall; Fairchild, Karen D; Delos, John B

    2015-03-01

    Apnea is nearly universal among very low birth weight (VLBW) infants, and the associated bradycardia and desaturation may have detrimental consequences. We describe here very long (>60 s) central apnea events (VLAs) with bradycardia and desaturation, discovered using a computerized detection system applied to our database of over 100 infant years of electronic signals. Eighty-six VLAs occurred in 29 out of 335 VLBW infants. Eighteen of the 29 infants had a clinical event or condition possibly related to the VLA. Most VLAs occurred while infants were on nasal continuous positive airway pressure, supplemental oxygen, and caffeine. Apnea alarms on the bedside monitor activated in 66% of events, on average 28 s after cessation of breathing. Bradycardia alarms activated late, on average 64 s after cessation of breathing. Before VLAs oxygen saturation was unusually high, and during VLAs oxygen saturation and heart rate fell unusually slowly. We give measures of the relative severity of VLAs and theoretical calculations that describe the rate of decrease of oxygen saturation. A clinical conclusion is that very long apnea (VLA) events with bradycardia and desaturation are not rare. Apnea alarms failed to activate for about one-third of VLAs. It appears that neonatal intensive care unit (NICU) personnel respond quickly to bradycardia alarms but not consistently to apnea alarms. We speculate that more reliable apnea detection systems would improve patient safety in the NICU. A physiological conclusion is that the slow decrease of oxygen saturation is consistent with a physiological model based on assumed high values of initial oxygen saturation. PMID:25549762

  7. Very long apnea events in preterm infants

    PubMed Central

    Vergales, Brooke D.; Lee, Hoshik; Clark, Matthew T.; Lake, Douglas E.; Mennen, Anne C.; Kattwinkel, John; Sinkin, Robert A.; Moorman, J. Randall; Fairchild, Karen D.; Delos, John B.

    2014-01-01

    Apnea is nearly universal among very low birth weight (VLBW) infants, and the associated bradycardia and desaturation may have detrimental consequences. We describe here very long (>60 s) central apnea events (VLAs) with bradycardia and desaturation, discovered using a computerized detection system applied to our database of over 100 infant years of electronic signals. Eighty-six VLAs occurred in 29 out of 335 VLBW infants. Eighteen of the 29 infants had a clinical event or condition possibly related to the VLA. Most VLAs occurred while infants were on nasal continuous positive airway pressure, supplemental oxygen, and caffeine. Apnea alarms on the bedside monitor activated in 66% of events, on average 28 s after cessation of breathing. Bradycardia alarms activated late, on average 64 s after cessation of breathing. Before VLAs oxygen saturation was unusually high, and during VLAs oxygen saturation and heart rate fell unusually slowly. We give measures of the relative severity of VLAs and theoretical calculations that describe the rate of decrease of oxygen saturation. A clinical conclusion is that very long apnea (VLA) events with bradycardia and desaturation are not rare. Apnea alarms failed to activate for about one-third of VLAs. It appears that neonatal intensive care unit (NICU) personnel respond quickly to bradycardia alarms but not consistently to apnea alarms. We speculate that more reliable apnea detection systems would improve patient safety in the NICU. A physiological conclusion is that the slow decrease of oxygen saturation is consistent with a physiological model based on assumed high values of initial oxygen saturation. PMID:25549762

  8. Patients with Obstructive Sleep Apnea at Altitude.

    PubMed

    Bloch, Konrad E; Latshang, Tsogyal D; Ulrich, Silvia

    2015-06-01

    Bloch, Konrad E., Tsogyal D. Latshang, and Silvia Ulrich. Patients with obstructive sleep apnea at altitude. High Alt Med Biol 16:110-116, 2015.--Obstructive sleep apnea (OSA) is highly prevalent in the general population, in particular in men and women of older age. In OSA patients sleeping near sea level, the apneas/hypopneas associated with intermittent hypoxemia are predominantly due to upper airway collapse. When OSA patients stay at altitudes above 1600 m, corresponding to that of many tourist destinations, hypobaric hypoxia promotes frequent central apneas in addition to obstructive events, resulting in combined intermittent and sustained hypoxia. This induces strong sympathetic activation with elevated heart rate, cardiac arrhythmia, and systemic hypertension. There are concerns that these changes expose susceptible OSA patients, in particular those with advanced age and co-morbidities, to an excessive risk of cardiovascular and other adverse events during a stay at altitude. Based on data from randomized trials, it seems advisable for OSA patients to use continuous positive airway pressure treatment with computer controlled mask pressure adjustment (autoCPAP) in combination with acetazolamide during an altitude sojourn. If CPAP therapy is not feasible, acetazolamide alone is better than no treatment at all, as it improves oxygenation and sleep apnea and prevents excessive blood pressure rises of OSA patients at altitude. PMID:25973669

  9. Sodium oxybate-induced central sleep apneas.

    PubMed

    Frase, Lukas; Schupp, Jonas; Sorichter, Stephan; Randelshofer, Wolfgang; Riemann, Dieter; Nissen, Christoph

    2013-09-01

    Sodium oxybate (γ-hydroxybutyric acid, GHB) is a neurotransmitter in the human brain which exerts sedative effects and is used therapeutically in the treatment of narcolepsy. Current safety recommendations have been formulated for the use of GHB in patients with preexisting breathing disorders. We report the case of a 39-year-old female with narcolepsy and cataplexy revealing the de novo emergence of central sleep apneas in a Cheyne-Stokes pattern under constant treatment with GHB. After discontinuation of GHB, polysomnographic re-evaluation demonstrated the disappearance of central sleep apneas. To our knowledge, this is the first report of de novo central sleep apneas induced by GHB in a patient without pre-existing sleep-disordered breathing, suggesting that there is a need for further investigation and potentially an extension of the safety guidelines to patients without a pre-existing breathing disorder. PMID:23834969

  10. [Obstructive sleep apnea features and occupational fitness of railway workers].

    PubMed

    Buniatyan, M S; Belozerova, N V; At'kov, O Yu

    2016-01-01

    The article covers prevalence of obstructive sleep apnea syndrome, its role in health disorders of workers engaged into railway safety. The authors analyzed present standards of occupational fitness in workers performing critically important operating activities and methods of occupational selection with possible obstructive sleep apnea syndrome. I stage recommendations are suggested in diagnosis of obstructive sleep apnea syndrome in workers engaged into railway safety. Obstructive sleep apnea syndrome appeared to threaten operators' activity, to cause accidents, to early disablement due to life-threatening complications, to unsuitability for the occupation due to diseases connected with obstructive sleep apnea syndrome (arterial hypertension, diabetes mellitus, metabolic syndrome, cardiac rhythm and conductivity disorders, obesity). PMID:27396145

  11. Does nasal decongestion improve obstructive sleep apnea?

    PubMed

    Clarenbach, Christian F; Kohler, Malcolm; Senn, Oliver; Thurnheer, Robert; Bloch, Konrad E

    2008-12-01

    Whether nasal congestion promotes obstructive sleep apnea is controversial. Therefore, we performed a randomized placebo-controlled cross-over trial on the effects of topical nasal decongestion in patients with obstructive sleep apnea syndrome (OSA) and nasal congestion. Twelve OSA patients with chronic nasal congestion (mean +/- SD age 49.1 +/- 11.1 years, apnea/hypopnea index 32.6 +/- 24.5/h) were treated with nasal xylometazoline or placebo for 1 week each. At the end of treatment periods, polysomnography including monitoring of nasal conductance by an unobtrusive technique, vigilance by the OSLER test, and symptom scores were assessed. Data from xylometazoline and placebo treatments were compared. Mean nocturnal nasal conductance on xylometazoline was significantly higher than on placebo (8.6 +/- 5.3 versus 6.3 +/- 5.8 mL s(-1)Pa(-1), P < 0.05) but the apnea/hypopnea index was similar (29.3 +/- 32.5/h versus 33.2 +/- 32.8/h, P = NS). However, 30-210 min after application of xylometazoline, at the time of the maximal pharmacologic effect, the apnea/hypopnea index was slightly reduced (27.3 +/- 30.5/h versus 33.2 +/- 33.9/h, P < 0.05). Xylometazoline did not alter sleep quality, sleep resistance time (33.6 +/- 8.8 versus 33.4 +/- 10.1 min, P = NS) and subjective sleepiness (Epworth score 10.5 +/- 3.8 versus 11.8 +/- 4.4, P = NS). The reduced apnea/hypopnea index during maximal nasal decongestion by xylometazoline suggests a pathophysiologic link but the efficacy of nasal decongestion was not sufficient to provide a clinically substantial improvement of OSA. PMID:18710420

  12. [Multisystemic involvement in obstructive sleep apnea].

    PubMed

    Labarca, Gonzalo; Cruz N, Rodrigo; Descalzi, Fernando

    2014-06-01

    Obstructive Sleep Apnea (OSA) is characterized by repetitive upper airway collapse with apnea/hypopnea and recurrent hypoxia during sleep, which results in fragmented sleep and intermittent drops in arterial blood oxygen saturation (hypoxemia). Several dysfunctions of neurocognitive, endocrine, cardiovascular, and metabolic systems are recognized in patients with OSA. The most commonly reported associations are with obesity, increased cardiovascular risk, dyslipidemia, diabetes mellitus 2 and liver damage. However, there is a proven relationship between OSA and other diseases, such as polycystic ovary syndrome, gastroesophageal reflux, and chronic kidney disease. The aim of this review is to analyze clinical and experimental evidence linking OSA with other diseases. PMID:25327320

  13. Apnea MedAssist: real-time sleep apnea monitor using single-lead ECG.

    PubMed

    Bsoul, Majdi; Minn, Hlaing; Tamil, Lakshman

    2011-05-01

    We have developed a low-cost, real-time sleep apnea monitoring system ''Apnea MedAssist" for recognizing obstructive sleep apnea episodes with a high degree of accuracy for both home and clinical care applications. The fully automated system uses patient's single channel nocturnal ECG to extract feature sets, and uses the support vector classifier (SVC) to detect apnea episodes. "Apnea MedAssist" is implemented on Android operating system (OS) based smartphones, uses either the general adult subject-independent SVC model or subject-dependent SVC model, and achieves a classification F-measure of 90% and a sensitivity of 96% for the subject-independent SVC. The real-time capability comes from the use of 1-min segments of ECG epochs for feature extraction and classification. The reduced complexity of "Apnea MedAssist" comes from efficient optimization of the ECG processing, and use of techniques to reduce SVC model complexity by reducing the dimension of feature set from ECG and ECG-derived respiration signals and by reducing the number of support vectors. PMID:20952340

  14. Modeling sleep apnea severity using bioimpedance measurements.

    PubMed

    Gavrilovic, Bojan; Popovic, Milos R; Yadollahi, Azadeh

    2015-08-01

    Obstructive sleep apnea (OSA) is a common disorder in adults characterized by repetitive collapse of the pharynx. OSA prevalence increases in fluid retaining patients such as those with heart or renal failure, and worsens with overnight fluid accumulation in the neck. The objective of this study was to develop a new method of measuring changes in intracellular water (ICW) in the neck, and investigate metrics that represent total neck impedance and their relationship to sleep apnea severity. In 18 non-obese men, neck fluid volume (NFV) was measured before and after sleep using bioelectrical impedance at 50 kHz. For each participant, resistance and reactance was extracted from the impedance measurements. A model was developed to estimate the cell membrane capacitance which could represent changes in intracellular fluid in the neck. OSA severity was assessed using polysomnography to estimate the apnea-hypopnea index (AHI) as well as the obstructive AHI (OAHI). Our results showed a strong correlation between the changes in NFV from before to after sleep with the changes in cell membrane capacitance from before to after sleep, indicating an increase in ICW in the neck during sleep. Using linear stepwise regression we were also able to develop models to accurately predict AHI and OAHI using baseline anthropometric and bioimpedance measurements. These promising results demonstrate that non-invasive measurements of bioimpedance can be used to develop a novel biomarker to model sleep apnea severity, and assess patients at high risk of OSA. PMID:26737658

  15. Cardiovascular regulation during apnea in elite divers.

    PubMed

    Heusser, Karsten; Dzamonja, Gordan; Tank, Jens; Palada, Ivan; Valic, Zoran; Bakovic, Darija; Obad, Ante; Ivancev, Vladimir; Breskovic, Toni; Diedrich, André; Joyner, Michael J; Luft, Friedrich C; Jordan, Jens; Dujic, Zeljko

    2009-04-01

    Involuntary apnea during sleep elicits sustained arterial hypertension through sympathetic activation; however, little is known about voluntary apnea, particularly in elite athletes. Their physiological adjustments are largely unknown. We measured blood pressure, heart rate, hemoglobin oxygen saturation, muscle sympathetic nerve activity, and vascular resistance before and during maximal end-inspiratory breath holds in 20 elite divers and in 15 matched control subjects. At baseline, arterial pressure and heart rate were similar in both groups. Maximal apnea time was longer in divers (1.7+/-0.4 versus 3.9+/-1.1 minutes; P<0.0001), and it was accompanied by marked oxygen desaturation (97.6+/-0.7% versus 77.6+/-13.9%; P<0.0001). At the end of apnea, divers showed a >5-fold greater muscle sympathetic nerve activity increase (P<0.01) with a massively increased pressor response compared with control subjects (9+/-5 versus 32+/-15 mm Hg; P<0.001). Vascular resistance increased in both groups, but more so in divers (79+/-46% versus 140+/-82%; P<0.01). Heart rate did not change in either group. The rise in muscle sympathetic nerve activity correlated with oxygen desaturation (r(2)=0.26; P<0.01) and with the increase in mean arterial pressure (r(2)=0.40; P<0.0001). In elite divers, breath holds for several minutes result in an excessive chemoreflex activation of sympathetic vasoconstrictor activity. Extensive sympathetically mediated peripheral vasoconstriction may help to maintain adequate oxygen supply to vital organs under asphyxic conditions that untrained subjects are not able to tolerate voluntarily. Our results are relevant to conditions featuring periodic apnea. PMID:19255361

  16. Behavioral Hyperventilation and Central Sleep Apnea in Two Children

    PubMed Central

    Johnston, Thomas P.; Tam-Williams, Jade; Schmandt, Margaret; Patel, Anand C.; Cleveland, Claudia; Coste, Ferdinand; Kemp, James S.

    2015-01-01

    Behavioral hyperventilation is a rarely recognized cause of central sleep apnea (CSA) among children. We report two pediatric patients who presented with prolonged central sleep apnea secondary to behavioral hyperventilation. One patient also had a prolonged corrected QT (QTC) interval resulting from hyperventilation. Citation: Johnston TP, Tam-Williams J, Schmandt M, Patel AC, Cleveland C, Coste F, Kemp JS. Behavioral hyperventilation and central sleep apnea in two children. J Clin Sleep Med 2015;11(4):487–489. PMID:26106657

  17. Novel Therapies for the Treatment of Central Sleep Apnea.

    PubMed

    Javaheri, Shahrokh; Germany, Robin; Greer, John J

    2016-06-01

    Neurophysiologically, central apnea is due to a temporary cessation of respiratory rhythmogenesis in medullary respiratory networks. Central apneas occur in several disorders and result in pathophysiological consequences, including arousals and desaturation. The 2 most common causes in adults are congestive heart failure and chronic use of opioids to treat pain. Under such circumstances, diagnosis and treatment of central sleep apnea may improve quality of life, morbidity, and mortality. This article discusses recent developments in the treatment of central sleep apnea in heart failure and opioids use. PMID:27236059

  18. Obstructive Sleep Apnea and Risk of Motor Vehicle Crash: Systematic Review and Meta-Analysis

    PubMed Central

    Tregear, Stephen; Reston, James; Schoelles, Karen; Phillips, Barbara

    2009-01-01

    Study Objectives: We performed a systematic review of the OSA-related risk of crash in commercial motor vehicle (CMV) drivers. The primary objective involved determining whether individuals with obstructive sleep apnea (OSA) are at an increased risk for a motor vehicle crash when compared to comparable individuals who do not have the disorder. A secondary objective involved determining what factors are associated with an increased motor vehicle crash risk among individuals with OSA. Design/Setting: Seven electronic databases (MEDLINE, PubMed (PreMEDLINE), EMBASE, PsycINFO, CINAHL, TRIS, and the Cochrane library) were searched (through May 27, 2009), as well as the reference lists of all obtained articles. We included controlled studies (case-control or cohort) that evaluated crash risk in individuals with OSA. We evaluated the quality of each study and the interplay between the quality, quantity, robustness, and consistency of the body of evidence, and tested for publication bias. Data were extracted by 2 independent analysts. When appropriate, data from different studies were combined in a fixed- or random-effects meta-analysis. Results: Individuals with OSA are clearly at increased risk for crash. The mean crash-rate ratio associated with OSA is likely to fall within the range of 1.21 to 4.89. Characteristics that may predict crash in drivers with OSA include BMI, apnea plus hypopnea index, oxygen saturation, and possibly daytime sleepiness. Conclusions: Untreated sleep apnea is a significant contributor to motor vehicle crashes. Citation: Tregear S; Reston J; Schoelles K; Phillips B. Obstructive sleep apnea and risk of motor vehicle crash: systematic review and meta-analysis. J Clin Sleep Med 2009;5(6):573-581. PMID:20465027

  19. Relationship Between Sleep Apnea and Cancer.

    PubMed

    Martínez-García, Miguel Ángel; Campos-Rodríguez, Francisco; Almendros, Isaac; Farré, Ramón

    2015-09-01

    In the light of relationships reported between hypoxemia (tissue hypoxia) and cancer, Abrams et al. concluded in 2008 that sleep apnea-hypopnea syndrome (SAHS) and its main consequence, intermittent hypoxia, could be related with increased susceptibility to cancer or poorer prognosis of a pre-existing tumor. This pathophysiological association was confirmed in animal studies. Two large independent historical cohort studies subsequently found that the degree of nocturnal hypoxia in patients with SAHS was associated with higher cancer incidence and mortality. This finding has been confirmed in almost all subsequent studies, although the retrospective nature of some requires that they be considered as hypothesis-generating only. The relationship between sleep apnea and cancer, and the pathophysiological mechanisms governing it, could be clarified in the near future in a currently on-going study in a large group of melanoma patients. PMID:25843225

  20. Sleep Apnea, Heart Failure, and Pulmonary Hypertension

    PubMed Central

    Javaheri, Shahrokh; Javaheri, Ali

    2014-01-01

    Despite the emergence of sleep apnea (SA) as a significant risk factor for heart failure (HF) mortality, data indicate that SA remains under-diagnosed and under-treated. Less well established, though perhapsmore emphasized, is the role of sleep apnea in pulmonary hypertension (PH). SA occurs in approximately 50 % of HF patients, and its consequences include intermittent hypoxemia, arousal, and intrathoracic pressure swings leading to neurohormonal stimulation, oxidative stress and inflammation. While SA is also considered a cause of PH, severe PH due solely to SA is rare. Combining the results of several studies using Swan-Ganz catheters for diagnosis of PH, approximately 10 % of patients with OSA have PH. Effective treatment of SA in HF is associated with improved survival, while treatment of SA in PH is typically associated with modest hemodynamic improvement. PMID:24097114

  1. Apnea of prematurity: from cause to treatment.

    PubMed

    Zhao, Jing; Gonzalez, Fernando; Mu, Dezhi

    2011-09-01

    Apnea of prematurity (AOP) is a common problem affecting premature infants, likely secondary to a "physiologic" immaturity of respiratory control that may be exacerbated by neonatal disease. These include altered ventilatory responses to hypoxia, hypercapnia, and altered sleep states, while the roles of gastroesophageal reflux and anemia remain controversial. Standard clinical management of the obstructive subtype of AOP includes prone positioning and continuous positive or nasal intermittent positive pressure ventilation to prevent pharyngeal collapse and alveolar atelectasis, while methylxanthine therapy is a mainstay of treatment of central apnea by stimulating the central nervous system and respiratory muscle function. Other therapies, including kangaroo care, red blood cell transfusions, and CO(2) inhalation, require further study. The physiology and pathophysiology behind AOP are discussed, including the laryngeal chemoreflex and sensitivity to inhibitory neurotransmitters, as are the mechanisms by which different therapies may work and the potential long-term neurodevelopmental consequences of AOP and its treatment. PMID:21301866

  2. Health promotion in obstructive sleep apnea syndrome.

    PubMed

    Corrêa, Camila de Castro; Blasca, Wanderléia Quinhoneiro; Berretin-Felix, Giédre

    2015-04-01

    Introduction Obstructive sleep apnea syndrome (OSAS), which is commonly underdiagnosed, has a high occurrence in the world population. Health education concerning sleep disorders and OSAS should be implemented. Objectives The objective was to identify studies related to preventive actions on sleep disorders, with emphasis on OSAS. Data Synthesis A literature review was conducted using Lilacs, Medline, PubMed, and Scopus by combining the following keywords: "Health Promotion," "Sleep Disorders," "Primary Prevention," "Health Education," and "Obstructive Sleep Apnea Syndromes." Initially, 1,055 papers, from 1968 to 2013, were located, with the majority from the Scopus database. The inclusion criteria were applied, and four articles published between 2006 and 2012 were included in the present study. Conclusions The studies on preventive actions in sleep disorders, with emphasis on OSAS, involved the general population and professionals and students in the health field and led to increased knowledge on sleep disorders and more appropriate practices. PMID:25992174

  3. Pharyngeal fat in obstructive sleep apnea.

    PubMed

    Shelton, K E; Woodson, H; Gay, S; Suratt, P M

    1993-08-01

    Although most patients with obstructive sleep apnea (OSA) are obese, it is not known how obesity contributes to airway collapse during sleep. The purpose of this study was to determine whether the volume of adipose tissue adjacent to the pharyngeal airway in humans is related to the degree of OSA. We studied 30 subjects, nine without OSA and 21 with OSA; two subjects were studied before and after weight loss. Adipose tissue was detected with magnetic resonance imaging using T1-weighted spin echo sequences. The volume of adipose tissue adjacent to the upper airway was determined by measuring the volume of all pixels in the intensity range of adipose tissue within the region bounded by the ramus of the mandible, the spine, the anterior border of the soft palate, and the hard palate. Polysomnography was performed with conventional techniques. All subjects had a collection of adipose tissue adjacent to the upper airway; the volume of this adipose tissue correlated with the number of apneas plus hypopneas per hour of sleep (r = 0.59, p < 0.001). Both patients who lost weight and had fewer apneas and hypopneas had a marked decrease in the pharyngeal adipose tissue volume. We conclude that adipose tissue is deposited adjacent to the pharyngeal airway in patients with OSA and that the volume of this tissue is related to the presence and degree of OSA. PMID:8342912

  4. Obstructive Sleep Apnea and Atrial Arrhythmogenesis

    PubMed Central

    Hohl, Mathias; Linz, Benedikt; Böhm, Michael; Linz, Dominik

    2014-01-01

    Atrial fibrillation (AF) is the most common sustained arrhythmia and is associated with relevant morbidity and mortality. Besides hypertension, valvular disease and cardiomyopathy, mainly ischemic and dilated, also other conditions like obesity, alcohol abusus, genetic factors and obstructive sleep apnea (OSA) are discussed to contribute to the progression from paroxysmal to persistent AF. The prevalence of OSA among patients with AF is 40-50%. OSA is characterized by periodic or complete cessation of effective breathing during sleep due to obstruction of the upper airways. Obstructive respiratory events result in acute intrathoracic pressure swings and profound changes in blood gases together leading to atrial stretch and acute sympatho-vagal dysbalance resulting in acute apnea related to electrophysiological and hemodynamic alterations. Additionally, repetitive obstructive events in patients with OSA may lead to sympathetic and neurohumoral activation and subsequent structural and functional changes in the atrium creating an arrhythmogenic substrate for AF in the long run. This review focuses on the acute and chronic effects of negative thoracic pressure swings, changes in blood pressure and sympatho-vagal dysbalance induced by obstructive respiratory events on atrial electrophysiology and atrial structure in patients with obstructive sleep apnea. PMID:25004989

  5. Obstructive apnea during sleep is associated with peripheral vasoconstriction

    NASA Technical Reports Server (NTRS)

    Imadojemu, Virginia A.; Gleeson, Kevin; Gray, Kristen S.; Sinoway, Lawrence I.; Leuenberger, Urs A.

    2002-01-01

    Obstructive apnea during sleep is associated with a substantial transient blood pressure elevation. The mechanism of this pressor response is unclear. In this study we measured muscle sympathetic nerve activity (MSNA), mean arterial pressure (Psa), and mean limb blood velocity as an index of blood flow (MBV, Doppler) and calculated changes in limb vascular resistance during and after apneas during both wakefulness and sleep in patients with the obstructive sleep apnea syndrome. Immediately postapnea during sleep Psa increased significantly compared with the earlier stages of apnea and this was preceded by a rise of MSNA (n = 5). In contrast to blood pressure, MBV remained unchanged. Because resistance = blood pressure/blood flow, limb vascular resistance increased by 29 +/- 8% from late apnea to postapnea (n = 7, p < 0.002). Voluntary breathhold maneuvers during room air exposure evoked similar responses (n = 10). Supplemental oxygen administered via nonrebreather face mask attenuated the MSNA and vasoconstrictor responses to obstructive (n = 2) and voluntary apneas (n = 10). Our data suggest that obstructive apneas in patients with the obstructive apnea syndrome are accompanied by transient limb vasoconstriction. This vasoconstrictor response appears to be, at least in part, mediated by the sympathetic nervous system and may be linked to hypoxia.

  6. 77 FR 25226 - Proposed Recommendations on Obstructive Sleep Apnea

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-27

    ... was published in the Federal Register on April 20, 2012 (77 FR 23794) announcing proposed regulatory... Federal Motor Carrier Safety Administration Proposed Recommendations on Obstructive Sleep Apnea AGENCY... withdrawing its proposed regulatory guidance for obstructive sleep apnea (OSA) and request for comment...

  7. Spleen volume and blood flow response to repeated breath-hold apneas.

    PubMed

    Baković, Darija; Valic, Zoran; Eterović, Davor; Vukovic, Ivica; Obad, Ante; Marinović-Terzić, Ivana; Dujić, Zeljko

    2003-10-01

    The purpose of this study was 1) to answer whether the reduction in spleen size in breath-hold apnea is an active contraction or a passive collapse secondary to reduced splenic arterial blood flow and 2) to monitor the spleen response to repeated breath-hold apneas. Ten trained apnea divers and 10 intact and 7 splenectomized untrained persons repeated five maximal apneas (A1-A5) with face immersion in cold water, with 2 min interposed between successive attempts. Ultrasonic monitoring of the spleen and noninvasive cardiopulmonary measurements were performed before, between apneas, and at times 0, 10, 20, 40, and 60 min after the last apnea. Blood flows in splenic artery and splenic vein were not significantly affected by breath-hold apnea. The duration of apneas peaked after A3 (143, 127, and 74 s in apnea divers, intact, and splenectomized persons, respectively). A rapid decrease in spleen volume ( approximately 20% in both apnea divers and intact persons) was mainly completed throughout the first apnea. The spleen did not recover in size between apneas and only partly recovered 60 min after A5. The well-known physiological responses to apnea diving, i.e., bradycardia and increased blood pressure, were observed in A1 and remained unchanged throughout the following apneas. These results show rapid, probably active contraction of the spleen in response to breath-hold apnea in humans. Rapid spleen contraction and its slow recovery may contribute to prolongation of successive, briefly repeated apnea attempts. PMID:12819225

  8. Sleep apnea syndrome after irradiation of the neck

    SciTech Connect

    Herlihy, J.P.; Whitlock, W.L.; Dietrich, R.A.; Shaw, T. )

    1989-12-01

    After irradiation of the neck for a squamous cell carcinoma of the tonsillar pillar and vocal cord, a 71-year-old man presented with a rapidly progressive sleep apnea syndrome. Previous reports describe the condition of patients with obstructive sleep apnea that developed after neck irradiation and secondary to supraglottic edema. Our patient had an obstructive component to his apnea similar to that described in previous cases, but, in addition, he had hypothyroidism. Myxedema is a well-described cause of both obstructive and central apnea. We believe both contributed to his condition. He was successfully treated by placement of a tracheostomy and by thyroid supplementation. In patients who present with sleep apnea after neck irradiation, especially with acute or severe symptoms, the differential diagnosis should include both a central cause from hypothyroidism as well as a peripheral obstructive cause from laryngeal edema.

  9. Systolic pressure response to voluntary apnea predicts sympathetic tone in obstructive sleep apnea as a clinically useful index.

    PubMed

    Jouett, Noah P; Hardisty, Janelle M; Mason, J Ryan; Niv, Dorene; Romano, James J; Watenpaugh, Donald E; Burk, John R; Smith, Michael L

    2016-01-01

    The present investigation tested the hypotheses that systolic arterial pressure (SAP) responses to voluntary apnea (a) serve as a surrogate of sympathetic nerve activity (SNA), (b) can distinguish Obstructive Sleep Apnea (OSA) patients from control subjects and (c) can document autonomic effects of treatment. 9 OSA and 10 control subjects were recruited in a laboratory study; 44 OSA subjects and 78 control subjects were recruited in a clinical study; and 21 untreated OSA subjects and 14 well-treated OSA subjects were recruited into a treatment study. Each subject performed hypoxic and room air voluntary apneas in triplicate. Muscle SNA (MSNA) and continuous AP were measured during each apnea in the laboratory study, while systolic arterial pressure (SAP) responses were measured continuously and by standard auscultation in the clinical and treatment studies. OSA subjects exhibited increased mean arterial pressure (MAP), SAP and MSNA responses to hypoxic apnea (all P<0.01) and the SAP response highly correlated with the MSNA response (R(2)=0.72, P<0.001). Clinical assessment confirmed that OSA subjects exhibited markedly elevated SAP responses (P<0.01), while treated OSA subjects had a decreased SAP response to apnea (P<0.04) compared to poorly treated subjects. These data indicate that (a) OSA subjects exhibit increased pressor and MSNA responses to apnea, and that (b) voluntary apnea may be a clinically useful assessment tool of autonomic dysregulation and treatment efficacy in OSA. PMID:26774324

  10. Obstructive Sleep Apnea and Sickle Cell Anemia

    PubMed Central

    Debaun, Michael R.; Strunk, Robert C.; Redline, Susan; Seicean, Sinziana; Craven, Daniel I.; Gavlak, Johanna C.D.; Wilkey, Olu; Inusa, Baba; Roberts, Irene; Goodpaster, R. Lucas; Malow, Beth; Rodeghier, Mark; Kirkham, Fenella J.

    2014-01-01

    OBJECTIVE: To ascertain the prevalence of and risk factors for obstructive sleep apnea syndrome (OSAS) in children with sickle cell anemia (SCA). METHODS: Cross-sectional baseline data were analyzed from the Sleep and Asthma Cohort Study, a multicenter prospective study designed to evaluate the contribution of sleep and breathing abnormalities to SCA-related morbidity in children ages 4 to 18 years, unselected for OSAS symptoms or asthma. Multivariable logistic regression assessed the relationships between OSAS status on the basis of overnight in-laboratory polysomnography and putative risk factors obtained from questionnaires and direct measurements. RESULTS: Participants included 243 children with a median age of 10 years; 50% were boys, 99% were of African heritage, and 95% were homozygous for βS hemoglobin. OSAS, defined by obstructive apnea hypopnea indices, was present in 100 (41%) or 25 (10%) children at cutpoints of ≥1 or ≥5, respectively. In univariate analyses, OSAS was associated with higher levels of habitual snoring, lower waking pulse oxygen saturation (Spo2), reduced lung function, less caretaker education, and non–preterm birth. Lower sleep-related Spo2 metrics were also associated with higher obstructive apnea hypopnea indices. In multivariable analyses, habitual snoring and lower waking Spo2 remained risk factors for OSAS in children with SCA. CONCLUSIONS: The prevalence of OSAS in children with SCA is higher than in the general pediatric population. Habitual snoring and lower waking Spo2 values, data easily obtained in routine care, were the strongest OSAS risk factors. Because OSAS is a treatable condition with adverse health outcomes, greater efforts are needed to screen, diagnose, and treat OSAS in this high-risk, vulnerable population. PMID:25022740

  11. A Sludge Drum in the APNea System

    SciTech Connect

    Hensley, D.

    1998-11-17

    The assay of sludge drums pushes the APNea System to a definite extreme. Even though it seems clear that neutron based assay should be the method of choice for sludge drums, the difficulties posed by this matrix push any NDA technique to its limits. Special emphasis is given here to the differential die-away technique, which appears to approach the desired sensitivity. A parallel analysis of ethafoam drums will be presented, since the ethafoam matrix fits well within the operating range of the AIWea System, and, having been part of the early PDP trials, has been assayed by many in the NDA community.

  12. Obstructive sleep apnea and vascular disease

    PubMed Central

    Lanfranchi, Paola; Somers, Virend A

    2001-01-01

    There is emerging evidence linking obstructive sleep apnea (OSA) to vascular disease, including hypertension. This relationship may be independent of co-morbidity, such as obesity. Even apparently healthy OSA patients have evidence of subtle functional vascular abnormalities that are known to occur in patients with hypertension and atherosclerosis. Untreated OSA may possibly contribute to the initiation and/or progression of pathophysiologic mechanisms involved in hypertension, heart failure, cardiac ischemia and stroke. This brief commentary will examine the evidence and mechanisms linking OSA to vascular disease. PMID:11737928

  13. Consequences of Obstructive Sleep Apnea in Children.

    PubMed

    Blechner, Michael; Williamson, Ariel A

    2016-01-01

    Obstructive sleep apnea syndrome (OSAS) has various negative health and behavioral consequences in the pediatric population. As shown in adults, there are metabolic derangements such as obesity, insulin sensitivity, dyslipidemia, and metabolic syndrome, as well as cardiovascular derangements like hypertension, chronic inflammation, endothelial dysfunction, ventricular size/function abnormalities, and even elevated pulmonary arterial pressures, that can be seen in children with OSAS. The first two sections will discuss the metabolic and cardiovascular consequences on OSAS in children. The last section summarizes selected studies and reviews on the behavioral, neurocognitive and academic consequences of OSAS in children. PMID:26631839

  14. Surgical Approaches to Obstructive Sleep Apnea.

    PubMed

    MacKay, Stuart G; Chan, Lyndon

    2016-09-01

    Surgery in adult obstructive sleep apnea (OSA) has undergone significant advancement in recent years and continues to evolve. It is a modality of treatment used in the context of failed device use, specifically, failed continuous positive airway pressure or mandibular advancement splint. In this context, the role of surgery is either as salvage therapy or to facilitate better tolerance of device use. Other treatments such as weight loss, adjuvant nasal therapy (medical ± prephase nasal surgery) and positional devices may be combined with airway surgery. In general, patients with OSA are managed with in-hospital monitoring perioperatively. PMID:27542879

  15. Brainstem areas activated by intermittent apnea in awake unrestrained rats.

    PubMed

    Ferreira, C B; Schoorlemmer, G H; Rossi, M V; Takakura, A C; Barna, B F; Moreira, T S; Cravo, S L

    2015-06-25

    We investigated the role of the autonomic nervous system to cardiovascular responses to obstructive apnea in awake, unrestrained rats, and measured expression of Fos induced by apnea in the brainstem. We implanted a tracheal balloon contained in a rigid tube to allow the induction of apnea without inducing pain in the trachea. During bouts of 15s of apnea, heart rate fell from 371±8 to 161±11bpm (mean±SEM, n=15, p<0.01) and arterial pressure increased from 115±2 to 131±4mmHg (p<0.01). Bradycardia was due to parasympathetic activity because it was blocked by the muscarinic antagonist, methylatropine. The pressor response was due to vasoconstriction caused by sympathetic activation because it was blocked by the α1 antagonist, prazosin. Apnea induced Fos expression in several brainstem areas involved in cardiorespiratory control such as the nucleus of the solitary tract (NTS), ventrolateral medulla (VLM), and pons. Ligation of the carotid body artery reduced apnea-induced bradycardia, blocked heart rate responses to i.v. injection of cyanide, reduced Fos expression in the caudal NTS, and increased Fos expression in the rostral VLM. In conclusion, apnea activates neurons in regions that process signals from baroreceptors, chemoreceptors, pulmonary receptors, and regions responsible for autonomic and respiratory activity both in the presence and absence of carotid chemoreceptors. PMID:25862588

  16. Respiratory sound recordings for detection of sleep apnea

    NASA Astrophysics Data System (ADS)

    Waldemark, Karina E.; Agehed, Kenneth I.; Lindblad, Thomas

    1999-03-01

    Sleep apnea is characterized by frequent prolonged interruptions of breathing during sleep. This syndrome causes severe sleep disorders and is often responsible for development of other diseases such as heart problems, high blood pressure and daytime fatigue, etc. After diagnosis, sleep apnea is often successfully treated by applying positive air pressure (CPAP) to the mouth and nose. Although effective, the (CPAP) equipment takes up a lot of space and the connected mask causes a lot of inconvenience for the patients. This raised interest in developing new techniques for treatment of sleep apnea syndrome. Several studies indicated that electrical stimulation of the hypoglossal nerve and muscle in the tongue may be a useful method for treating patients with severe sleep apnea. In order to be able to successfully prevent the occurrence of apnea it is necessary to have some technique for early and fast on-line detection or prediction of the apnea events. This paper suggests using measurements of respiratory airflow (mouth temperature). The signal processing for this task includes the use of a window short-FFT technique and uses an artificial back propagation neural net to model or predict the occurrence of apneas. The results show that early detection of respiratory interruption is possible and that the delay time for this is small.

  17. Diagnosis and Treatment of Obstructive Sleep Apnea in Adults.

    PubMed

    Semelka, Michael; Wilson, Jonathan; Floyd, Ryan

    2016-09-01

    Obstructive sleep apnea is a common disorder that causes patients to temporarily stop or decrease their breathing repeatedly during sleep. This results in fragmented, nonrestful sleep that can lead to symptoms such as morning headache and daytime sleepiness. Obstructive sleep apnea affects persons of all ages, with an increasing prevalence in those older than 60 years. The exact prevalence is unknown but is estimated to be between 2% and 14%. There are many health conditions associated with obstructive sleep apnea, including hypertension, coronary artery disease, cardiac arrhythmias, and depression. Loud snoring, gasping during sleep, obesity, and enlarged neck circumference are predictive clinical features. Screening questionnaires can be used to assess for sleep apnea, although their accuracy is limited. The diagnostic standard for obstructive sleep apnea is nocturnal polysomnography in a sleep laboratory. Home sleep apnea tests can be performed for certain patients but are generally considered less accurate. Continuous positive airway pressure is the first-line treatment; adherence rates are variable and seem to improve with early patient education and support. Other treatment modalities include weight reduction, oral appliance therapy, and surgery to correct anatomic obstructions, although there is insufficient evidence to support these types of surgeries. Bariatric surgery can improve sleep parameters and symptoms in obese patients with obstructive sleep apnea and can result in remission in many patients. PMID:27583421

  18. Obstructive Sleep Apnea, Posttraumatic Stress Disorder, and Health in Immigrants

    PubMed Central

    Arnetz, Bengt B.; Templin, Thomas; Saudi, Waleed; Jamil, Hikmet

    2013-01-01

    Objective To determine whether obstructive sleep apnea mediates the relationship between posttraumatic stress disorder (PTSD) and psychosomatic and somatic disorders and its implications for self-rated health (SRH) among Iraqi immigrants in the United States. Methods A random sample of immigrants who had left Iraq before the 1991 Gulf War (n = 145) or after (n = 205) and are residing in metropolitan Detroit responded to a structured interview covering questions on sociodemographics, premigration trauma, SRH, physician-diagnosed and -treated obstructive sleep apnea, somatic disorders, and psychosomatic disorders. Structural equation modeling was used to evaluate the relationship between premigration trauma scores and health, as well as to explore mediating pathways between PTSD, obstructive sleep apnea, and health. Results The prevalence of obstructive sleep apnea among post-Gulf War immigrants (30.2%) was significantly higher than among pre-Gulf War immigrants (0.7%; p < .001). Premigration trauma scores were positively associated with depression and PTSD. Structural equation modeling supported a model in which obstructive sleep apnea mediated the relationship between PTSD and psychosomatic and somatic disorders. Premigration trauma also related directly to SRH. Conclusions Part of the PTSD-associated adverse health effects observed in Iraqi immigrants is mediated by obstructive sleep apnea. Because sleep apnea in the current study is based on medical history and current treatment, there is a need for future confirmatory polysomnographic studies. PMID:23023679

  19. Sex differences in sleep apnea predictors and outcomes from home sleep apnea testing

    PubMed Central

    Cairns, Alyssa; Poulos, Greg; Bogan, Richard

    2016-01-01

    Study objectives To evaluate sex differences in predictors of obstructive sleep apnea (OSA) as per outcomes from home sleep apnea testing. Design This was a retrospective analysis of a large repository of anonymous test results and pretest risk factors for OSA. Setting and patients A total of 272,705 patients were referred for home sleep apnea testing from a variety of clinical practices for suspected sleep disordered breathing across North America from 2009 to 2013. Interventions Not applicable. Measurements and results Predictors of OSA (apnea hypopnea index4%≥5) were evaluated by multiple logistic regression; sex differences were evaluated by interaction effects. Middle age was the single most robust predictor of OSA for both sexes and was particularly foretelling for females (P<0.001) even after controlling for measures of adiposity and medical conditions. Females over the age of 45 years were much more likely to have OSA compared to their younger counterparts (78.7% vs 42.5%, respectively; odds ratio: 5.0) versus males (88.1% vs 68.8%, respectively; odds ratio: 3.4). Snoring, although more frequently reported by males, was similarly predictive of OSA for both sexes. Witnessed apneas and measures of adiposity were better predictors of OSA for males than females. Insomnia, depression, and use of sleep medication, although more commonly reported in females, did not predict OSA. Hypertension, although equally reported by both sexes, performed better as a predictor in females (P<0.001), even after controlling for age, measures of adiposity, and other medical conditions. Diabetes, heart disease, stroke, and sleepiness did not contribute unique variance in OSA in adjusted models. Conclusion This study found that males and females report different symptoms upon clinical evaluation for suspected sleep apnea, with some of the “classic” OSA features to be more common in and robustly predictive for males. The finding that advancing age uniquely and robustly

  20. Obstructive sleep apnea – management update

    PubMed Central

    Hukins, Craig A

    2006-01-01

    Obstructive sleep apnea (OSA) is a highly significant condition based both on the high prevalence in community and significant consequences. Obstructive sleep apnea syndrome (OSAS), OSA together with hypersomnolence, is seen in 4% of middle-aged men and 2% of middle-aged women. OSA is associated with impaired quality of life and increased risks of motor vehicle accidents, cardiovascular disease (including hypertension and coronary artery disease), and metabolic syndrome. There is some evidence for the use of conservative interventions such as weight loss and position modification. CPAP remains the mainstay of treatment in this condition with high-level evidence supporting its efficacy. Continuous positive airway pressure (CPAP) is an intrusive therapy, with long-term adherence rates of less than 70%. Dental appliances have been shown to be effective therapy in some subjects but are limited by the inability to predict treatment responders. Alternative treatments are discussed but there is little role for upper airway surgery (except in a select few experienced institutions) or pharmacological treatment. The current levels of evidence for the different treatment regimens are reviewed. PMID:19412478

  1. Facial morphology and obstructive sleep apnea

    PubMed Central

    Capistrano, Anderson; Cordeiro, Aldir; Capelozza, Leopoldino; Almeida, Veridiana Correia; Silva, Priscila Izabela de Castro e; Martinez, Sandra; de Almeida-Pedrin, Renata Rodrigues

    2015-01-01

    Objective: This study aimed at assessing the relationship between facial morphological patterns (I, II, III, Long Face and Short Face) as well as facial types (brachyfacial, mesofacial and dolichofacial) and obstructive sleep apnea (OSA) in patients attending a center specialized in sleep disorders. Methods: Frontal, lateral and smile photographs of 252 patients (157 men and 95 women), randomly selected from a polysomnography clinic, with mean age of 40.62 years, were evaluated. In order to obtain diagnosis of facial morphology, the sample was sent to three professors of Orthodontics trained to classify patients' face according to five patterns, as follows: 1) Pattern I; 2) Pattern II; 3) Pattern III; 4) Long facial pattern; 5) Short facial pattern. Intraexaminer agreement was assessed by means of Kappa index. The professors ranked patients' facial type based on a facial index that considers the proportion between facial width and height. Results: The multiple linear regression model evinced that, when compared to Pattern I, Pattern II had the apnea and hypopnea index (AHI) worsened in 6.98 episodes. However, when Pattern II was compared to Pattern III patients, the index for the latter was 11.45 episodes lower. As for the facial type, brachyfacial patients had a mean AHI of 22.34, while dolichofacial patients had a significantly statistical lower index of 10.52. Conclusion: Patients' facial morphology influences OSA. Pattern II and brachyfacial patients had greater AHI, while Pattern III patients showed a lower index. PMID:26691971

  2. Chemoreflexes, Sleep Apnea, and Sympathetic Dysregulation

    PubMed Central

    Mansukhani, Meghna P.; Kara, Tomas; Caples, Sean; Somers, Virend K.

    2014-01-01

    Obstructive sleep apnea (OSA) and hypertension are closely linked conditions. Disordered breathing events in OSA are characterized by increasing efforts against an occluded airway whilst asleep, resulting in a marked sympathetic response. This is predominantly due to hypoxemia activating the chemoreflexes, resulting in reflex increases in sympathetic neural outflow. In addition, apnea, and the consequent lack of inhibition of the sympathetic system that occurs with lung inflation during normal breathing, potentiates central sympathetic outflow. Sympathetic activation persists into the daytime, and is thought to contribute to hypertension and other adverse cardiovascular outcomes. This review discusses chemoreflex physiology and sympathetic modulation during normal sleep, as well as the sympathetic dysregulation seen in OSA, its extension into wakefulness, and changes after treatment. Evidence supporting the role of the peripheral chemoreflex in the sympathetic dysregulation seen in OSA, including in the context of co-morbid obesity, metabolic syndrome and systemic hypertension is reviewed. Finally, alterations in cardiovascular variability and other potential mechanisms that might play a role in the autonomic imbalance seen in OSA are also discussed. PMID:25097113

  3. Health Promotion in Obstructive Sleep Apnea Syndrome

    PubMed Central

    Corrêa, Camila de Castro; Blasca, Wanderléia Quinhoneiro; Berretin-Felix, Giédre

    2015-01-01

    Introduction Obstructive sleep apnea syndrome (OSAS), which is commonly underdiagnosed, has a high occurrence in the world population. Health education concerning sleep disorders and OSAS should be implemented. Objectives The objective was to identify studies related to preventive actions on sleep disorders, with emphasis on OSAS. Data Synthesis A literature review was conducted using Lilacs, Medline, PubMed, and Scopus by combining the following keywords: “Health Promotion,” “Sleep Disorders,” “Primary Prevention,” “Health Education,” and “Obstructive Sleep Apnea Syndromes.” Initially, 1,055 papers, from 1968 to 2013, were located, with the majority from the Scopus database. The inclusion criteria were applied, and four articles published between 2006 and 2012 were included in the present study. Conclusions The studies on preventive actions in sleep disorders, with emphasis on OSAS, involved the general population and professionals and students in the health field and led to increased knowledge on sleep disorders and more appropriate practices. PMID:25992174

  4. Occult laryngomalacia resulting in obstructive sleep apnea in an infant.

    PubMed

    Oomen, Karin P Q; Modi, Vikash K

    2013-09-01

    Classic laryngomalacia presents in the awake infant with progressive stridor when agitated. Occult laryngomalacia usually presents with stridor in children older than 2 years and is limited to sleep or exercise. There have been no documented cases of occult laryngomalacia causing obstructive sleep apnea in infants. We report the youngest documented case of an infant with state-dependent laryngomalacia resulting in severe obstructive sleep apnea. This patient was successfully treated with supraglottoplasty, with resolution of symptoms. In conclusion, state-dependent laryngomalacia resulting in obstructive sleep apnea may present in children younger than 12 months of age. In these individuals, supraglottoplasty should be considered. PMID:23911113

  5. Meteorological Satellites (METSAT) and Earth Observing System (EOS) Advanced Microwave Sounding Unit-A (AMSU-A) Failure Modes and Effects Analysis (FMEA) and Critical Items List (CIL)

    NASA Technical Reports Server (NTRS)

    1996-01-01

    This Failure Modes and Effects Analysis (FMEA) is for the Advanced Microwave Sounding Unit-A (AMSU-A) instruments that are being designed and manufactured for the Meteorological Satellites Project (METSAT) and the Earth Observing System (EOS) integrated programs. The FMEA analyzes the design of the METSAT and EOS instruments as they currently exist. This FMEA is intended to identify METSAT and EOS failure modes and their effect on spacecraft-instrument and instrument-component interfaces. The prime objective of this FMEA is to identify potential catastrophic and critical failures so that susceptibility to the failures and their effects can be eliminated from the METSAT/EOS instruments.

  6. CT demonstration of pharyngeal narrowing in adult obstructive sleep apnea

    SciTech Connect

    Bohlman, M.E.; Haponik, E.F.; Smith, P.L.; Allen, R.P.; Bleecker, E.R.; Goldman, S.M.

    1983-03-01

    Sleep apnea is a major cause of daytime hypersomnolence. Among the proposed etiologies, focal obstruction of the airways at the level of the pharynx has been suggested but not proven. Using computed tomography, the cross-sectional area of the airway can be readily assessed. Thirty-three adults with clinically proven sleep apnea and 12 normal adults underwent systematic computed tomography of the neck. Significant airway narrowing was demonstrated in all the patients with obstructive sleep apnea, whereas no such narrowing was seen in the controls. In 11, the narrowing was at a single level, whereas in 22 patients two or more levels were affected. This study has shown that a structurally abnormal airway may serve as an anatomic substrate for the development of sleep apnea. On the basis of this evidence, uvulopalatopharyngoplasty has been performed in two patients with relief of symptoms in one.

  7. Sleep Apnea May Raise Heart Risks in People with Pacemakers

    MedlinePlus

    ... risk for a dangerous heart rhythm disorder called atrial fibrillation, a new study suggests. With sleep apnea, breathing ... sleep disorder is a known risk factor for atrial fibrillation, but the risk for pacemaker patients with sleep ...

  8. Familial 'sleep apnea plus' syndrome: report of a family.

    PubMed

    Manon-Espaillat, R; Gothe, B; Adams, N; Newman, C; Ruff, R

    1988-02-01

    We describe a familial disorder consisting of sleep apnea, anosmia, colorblindness, partial complex seizures, and cognitive dysfunction. The phenotypic expression of the syndrome suggests an autosomal dominant inheritance with incomplete penetrance. PMID:3257550

  9. Apnea diving: long-term neurocognitive sequelae of repeated hypoxemia.

    PubMed

    Ridgway, Lynne; McFarland, Ken

    2006-02-01

    This article examines the neurocognitive sequelae of repeated exposure to hypoxemia in apnea (breath-hold) divers. A brief review of the literature on the physiological and neurological adaptations involved in the "human diving reflex" is presented. The results from a neuropsychological investigation of N = 21 elite apnea divers are evaluated. Standard neuropsychological tests, with known sensitivity to mild brain insults, included speed of visuo-motor responding, speed of language comprehension, response inhibition, and visual and verbal attention and recall tasks. Results indicated that the breath-hold divers performed tasks within the average range compared to norms on all tests, suggesting that 1-20 years of repeated exposure to hypoxemia including multiple adverse neurological events did not impact on performance on standard neuropsychological tasks. The results are discussed in relation to implications for clinical conditions such as sleep apnea, respiratory disorders, altitude sickness, and recreational apnea activities. PMID:16410228

  10. Low-grade albuminuria in children with obstructive sleep apnea.

    PubMed

    Varlami, Vasiliki; Malakasioti, Georgia; Alexopoulos, Emmanouel I; Theologi, Vasiliki; Theophanous, Eleni; Liakos, Nikolaos; Daskalopoulou, Euphemia; Gourgoulianis, Konstantinos; Kaditis, Athanasios G

    2013-06-01

    Small urinary protein loss (low-grade albuminuria or microalbuminuria) may reflect altered permeability of the glomerular filtration barrier. In the present study, it was hypothesized that children with obstructive sleep apnea have an increased risk of microalbuminuria compared with control subjects without sleep-disordered breathing. Albumin-to-creatinine ratio was measured in morning spot urine specimens collected from consecutive children with or without snoring who were referred for polysomnography. Three groups were studied: (i) control subjects (no snoring, apnea-hypopnea index < 1 episode h(-1) ; n = 31); (ii) mild obstructive sleep apnea (snoring, apnea-hypopnea index = 1-5 episodes h(-1) ; n = 71); and (iii) moderate-to-severe obstructive sleep apnea (snoring, apnea-hypopnea index > 5 episodes∙h(-1) ; n = 27). Indications for polysomnography in control subjects included nightmares, somnambulism and morning headaches. An albumin-to-creatinine ratio > median value in the control group (1.85 mg of albumin per g of creatinine) was defined as elevated. Logistic regression analysis revealed that children with moderate-to-severe obstructive sleep apnea, but not those with mild obstructive sleep apnea, had increased risk of elevated albumin-to-creatinine ratio relative to controls (reference) after adjustment for age, gender and presence of obesity: odds ratio 3.8 (95% confidence interval 1.1-12.6); P = 0.04 and 1.5 (0.6-3.7); P > 0.05, respectively. Oxygen desaturation of hemoglobin and respiratory arousal indices were significant predictors of albumin-to-creatinine ratio (r = 0.31, P = 0.01; and r = 0.43, P < 0.01, respectively). In conclusion, children with moderate-to-severe obstructive sleep apnea are at significantly higher risk of increased low-grade excretion of albumin in the morning urine as compared with control subjects without obstructive sleep apnea. These findings may reflect altered permeability of the glomerular

  11. Obstructive Sleep Apnea: A Cluster Analysis at Time of Diagnosis

    PubMed Central

    Grillet, Yves; Richard, Philippe; Stach, Bruno; Vivodtzev, Isabelle; Timsit, Jean-Francois; Lévy, Patrick; Tamisier, Renaud; Pépin, Jean-Louis

    2016-01-01

    Background The classification of obstructive sleep apnea is on the basis of sleep study criteria that may not adequately capture disease heterogeneity. Improved phenotyping may improve prognosis prediction and help select therapeutic strategies. Objectives: This study used cluster analysis to investigate the clinical clusters of obstructive sleep apnea. Methods An ascending hierarchical cluster analysis was performed on baseline symptoms, physical examination, risk factor exposure and co-morbidities from 18,263 participants in the OSFP (French national registry of sleep apnea). The probability for criteria to be associated with a given cluster was assessed using odds ratios, determined by univariate logistic regression. Results: Six clusters were identified, in which patients varied considerably in age, sex, symptoms, obesity, co-morbidities and environmental risk factors. The main significant differences between clusters were minimally symptomatic versus sleepy obstructive sleep apnea patients, lean versus obese, and among obese patients different combinations of co-morbidities and environmental risk factors. Conclusions Our cluster analysis identified six distinct clusters of obstructive sleep apnea. Our findings underscore the high degree of heterogeneity that exists within obstructive sleep apnea patients regarding clinical presentation, risk factors and consequences. This may help in both research and clinical practice for validating new prevention programs, in diagnosis and in decisions regarding therapeutic strategies. PMID:27314230

  12. Stochastic modeling of central apnea events in preterm infants.

    PubMed

    Clark, Matthew T; Delos, John B; Lake, Douglas E; Lee, Hoshik; Fairchild, Karen D; Kattwinkel, John; Randall Moorman, J

    2016-04-01

    A near-ubiquitous pathology in very low birth weight infants is neonatal apnea, breathing pauses with slowing of the heart and falling blood oxygen. Events of substantial duration occasionally occur after an infant is discharged from the neonatal intensive care unit (NICU). It is not known whether apneas result from a predictable process or from a stochastic process, but the observation that they occur in seemingly random clusters justifies the use of stochastic models. We use a hidden-Markov model to analyze the distribution of durations of apneas and the distribution of times between apneas. The model suggests the presence of four breathing states, ranging from very stable (with an average lifetime of 12 h) to very unstable (with an average lifetime of 10 s). Although the states themselves are not visible, the mathematical analysis gives estimates of the transition rates among these states. We have obtained these transition rates, and shown how they change with post-menstrual age; as expected, the residence time in the more stable breathing states increases with age. We also extrapolated the model to predict the frequency of very prolonged apnea during the first year of life. This paradigm-stochastic modeling of cardiorespiratory control in neonatal infants to estimate risk for severe clinical events-may be a first step toward personalized risk assessment for life threatening apnea events after NICU discharge. PMID:26963049

  13. Sleep apnea detection using time-delayed heart rate variability.

    PubMed

    Nano, Marina-Marinela; Xi Long; Werth, Jan; Aarts, Ronald M; Heusdens, Richard

    2015-08-01

    Sleep apnea is a sleep disorder distinguished by repetitive absence of breathing. Compared with the traditional expensive and cumbersome methods, sleep apnea diagnosis or screening with physiological information that can be easily acquired is needed. This paper describes algorithms using heart rate variability (HRV) to automatically detect sleep apneas as long as it can be easily acquired with unobtrusive sensors. Because the changes in cardiac activity are usually hysteretic than the presence of apneas with a few minutes, we propose to use the delayed HRV features to identify the episodes with sleep apneic events. This is expected to help improve the apnea detection performance. Experiments were conducted with a data set of 23 sleep apnea patients using support vector machine (SVM) classifiers and cross validations. Results show that using eleven HRV features with a time delay of 1.5 minutes rather than the features without time delay for SA detection, the overall accuracy increased from 74.9% to 76.2% and the Cohen's Kappa coefficient increased from 0.49 to 0.52. Further, an accuracy of 94.5% and a Kappa of 0.89 were achieved when applying subject-specific classifiers. PMID:26738071

  14. Cognitive impairment in obstructive sleep apnea.

    PubMed

    Gagnon, K; Baril, A-A; Gagnon, J-F; Fortin, M; Décary, A; Lafond, C; Desautels, A; Montplaisir, J; Gosselin, N

    2014-10-01

    Obstructive sleep apnea (OSA) is characterised by repetitive cessation or reduction of airflow due to upper airway obstructions. These respiratory events lead to chronic sleep fragmentation and intermittent hypoxemia. Several studies have shown that OSA is associated with daytime sleepiness and cognitive dysfunctions, characterized by impairments of attention, episodic memory, working memory, and executive functions. This paper reviews the cognitive profile of adults with OSA and discusses the relative role of altered sleep and hypoxemia in the aetiology of these cognitive deficits. Markers of cognitive dysfunctions such as those measured with waking electroencephalography and neuroimaging are also presented. The effects of continuous positive airway pressure (CPAP) on cognitive functioning and the possibility of permanent brain damage associated with OSA are also discussed. Finally, this paper reviews the evidence suggesting that OSA is a risk factor for developing mild cognitive impairment and dementia in the aging population and stresses the importance of its early diagnosis and treatment. PMID:25070768

  15. Obstructive sleep apnea presenting as pseudopheochromocytoma.

    PubMed

    Marmouch, Hela; Arfa, Sondes; Graja, Sameh; Slim, Tensim; Khochtali, Ines

    2016-01-01

    A 52-year-old female with a history of poorly controlled resistant hypertension was admitted to our hospital with severe hypertension. She had a history of fatigue and intermittent episodes of palpitations. Laboratory evaluation was significant for elevated 24-h urinary catecholamine levels (3,5 times the upper normal levels). This case was presenting with a clinical and biochemical picture indistinguishable from that of pheochromocytoma. However, neither computed tomography nor meta-iodo-benzyl-guanidine scintigraphy detected any catecholamine-producing tumor in or outside the adrenal glands. Our patient was screened with full polysomnography because of heavy snoring, daytime somnolence and obesity. It revealed severe obstructive sleep apnea syndrome. After three months of continuous positive airway pressure therapy, the patient experienced resolution of his presenting symptoms, improved blood pressure control and normalization of his urinary catecholamine levels. This case highlights sleep disordered breathing as a potentially reversible cause of pseudo-pheochromocytoma. PMID:27217898

  16. Obstructive sleep apnea presenting as pseudopheochromocytoma

    PubMed Central

    Marmouch, Hela; Arfa, Sondes; Graja, Sameh; Slim, Tensim; Khochtali, Ines

    2016-01-01

    A 52-year-old female with a history of poorly controlled resistant hypertension was admitted to our hospital with severe hypertension. She had a history of fatigue and intermittent episodes of palpitations. Laboratory evaluation was significant for elevated 24-h urinary catecholamine levels (3,5 times the upper normal levels). This case was presenting with a clinical and biochemical picture indistinguishable from that of pheochromocytoma. However, neither computed tomography nor meta-iodo-benzyl-guanidine scintigraphy detected any catecholamine-producing tumor in or outside the adrenal glands. Our patient was screened with full polysomnography because of heavy snoring, daytime somnolence and obesity. It revealed severe obstructive sleep apnea syndrome. After three months of continuous positive airway pressure therapy, the patient experienced resolution of his presenting symptoms, improved blood pressure control and normalization of his urinary catecholamine levels. This case highlights sleep disordered breathing as a potentially reversible cause of pseudo-pheochromocytoma. PMID:27217898

  17. In the clinic. Obstructive sleep apnea.

    PubMed

    Balachandran, Jay S; Patel, Sanjay R

    2014-11-01

    This issue provides a clinical overview of Obstructive Sleep Apnea focusing on prevention, diagnosis, treatment, practice improvement, and patient information. The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including ACP Smart Medicine and MKSAP (Medical Knowledge and Self-Assessment Program). Annals of Internal Medicine editors develop In the Clinic from these primary sources in collaboration with the ACP's Medical Education and Publishing divisions and with the assistance of science writers and physician writers. Editorial consultants from ACP Smart Medicine and MKSAP provide expert review of the content. Readers who are interested in these primary resources for more detail can consult http://smartmedicine.acponline.org, http://mksap.acponline.org, and other resources referenced in each issue of In the Clinic. PMID:25364899

  18. The Association between Obstructive Sleep Apnea and Neurocognitive Performance—The Apnea Positive Pressure Long-term Efficacy Study (APPLES)

    PubMed Central

    Quan, Stuart F.; Chan, Cynthia S.; Dement, William C.; Gevins, Alan; Goodwin, James L.; Gottlieb, Daniel J.; Green, Sylvan; Guilleminault, Christian; Hirshkowitz, Max; Hyde, Pamela R.; Kay, Gary G.; Leary, Eileen B.; Nichols, Deborah A.; Schweitzer, Paula K.; Simon, Richard D.; Walsh, James K.; Kushida, Clete A.

    2011-01-01

    Study Objectives: To determine associations between obstructive sleep apnea (OSA) and neurocognitive performance in a large cohort of adults. Study Design: Cross-sectional analyses of polysomnographic and neurocognitive data from 1204 adult participants with a clinical diagnosis of obstructive sleep apnea (OSA) in the Apnea Positive Pressure Long-term Efficacy Study (APPLES), assessed at baseline before randomization to either continuous positive airway pressure (CPAP) or sham CPAP. Measurements: Sleep and respiratory indices obtained by laboratory polysomnography and several measures of neurocognitive performance. Results: Weak correlations were found for both the apnea hypopnea index (AHI) and several indices of oxygen desaturation and neurocognitive performance in unadjusted analyses. After adjustment for level of education, ethnicity, and gender, there was no association between the AHI and neurocognitive performance. However, severity of oxygen desaturation was weakly associated with worse neurocognitive performance on some measures of intelligence, attention, and processing speed. Conclusions: The impact of OSA on neurocognitive performance is small for many individuals with this condition and is most related to the severity of hypoxemia. Citation: Quan SF; Chan CS; Dement WC; Gevins A; Goodwin JL; Gottlieb DJ; Green S; Guilleminault C; Hirshkowitz M; Hype PR; Kay GG; Leary EB; Nichols DA; Schweitzer PK; Simon RD; Walsh JK; Kushida CA. The association between obstructive sleep apnea and neurocognitive performance—the Apnea Positive Pressure Long-term Efficacy Study (APPLES). SLEEP 2011;34(3):303-314. PMID:21358847

  19. Software List.

    ERIC Educational Resources Information Center

    Computers in Chemical Education Newsletter, 1984

    1984-01-01

    Lists and briefly describes computer programs recently added to those currently available from Project SERAPHIM. Program name, subject, hardware, author, supplier, and current cost are provided in separate listings for Apple, Atari, Pet, VIC-20, TRS-80, and IBM-PC. (JN)

  20. TIP list

    SciTech Connect

    Ludwig, M E

    2006-06-22

    Subcontractors and vendors providing services, including the installation of purchased goods, are required to complete a TIP List. This list does not include every Environment, Safety, and Health (ES&H) related concern at LLNL. It is intended to highlight major concerns common to most on-site service activities.

  1. Crash Risk Soars When Truck Drivers Don't Treat Sleep Apnea

    MedlinePlus

    ... Risk Soars When Truck Drivers Don't Treat Sleep Apnea: Study Consistent treatment with breathing device can reduce ... March 21, 2016 (HealthDay News) -- Truck drivers with sleep apnea who don't regularly follow their treatment program ...

  2. Still Tired After Getting Your Zzz's? You Might Have Sleep Apnea

    MedlinePlus

    ... Tired After Getting Your Zzz's? You Might Have Sleep Apnea What you need to know about a breathing ... Daylight Saving Time starts. But some people with sleep apnea wake up feeling exhausted every morning. More than ...

  3. Posthypoxic ventilatory decline during NREM sleep: influence of sleep apnea.

    PubMed

    Omran, Amal M; Aboubakr, Salah E; Aboussouan, Loutfi S; Pierchala, Lisa; Badr, M Safwan

    2004-06-01

    We wished to determine the severity of posthypoxic ventilatory decline in patients with sleep apnea relative to normal subjects during sleep. We studied 11 men with sleep apnea/hypopnea syndrome and 11 normal men during non-rapid eye movement sleep. We measured EEG, electrooculogram, arterial O(2) saturation, and end-tidal P(CO2). To maintain upper airway patency in patients with sleep apnea, nasal continuous positive pressure was applied at a level sufficient to eliminate apneas and hypopneas. We compared the prehypoxic control (C) with posthypoxic recovery breaths. Nadir minute ventilation in normal subjects was 6.3 +/- 0.5 l/min (83.8 +/- 5.7% of room air control) vs. 6.7 +/- 0.9 l/min, 69.1 +/- 8.5% of room air control in obstructive sleep apnea (OSA) patients; nadir minute ventilation (% of control) was lower in patients with OSA relative to normal subjects (P < 0.05). Nadir tidal volume was 0.55 +/- 0.05 liter (80.0 +/- 6.6% of room air control) in OSA patients vs. 0.42 +/- 0.03 liter, 86.5 +/- 5.2% of room air control in normal subjects. In addition, prolongation of expiratory time (Te) occurred in the recovery period. There was a significant difference in Te prolongation between normal subjects (2.61 +/- 0.3 s, 120 +/- 11.2% of C) and OSA patients (5.6 +/- 1.5 s, 292 +/- 127.6% of C) (P < 0.006). In conclusion, 1) posthypoxic ventilatory decline occurred after termination of hypocapnic hypoxia in normal subjects and patients with sleep apnea and manifested as decreased tidal volume and prolongation of Te; and 2) posthypoxic ventilatory prolongation of Te was more pronounced in patients with sleep apnea relative to normal subjects. PMID:14990552

  4. Spleen and cardiovascular function during short apneas in divers.

    PubMed

    Palada, Ivan; Eterovic, Davor; Obad, Ante; Bakovic, Darija; Valic, Zoran; Ivancev, Vladimir; Lojpur, Mihajlo; Shoemaker, J Kevin; Dujic, Zeljko

    2007-12-01

    We investigated the spleen volume changes as related to the cardiovascular responses during short-duration apneas at rest. We used dynamic ultrasound splenic imaging and noninvasive photoplethysmographic cardiovascular measurements before, during, and after 15-20 s apneas in seven trained divers. The role of baroreflex was studied by intravenous bolus of vasodilating drug trinitrosan during tidal breathing. The role of lung volume was studied by comparing the apneas at near-maximal lung volume with apneas after inhaling tidal volume, with and without cold forehead stimulation. In apneas at near maximal lung volume, a 20% reduction in splenic volume (P = 0.03) was observed as early as 3 s after the onset of breath holding. Around that time the heart rate increased, the mean arterial pressure abruptly decreased from 89.6 to 66.7 mmHg (P = 0.02), and cardiac output decreased, on account of reduction in stroke volume. Intravenous application of trinitrosan resulted in approximately 6-mmHg decrement in mean arterial pressure, while the splenic volume decreased for approximately 13%. In apneas at low lung volume, the early splenic contraction was also observed, 10% without and 12% with cold forehead stimulation, although the mean arterial pressure did not change or even increased, respectively. In conclusion, the spleen contraction is present at the beginning of apnea, accentuated by cold forehead stimulation. At large, but not small, lung volume, this initial contraction is probably facilitated by downloaded baroreflex in conditions of decreased blood pressure and cardiac output. PMID:17947504

  5. Isolated sleep apnea due to Chiari type I malformation and syringomyelia.

    PubMed

    Shiihara, T; Shimizu, Y; Mitsui, T; Saitoh, E; Sato, S

    1995-10-01

    We report an 11-year-old girl with Chiari type I malformation and syringomyelia, who experienced isolated sleep apnea without other neurologic problems. Monitoring with oximetry and movement of thoracic and abdominal walls indicated mixed-type sleep apnea. Chiari type I malformation should be differentiated from other disorders causing sleep apnea. PMID:8554669

  6. Listing people.

    PubMed

    Delbourgo, James

    2012-12-01

    Historians and commentators have long discussed tensions between specialist and lay expertise in the making of scientific knowledge. Such accounts have often described quarrels over the distribution of expertise in nineteenth-century "popular" and imperial sciences. The "crowdsourcing" of science on a global scale, however, arguably began in the early modern era. This essay examines the lists of specimen suppliers, the artifacts of a worldwide collecting campaign, published by the London apothecary James Petiver at the turn of the eighteenth century. Listing suppliers helped Petiver advertise his status as a global specimen broker in the Republic of Letters. However, publicly listing his sources drew criticism over the social character of his collecting project, while lists became synonymous with the debasement of learning in polemics over natural history. PMID:23488241

  7. Obstructive Sleep Apnea and Diabetic Nephropathy

    PubMed Central

    Tahrani, Abd A.; Ali, Asad; Raymond, Neil T.; Begum, Safia; Dubb, Kiran; Altaf, Quratul-ain; Piya, Milan K.; Barnett, Anthony H.; Stevens, Martin J.

    2013-01-01

    OBJECTIVE Diabetic nephropathy (DN) is a leading cause of end-stage renal disease (ESRD). Obstructive sleep apnea (OSA) is common in type 2 diabetes and increases oxidative stress. Hence, OSA could promote the development and progression of DN. RESEARCH DESIGN AND METHODS This was a cohort study in adults with type 2 diabetes. Patients with known OSA or ESRD were excluded. DN was defined as the presence of albuminuria or an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2. DN progression was based on eGFR measurements. OSA was defined as apnea hypopnea index (AHI) ≥5 events/h. Serum nitrotyrosine abundance (a marker of nitrosative stress) was measured by ELISA. RESULTS A total of 224 patients were included. OSA and DN prevalence was 64.3 and 40.2, respectively. DN prevalence was higher in patients with OSA (OSA+) compared with those without OSA (OSA−) (49.3% vs. 23.8%, P < 0.001). After adjustment, OSA (odds ratio 2.64 [95% CI 1.13–6.16], P = 0.02) remained independently associated with DN. After an average follow-up of 2.5 (0.7) years, eGFR decline was greater in OSA+ compared with OSA− patients (median −6.8% [interquartile range −16.1 to 2.2] vs. −1.6% [−7.7 to 5.3%], P = 0.002). After adjusting, both baseline OSA (B = −3.8, P = 0.044) and AHI (B = −4.6, P = 0.02) remained independent predictors of study-end eGFR. Baseline serum nitrotyrosine abundance (B = −0.24, P = 0.015) was an independent predictor of study-end eGFR after adjustment. CONCLUSIONS OSA is independently associated with DN in type 2 diabetes. eGFR declined faster in patients with OSA. Nitrosative stress may provide a pathogenetic link between OSA and DN. Interventional studies assessing the impact of OSA treatment on DN are needed. PMID:24062320

  8. Obstructive sleep apnea syndrome and the quality of life

    PubMed Central

    COMAN, ANDREEA CODRUTA; BORZAN, CRISTINA; VESA, CRISTIAN STEFAN; TODEA, DOINA ADINA

    2016-01-01

    Background and aims Obstructive sleep apnea syndrome (OSA) affects the quality of life (QOL) due to the effects on the patient’s physical and mental function. QOL in sleep apnea may improve under continuous airway positive pressure (CPAP) therapy. The purpose of this study was to assess the OSA patients QOL before and after 3 months of CPAP therapy using Calgary Sleep Apnea Quality of Life Index (SAQLI). Methods We conducted a study in 79 sleep apnea subjects diagnosed using cardiorespiratory portable monitoring, under CPAP therapy, monitored in our Sleep Laboratory from January 2011 to December 2014. This is a cross-sectional study, achieved through quantitative research (SAQLI questionnaire application) about the perception of quality of life in patients with sleep apnea in the moment of diagnosis and 3 months after CPAP therapy. Results Of the 79 subjects, 59 (74.7%) were men and 20 (26.3%) women; mean age was 54.13 years (SD±10.87), the mean apnea-hypopnea index (AHI) was 52.46±20.83 events/h. In all 4 domains of SAQLI: daily functioning with mean pretreatment score 4.13±0.58 versus mean post treatment score 5.43±0.52; social interactions with mean pretreatment score 3.68±0.55 versus post treatment mean score 5.36±0.57; emotional functioning with mean pretreatment score 3.83±0.53 versus mean post treatment mean 5.38±0.56 and symptoms with mean pretreatment score 0.81±0.12 versus mean post treatment score 1.15±0.14, quality of life was improved after 3 months of therapy, with significantly statistical correlation (p=0.00). Also, an improvement was seen in mean total score of SAQLI after therapy as compared to baseline 3.11±0.32 versus 4.24±0.39 (p<0.01). Conclusion The quality of life in sleep apnea was better after CPAP therapy than from baseline, according Calgary Sleep Apnea Quality of Life Index. The SAQLI is a useful toll to evaluate quality of life in sleep apnea, especially to highlight the benefits of CPAP therapy, even with short time

  9. Sleep Apnea-Hypopnea Quantification by Cardiovascular Data Analysis

    PubMed Central

    Camargo, Sabrina; Riedl, Maik; Anteneodo, Celia; Kurths, Jürgen; Penzel, Thomas; Wessel, Niels

    2014-01-01

    Sleep disorders are a major risk factor for cardiovascular diseases. Sleep apnea is the most common sleep disturbance and its detection relies on a polysomnography, i.e., a combination of several medical examinations performed during a monitored sleep night. In order to detect occurrences of sleep apnea without the need of combined recordings, we focus our efforts on extracting a quantifier related to the events of sleep apnea from a cardiovascular time series, namely systolic blood pressure (SBP). Physiologic time series are generally highly nonstationary and entrap the application of conventional tools that require a stationary condition. In our study, data nonstationarities are uncovered by a segmentation procedure which splits the signal into stationary patches, providing local quantities such as mean and variance of the SBP signal in each stationary patch, as well as its duration . We analysed the data of 26 apneic diagnosed individuals, divided into hypertensive and normotensive groups, and compared the results with those of a control group. From the segmentation procedure, we identified that the average duration , as well as the average variance , are correlated to the apnea-hypoapnea index (AHI), previously obtained by polysomnographic exams. Moreover, our results unveil an oscillatory pattern in apneic subjects, whose amplitude is also correlated with AHI. All these quantities allow to separate apneic individuals, with an accuracy of at least . Therefore, they provide alternative criteria to detect sleep apnea based on a single time series, the systolic blood pressure. PMID:25222746

  10. Sleep apnea-hypopnea quantification by cardiovascular data analysis.

    PubMed

    Camargo, Sabrina; Riedl, Maik; Anteneodo, Celia; Kurths, Jürgen; Penzel, Thomas; Wessel, Niels

    2014-01-01

    Sleep disorders are a major risk factor for cardiovascular diseases. Sleep apnea is the most common sleep disturbance and its detection relies on a polysomnography, i.e., a combination of several medical examinations performed during a monitored sleep night. In order to detect occurrences of sleep apnea without the need of combined recordings, we focus our efforts on extracting a quantifier related to the events of sleep apnea from a cardiovascular time series, namely systolic blood pressure (SBP). Physiologic time series are generally highly nonstationary and entrap the application of conventional tools that require a stationary condition. In our study, data nonstationarities are uncovered by a segmentation procedure which splits the signal into stationary patches, providing local quantities such as mean and variance of the SBP signal in each stationary patch, as well as its duration L. We analysed the data of 26 apneic diagnosed individuals, divided into hypertensive and normotensive groups, and compared the results with those of a control group. From the segmentation procedure, we identified that the average duration , as well as the average variance <σ2>, are correlated to the apnea-hypoapnea index (AHI), previously obtained by polysomnographic exams. Moreover, our results unveil an oscillatory pattern in apneic subjects, whose amplitude S* is also correlated with AHI. All these quantities allow to separate apneic individuals, with an accuracy of at least 79%. Therefore, they provide alternative criteria to detect sleep apnea based on a single time series, the systolic blood pressure. PMID:25222746

  11. The pathogenesis of obstructive sleep apnea

    PubMed Central

    Schwartz, Alan R.

    2015-01-01

    Obstructive sleep apnea (OSA) is a major source of cardiovascular morbidity and mortality, and represents an increasing burden on health care resources. Understanding underlying pathogenic mechanisms of OSA will ultimately allow for the development of rational therapeutic strategies. In this article, we review current concepts about the pathogenesis of OSA. Specifically, we consider the evidence that the upper airway plays a primary role in OSA pathogenesis and provide a framework for modelling its biomechanical properties and propensity to collapse during sleep. Anatomical and neuromuscular factors that modulate upper airway obstruction are also discussed. Finally, we consider models of periodic breathing, and elaborate generalizable mechanisms by which upper airway obstruction destabilizes respiratory patterns during sleep. In our model, upper airway obstruction triggers a mismatch between ventilatory supply and demand. In this model, trade-offs between maintaining sleep stability or ventilation can account for a full range of OSA disease severity and expression. Recurrent arousals and transient increases in airway patency may restore ventilation between periods of sleep, while alterations in neuromuscular and arousal responses to upper airway obstruction may improve sleep stability at still suboptimal levels of ventilation. PMID:26380762

  12. Prosthodontic Approach to Treat Obstructive Sleep Apnea

    PubMed Central

    Annapurna, K; Suganya, S; Vasanth, R; Kumar, P Ranjith

    2014-01-01

    Sleep disordered breathing represents a continuum, ranging from simple snoring sans sleepiness, upper-airway resistance syndrome, obstructive sleep apnea (OSA) syndrome, to hypercapnic respiratory failure. Fifty seven articles formed the initial database and a final total of 50 articles were selected to form this review report. Four months were spent on the collection and retrieval of the articles. Articles were selected based on accuracy and evidence in the scientific literature. Oral appliances (OAs) are indicated for use in patients with mild to moderate OSA who prefer them to continuous positive airway pressure (CPAP) therapy, or for those who do not respond to, are not appropriate candidates for, or for those who have failed treatment attempts with CPAP. OAs protrude the mandible and hold it in a forward and downward position. As a consequence, the upper airway enlarges antero-posteriorly and laterally, improving its stability. Although OA are effective in some patients with OSA, they are not universally suitable. Compliance with OAs depends mainly on the balance between the perception of benefit and the side effects. In conclusion, marked variability is illustrated in the individual response to OA therapy and hence the treatment outcome is subjective. PMID:25221691

  13. Cognitive complaints in obstructive sleep apnea.

    PubMed

    Vaessen, Tim J A; Overeem, Sebastiaan; Sitskoorn, Margriet M

    2015-02-01

    Obstructive sleep apnea (OSA) is associated with impairments in cognitive functioning. Although cognitive complaints are related to quality of life, work productivity and health care expenditures, most research and all reviews have focused exclusively on objective cognitive functioning so far. In this systematic review, we assessed the available literature on subjective measures of cognition in adult OSA patients. Concentration complaints were consistently found to be more severe in untreated OSA patients as compared to primary snorers and healthy controls. The same seems to be true for memory and executive function problems, but firm conclusions cannot be made as of yet, due to methodological limitations of the available studies. Cognitive complaints appear to be at least partially related to subjective sleepiness. Importantly, they are not necessarily a sign of objective cognitive impairment. Additional research is needed to explore the relation between cognitive complaints, sleepiness and mood problems using validated and norm-referenced questionnaires for cognitive complaints. In addition, the impact of continuous positive airway pressure (CPAP) treatment on cognitive complaints in OSA warrants further study. PMID:24846772

  14. Obstructive sleep apnea screening by NIRS imaging

    NASA Astrophysics Data System (ADS)

    Kashefi, Feraydune; Watenpaugh, Donald E.; Liu, Hanli

    2007-02-01

    This study aimed at determining cerebral hemodynamic parameters in human subjects during breath holding using near infrared spectroscopy (NIRS). Breath holding serves as a method of simulation OSA (Obstructive Sleep Apnea). Data was acquired non-invasively from 40 subjects, twenty OSA sufferers (10 females, 10 males, age 20-70 years), and twenty normal volunteers (10 females, 10 males, age 20-65 years). Measurements were conducted using a LED Imager (LEDI) during breath holding. In comparing OSA subjects with controls during breath holding, a consistent increase or even a decrease in oxy- ([O IIHb]), deoxy- ([HHb]), total hemoglobin ([tHb]) concentrations, and tissue hemoglobin oxygen saturation (SO II) in the regional brain tissue were observed. The LEDI probe consists of 4 sources and 10 detectors serving as 4 sets of 1 source and 4 detectors each. A three wavelength (730, 805, and 850 nm) LED was used and the wavelengths were switched sequentially. The distance between sources and the source-detector separation were 2.5 cm. Data acquisition consisted of three segments, baseline for one minute, followed by a period of breath holding, and then 2 minutes of recovery time. The duration of the breath holding was subject-dependent. Our investigation proves that NIR spectroscopy could be used as a tool for detecting cerebral hemodynamics and also serves as a method of screening patients with OSA.

  15. [Sleep apnea-hypopnea syndrome 2009].

    PubMed

    Escrig, Ana Camarasa; Vergara, Demetrio González; Rebollo, José Carlos Serrano; Barbé, Ferran

    2009-01-01

    Sleep apnea-hypopnea syndrome (SAHS) is a highly prevalent disease in the general population and, due to its social and health repercussions, has become a major public health problem. The definition of this syndrome, as well as that of respiratory event, have been refined. The role of inflammatory mechanisms in the development of cardiovascular disease is currently under investigation and biological markers will probably be added, both in the definition of SAHS and in the choice of treatment. Although the gold standard in diagnosis is polysomnography, respiratory polygraphy has become a valid and complementary alternative, since this technique is a simplified method that can be performed in the home to confirm or exclude this disease. Expert systems such as single-channel devices may help to simplify diagnosis. Currently, the mainstay of treatment is still continuous positive airway pressure (CPAP); this modality is mainly indicated in patients with moderate or severe SAHS and has been shown to reduce mortality in this group. PMID:20116739

  16. Wireless remote monitoring system for sleep apnea

    NASA Astrophysics Data System (ADS)

    Oh, Sechang; Kwon, Hyeokjun; Varadan, Vijay K.

    2011-04-01

    Sleep plays the important role of rejuvenating the body, especially the central nervous system. However, more than thirty million people suffer from sleep disorders and sleep deprivation. That can cause serious health consequences by increasing the risk of hypertension, diabetes, heart attack and so on. Apart from the physical health risk, sleep disorders can lead to social problems when sleep disorders are not diagnosed and treated. Currently, sleep disorders are diagnosed through sleep study in a sleep laboratory overnight. This involves large expenses in addition to the inconvenience of overnight hospitalization and disruption of daily life activities. Although some systems provide home based diagnosis, most of systems record the sleep data in a memory card, the patient has to face the inconvenience of sending the memory card to a doctor for diagnosis. To solve the problem, we propose a wireless sensor system for sleep apnea, which enables remote monitoring while the patient is at home. The system has 5 channels to measure ECG, Nasal airflow, body position, abdominal/chest efforts and oxygen saturation. A wireless transmitter unit transmits signals with Zigbee and a receiver unit which has two RF modules, Zigbee and Wi-Fi, receives signals from the transmitter unit and retransmits signals to the remote monitoring system with Zigbee and Wi-Fi, respectively. By using both Zigbee and Wi-Fi, the wireless sensor system can achieve a low power consumption and wide range coverage. The system's features are presented, as well as continuous monitoring results of vital signals.

  17. Operation and control software for APNEA

    SciTech Connect

    McClelland, J.H.; Storm, B.H. Jr.; Ahearn, J.

    1997-11-01

    The human interface software for the Lockheed Martin Specialty Components (LMSC) Active/Passive Neutron Examination & Analysis System (APENA) provides a user friendly operating environment for the movement and analysis of waste drums. It is written in Microsoft Visual C++ on a Windows NT platform. Object oriented and multitasking techniques are used extensively to maximize the capability of the system. A waste drum is placed on a loading platform with a fork lift and then automatically moved into the APNEA chamber in preparation for analysis. A series of measurements is performed, controlled by menu commands to hardware components attached as peripheral devices, in order to create data files for analysis. The analysis routines use the files to identify the pertinent radioactive characteristics of the drum, including the type, location, and quantity of fissionable material. At the completion of the measurement process, the drum is automatically unloaded and the data are archived in preparation for storage as part of the drum`s data signature. 3 figs.

  18. Single-Unit Muscle Sympathetic Nerve Activity Reflects Sleep Apnea Severity, Especially in Severe Obstructive Sleep Apnea Patients.

    PubMed

    Hamaoka, Takuto; Murai, Hisayoshi; Kaneko, Shuichi; Usui, Soichiro; Okabe, Yoshitaka; Tokuhisa, Hideki; Kato, Takeshi; Furusho, Hiroshi; Sugiyama, Yu; Nakatsumi, Yasuto; Takata, Shigeo; Takamura, Masayuki

    2016-01-01

    Obstructive sleep apnea syndrome (OSAS) is associated with augmented sympathetic nerve activity, as assessed by multi-unit muscle sympathetic nerve activity (MSNA). However, it is still unclear whether single-unit MSNA is a better reflection of sleep apnea severity according to the apnea-hypopnea index (AHI). One hundred and two OSAS patients underwent full polysomnography and single- and multi-unit MSNA measurements. Univariate and multivariate regression analysis were performed to determine which parameters correlated with OSAS severity, which was defined by the AHI. Single- and multi-unit MSNA were significantly and positively correlated with AHI severity. The AHI was also significantly correlated with multi-unit MSNA burst frequency (r = 0.437, p < 0.0001) and single-unit MSNA spike frequency (r = 0.632, p < 0.0001). Multivariable analysis revealed that SF was correlated most significantly with AHI (T = 7.27, p < 0.0001). The distributions of multiple single-unit spikes per one cardiac interval did not differ between patients with an AHI of <30 and those with and AHI of 30-55 events/h; however, the pattern of each multiple spike firing were significantly higher in patients with an AHI of >55. These results suggest that sympathetic nerve activity is associated with sleep apnea severity. In addition, single-unit MSNA is a more accurate reflection of sleep apnea severity with alternation of the firing pattern, especially in patients with very severe OSAS. PMID:26973534

  19. Single-Unit Muscle Sympathetic Nerve Activity Reflects Sleep Apnea Severity, Especially in Severe Obstructive Sleep Apnea Patients

    PubMed Central

    Hamaoka, Takuto; Murai, Hisayoshi; Kaneko, Shuichi; Usui, Soichiro; Okabe, Yoshitaka; Tokuhisa, Hideki; Kato, Takeshi; Furusho, Hiroshi; Sugiyama, Yu; Nakatsumi, Yasuto; Takata, Shigeo; Takamura, Masayuki

    2016-01-01

    Obstructive sleep apnea syndrome (OSAS) is associated with augmented sympathetic nerve activity, as assessed by multi-unit muscle sympathetic nerve activity (MSNA). However, it is still unclear whether single-unit MSNA is a better reflection of sleep apnea severity according to the apnea-hypopnea index (AHI). One hundred and two OSAS patients underwent full polysomnography and single- and multi-unit MSNA measurements. Univariate and multivariate regression analysis were performed to determine which parameters correlated with OSAS severity, which was defined by the AHI. Single- and multi-unit MSNA were significantly and positively correlated with AHI severity. The AHI was also significantly correlated with multi-unit MSNA burst frequency (r = 0.437, p < 0.0001) and single-unit MSNA spike frequency (r = 0.632, p < 0.0001). Multivariable analysis revealed that SF was correlated most significantly with AHI (T = 7.27, p < 0.0001). The distributions of multiple single-unit spikes per one cardiac interval did not differ between patients with an AHI of <30 and those with and AHI of 30–55 events/h; however, the pattern of each multiple spike firing were significantly higher in patients with an AHI of >55. These results suggest that sympathetic nerve activity is associated with sleep apnea severity. In addition, single-unit MSNA is a more accurate reflection of sleep apnea severity with alternation of the firing pattern, especially in patients with very severe OSAS. PMID:26973534

  20. Obstructive sleep apnea and other sleep-related syndromes.

    PubMed

    Paiva, Teresa; Attarian, Hrayr

    2014-01-01

    Obstructive sleep apnea syndrome (OSAS) is a common disorder characterized by repetitive episodes of breathing cessation due to complete or partial collapse of the upper airway therefore affecting ventilation. It is quite common, with a prevalence of about 2-4%, has a strong genetic component, and creates a proinflammatory state with elevated TNFα and other cytokines. If untreated, OSA can lead to significant neurological problems that include stroke, cognitive decline, depression, headaches, peripheral neuropathy, and nonarteritic ischemic optic neuropathy (NAION). Treatment reverses some of these neurological problems. Treatment includes continuous positive airway pressure and its variants, oral appliances, weight loss, upper airway surgery, and rarely maxillofacial procedures. Other sleep breathing disorders such as hypoventilation, central sleep apnea, complex sleep apnea, and Cheyne-Stokes respiration are less common and are sometimes associated with neuromuscular disorders causing diaphragmatic paralysis, but can also be seen in opiate exposure and severe obesity. PMID:24365301

  1. Obstructive sleep apnea and hypertension: a critical review.

    PubMed

    Mohsenin, Vahid

    2014-10-01

    Obstructive sleep apnea (OSA) is a prevalent sleep disorder which is characterized by recurrent upper closure with oxygen desaturation and sleep disruption. OSA increases the risk of vascular disorders in the form of stroke, myocardial infarction, congestive heart failure, and hypertension. The mechanisms underlying the vascular disorders are several and include intermittent hypoxia with release of cytokines, angiogenic inhibitors, free radicals, and adhesion molecules. During apneas, arterial blood pressure gradually rises and surges abruptly after the termination of apnea. Two thirds of patients with OSA will ultimately have diurnal hypertension. This review discusses the literature supporting the significant role of OSA in hypertension and the effect of OSA treatment on blood pressure. PMID:25139780

  2. Sodium Oxybate and Sleep Apnea: A Clinical Case

    PubMed Central

    Hartley, Sarah; Quera-Salva, Maria-Antonia; Machou, Mourad

    2011-01-01

    Sodium oxybate (GHB, Xyrem, Jazz Pharmaceuticals) is used to treat cataplexy in patients with narcolepsy. We report the case of a middle aged, normo-ponderal narcoleptic woman without risk factors who developed reversible sleep apnea and objective sleepiness when treated by sodium oxybate, with an apnea-hypopnea index (AHI) of 19.7 on sodium oxybate and AHI 4.8 without treatment. Despite a subjective improvement in vigilance, mean sleep latency on MWT decreased from 21 minutes to 8 minutes on sodium oxybate. Citation: Hartley S; Quera-Salva MA; Machou M. Sodium oxybate and sleep apnea: a clinical case. J Clin Sleep Med 2011;7(6):667-668. PMID:22171208

  3. Use of modified silicone tracheal cannula for obstructive sleep apnea.

    PubMed

    Strauss, M

    1990-02-01

    Experience with the original Montgomery silicone tracheal cannulas in 47 patients with obstructive sleep apnea has been reported. Further experience with 10 obstructive sleep apnea patients who used modified silicone tracheal cannulas that permit periodic self-removal, cleaning, and reinsertion was analyzed. Two patients used the tube briefly and without complications. The remaining eight patients used the modified cannula for 18 to 24 months. The average number of office visits following insertion was three. Compared to the original cannulas, there were markedly fewer difficulties with granulations, infection, and tube malposition with the modified cannulas. The improvements make this modified device a useful tool worth further study in obstructive sleep apnea patients requiring tracheostomy. PMID:2299956

  4. Tongue Fat and its Relationship to Obstructive Sleep Apnea

    PubMed Central

    Kim, Andrew M.; Keenan, Brendan T.; Jackson, Nicholas; Chan, Eugenia L.; Staley, Bethany; Poptani, Harish; Torigian, Drew A.; Pack, Allan I.; Schwab, Richard J.

    2014-01-01

    Study Objectives: The objective of this study was to determine whether tongue fat is increased in obese sleep apneics compared to obese subjects without sleep apnea. We hypothesized that excess fat is deposited in the tongue in obese patients with sleep apnea. Design: Case-control design. Setting: Academic medical center. Patients: We examined tongue fat in 31 obese controls (apnea-hypopnea index, 4.1 ± 2.7 events/h) and 90 obese apneics (apnea-hypopnea index, 43.2 ± 27.3 events/h). Analyses were repeated in a subsample of 18 gender-, race-, age-, and BMI-matched case-control pairs. Interventions: All subjects underwent a MRI with three-point Dixon magnetic resonance imaging. We used sophisticated volumetric reconstruction algorithms to study the size and distribution of upper airway fat deposits in the tongue and masseter muscles within apneics and obese controls. Measurements and Results: The data supported our a priori hypotheses that after adjustment for age, BMI, gender, and race, the tongue in apneics was significantly larger (P = 0.001) and had an increased amount of fat (P = 0.002) compared to controls. Similar results were seen in our matched sample. Our data also demonstrate that within the apneic and normal tongue, there are regional differences in fat distribution, with larger fat deposits at the base of the tongue. Conclusions: There is increased tongue volume and deposition of fat at the base of tongue in apneics compared to controls. Increased tongue fat may begin to explain the relationship between obesity and obstructive sleep apnea. Citation: Kim AM, Keenan BT, Jackson N, Chan EL, Staley B, Poptani H, Torigian DA, Pack AI, Schwab RJ. Tongue fat and its relationship to obstructive sleep apnea. SLEEP 2014;37(10):1639-1648. PMID:25197815

  5. White Matter Damage and Systemic Inflammation in Obstructive Sleep Apnea

    PubMed Central

    Chen, Hsiu-Ling; Lu, Cheng-Hsien; Lin, Hsin-Ching; Chen, Pei-Chin; Chou, Kun-Hsien; Lin, Wei-Ming; Tsai, Nai-Wen; Su, Yu-Jih; Friedman, Michael; Lin, Ching-Po; Lin, Wei-Che

    2015-01-01

    Study Objectives: To evaluate white matter integrity in patients with obstructive sleep apnea (OSA) using diffusion tensor imaging (DTI) and to assess its relationship with systemic inflammation. Design: Cross-sectional study. Setting: One tertiary medical center research institute. Patients or Participants: Twenty patients with severe OSA (apnea-hypopnea index [AHI] > 30, 18 men and 2 women) and 14 healthy volunteers (AHI < 5, 11 men and 3 women). Interventions: N/A. Measurements and Results: Patients with severe OSA and healthy volunteers underwent polysomnography to determine the severity of sleep apnea, and DTI scanning to determine fiber integrity. Early or late phase changes in leukocyte apoptosis and its subsets were determined by flow cytometry. DTI-related indices (including fractional anisotropy [FA], axial diffusivity [AD], radial diffusivity [RD], and mean diffusivity [MD]) were derived from DTI. The FA maps were compared using voxel-based statistics to determine differences between the severe OSA and control groups. The differences in DTI indices, clinical severity, and leukocyte apoptosis were correlated after adjusting for age, sex, body mass index, and systolic blood pressure. Exploratory group-wise comparison between the two groups revealed that patients with OSA exhibited low FA accomplished by high RD in several brain locations, without any differences in AD and MD. The FA values were negatively correlated with clinical disease severity and leukocyte early apoptosis. Conclusions: Obstructive sleep apnea impairs white matter integrity in vulnerable regions, and this impairment is associated with increased disease severity. The possible interactions between systemic inflammation and central nervous system microstructural damage may represent variant hypoxic patterns and their consequent processes in obstructive sleep apnea. Citation: Chen HL, Lu CH, Lin HC, Chen PC, Chou KH, Lin WM, Tsai NW, Su YJ, Friedman M, Lin CP, Lin WC. White matter damage

  6. Acute dietary nitrate supplementation improves dry static apnea performance.

    PubMed

    Engan, Harald K; Jones, Andrew M; Ehrenberg, Fanny; Schagatay, Erika

    2012-07-01

    Acute dietary nitrate (NO₃⁻) supplementation has been reported to lower resting blood pressure, reduce the oxygen (O₂) cost of sub-maximal exercise, and improve exercise tolerance. Given the proposed effects of NO₃⁻ on tissue oxygenation and metabolic rate, it is possible that NO₃⁻ supplementation might enhance the duration of resting apnea. If so, this might have important applications both in medicine and sport. We investigated the effects of acute NO₃⁻ supplementation on pre-apnea blood pressure, apneic duration, and the heart rate (HR) and arterial O₂ saturation (SaO₂) responses to sub-maximal and maximal apneas in twelve well-trained apnea divers. Subjects were assigned in a randomized, double blind, crossover design to receive 70 ml of beetroot juice (BR; containing ∼5.0 mmol of nitrate) and placebo juice (PL; ∼0.003 mmol of nitrate) treatments. At 2.5 h post-ingestion, the subjects completed a series of two 2-min (sub-maximal) static apneas separated by 3 min of rest, followed by a maximal effort apnea. Relative to PL, BR reduced resting mean arterial pressure by 2% (PL: 86±7 vs. BR: 84 ± 6 mmHg; P=0.04). The mean nadir for SaO₂ after the two sub-maximal apneas was 97.2±1.6% in PL and 98.5±0.9% in BR (P=0.03) while the reduction in HR from baseline was not significantly different between PL and BR. Importantly, BR increased maximal apneic duration by 11% (PL: 250 ± 58 vs. BR: 278±64s; P=0.04). In the longer maximal apneas in BR, the magnitude of the reductions in HR and SaO₂ were greater than in PL (P ≤ 0.05). The results suggest that acute dietary NO₃⁻ supplementation may increase apneic duration by reducing metabolic costs. PMID:22588047

  7. Promoting safety of postoperative orthopaedic patients with obstructive sleep apnea.

    PubMed

    Veney, Amy J

    2013-01-01

    Orthopaedic patients with obstructive sleep apnea are at risk for postoperative complications related to administration of pain medications, anxiolytics, and antiemetics. They are more likely to experience respiratory and cardiac complications, be transferred to an intensive care unit, or have an increased length of stay in the hospital. This informational article is for nurses who care for postoperative orthopaedic patients with obstructive sleep apnea. The focus is on promoting patient safety through communication, vigilant postoperative sedation assessment, and nursing interventions that include appropriate patient positioning, patient education, and involving patients and their families in care. PMID:24247310

  8. Sodium oxybate and sleep apnea: a clinical case.

    PubMed

    Hartley, Sarah; Quera-Salva, Maria-Antonia; Machou, Mourad

    2011-12-15

    Sodium oxybate (GHB, Xyrem, Jazz Pharmaceuticals) is used to treat cataplexy in patients with narcolepsy. We report the case of a middle aged, normo-ponderal narcoleptic woman without risk factors who developed reversible sleep apnea and objective sleepiness when treated by sodium oxybate, with an apnea-hypopnea index (AHI) of 19.7 on sodium oxybate and AHI 4.8 without treatment. Despite a subjective improvement in vigilance, mean sleep latency on MWT decreased from 21 minutes to 8 minutes on sodium oxybate. PMID:22171208

  9. Stridor and apnea as the initial presentation of primary hypoparathyroidism.

    PubMed

    Chou, Courtney T; Siegel, Bianca; Mehta, Deepak

    2016-01-01

    We present a previously undescribed case of stridor and apnea as the initial presentation of primary hypoparathyroidism. A neonate presenting with these symptoms was initially diagnosed with laryngopharyngeal reflux and laryngomalacia. After failing medical management, she underwent supraglottoplasty with improvement of stridor, but persistent apneic events. Further work-up showed severe hypocalcemia due to hypoparathyroidism. Subsequent genetic testing revealed a diagnosis of Bartter Syndrome Type V, a rare cause of primary hypoparathyroidism. Although uncommon, hypocalcemic tetany can present as apneic episodes in the setting of unrecognized primary hypoparathyroidism. Electrolyte abnormalities should be explored in neonates with recurrent apnea of unknown etiology. PMID:26746608

  10. Anesthetic and postoperative management of the obstructive sleep apnea patient.

    PubMed

    Mickelson, Samuel A

    2009-11-01

    Sleep apnea patients pose a challenge for surgeons, anesthesiologists, and surgical facilities as there is increased risk for anesthetic and postoperative complications. Precautions before and after surgery minimize these risks. Screening for sleep apnea should be done for all surgical patients. Safe perioperative management requires judicious use of narcotics and sedating medications, reducing upper airway edema, prevention of aspiration and deep vein thrombosis, blood pressure control, use of positive airway pressure, and proper postoperative monitoring. Although the literature lacks specific recommendations, the guidelines presented in this article are based on more than 20 years of experience and supported by peer-reviewed medical literature. PMID:19944343

  11. Synchronization and Cardio-pulmonary feedback in Sleep Apnea

    NASA Astrophysics Data System (ADS)

    Xu, Limei; Ivanov, Plamen Ch.; Chen, Zhi; Hu, Kun; Paydarfar, David; Stanley, H. Eugene

    2004-03-01

    Findings indicate a dynamical coupling between respiratory and cardiac function. However, the nature of this nonlinear interaction remains not well understood. We investigate transient patterns in the cardio-pulmonary interaction under healthy conditions by means of cross-correlation and nonlinear synchronization techniques, and we compare how these patterns change under pathologic conditions such as obstructive sleep apnea --- a periodic cessation of breathing during sleep. We find that during apnea episodes the nonlinear features of cardio-pulmonary interaction change intermittently, and can exhibit variations characterized by different time delays in the phase synchronization between breathing and heartbeat dynamics.

  12. Glossopharyngeal insufflation induces cardioinhibitory syncope in apnea divers.

    PubMed

    Dzamonja, Gordan; Tank, Jens; Heusser, Karsten; Palada, Ivan; Valic, Zoran; Bakovic, Darija; Obad, Ante; Ivancev, Vladimir; Breskovic, Toni; Diedrich, André; Luft, Friedrich C; Dujic, Zeljko; Jordan, Jens

    2010-12-01

    Apnea divers increase intrathoracic pressure voluntarily by taking a deep breath followed by glossopharyngeal insufflation. Because apnea divers sometimes experience hypotension and syncope during the maneuver, they may serve as a model to study the mechanisms of syncope. We recorded changes in hemodynamics and sympathetic vasomotor tone with microneurography during breath holding with glossopharyngeal insufflation. Five men became hypotensive and fainted during breath holding with glossopharyngeal insufflation within the first minute. In four divers, heart rate dropped suddenly to a minimum of 38 ± 4 beats/min. Therefore, cardioinhibitory syncope was more common than low cardiac output syncope. PMID:20623312

  13. Adaptation of the modified Bouc–Wen model to compensate for hysteresis in respiratory motion for the list-mode binning of cardiac SPECT and PET acquisitions: Testing using MRI

    PubMed Central

    Dasari, Paul K. R.; Shazeeb, Mohammed Salman; Könik, Arda; Lindsay, Clifford; Mukherjee, Joyeeta M.; Johnson, Karen L.; King, Michael A.

    2014-01-01

    Purpose: Binning list-mode acquisitions as a function of a surrogate signal related to respiration has been employed to reduce the impact of respiratory motion on image quality in cardiac emission tomography (SPECT and PET). Inherent in amplitude binning is the assumption that there is a monotonic relationship between the amplitude of the surrogate signal and respiratory motion of the heart. This assumption is not valid in the presence of hysteresis when heart motion exhibits a different relationship with the surrogate during inspiration and expiration. The purpose of this study was to investigate the novel approach of using the Bouc–Wen (BW) model to provide a signal accounting for hysteresis when binning list-mode data with the goal of thereby improving motion correction. The study is based on the authors’ previous observations that hysteresis between chest and abdomen markers was indicative of hysteresis between abdomen markers and the internal motion of the heart. Methods: In 19 healthy volunteers, they determined the internal motion of the heart and diaphragm in the superior–inferior direction during free breathing using MRI navigators. A visual tracking system (vts) synchronized with MRI acquisition tracked the anterior–posterior motions of external markers placed on the chest and abdomen. These data were employed to develop and test the Bouc–Wen model by inputting the vts derived chest and abdomen motions into it and using the resulting output signals as surrogates for cardiac motion. The data of the volunteers were divided into training and testing sets. The training set was used to obtain initial values for the model parameters for all of the volunteers in the set, and for set members based on whether they were or were not classified as exhibiting hysteresis using a metric derived from the markers. These initial parameters were then employed with the testing set to estimate output signals. Pearson’s linear correlation coefficient between the

  14. Adaptation of the modified Bouc–Wen model to compensate for hysteresis in respiratory motion for the list-mode binning of cardiac SPECT and PET acquisitions: Testing using MRI

    SciTech Connect

    Dasari, Paul K. R.; Shazeeb, Mohammed Salman; Könik, Arda; Lindsay, Clifford; Mukherjee, Joyeeta M.; Johnson, Karen L.; King, Michael A.

    2014-11-01

    Purpose: Binning list-mode acquisitions as a function of a surrogate signal related to respiration has been employed to reduce the impact of respiratory motion on image quality in cardiac emission tomography (SPECT and PET). Inherent in amplitude binning is the assumption that there is a monotonic relationship between the amplitude of the surrogate signal and respiratory motion of the heart. This assumption is not valid in the presence of hysteresis when heart motion exhibits a different relationship with the surrogate during inspiration and expiration. The purpose of this study was to investigate the novel approach of using the Bouc–Wen (BW) model to provide a signal accounting for hysteresis when binning list-mode data with the goal of thereby improving motion correction. The study is based on the authors’ previous observations that hysteresis between chest and abdomen markers was indicative of hysteresis between abdomen markers and the internal motion of the heart. Methods: In 19 healthy volunteers, they determined the internal motion of the heart and diaphragm in the superior–inferior direction during free breathing using MRI navigators. A visual tracking system (VTS) synchronized with MRI acquisition tracked the anterior–posterior motions of external markers placed on the chest and abdomen. These data were employed to develop and test the Bouc–Wen model by inputting the VTS derived chest and abdomen motions into it and using the resulting output signals as surrogates for cardiac motion. The data of the volunteers were divided into training and testing sets. The training set was used to obtain initial values for the model parameters for all of the volunteers in the set, and for set members based on whether they were or were not classified as exhibiting hysteresis using a metric derived from the markers. These initial parameters were then employed with the testing set to estimate output signals. Pearson’s linear correlation coefficient between the

  15. Tongue Volume Influences Lowest Oxygen Saturation but Not Apnea-Hypopnea Index in Obstructive Sleep Apnea

    PubMed Central

    Ahn, Sang Hyeon; Kim, Jinna; Min, Hyun Jin; Chung, Hyo Jin; Hong, Jae Min; Lee, Jeung-Gweon; Kim, Chang-Hoon; Cho, Hyung-Ju

    2015-01-01

    Objectives The aim of this study was to identify correlations between sleep apnea severity and tongue volume or posterior airway space measured via three-dimensional reconstruction of volumetric computerized tomography (CT) images in patients with obstructive sleep apnea (OSA) for use in predicting OSA severity and in surgical treatment. We also assessed associations between tongue volume and Mallampati score. Methods Snoring/OSA male patients (n = 64) who underwent polysomnography, cephalometry, and CT scans were enrolled in this retrospective study. OSA was diagnosed when the apnea-hypopnea index (AHI) was greater than 5 (mild 5–14; moderate 15–29; severe>30). The patients were also categorized into the normal-mild group (n = 22) and the moderate-severe group (n = 42). Using volumetric CT images with the three-dimensional reconstruction technique, the volume of the tongue, posterior airway space volume, and intra-mandibular space were measured. The volumes, polysomnographic parameters, and physical examination findings were compared, and independent factors that are related to OSA were analysed. Results No associations between tongue volume or posterior airway space and the AHI were observed. However, multivariate linear analyses showed that tongue volume had significantly negative association with lowest O2 saturation (r = 0.365, p = 0.027). High BMI was related to an increase in tongue volume. Modified Mallampati scores showed borderline significant positive correlations with absolute tongue volume (r = 0.251, p = 0.046) and standardized tongue volume (absolute tongue volume / intramandibular area; r = 0.266, p = 0.034). Between the normal-mild and moderate-severe groups, absolute tongue volumes were not different, although the standardized tongue volume in the moderate-severe group was significantly higher. Conclusion Absolute tongue volume showed stronger associations with lowest O2 saturation during sleep than with the severity of AHI. We also found that

  16. Pathophysiology of Pediatric Obstructive Sleep Apnea

    PubMed Central

    Katz, Eliot S.; D'Ambrosio, Carolyn M.

    2008-01-01

    Sleep-disordered breathing is a common and serious cause of metabolic, cardiovascular, and neurocognitive morbidity in children. The spectrum of obstructive sleep-disordered breathing ranges from habitual snoring to partial or complete airway obstruction, termed obstructive sleep apnea (OSA). Breathing patterns due to airway narrowing are highly variable, including obstructive cycling, increased respiratory effort, flow limitation, tachypnea, and/or gas exchange abnormalities. As a consequence, sleep homeostasis may be disturbed. Increased upper airway resistance is an essential component of OSA, including any combination of narrowing/retropositioning of the maxilla/mandible and/or adenotonsillar hypertrophy. However, in addition to anatomic factors, the stability of the upper airway is predicated on neuromuscular activation, ventilatory control, and arousal threshold. During sleep, most children with OSA intermittently attain a stable breathing pattern, indicating successful neuromuscular activation. At sleep onset, airway muscle activity is reduced, ventilatory variability increases, and an apneic threshold slightly below eupneic levels is observed in non-REM sleep. Airway collapse is offset by pharyngeal dilator activity in response to hypercapnia and negative lumenal pressure. Ventilatory overshoot results in sudden reduction in airway muscle activation, contributing to obstruction during non-REM sleep. Arousal from sleep exacerbates ventilatory instability and, thus, obstructive cycling. Paroxysmal reductions in pharyngeal dilator activity related to central REM sleep processes likely account for the disproportionate severity of OSA observed during REM sleep. Understanding the pathophysiology of pediatric OSA may permit more precise clinical phenotyping, and therefore improve or target therapies related to anatomy, neuromuscular compensation, ventilatory control, and/or arousal threshold. PMID:18250219

  17. OBSTRUCTIVE SLEEP APNEA AND CENTRAL SEROUS CHORIORETINOPATHY

    PubMed Central

    BRODIE, FRANK L.; CHARLSON, EMILY S.; ALEMAN, TOMAS S.; SALVO, REBECCA T.; GEWAILY, DINA Y.; LAU, MARISA K.; FARREN, NEIL D.; ENGELHARD, STEPHANIE B.; PISTILLI, MAXWELL; BRUCKER, ALEXANDER J.

    2016-01-01

    Purpose The purpose of this study was to determine if there is an association between obstructive sleep apnea (OSA) and central serous chorioretinopathy (CSCR). Methods Patients with CSCR without a history of steroid use or secondary retinal disease were matched based on age/gender/body mass index with control patients and administered the Berlin Questionnaire to assess for OSA risk. Patients were scored “OSA+” if they were at “high risk” on the Berlin Questionnaire or reported a previous OSA diagnosis. Rates of OSA+ were compared between the 2 groups, odds ratio and its 95% confidence interval was calculated using exact conditional logistic regression. Results Forty-eight qualifying patients with CSCR were identified. There were no statistically significant differences between the CSCR and control groups by age (mean = 55 years), gender (79% male), body mass index (mean = 28.2), history of diabetes, or hypertension. Within the CSCR group, 22 patients (45.8%) were OSA+ versus 21 control patients (43.8%) (difference = 2.1%; 95% confidence interval, −18.2% to 22.2%; exact odds ratio = 1.08, 95% confidence interval, 0.47–2.49; P = 1.00). Conclusion When compared with matched controls, patients with CSCR did not have statistically significant higher rates of OSA risk or previous diagnosis. This finding contrasts with previous work showing a strong association between the diseases. The divergence is likely due to our matching controls for body mass index, a significant risk factor for OSA. PMID:25127049

  18. New developments in the use of positive airway pressure for obstructive sleep apnea

    PubMed Central

    Boeder, Schafer; Malhotra, Atul; Patel, Sanjay R.

    2015-01-01

    Obstructive sleep apnea (OSA) is a disorder which afflicts a large number of individuals around the world. OSA causes sleepiness and is a major cardiovascular risk factor. Since its inception in the early 1980’s, continuous positive airway pressure (CPAP) has emerged as the major treatment of OSA, and it has been shown to improve sleepiness, hypertension, and a number of cardiovascular indices. Despite its successes, adherence with treatment remains a major limitation. Herein we will review the evidence behind the use of positive airway pressure (PAP) therapy, its various modes, and the methods employed to improve adherence. We will also discuss the future of PAP therapy in OSA and personalization of care. PMID:26380760

  19. The Treatment of Central Sleep Apnea Syndromes in Adults: Practice Parameters with an Evidence-Based Literature Review and Meta-Analyses

    PubMed Central

    Aurora, R. Nisha; Chowdhuri, Susmita; Ramar, Kannan; Bista, Sabin R.; Casey, Kenneth R.; Lamm, Carin I.; Kristo, David A.; Mallea, Jorge M.; Rowley, James A.; Zak, Rochelle S.; Tracy, Sharon L.

    2012-01-01

    The International Classification of Sleep Disorders, Second Edition (ICSD-2) distinguishes 5 subtypes of central sleep apnea syndromes (CSAS) in adults. Review of the literature suggests that there are two basic mechanisms that trigger central respiratory events: (1) post-hyperventilation central apnea, which may be triggered by a variety of clinical conditions, and (2) central apnea secondary to hypoventilation, which has been described with opioid use. The preponderance of evidence on the treatment of CSAS supports the use of continuous positive airway pressure (CPAP). Much of the evidence comes from investigations on CSAS related to congestive heart failure (CHF), but other subtypes of CSAS appear to respond to CPAP as well. Limited evidence is available to support alternative therapies in CSAS subtypes. The recommendations for treatment of CSAS are summarized as follows: CPAP therapy targeted to normalize the apnea-hypopnea index (AHI) is indicated for the initial treatment of CSAS related to CHF. (STANDARD)Nocturnal oxygen therapy is indicated for the treatment of CSAS related to CHF. (STANDARD)Adaptive Servo-Ventilation (ASV) targeted to normalize the apnea-hypopnea index (AHI) is indicated for the treatment of CSAS related to CHF. (STANDARD)BPAP therapy in a spontaneous timed (ST) mode targeted to normalize the apnea-hypopnea index (AHI) may be considered for the treatment of CSAS related to CHF only if there is no response to adequate trials of CPAP, ASV, and oxygen therapies. (OPTION)The following therapies have limited supporting evidence but may be considered for the treatment of CSAS related to CHF after optimization of standard medical therapy, if PAP therapy is not tolerated, and if accompanied by close clinical follow-up: acetazolamide and theophylline. (OPTION)Positive airway pressure therapy may be considered for the treatment of primary CSAS. (OPTION)Acetazolamide has limited supporting evidence but may be considered for the treatment of primary

  20. Treatment Options for Central Sleep Apnea: Comparison of Ventilator, Oxygen, and Drug Therapies.

    PubMed

    Yayan, Josef; Rasche, Kurt

    2016-01-01

    Central sleep apnea (CSA) is a sleep-related disorder characterized by pauses in breathing during sleep when the brain respiratory network momentarily interrupts transmission of impulses to the respiratory musculature. CSA presents significant problems being an independent risk factor for cardiovascular events and death. There are several available treatment options according to CSA severity. Currently, adaptive servo-ventilation is considered best for CSA patients. The goal of the present study was to retrospectively investigate different treatment methods employed for CSA, such as different modes of ventilation, oxygen therapy, and drugs to determine the most effective one. Data were obtained from hospital records during 2010-2015. The diagnosis of CSA and the optimal treatment method were supported by polysomnography examinations. Devices used during sleep to support breathing included continuous positive airway pressure, bi-level positive airway pressure, or adaptive servo-ventilation. We classified 71 (2.9 %) patients as having CSA from 2,463 patients with sleep-disordered breathing. Of those 71 patients, 54 (76.1 %, 95 % CI 66.2-86.0 %) were male and 17 (23.9 %, 95 % CI 14.0-33.8 %) were female, and they had a mean age of 67.1 ± 14.1. Four (5.6 %) patients underwent a combination therapy, 39 (54.9 %) received a ventilator in proper ventilation mode, 25 (35.2 %) received oxygen therapy, 7 (9.9 %) received medication, and 4 (5.6 %) received no treatment. We conclude that although the majority of patients needed treatment for central sleep apnea, a clear advantage in using ventilators when compared to oxygen therapy or drug therapy could not be found. PMID:26747067

  1. 77 FR 23794 - Proposed Recommendations on Obstructive Sleep Apnea

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-20

    ...FMCSA announces proposed recommendations from the Motor Carrier Safety Advisory Committee (MCSAC) and the Medical Review Board (MRB) on Obstructive Sleep Apnea (OSA) and the medical certification of commercial motor vehicle (CMV) drivers. The MCSAC and the MRB are FMCSA advisory committees and operate in accordance with the Federal Advisory Committee Act (FACA). At the Agency's request, the......

  2. Obstructive sleep apnea syndrome: natural history, diagnosis, and emerging treatment options

    PubMed Central

    Gharibeh, Tarek; Mehra, Reena

    2010-01-01

    Sleep apnea is an entity characterized by repetitive upper airway obstruction resulting in nocturnal hypoxia and sleep fragmentation. It is estimated that 2%–4% of the middle-aged population has sleep apnea with a predilection in men relative to women. Risk factors of sleep apnea include obesity, gender, age, menopause, familial factors, craniofacial abnormalities, and alcohol. Sleep apnea has been increasingly recognized as a major health burden associated with hypertension and increased risk of cardiovascular disease and death. Increased airway collapsibility and derangement in ventilatory control responses are the major pathological features of this disorder. Polysomnography (PSG) is the gold-standard method for diagnosis of sleep apnea and assessment of sleep apnea severity; however, portable sleep monitoring has a diagnostic role in the setting of high pretest probability sleep apnea in the absence of significant comorbidity. Positive pressure therapy is the mainstay therapy of sleep apnea. Other treatment modalities, such as upper airway surgery or oral appliances, may be used for the treatment of sleep apnea in select cases. In this review, we focus on describing the sleep apnea definition, risk factor profile, underlying pathophysiologic mechanisms, associated adverse consequences, diagnostic modalities, and treatment strategies. PMID:23616712

  3. Sleep Quality and Risk for Sleep Apnea in Incarcerated Women

    PubMed Central

    Harner, Holly M.; Budescu, Mia

    2014-01-01

    Background Little is known about characteristics of women's sleep during incarceration. Objectives The study objectives were to: describe incarcerated women's sleep quality; document incarcerated women's risk for sleep apnea; and identify other factors that contribute to poor sleep quality during incarceration. Methods This cross-sectional descriptive exploratory investigation was conducted in a maximum security women's prison in the United States. Incarcerated women's sleep quality and their risk for sleep apnea was assessed by using the Pittsburgh Sleep Quality Index (PSQI) and the Multivariable Apnea Prediction Score (MAPS), respectively. Results Four hundred thirty-eight incarcerated women participated in this investigation. Results indicate that 72% of the sample met the PSQI criteria for “poor sleepers.” Poor sleepers were significantly more likely to report sleep disturbances, and scored significantly higher on the risk for sleep apnea scale compared to women who did not meet the poor sleep threshold. Approximately 10% of the sample had a probability for sleep apnea higher than .50. Factors that contributed to poor sleep included: (a) “racing thoughts/worry/thinking about things”; (b) environmental noise and other factors; (c) physical health conditions/pain; (d) nightmares and flashbacks; and (e) not taking sleep medication. Discussion Most participants reported poor sleep quality during incarceration. Poor sleep might exacerbate existing health conditions and contribute to the development of new health problems for incarcerated women. Furthermore, poor sleep quality may reduce a woman's ability to fully participate in beneficial prison programming. This investigation provides a first look at how women sleep in prison and offers recommendations for future research. PMID:24785244

  4. Caffeine for apnea of prematurity: a neonatal success story.

    PubMed

    Kreutzer, K; Bassler, D

    2014-01-01

    Caffeine, a methylxanthine and nonspecific inhibitor of adenosine receptors, is an example of a drug that has been in use for more than 40 years. It is one of the most commonly prescribed drugs in neonatal medicine. However, until 2006, it had only a few relatively small and short-term studies supporting its use. It is thanks to the efforts of Barbara Schmidt and the Caffeine for Apnea of Prematurity (CAP) Trial Group that we now have high-quality and reliable data not only on short-term but also long-term outcomes of caffeine use for apnea of prematurity. CAP was an international, multicenter, placebo-controlled randomized trial designed to determine whether survival without neurodevelopmental disability at a corrected age of 18 months is improved if apnea of prematurity is managed without methylxanthines in infants at a high risk of apneic attacks. CAP was kept simple and pragmatic in order to allow for maximum generalizability and applicability. Infants with birth weights of 500-1,250 g were enrolled during the first 10 days of life if their clinicians considered them to be candidates for methylxanthine therapy. The most frequent indication for therapy reported in CAP was treatment of documented apnea, followed by the facilitation of the removal of an endotracheal tube. Only about 20% of the neonatologists in the trial started caffeine for the prevention of apnea and the findings of CAP cannot automatically be extrapolated to an exclusive prophylactic indication. However, recent data suggest that the administration of prophylactic methylxanthine by neonatologists is now common practice. PMID:24931325

  5. Classification algorithms for predicting sleepiness and sleep apnea severity

    PubMed Central

    Eiseman, Nathaniel A.; Westover, M. Brandon; Mietus, Joseph E.; Thomas, Robert J.; Bianchi, Matt T.

    2013-01-01

    SUMMARY Identifying predictors of subjective sleepiness and severity of sleep apnea are important yet challenging goals in sleep medicine. Classification algorithms may provide insights, especially when large data sets are available. We analyzed polysomnography and clinical features available from the Sleep Heart Health Study. The Epworth Sleepiness Scale and the apnea–hypopnea index were the targets of three classifiers: k-nearest neighbor, naive Bayes and support vector machine algorithms. Classification was based on up to 26 features including demographics, polysomnogram, and electrocardiogram (spectrogram). Naive Bayes was best for predicting abnormal Epworth class (0–10 versus 11–24), although prediction was weak: polysomnogram features had 16.7% sensitivity and 88.8% specificity; spectrogram features had 5.3% sensitivity and 96.5% specificity. The support vector machine performed similarly to naive Bayes for predicting sleep apnea class (0–5 versus >5): 59.0% sensitivity and 74.5% specificity using clinical features and 43.4% sensitivity and 83.5% specificity using spectrographic features compared with the naive Bayes classifier, which had 57.5% sensitivity and 73.7% specificity (clinical), and 39.0% sensitivity and 82.7% specificity (spectrogram). Mutual information analysis confirmed the minimal dependency of the Epworth score on any feature, while the apnea–hypopnea index showed modest dependency on body mass index, arousal index, oxygenation and spectrogram features. Apnea classification was modestly accurate, using either clinical or spectrogram features, and showed lower sensitivity and higher specificity than common sleep apnea screening tools. Thus, clinical prediction of sleep apnea may be feasible with easily obtained demographic and electrocardiographic analysis, but the utility of the Epworth is questioned by its minimal relation to clinical, electrocardiographic, or polysomnographic features. PMID:21752133

  6. Length of Individual Apnea Events Is Increased by Supine Position and Modulated by Severity of Obstructive Sleep Apnea

    PubMed Central

    Töyräs, Juha; Muraja-Murro, Anu; Kupari, Salla; Tiihonen, Pekka; Mervaala, Esa; Kulkas, Antti

    2016-01-01

    Positional obstructive sleep apnea (OSA) is common among OSA patients. In severe OSA, the obstruction events are longer in supine compared to nonsupine positions. Corresponding scientific information on mild and moderate OSA is lacking. We studied whether individual obstruction and desaturation event severity is increased in supine position in all OSA severity categories and whether the severity of individual events is linked to OSA severity categories. Polygraphic recordings of 2026 patients were retrospectively analyzed. The individual apnea, and hypopnea durations and desaturation event depth, duration, and area of 526 included patients were compared between supine and nonsupine positions in different OSA severity categories. Apnea events were 6.3%, 12.5%, and 11.1% longer (p < 0.001) in supine compared to nonsupine position in mild, moderate, and severe OSA categories, respectively. In moderate and severe OSA categories desaturation areas were 5.7% and 25.5% larger (p < 0.001) in supine position. In both positions the individual event severity was elevated along increasing OSA severity category (p < 0.05). Supine position elevates apnea duration in all and desaturation area in moderate and severe OSA severity categories. This might be more hazardous for supine OSA patients and therefore, estimation of clinical severity of OSA should incorporate also information about individual event characteristics besides AHI. PMID:27051535

  7. Obstructive sleep apnea is a common disorder in the population—a review on the epidemiology of sleep apnea

    PubMed Central

    Lindberg, Eva

    2015-01-01

    The prevalence of obstructive sleep apnea (OSA) defined at an apnea-hypopnea index (AHI) ≥5 was a mean of 22% (range, 9-37%) in men and 17% (range, 4-50%) in women in eleven published epidemiological studies published between 1993 and 2013. OSA with excessive daytime sleepiness occurred in 6% (range, 3-18%) of men and in 4% (range, 1-17%) of women. The prevalence increased with time and OSA was reported in 37% of men and in 50% of women in studies from 2008 and 2013 respectively. OSA is more prevalent in men than in women and increases with age and obesity. Smoking and alcohol consumption are also suggested as risk factors, but the results are conflicting. Excessive daytime sleepiness is suggested as the most important symptom of OSA, but only a fraction of subjects with AHI >5 report daytime sleepiness and one study did not find any relationship between daytime sleepiness and sleep apnea in women. Stroke and hypertension and coronary artery disease are associated with sleep apnea. Cross-sectional studies indicate an association between OSA and diabetes mellitus. Patients younger than 70 years run an increased risk of early death if they suffer from OSA. It is concluded that OSA is highly prevalent in the population. It is related to age and obesity. Only a part of subjects with OSA in the population have symptoms of daytime sleepiness. The prevalence of OSA has increased in epidemiological studies over time. Differences and the increase in prevalence of sleep apnea are probably due to different diagnostic equipment, definitions, study design and characteristics of included subjects including effects of the obesity epidemic. Cardiovascular disease, especially stroke is related to OSA, and subjects under the age of 70 run an increased risk of early death if they suffer from OSA. PMID:26380759

  8. Elevated Body Position Early after Delivery Increased Airway Size during Wakefulness, and Decreased Apnea Hypopnea Index in a Woman with Pregnancy Related Sleep Apnea

    PubMed Central

    Jung, Stefanie; Zaremba, Sebastian; Heisig, Anne; Eikermann, Matthias

    2014-01-01

    We report a patient with pregnancy related obstructive sleep apnea ([OSA]; apnea hypopnea index [AHI] 18/h) early after delivery, with improvement of AHI by 87% following 45-degree elevation in body position compared with the non-elevated position. Improvement associated with this position may be explained, at least in part, by an increased upper airway diameter (as measured during wakefulness). Sleep apnea in this patient resolved at 9 months postpartum. This observation suggests that 45-degree elevated body position may be an effective treatment of pregnancy related OSA during the postpartum period. Citation: Jung S, Zaremba S, Heisig A, Eikermann M. Elevated body position early after delivery increased airway size during wakefulness, and decreased apnea hypopnea index in a woman with pregnancy related sleep apnea. J Clin Sleep Med 2014;10(7):815-817. PMID:25024663

  9. Daytime sleepiness in obesity: mechanisms beyond obstructive sleep apnea--a review.

    PubMed

    Panossian, Lori A; Veasey, Sigrid C

    2012-05-01

    Increasing numbers of overweight children and adults are presenting to sleep medicine clinics for evaluation and treatment of sleepiness. Sleepiness negatively affects quality of life, mental health, productivity, and safety. Thus, it is essential to comprehensively address all potential causes of sleepiness. While many obese individuals presenting with hypersomnolence will be diagnosed with obstructive sleep apnea and their sleepiness will improve with effective therapy for sleep apnea, a significant proportion of patients will continue to have hypersomnolence. Clinical studies demonstrate that obesity without sleep apnea is also associated with a higher prevalence of hypersomnolence and that bariatric surgery can markedly improve hypersomnolence before resolution of obstructive sleep apnea. High fat diet in both humans and animals is associated with hypersomnolence. This review critically examines the relationships between sleepiness, feeding, obesity, and sleep apnea and then discusses the hormonal, metabolic, and inflammatory mechanisms potentially contributing to hypersomnolence in obesity, independent of sleep apnea and other established causes of excessive daytime sleepiness. PMID:22547886

  10. Pathologic apnea and brief respiratory pauses in preterm infants: relation to sleep state.

    PubMed

    Holditch-Davis, D; Edwards, L J; Wigger, M C

    1994-01-01

    The development of pathologic apnea, respiratory pauses, and periodic respiration was examined in 71 high-risk preterm infants, observed weekly. Respiration was recorded every 10 seconds; apnea length and periodic respiration were scored from a tape. All subjects had respiratory pauses, and 36 had pathologic apnea. The mean length of respiratory pauses was longer in quiet sleep, and the frequency of respiratory pauses was greater in active sleep. The mean length of respiratory pauses and probability of pathologic apnea in both sleep states and frequency of pauses in quiet sleep decreased with age. Sex, theophylline treatment, race, and length of mechanical ventilation affected the developmental trajectories of some apnea variables. Apnea in preterm infants cannot be considered a unitary phenomenon. PMID:7937176

  11. Apnea after awake-regional and general anesthesia in infants: The General Anesthesia compared to Spinal anesthesia (GAS) study: comparing apnea and neurodevelopmental outcomes, a randomized controlled trial

    PubMed Central

    Davidson, Andrew J.; Morton, Neil S.; Arnup, Sarah J.; de Graaff, Jurgen C.; Disma, Nicola; Withington, Davinia E.; Frawley, Geoff; Hunt, Rodney W.; Hardy, Pollyanna; Khotcholava, Magda; von Ungern Sternberg, Britta S.; Wilton, Niall; Tuo, Pietro; Salvo, Ida; Ormond, Gillian; Stargatt, Robyn; Locatelli, Bruno Guido; McCann, Mary Ellen

    2015-01-01

    Background Post-operative apnea is a complication in young infants. Awake-regional anesthesia (RA) may reduce the risk; however the evidence is weak. The General Anesthesia compared to Spinal anesthesia (GAS) study is a randomized, controlled, trial designed to assess the influence of general anesthesia (GA) on neurodevelopment. A secondary aim is to compare rates of apnea after anesthesia. Methods Infants ≤ 60 weeks postmenstrual age scheduled for inguinal herniorraphy were randomized to RA or GA. Exclusion criteria included risk factors for adverse neurodevelopmental outcome and infants born < 26 weeks’ gestation. The primary outcome of this analysis was any observed apnea up to 12 hours post-operatively. Apnea assessment was unblinded. Results 363 patients were assigned to RA and 359 to GA. Overall the incidence of apnea (0 to 12 hours) was similar between arms (3% in RA and 4% in GA arms, Odds Ratio (OR) 0.63, 95% Confidence Intervals (CI): 0.31 to 1.30, P=0.2133), however the incidence of early apnea (0 to 30 minutes) was lower in the RA arm (1% versus 3%, OR 0.20, 95%CI: 0.05 to 0.91, P=0.0367). The incidence of late apnea (30 minutes to 12 hours) was 2% in both RA and GA arms (OR 1.17, 95%CI: 0.41 to 3.33, P=0.7688). The strongest predictor of apnea was prematurity (OR 21.87, 95% CI 4.38 to 109.24) and 96% of infants with apnea were premature. Conclusions RA in infants undergoing inguinal herniorraphy reduces apnea in the early post-operative period. Cardio-respiratory monitoring should be used for all ex-premature infants. PMID:26001033

  12. Peripheral chemoreflex inhibition with low-dose dopamine: new insight into mechanisms of extreme apnea.

    PubMed

    Bain, Anthony R; Dujic, Zeljko; Hoiland, Ryan L; Barak, Otto F; Madden, Dennis; Drvis, Ivan; Stembridge, Mike; MacLeod, David B; MacLeod, Douglas M; Ainslie, Philip N

    2015-11-01

    The purpose of this study was to determine the impact of peripheral chemoreflex inhibition with low-dose dopamine on maximal apnea time, and the related hemodynamic and cerebrovascular responses in elite apnea divers. In a randomized order, participants performed a maximal apnea while receiving either intravenous 2 μg·kg(-1)·min(-1) dopamine or volume-matched saline (placebo). The chemoreflex and hemodynamic response to dopamine was also assessed during hypoxia [arterial O2 tension, (PaO2 ) ∼35 mmHg] and mild hypercapnia [arterial CO2 tension (PaCO2 ) ∼46 mmHg] that mimicked the latter parts of apnea. Outcome measures included apnea duration, arterial blood gases (radial), heart rate (HR, ECG), mean arterial pressure (MAP, intra-arterial), middle (MCAv) and posterior (PCAv) cerebral artery blood velocity (transcranial ultrasound), internal carotid (ICA) and vertebral (VA) artery blood flow (ultrasound), and the chemoreflex responses. Although dopamine depressed the ventilatory response by 27 ± 41% (vs. placebo; P = 0.01), the maximal apnea duration was increased by only 5 ± 8% (P = 0.02). The PaCO2 and PaO2 at apnea breakpoint were similar (P > 0.05). When compared with placebo, dopamine increased HR and decreased MAP during both apnea and chemoreflex test (P all <0.05). At rest, dopamine compared with placebo dilated the ICA (3.0 ± 4.1%, P = 0.05) and VA (6.6 ± 5.0%, P < 0.01). During apnea and chemoreflex test, conductance of the cerebral vessels (ICA, VA, MCAv, PCAv) was increased with dopamine; however, flow (ICA and VA) was similar. At least in elite apnea divers, the small increase in apnea time and similar PaO2 at breakpoint (∼31 mmHg) suggest the apnea breakpoint is more related to PaO2 , rather than peripheral chemoreflex drive to breathe. PMID:26290106

  13. American Thoracic Society patient information series. Other therapies for sleep apnea.

    PubMed

    2015-01-15

    Treatment is needed for obstructive sleep apnea (OSA) because untreated OSA can result in serious health problems. Continuous positive airway pressure (CPAP) therapy is the most common treatment used for obstructive sleep apnea (OSA). (see ATS Patient Series http://patients.thoracic.org/wp-content/uploads/ 2014/03/obstructive-sleep-apnea.pdf) For those who cannot use CPAP or want to try another option, there are other therapies that can work for people with OSA. PMID:25590163

  14. Personalized Medicine for Obstructive Sleep Apnea Therapies: Are We There Yet?

    PubMed

    Edwards, Bradley A; Landry, Shane; Joosten, Simon A; Hamilton, Garun S

    2016-09-01

    Currently there is no method to predict which treatments for obstructive sleep apnea will have the best outcomes in individual patients. Given that there is increasing interest in a personalized medicine approach to the treatment of a variety of disorders, this review describes the personalized approaches that are currently available for the treatment of obstructive sleep apnea as well as future directions for individualized obstructive sleep apnea treatment. PMID:27542876

  15. Tetraplegia is a risk factor for central sleep apnea.

    PubMed

    Sankari, Abdulghani; Bascom, Amy T; Chowdhuri, Susmita; Badr, M Safwan

    2014-02-01

    Sleep-disordered breathing (SDB) is highly prevalent in patients with spinal cord injury (SCI); the exact mechanism(s) or the predictors of disease are unknown. We hypothesized that patients with cervical SCI (C-SCI) are more susceptible to central apnea than patients with thoracic SCI (T-SCI) or able-bodied controls. Sixteen patients with chronic SCI, level T6 or above (8 C-SCI, 8 T-SCI; age 42.5 ± 15.5 years; body mass index 25.9 ± 4.9 kg/m(2)) and 16 matched controls were studied. The hypocapnic apneic threshold and CO2 reserve were determined using noninvasive ventilation. For participants with spontaneous central apnea, CO2 was administered until central apnea was abolished, and CO2 reserve was measured as the difference in end-tidal CO2 (PetCO2) before and after. Steady-state plant gain (PG) was calculated from PetCO2 and VE ratio during stable sleep. Controller gain (CG) was defined as the ratio of change in VE between control and hypopnea or apnea to the ΔPetCO2. Central SDB was more common in C-SCI than T-SCI (63% vs. 13%, respectively; P < 0.05). Mean CO2 reserve for all participants was narrower in C-SCI than in T-SCI or control group (-0.4 ± 2.9 vs.-2.9 ± 3.3 vs. -3.0 ± 1.2 l·min(-1)·mmHg(-1), respectively; P < 0.05). PG was higher in C-SCI than in T-SCI or control groups (10.5 ± 2.4 vs. 5.9 ± 2.4 vs. 6.3 ± 1.6 mmHg·l(-1)·min(-1), respectively; P < 0.05) and CG was not significantly different. The CO2 reserve was an independent predictor of apnea-hypopnea index. In conclusion, C-SCI had higher rates of central SDB, indicating that tetraplegia is a risk factor for central sleep apnea. Sleep-related hypoventilation may play a significant role in the mechanism of SDB in higher SCI levels. PMID:24114704

  16. CPAP for Prevention of Cardiovascular Events in Obstructive Sleep Apnea.

    PubMed

    McEvoy, R Doug; Antic, Nick A; Heeley, Emma; Luo, Yuanming; Ou, Qiong; Zhang, Xilong; Mediano, Olga; Chen, Rui; Drager, Luciano F; Liu, Zhihong; Chen, Guofang; Du, Baoliang; McArdle, Nigel; Mukherjee, Sutapa; Tripathi, Manjari; Billot, Laurent; Li, Qiang; Lorenzi-Filho, Geraldo; Barbe, Ferran; Redline, Susan; Wang, Jiguang; Arima, Hisatomi; Neal, Bruce; White, David P; Grunstein, Ron R; Zhong, Nanshan; Anderson, Craig S

    2016-09-01

    Background Obstructive sleep apnea is associated with an increased risk of cardiovascular events; whether treatment with continuous positive airway pressure (CPAP) prevents major cardiovascular events is uncertain. Methods After a 1-week run-in period during which the participants used sham CPAP, we randomly assigned 2717 eligible adults between 45 and 75 years of age who had moderate-to-severe obstructive sleep apnea and coronary or cerebrovascular disease to receive CPAP treatment plus usual care (CPAP group) or usual care alone (usual-care group). The primary composite end point was death from cardiovascular causes, myocardial infarction, stroke, or hospitalization for unstable angina, heart failure, or transient ischemic attack. Secondary end points included other cardiovascular outcomes, health-related quality of life, snoring symptoms, daytime sleepiness, and mood. Results Most of the participants were men who had moderate-to-severe obstructive sleep apnea and minimal sleepiness. In the CPAP group, the mean duration of adherence to CPAP therapy was 3.3 hours per night, and the mean apnea-hypopnea index (the number of apnea or hypopnea events per hour of recording) decreased from 29.0 events per hour at baseline to 3.7 events per hour during follow-up. After a mean follow-up of 3.7 years, a primary end-point event had occurred in 229 participants in the CPAP group (17.0%) and in 207 participants in the usual-care group (15.4%) (hazard ratio with CPAP, 1.10; 95% confidence interval, 0.91 to 1.32; P=0.34). No significant effect on any individual or other composite cardiovascular end point was observed. CPAP significantly reduced snoring and daytime sleepiness and improved health-related quality of life and mood. Conclusions Therapy with CPAP plus usual care, as compared with usual care alone, did not prevent cardiovascular events in patients with moderate-to-severe obstructive sleep apnea and established cardiovascular disease. (Funded by the National Health and

  17. A Measure of Ventilatory Variability at Wake-Sleep Transition Predicts Sleep Apnea Severity

    PubMed Central

    Ibrahim, Lamia H; Patel, Sanjay R; Modarres, Mohammad; Johnson, Nathan L; Mehra, Reena; Kirchner, H. Lester; Redline, Susan

    2009-01-01

    Rationale Increased variability in ventilation may contribute to the pathogenesis of obstructive sleep apnea (OSA) by promoting ventilatory instability, fluctuations of neuromuscular output to the upper airway, and pharyngeal collapsibility. We assessed the association of a measure of ventilatory variability measured at the wake-sleep transition with OSA and associated covariates. Methods 485 participants in the Cleveland Family Study underwent overnight polysomnography with independent derivation of the Ventilatory Variability Index and the Apnea Hypopnea Index. The Ventilatory Variability Index was calculated from the variability in the power spectrum of the abdominal inductance signal over a 2-minute period beginning at sleep onset. Results The Ventilatory Variability Index was strongly correlated with the Apnea Hypopnea Index (r=0.43, p<0.001). After adjusting for age, body mass index, sex, and race, the Ventilatory Variability Index remained significantly associated with Apnea Hypopnea Index (p<0.001). The adjusted odds ratio for obstructive sleep apnea (Apnea Hypopnea Index ≥ 15) with each half standard deviation increase in Ventilatory Variability Index was 1.41 [1.25–1.59]. In a subgroup analysis of obese snorers, to limit analyses to those with a presumed anatomic predisposition for apnea, Ventilatory Variability Index remained associated with an elevated Apnea Hypopnea Index. Conclusions Increased ventilatory variability may be a useful phenotype in characterizing obstructive sleep apnea. PMID:18347208

  18. Reduced evoked motor and sensory potential amplitudes in obstructive sleep apnea patients.

    PubMed

    Mihalj, Mario; Lušić, Linda; Đogaš, Zoran

    2016-06-01

    It is unknown to what extent chronic intermittent hypoxaemia in obstructive sleep apnea causes damage to the motor and sensory peripheral nerves. It was hypothesized that patients with obstructive sleep apnea would have bilaterally significantly impaired amplitudes of both motor and sensory peripheral nerve-evoked potentials of both lower and upper limbs. An observational study was conducted on 43 patients with obstructive sleep apnea confirmed by the whole-night polysomnography, and 40 controls to assess the relationship between obstructive sleep apnea and peripheral neuropathy. All obstructive sleep apnea subjects underwent standardized electroneurographic testing, with full assessment of amplitudes of evoked compound muscle action potentials, sensory neural action potentials, motor and sensory nerve conduction velocities, and distal motor and sensory latencies of the median, ulnar, peroneal and sural nerves, bilaterally. All nerve measurements were compared with reference values, as well as between the untreated patients with obstructive sleep apnea and control subjects. Averaged compound muscle action potential and sensory nerve action potential amplitudes were significantly reduced in the nerves of both upper and lower limbs in patients with obstructive sleep apnea compared with controls (P < 0.001). These results confirmed that patients with obstructive sleep apnea had significantly lower amplitudes of evoked action potentials of both motor and sensory peripheral nerves. Clinical/subclinical axonal damage exists in patients with obstructive sleep apnea to a greater extent than previously thought. PMID:26749257

  19. A home sleep apnea screening device with time-domain signal processing and autonomous scoring capability.

    PubMed

    Jin, Jiayi; Sánchez-Sinencio, Edgar

    2015-02-01

    Current solutions of sleep apnea diagnosis require the patient to undergo overnight studies at a specialized sleep laboratory. Due to such inconvenience and high cost, millions of sleep apnea patients remain undiagnosed and thus untreated. Based on a micro-electro-mechanical systems (MEMS) sensor and an effective apnea detection algorithm, we propose a low-cost single-channel apnea screening solution applicable in the comfort of patients' homes. A prototype device was designed and assembled including a MEMS sensor for measuring the patient's nasal air flows, and a time-domain signal processing IC for apnea detection and autonomous scoring. The IC chip was fabricated in standard 0.5- μm CMOS technology. The proposed device was tested for both respiratory rhythm detection and sleep apnea screening under clinical environment. Apnea-hypopnea indices (AHI) were scored to indicate severity of sleep apnea conditions. Test results suggest that the proposed device can be a valuable screening solution for the broader public with undiagnosed apnea conditions. PMID:25486649

  20. Anteroposterior difference in EEG sleep depth measure is reduced in apnea patients.

    PubMed

    Huupponen, Eero; Saastamoinen, Antti; Joutsen, Atte; Virkkala, Jussi; Alametsä, Jarmo; Hasan, Joel; Värri, Alpo; Himanen, Sari-Leena

    2005-10-01

    In the present work, mean frequencies of FFT amplitude spectra from six EEG derivations were used to provide a frontopolar, a central and an occipital sleep depth measure. Parameters quantifying the anteroposterior differences in these three sleep depth measures during the night were also developed. The method was applied to analysis of 30 all-night recordings from 15 healthy control subjects and 15 apnea patients. Control subjects showed larger differences in sleep depth between frontopolar and central positions than the apnea patients. The relatively reduced frontal sleep depth in apnea patients might reflect the disruption of the dynamic sleep process caused by apneas. PMID:16180488

  1. A Novel Echocardiographic Method for Assessing Arterial Stiffness in Obstructive Sleep Apnea Syndrome

    PubMed Central

    Akyol, Aytac; Cakmak, Huseyin Altug; Gunbatar, Hulya; Asker, Muntecep; Babat, Naci; Tosu, Aydin Rodi; Yaman, Mehmet; Gumrukcuoglu, Hasan Ali

    2015-01-01

    Background and Objectives Obstructive sleep apnea syndrome (OSAS) is associated with increased arterial stiffness and cardiovascular complications. The objective of this study was to assess whether the color M-mode-derived propagation velocity of the descending thoracic aorta (aortic velocity propagation, AVP) was an echocardiographic marker for arterial stiffness in OSAS. Subjects and Methods The study population included 116 patients with OSAS and 90 age and gender-matched control subjects. The patients with OSAS were categorized according to their apnea hypopnea index (AHI) as follows: mild to moderate degree (AHI 5-30) and severe degree (AHI≥30). Aortofemoral pulse wave velocity (PWV), carotid intima-media thickness (CIMT), brachial artery flow-mediated dilatation (FMD), and AVP were measured to assess arterial stiffness. Results AVP and FMD were significantly decreased in patients with OSAS compared to controls (p<0.001). PWV and CIMT were increased in the OSAS group compared to controls (p<0.001). Moreover, AVP and FMD were significantly decreased in the severe OSAS group compared to the mild to moderate OSAS group (p<0.001). PWV and CIMT were significantly increased in the severe group compared to the mild to moderate group (p<0.001). AVP was significantly positively correlated with FMD (r=0.564, p<0.001). However, it was found to be significantly inversely related to PWV (r=-0.580, p<0.001) and CIMT (r=-0.251, p<0.001). Conclusion The measurement of AVP is a novel and practical echocardiographic method, which may be used to identify arterial stiffness in OSAS. PMID:26617653

  2. Maxillomandibular Advancement in the Management of Obstructive Sleep Apnea

    PubMed Central

    Varghese, Ranji; Adams, Nathan G.; Slocumb, Nancy L.; Viozzi, Christopher F.; Ramar, Kannan; Olson, Eric J.

    2012-01-01

    Maxillomandibular advancement (MMA) is a surgical option for obstructive sleep apnea (OSA). MMA involves forward-fixing the maxilla and mandible approximately 10  mm via Le Fort I maxillary and sagittal split mandibular osteotomies. We retrospectively reviewed outcomes from 24 consecutive OSA patients who underwent MMA at our institution. MMA resulted in an 83% reduction in the group mean apnea-hypopnea index (AHI) per polysomnography an average of 6.7 months after surgery. Forty-two percent of patients achieved a post-MMA AHI of less than 5 events/hour sleep and 71% achieved an AHI less than or equal to 10 events/hour sleep. The Epworth Sleepiness Scale score decreased by an average of 5 post-surgery. No parameters predictive of cure for OSA by MMA were identified. PMID:22518154

  3. [Obstructive sleep apnea syndrome, endothelial dysfunction and coronary atherosclerosis].

    PubMed

    Dursunoğlu, Neşe; Dursunoğlu, Dursun

    2005-01-01

    In obstructive sleep apnea syndrome (OSAS), repetitive episodes of apnea cause increased sympathetic nerve activity, increased surges in arterial blood pressure, swings in intrathoracic pressure, oxidative stres, hypoxia and hypercapnia. The association of OSAS with some diseases, having endothelial dysfunction in their physiopathology, such as hypertension, diabetes mellitus, obesity, coronary artery diseases, stroke and heart failure is common. Increased sympathetic nerve activity and also endothelial dysfunction which are the results of hypoxia, have important roles in vascular complications of OSAS. When compared with healthy population, an important endothelial dysfunction in OSAS patients and relationship between OSAS severity and endothelial dysfunction have been shown. In this review, the relationship between OSAS and endothelial dysfunction was overviewed. PMID:16258893

  4. Simulated central apnea detection using the pressure variance.

    PubMed

    Townsend, Daphne I; Holtzman, Megan; Goubran, Rafik; Frize, Monique; Knoefel, Frank

    2009-01-01

    This paper presents use of an unobtrusive pressure sensor array for simulated central apnea detection. Data was collected from seven volunteers who performed a series of regular breathing and breath holding exercises to simulate central apneas. Results of the feature extraction from the breathing signals show that breathing events may be differentiated with epoch based variance calculations. Two approaches were considered: the single sensor approach and the multisensor vote approach. The multisensor vote approach can decrease false positives and increase the value of Matthew's Correlation Coefficient. The effect of lying position on correct classification was investigated by modifying the multisensor vote approach to reduce false positives segments caused by the balistocardiogram signal and as such increase sensitivity while maintaining a low false positive rate. Intersubject classification results had low variability in both approaches. PMID:19964320

  5. Hypoxia Inducible Factors and Hypertension: Lessons from Sleep Apnea Syndrome

    PubMed Central

    Nanduri, Jayasri; Peng, Ying-Jie; Yuan, Guoxiang; Kumar, Ganesh K.; Prabhakar, Nanduri R.

    2015-01-01

    Systemic hypertension is one of the most prevalent cardiovascular diseases. Sleep disordered breathing (SDB) with recurrent apnea is a major risk factor for developing essential hypertension. Chronic intermittent hypoxia (CIH) is a hallmark manifestation of recurrent apnea. Rodent models patterned after the O2 profiles seen with SDB patients showed that CIH is the major stimulus for causing systemic hypertension. This article reviews the physiological and molecular basis of CIH-induced hypertension. Physiological studies have identified that augmented carotid body chemosensory reflex and the resulting increase in sympathetic nerve activity is a major contributor to CIH-induced hypertension. Analysis of molecular mechanisms revealed that CIH activates hypoxia-inducible factor (HIF)-1 and suppresses HIF-2- mediated transcription. Dysregulation of HIF-1- and HIF-2- mediated transcription leads to imbalance of pro-oxidant and anti-oxidant enzyme gene expression resulting in increased reactive species (ROS) generation in the chemosensory reflex which is central for developing hypertension. PMID:25772710

  6. Fatal Consequences: Obstructive Sleep Apnea in a Train Engineer

    PubMed Central

    McKay, Mary Pat

    2015-01-01

    This special report describes the findings of the National Transportation Safety Board’s investigation into the probable cause of the derailment of a Metro-North passenger train in the Bronx, New York on December 1, 2013, that resulted in 4 deaths and injuries to 59 additional persons. A key finding in the medical investigation was the engineer’s post-accident diagnosis of severe, obstructive sleep apnea, and the probable cause of the accident was determined to be the result of the engineer having fallen asleep while operating the train. This accident highlights the importance of screening, evaluating, and ensuring adequate treatment of obstructive sleep apnea, particularly among patients working in positions where impairment of physical or cognitive function or sudden incapacitation may result in serious harm to the public. PMID:26553898

  7. Obstructive sleep apnea and insight into mechanisms of sympathetic overactivity

    PubMed Central

    Abboud, François; Kumar, Ravinder

    2014-01-01

    Nearly two decades ago, we evaluated ten patients with obstructive sleep apnea (OSA). We determined that alarming nocturnal oscillations in arterial pressure and sympathetic nerve activity (SNA) were caused by regulatory coupling and neural interactions among SNA, apnea, and ventilation. Patients with OSA exhibited high levels of SNA when awake, during normal ventilation, and during normoxia, which contributed to hypertension and organ damage. Additionally, we achieved a beneficial and potentially lifesaving reduction in SNA through the application of continuous positive airway pressure (CPAP), which remains a primary therapeutic approach for patients with OSA. With these results in hindsight, we herein discuss three concepts with functional and therapeutic relevance to the integrative neurobiology of autonomic cardiovascular control and to the mechanisms involved in excessive sympathoexcitation in OSA. PMID:24691480

  8. Fatal Consequences: Obstructive Sleep Apnea in a Train Engineer.

    PubMed

    McKay, Mary Pat

    2015-11-01

    This special report describes the findings of the National Transportation Safety Board's investigation into the probable cause of the derailment of a Metro-North passenger train in the Bronx, New York on December 1, 2013, that resulted in 4 deaths and injuries to 59 additional persons. A key finding in the medical investigation was the engineer's post-accident diagnosis of severe, obstructive sleep apnea, and the probable cause of the accident was determined to be the result of the engineer having fallen asleep while operating the train. This accident highlights the importance of screening, evaluating, and ensuring adequate treatment of obstructive sleep apnea, particularly among patients working in positions where impairment of physical or cognitive function or sudden incapacitation may result in serious harm to the public. PMID:26553898

  9. New Technologies for the Diagnosis of Sleep Apnea.

    PubMed

    Alshaer, Hisham

    2016-01-01

    Sleep Apnea is a very common condition that has serious cardiovascular sequelae such as hypertension, heart failure, and stroke. Since the advent of modern computers and digital circuits, several streams of new technologies have been introduced to enhance the traditional diagnostic method of polysomnography and offer alternatives that are more accessible, comfortable, and economic. The categories presented in this review include portable polygraphy, mattress-like devices, remote sensing, and acoustic technologies. These innovations are classified as a function of their physical structure and the capabilities of their sensing technologies, due to the importance of these factors in determining the end-user experiences (both patients and medical professionals). Each of those categories offers unique strengths, which then make them particularly suitable for specific applications and end users. To our knowledge, this is a unique approach in presenting and classifying sleep apnea diagnostic innovations. PMID:26778198

  10. Cerebrovascular Reactivity in Young Subjects with Sleep Apnea

    PubMed Central

    Buterbaugh, John; Wynstra, Charles; Provencio, Natalie; Combs, Daniel; Gilbert, Michael; Parthasarathy, Sairam

    2015-01-01

    Study Objectives: Regional brain alterations may be involved in the pathogenesis and adverse consequences of obstructive sleep apnea (OSA). The objectives for the current study were to (1) determine cerebrovascular reactivity in the motor areas that control upper airway musculature in patients with OSA, and (2) determine whether young patients with OSA have decreased cerebrovascular reactivity in response to breath holding. Design: Case-control study. Setting: Academic center. Participants: Twelve subjects with OSA (age 24–42 y; apnea-hypopnea index 17; interquartile range [IQR] 9, 69 per hour) and control subjects (n = 10; age 29–44 y; AHI 2; IQR 1, 3 per hour). Measurements and Results: Subjects underwent blood oxygen level-dependent functional magnetic resonance imaging (BOLD-fMRI) while awake, swallowing, and breath holding. In subjects with OSA, during swallowing, there was less activity in the brainstem than in controls (P = 0.03) that remained reduced after adjusting for cortical motor strip activity (P = 0.036). In OSA subjects, brain regions of increased cerebrovascular reactivity (38; IQR 17, 96 cm3) was smaller than that in controls (199; IQR 5, 423 cm3; P = 0.01). In OSA subjects, brain regions of decreased cerebrovascular reactivity during breath hold was greater (P = 0.01), and the ratio of increased-to-decreased brain regions was lower than that of controls (P = 0.006). Adjustment for cerebral volumes, body mass index, and white matter lesions did not change these results substantively. Conclusions: In patients with obstructive sleep apnea (OSA), diminished change in brainstem activity during swallowing and reduced cerebrovascular reactivity may contribute to the etiopathogenesis and adverse cerebrovascular consequences, respectively. We speculate that decreased cerebral auto-regulation may be causative of gray matter loss in OSA. Citation: Buterbaugh J, Wynstra C, Provencio N, Combs D, Gilbert M, Parthasarathy S. Cerebrovascular reactivity in

  11. Association between Occupational Accidents and Sleep Apnea in Hospital Staff

    PubMed Central

    Hassani, Somayeh; Rahnama, Nooshin; Seyedmehdi, Seyed Mohammad; Roozbahani, Rahim; Attarchi, Mirsaeed; Adimi Naghan, Parisa; Jamaati, Hamidreza

    2015-01-01

    Background: Obstructive sleep apnea syndrome (OSAS) is a common disorder in which instability of the upper airways leads to a reduction or cessation of airflow during sleep. Sleep disorders such as OSAS increase the risk of occupational accidents and impaired work performance. Sleep deprivation during shift increases the risk of occupational accidents among health care employees. The purpose of this study was to determine the association between occupational injuries in hospital staff and the risk of sleep apnea. Materials and Methods: This cross-sectional study was conducted on hospital staff of Masih Daneshvari Hospital in 2012. In this study, the hospital staff’s (715) response to the Berlin questionnaire plus additional information including a history of an occupational accident, night shifts, less than four hours of night sleep, history of smoking, chronic disease and quality of sleep were assessed. Information obtained was analyzed using SPSS 15. Results: In general, 27.6% reported a history of occupational accidents. The incidence of occupational accidents in the high-risk group for sleep apnea was significantly higher than the low-risk group (OR=2.736, CI=1.522–4.917, P=0.001). The results of logistic regression analysis also showed a statistically significant association between occupational accidents and risk of sleep apnea (OR = 2.247, CI = 1.194–4.231, P= 0.012). Conclusion: This study showed that the incidence of occupational accidents in the hospital employees is strongly related to the probability of OSA. Therefore, special attention should be directed to respiratory sleep disorders in order to reduce occupational injuries at hospitals. PMID:26858766

  12. Ophthalmic Diseases in Patients With Obstructive Sleep Apnea.

    PubMed

    Skorin, Leonid; Knutson, Rachel

    2016-08-01

    Symptomatic obstructive sleep apnea (OSA) affects 2% of women and 4% of men, but the prevalence of asymptomatic OSA is significantly higher. Several ophthalmic conditions are associated with OSA, including floppy eyelid syndrome, glaucoma, nonarteritic anterior ischemic optic neuropathy, papilledema, keratoconus, and central serous chorioretinopathy. The purpose of this review is to provide primary care physicians with a general knowledge of the signs, symptoms, and management of the ophthalmic diseases associated with OSA. PMID:27455101

  13. CO(2) homeostasis during periodic breathing in obstructive sleep apnea.

    PubMed

    Berger, K I; Ayappa, I; Sorkin, I B; Norman, R G; Rapoport, D M; Goldring, R M

    2000-01-01

    The contribution of apnea to chronic hypercapnia in obstructive sleep apnea (OSA) has not been clarified. Using a model (D. M. Rapoport, R. G. Norman, and R. M. Goldring. J. Appl. Physiol. 75: 2302-2309, 1993), we previously illustrated failure of CO(2) homeostasis during periodic breathing resulting from temporal dissociation between ventilation and perfusion ("temporal V/Q mismatch"). This study measures acute kinetics of CO(2) during periodic breathing and addresses interapnea ventilatory compensation for maintenance of CO(2) homeostasis in 11 patients with OSA during daytime sleep (37-171 min). Ventilation and expiratory CO(2) and O(2) fractions were measured on a breath-by-breath basis by means of a tight-fitting full facemask. Calculations included CO(2) excretion, metabolic CO(2) production, and CO(2) balance (metabolic CO(2) production - exhaled CO(2)). CO(2) balance was tabulated for each apnea/hypopnea event-interevent cycle and as a cumulative value during sleep. Cumulative CO(2) balance varied (-3,570 to +1,388 ml). Positive cumulative CO(2) balance occurred in the absence of overall hypoventilation during sleep. For each cycle, positive CO(2) balance occurred despite increased interevent ventilation to rates as high as 45 l/min. This failure of CO(2) homeostasis was dependent on the event-to-interevent duration ratio. The results demonstrate that 1) periodic breathing provides a mechanism for acute hypercapnia in OSA, 2) acute hypercapnia during periodic breathing may occur without a decrease in average minute ventilation, supporting the presence of temporal V/Q mismatch, as predicted from our model, and 3) compensation for CO(2) accumulation during apnea/hypopnea may be limited by the duration of the interevent interval. The relationship of this acute hypercapnia to sustained chronic hypercapnia in OSA remains to be further explored. PMID:10642388

  14. Role of Sleep Apnea and Gastroesophageal Reflux in Severe Asthma.

    PubMed

    Rogers, Linda

    2016-08-01

    Gastroesophageal reflux and obstructive sleep apnea syndrome are conditions that practitioners have been encouraged to evaluate and treat as part of a comprehensive approach to achieving asthma control. In this review, the author looks at the evidence linking these two conditions as factors that may impact difficult-to-control asthma and looks critically at the evidence suggesting that evaluation and treatment of these conditions when present impacts asthma control. PMID:27401619

  15. Pharmacologic Approaches to the Treatment of Obstructive Sleep Apnea.

    PubMed

    White, David P

    2016-06-01

    The concept of pharmacologic therapy for obstructive sleep apnea (OSA) treatment has always been considered but no agent has had a large enough effect size to drive substantial adoption. A new construct of the pathophysiology of OSA is that there are 4 primary physiologic traits that dictate who develops OSA. These traits vary substantially between patients, meaning OSA may develop for quite different reasons. This encourages new thinking regarding pharmacologic therapy and continued attempts to find the ideal or acceptable drug. PMID:27236057

  16. Mechanical parameters determining pharyngeal collapsibility in patients with sleep apnea.

    PubMed

    Oliven, Arie; Kaufman, Eran; Kaynan, Rotem; Oliven, Ron; Steinfeld, Uri; Tov, Nave; Odeh, Majed; Gaitini, Luis; Schwartz, Alan R; Kimmel, Eitan

    2010-10-01

    The relative impact of mechanical factors on pharyngeal patency in patients with obstructive sleep apnea is poorly understood. The present study was designed to evaluate parameters of the "tube law" on pharyngeal pressure-flow relationships and collapsibility in patients with obstructive sleep apnea. We developed a mathematical model that considered the collapsible segment of the pharynx to represent an orifice of varying diameter. The model enabled us to assess the effects of pharyngeal compliance (C), neutral cross-sectional area (A(o)), external peripharyngeal pressure (P(ex)), and the resistance proximal to the site of collapse on flow mechanics and pharyngeal collapsibility [critical pressure (P(crit))]. All parameters were measured in 15 patients with obstructive sleep apnea under propofol anesthesia, both at rest and during mandibular advancement and electrical stimulation of the genioglossus. The data was used both to confirm the validity of the model and to compare expected and actual relationships between the tube-law parameters and the pharyngeal pressure-flow relationship and collapsibility. We found a close correlation between predicted and measured P(crit) (R = 0.98), including changes observed during pharyngeal manipulations. C and A(o) were closely and directly interrelated (R = 0.93) and did not correlate with P(crit). A significant correlation was found between P(ex) and P(crit) (R = 0.77; P < 0.01). We conclude that the pharynx of patients with obstructive sleep apnea can be modeled as an orifice with varying diameter. Pharyngeal compliance and A(o) are closely interrelated. Pharyngeal collapsibility depends primarily on the surrounding pressure. PMID:20576847

  17. Cocaine abuse and sleep apnea in severe obesity.

    PubMed

    Marzullo, Paolo; Menegatti, Mirta; Guzzaloni, Gabriele; Fanari, Paolo; Uccelli, Elvira; Tagliaferri, Maria Antonella; Aimaretti, Gianluca; Liuzzi, Antonio

    2013-01-01

    Obesity is a cause of sleep breathing disorders that result in excessive daytime sleepiness. We describe the adaptive strategy used by an obese person who started to snort cocaine to remedy incoercible drowsiness affecting his working financial skills. Clinical workup documented severe sleep apnea, which was treated by noninvasive ventilation and resulted in withdrawing cocaine abuse. Undiagnosed sleep disorders may trigger surreptitious psychostimulant abuse in vulnerable individuals. PMID:23519053

  18. [The surgical risk in sleep apnea: the implications for tonsillectomies].

    PubMed

    Pérez-Padilla, R; Vázquez-García, J C; Meza-Vargas, S

    1999-01-01

    Hypertrophy of tonsils or adenoids is the commonest cause of obstructive sleep apnea (OSA) in children. Adenotonsillectomy (AT) is frequently curative in children with OSA but riskier than the same procedure without OSA. It is crucial to identify OSA among the patients programmed for AT because they require a detailed evaluation, frequently including total or limited polysomnogram. Patients with OSA need a continuous surveillance before, during, and after surgery, ideally in a referral hospital. PMID:10596490

  19. Obstructive Sleep Apnea Syndrome in a Railroad Controller Worker.

    PubMed

    Raşcu, Agripina; Moise, Laura; Naghi, Eugenia; Handra, Claudia; Oţelea, Marina; Raşcu, Alexandra; Lăcătuşu, Lavinia

    2015-01-01

    Sleep Apnea Syndrome (SAS) constitutes a healthcare issue of major importance at international level with a prevalence of 5% in the active population. Consequentially to the induced co-morbidities, the mortality reaches as high as 39% at eight years time lapse from the initial diagnostic. Seldom undiagnosed, the severity spectrum of SAS, in the absence of therapy, only continues to amplify. Here below, we are presenting the case of a 49 years old patient, railroad controller worker, non-smoker and occasionally alcohol user, who was hospitalized in our Clinic for Occupational Medicine. During last year, the patient was accusing excessive daytime somnolence, breath arrests during sleep, intense snoring, morning headaches, morning oral dryness, pin point chest pain, nocturia (4-5 nocturnal urination), concentration difficulties and an overall reduced work capacity. The presumptive diagnostic of Obstructive Sleep Apnea is being considered based on the correlation between the clinical presentation and the Epworth, Stanford and Berlin questionnaire results. The key diagnostic element was the polygraph recording over an 8 hours sleep period. Positive Diagnosis: Obstructive Sleep Apnea severe form. Management and recommendations: (1) Behavioral therapy (weight loss) and (2) CPAP (Continuous Positive Airway Pressure) therapy which was instituted immediately after the positive diagnosis was made. As a consequence, the respiratory symptoms, the frequent episodes of daytime snoozing and the concentration difficulties at work place diminished considerably. PMID:26076566

  20. Effect of Oral Appliance for Snoring and Obstructive Sleep Apnea.

    PubMed

    Jaiswal, Madhu; Srivastava, Govind Narayan; Pratap, Chandra Bhanu; Sharma, Vipul Kumar; Chaturvedi, Thakur Prasad

    2015-01-01

    To analyze therapeutic and clinical efficacy of mandibular advancement device (MAD) on snoring and obstructive sleep apnea (OSA). Thirty patients with OSA were recruited on the basis ofpolysomnography with an Apnea and Hypopnea Index (AHI) greater than 5 but less than 30. Repeat polysomnography was performed in follow up with the appliance in place. MAD used in the study is Medical Dental Sleep Appliance (MDSA). It is a titratable appliance. With the appliance in position, the mandible was advanced to an extent that did not exceed 70% of maximum protrusion capacity; Vertical opening did not exceed on an average 3-4 mm beyond freeway space. Comparison of pre AHI scores (diagnostic PSG) with post AHI scores (PSG with OA in-situ) showed a decrease from Mean +/- SD 26.2367 +/- 6.53 to 13.7111 +/- 627. A highly significant (p < 0.001) improvement in AHI was observed. Pre and post ESS score showed a mean decrease from 14.2333 +/- 5.00 to 6.1481 +/- 2.46 MDSA is effective in reducing apnea hypopnea index scores and improving oxygen saturation level. PMID:26720958

  1. Evaluation of Anthropometric and Metabolic Parameters in Obstructive Sleep Apnea

    PubMed Central

    Yildirim, Yaşar; Yilmaz, Süreyya; Güven, Mehmet; Kılınç, Faruk; Kara, Ali Veysel; Yilmaz, Zülfükar; Kırbaş, Gökhan; Tuzcu, Alpaslan Kemal; Yılmaz Aydın, Fatma

    2015-01-01

    Aims. Sleep disorders have recently become a significant public health problem worldwide and have deleterious health consequences. Obstructive sleep apnea (OSA) is the most common type of sleep-related breathing disorders. We aimed to evaluate anthropometric measurements, glucose metabolism, and cortisol levels in patients with obstructive sleep apnea (OSA). Materials and Methods. A total of 50 patients with a body mass index ≥30 and major OSA symptoms were included in this study. Anthropometric measurements of the patients were recorded and blood samples were drawn for laboratory analysis. A 24-hour urine sample was also collected from each subject for measurement of 24-hour cortisol excretion. Patients were divided equally into 2 groups according to polysomnography results: control group with an apnea-hypopnea index (AHI) <5 (n = 25) and OSA group with an AHI ≥5 (n = 25). Results. Neck and waist circumference, fasting plasma glucose, HbA1c, late-night serum cortisol, morning serum cortisol after 1 mg dexamethasone suppression test, and 24-hour urinary cortisol levels were significantly higher in OSA patients compared to control subjects. Newly diagnosed DM was more frequent in patients with OSA than control subjects (32% versus 8%, p = 0.034). There was a significant positive correlation between AHI and neck circumference, glucose, and late-night serum cortisol. Conclusions. Our study indicates that increased waist and neck circumferences constitute a risk for OSA regardless of obesity status. In addition, OSA has adverse effects on endocrine function and glucose metabolism. PMID:26257957

  2. Predicting performance in competitive apnea diving. Part III: deep diving.

    PubMed

    Schagatay, Erika

    2011-12-01

    The first of these reviews described the physiological factors defining the limits of static apnea, while the second examined performance in apneic distance swimming. This paper reviews the factors determining performance in depth disciplines, where hydrostatic pressure is added to the stressors associated with apnea duration and physical work. Apneic duration is essential for performance in all disciplines, and is prolonged by any means that increases gas storage or tolerance to asphyxia or reduces metabolic rate. For underwater distance swimming, the main challenge is to restrict metabolism despite the work of swimming, and to redirect blood flow to allow the most vital functions. Here, work economy, local tissue energy and oxygen stores, anaerobic capacity of the muscles, and possibly technical improvements will be essential for further development. In the depth disciplines, direct pressure effects causing barotrauma, the narcotic effects of gases, decompression sickness (DCS) and possibly air embolism during ascent need to be taken into account, as does the risk of hypoxia when the dive cannot be rapidly interrupted before the surface is reached again. While in most deep divers apneic duration is not the main limitation thus far, greater depths may call for exceptionally long apneas and slower ascents to avoid DCS. Narcotic effects may also affect the ultimate depth limit, which the divers currently performing 'constant weight with fins' dives predict to be around 156 metres' sea water. To reach these depths, serious physiological challenges have to be met, technical developments needed and safety procedures developed concomitantly. PMID:22183699

  3. Fasting improves static apnea performance in elite divers without enhanced risk of syncope.

    PubMed

    Schagatay, Erika; Lodin-Sundström, Angelica

    2014-01-01

    In competitive apnea divers, the nutritional demands may be essentially different from those of, for example, endurance athletes, where energy resources need to be maximised for successful performance. In competitive apnea, the goal is instead to limit metabolism, as the length of the sustainable apneic period will depend to a great extent on minimising oxygen consumption. Many but not all elite divers fast before performing static apnea in competition. This may increase oxygen consumption as mainly lipid stores are metabolised but could also have beneficial effects on apneic duration. Our aim was to determine the effect of over-night fasting on apnea performance. Six female and seven male divers performed a series of three apneas after eating and fasting, respectively. The series consisted of two 2-min apneas spaced by 3 min rest and, after 5 min rest, one maximal effort apnea. Apneas were performed at supine rest and preceded by normal respiration and maximal inspiration. Mean (± SD) time since eating was 13 h (± 2 h 43 min) for the fasting and 1 h 34 min (± 33 min) for the eating condition (P < 0.001). Mean blood glucose was 5.1 (± 0.4) mmol/L after fasting and 5.9 (± 0.7) mmol/L after eating (P<0.01). Lung volumes were similar in both conditions (NS). For the 2-min apneas, nadir SaO2 during fasting was 95 (± 1)% and 92 (± 2)% (P < 0.001) on eating and ETCO2 was lower in the fasting condition (P < 0.01) while heart rate (HR) during apnea was 74 (± 10) bpm for fasting and 80 (± 10) bpm for eating conditions (P < 0.01). Maximal apnea durations were 4 min 41 s (± 43 s) during fasting and 3 min 51 s (± 37 s) after eating (P < 0.001), and time without respiratory contractions was 31 s (25%) longer after fasting (P < 0.01). At maximal apnea termination, SaO2 and ETCO2 were similar in both conditions (NS) and apneic HR was 63 (± 9) bpm for fasting and 70 (± 10) bpm for eating (P < 0.01). The 22% longer apnea duration after fasting with analogous end apnea

  4. Absence of Typical Symptoms and Comorbidities in Patients with Central Sleep Apnea.

    PubMed

    Yayan, Josef; Rasche, Kurt

    2015-01-01

    Sleep apnea is characterized by pauses in breathing during sleep. There are three forms: central, obstructive, and complex, or mixed sleep apnea. Central sleep apnea, a manifestation of respiratory instability in many clinical conditions and with a variety of causes, is the result of a temporary cessation of breathing in which the inhibitory influences favoring the instability predominate over excitatory influences favoring stable breathing. In contrast to central sleep apnea, according to the published data from previous studies, an association exists between obstructive sleep apnea and various comorbidities, especially chronic obstructive pulmonary disease. This article examines retrospectively the possible association of central sleep apnea with special sleep-related symptoms and various co-morbidities. Data of all patients with different types of central sleep apnea were collected from our hospital charts within the Department of Pneumology, HELIOS Clinic, University of Witten/Herdecke, Wuppertal, Germany, within the study period of January 1, 2011 to September 19, 2014. After clinical examination, all patients underwent polysomnography in our sleep laboratory. We identified a total of 60 (3.5 %) patients with central sleep apnea from 1722 patients with assumed sleep disordered breathing of the mean age of 68.2 ± 13.7 years (44 males - 73.3 %, 95 % CI 0.6-0.9 and 16 females - 26.7 %, 95 % CI 0.2-0.4). Typical symptoms of sleep-disordered breathing were not observed. A relation to co-morbidities was not found. Central sleep apnea was often diagnosed in the elderly. A direct association between central sleep apnea and symptoms of sleep-disordered breathing and various co-morbidities was not detected. This is in direct contrast to the obstructive sleep apnea syndrome. PMID:26269028

  5. Association of Obstructive Sleep Apnea Syndrome and Buerger's Disease: a Pilot Study.

    PubMed

    Kazemzadeh, Gholam Hosein; Bameshki, Ali Reza; Navvabi, Iman; Ahmadi Hoseini, Seyed Hosein; Taghavi Gilani, Mehryar

    2015-10-01

    In this study we evaluated the incidence and severity of obstructive sleep apnea and Obstructive sleep apnea syndrome in patients with thromboangiitis obliterans for reduction of crisis. In 40 patients with Buerger's disease daily sleepiness and risk of Obstructive sleep apnea were evaluated using the Epworth sleeping scale (ESS) and the Stop-Bang score. An Apnea-link device was used for evaluation of chest motion, peripheral oxygenation, and nasal airflow during night-time sleep. The apnea/hypopnea index (AHI) and respiratory disurbance index were used for Obstructive sleep apnea syndrome diagnosis. All subjects were cigarette smokers and 80% were opium addicted. The prevalence of Obstructive sleep apnea (AHI>5) was 80%, but incidence of Obstructive sleep apnea syndrome (AHI>5 + ESS≥10) was 5% (2/40). There was no association between duration or frequency of hospitalization and Obstructive sleep apnea syndrome (P=0.74 and 0.86, respectively). In addition, no correlation between ESS and Stop-Bang scores and AHI was observed (P=0.58 and 0.41, respectively). There was an inverse correlation between smoking rate and AHI (P=0.032, r = -0.48). We did not find an association between Buerger's disease and Obstructive sleep apnea syndrome. Although the AHI was high (80%) and daily sleepiness was low. The negative correlation of smoking with AHI and on the other hand daily napping in addiction may be caused by the absence of a clear relationship between Obstructive sleep apnea syndrome and Buerger's disease. PMID:26615374

  6. List based prefetch

    DOEpatents

    Boyle, Peter; Christ, Norman; Gara, Alan; Kim; ,Changhoan; Mawhinney, Robert; Ohmacht, Martin; Sugavanam, Krishnan

    2012-08-28

    A list prefetch engine improves a performance of a parallel computing system. The list prefetch engine receives a current cache miss address. The list prefetch engine evaluates whether the current cache miss address is valid. If the current cache miss address is valid, the list prefetch engine compares the current cache miss address and a list address. A list address represents an address in a list. A list describes an arbitrary sequence of prior cache miss addresses. The prefetch engine prefetches data according to the list, if there is a match between the current cache miss address and the list address.

  7. List based prefetch

    SciTech Connect

    Boyle, Peter; Christ, Norman; Gara, Alan; Kim, Changhoan; Mawhinney, Robert; Ohmacht, Martin; Sugavanam, Krishnan

    2014-08-12

    A list prefetch engine improves a performance of a parallel computing system. The list prefetch engine receives a current cache miss address. The list prefetch engine evaluates whether the current cache miss address is valid. If the current cache miss address is valid, the list prefetch engine compares the current cache miss address and a list address. A list address represents an address in a list. A list describes an arbitrary sequence of prior cache miss addresses. The prefetch engine prefetches data according to the list, if there is a match between the current cache miss address and the list address.

  8. The Effect of Aging and Severity of Sleep Apnea on Heart Rate Variability Indices in Obstructive Sleep Apnea Syndrome

    PubMed Central

    Song, Man-Kyu; Ha, Jee Hyun; Ryu, Seung-Ho; Yu, Jaehak

    2012-01-01

    Objective This study aims to analyze how much heart rate variability (HRV) indices discriminatively respond to age and severity of sleep apnea in the obstructive sleep apnea syndrome (OSAS). Methods 176 male OSAS patients were classified into four groups according to their age and apnea-hypopnea index (AHI). The HRV indices were compared via analysis of covariance (ANCOVA). In particular, the partial correlation method was performed to identify the most statistically significant HRV indices in the time and frequency domains. Stepwise multiple linear regressions were further executed to examine the effects of age, AHI, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), and sleep parameters on the significant HRV indices. Results The partial correlation analysis yielded the NN50 count (defined as the number of adjacent R-wave to R-wave intervals differing by more than 50 ms) and low frequency/high frequency (LF/HF) ratio to be two most statistically significant HRV indices in both time and frequency domains. The two indices showed significant differences between the groups. The NN50 count was affected by age (p<0.001) and DBP (p=0.039), while the LF/HF ratio was affected by AHI (p<0.001), the amount of Stage 2 sleep (p=0.005), and age (p=0.021) in the order named in the regression analysis. Conclusion The NN50 count more sensitively responded to age than to AHI, suggesting that the index is mainly associated with an age-related parasympathetic system. On the contrary, the LF/HF ratio responded to AHI more sensitively than to age, suggesting that it is mainly associated with a sympathetic tone likely reflecting the severity of sleep apnea. PMID:22396687

  9. Association of Smoking, Sleep Apnea, and Plasma Alkalosis With Nocturnal Ventricular Arrhythmias in Men With Systolic Heart Failure

    PubMed Central

    Shukla, Rakesh; Wexler, Laura

    2012-01-01

    Background: Excess sudden death due to ventricular tachyarrhythmias remains a major mode of mortality in patients with systolic heart failure. The aim of this study was to determine the association of nocturnal ventricular arrhythmias in patients with low ejection fraction heart failure. We incorporated a large number of known pathophysiologic triggers to identify potential targets for therapy to reduce the persistently high incidence of sudden death in this population despite contemporary treatment. Methods: Eighty-six ambulatory male patients with stable low (≤ 45%) ejection fraction heart failure underwent full-night attendant polysomnography and simultaneous Holter recordings. Patients were divided into groups according to the presence or absence of couplets (paired premature ventricular excitations) and ventricular tachycardia (VT) (at least three consecutive premature ventricular excitations) during sleep. Results: In multiple regression analysis, four variables (current smoking status, increased number of arousals, plasma alkalinity, and old age) were associated with VT and two variables (apnea-hypopnea index and low right ventricular ejection fraction) were associated with couplets during sleep. Conclusions: We speculate that cessation of smoking, effective treatment of sleep apnea, and plasma alkalosis could collectively decrease the incidence of nocturnal ventricular tachyarrhythmias and the consequent risk of sudden death, which remains high despite the use of β blockades. PMID:22172636

  10. Association of Obstructive Sleep Apnea Severity with Exercise Capacity and Health-related Quality of Life

    PubMed Central

    Butner, Katrina L; Hargens, Trent A; Kaleth, Anthony S; Miller, Larry E; Zedalis, Donald; Herbert, William G

    2013-01-01

    Background: Current research is inconclusive as to whether obstructive sleep apnea severity directly limits exercise capacity and lowers health-related quality of life (HRQoL). Aims: The aim of this study was to evaluate the association of obstructive sleep apnea severity with determinants of exercise capacity and HRQoL. Subjects and Methods: Subjects were evaluated by home somnography and classified as no obstructive sleep apnea (n = 43) or as having mild (n = 27), moderate or severe obstructive sleep apnea (n = 21). Exercise capacity was assessed by a ramping cycle ergometer test, and HRQoL was assessed with the SF-36 questionnaire. Results: Greater obstructive sleep apnea severity was associated with older age, higher body weight, higher body mass index, lower peak aerobic capacity, a higher percentage of peak aerobic capacity at a submaximal exercise intensity of 55 watts, and lower physical component summary score from the SF-36. None of these variables were statistically different among obstructive sleep apnea severity groups after controlling for age and body weight. Obstructive sleep apnea severity was not associated with any cardiorespiratory fitness or HRQoL parameter. Conclusions: Obstructive sleep apnea severity has no independent association with exercise capacity or HRQoL. PMID:23923110

  11. Overweight explains the increased red blood cell aggregation in patients with obstructive sleep apnea.

    PubMed

    Sinnapah, Stéphane; Cadelis, Gilbert; Waltz, Xavier; Lamarre, Yann; Connes, Philippe

    2015-01-01

    Sleep apnea patients and obese subjects are overexposed to cardiovascular diseases. These two health conditions may be associated with hemorheological alterations which could increase the cardiovascular risk. The present study investigated the hemorheological characteristics in patients with overweight and/or sleep apnea to identify the main predictor of red blood cell (RBC) abnormalities in sleep apnea patients. Ninety-seven patients were subjected to one night sleep polygraphy to determine their sleep apnea status. Body mass index (BMI) and the apnea/hypopnea index (AHI) were determined for categorization of obesity and sleep apnea status. Blood was sampled for hematocrit, blood viscosity, RBC deformability, aggregation and disaggregation threshold measurements. BMI and AHI were positively associated and were both positively associated with RBC aggregation. Analyses of covariance and multiple regression analyses revealed that BMI was more predictive of RBC aggregation than AHI. No association of BMI classes and AHI classes with RBC deformability or blood viscosity was observed. This study shows that increased RBC aggregation in sleep apnea patients is caused by overweight. Therapies to improve blood rheology in sleep apnea patients, and therefore reduce the risk for cardiovascular disorders, should focus on weight-loss. PMID:23271197

  12. Chiari malformation and central sleep apnea syndrome: efficacy of treatment with adaptive servo-ventilation*

    PubMed Central

    do Vale, Jorge Marques; Silva, Eloísa; Pereira, Isabel Gil; Marques, Catarina; Sanchez-Serrano, Amparo; Torres, António Simões

    2014-01-01

    The Chiari malformation type I (CM-I) has been associated with sleep-disordered breathing, especially central sleep apnea syndrome. We report the case of a 44-year-old female with CM-I who was referred to our sleep laboratory for suspected sleep apnea. The patient had undergone decompressive surgery 3 years prior. An arterial blood gas analysis showed hypercapnia. Polysomnography showed a respiratory disturbance index of 108 events/h, and all were central apnea events. Treatment with adaptive servo-ventilation was initiated, and central apnea was resolved. This report demonstrates the efficacy of servo-ventilation in the treatment of central sleep apnea syndrome associated with alveolar hypoventilation in a CM-I patient with a history of decompressive surgery. PMID:25410846

  13. Comorbidities Associated with Obstructive Sleep Apnea: a Retrospective Study

    PubMed Central

    Pinto, José Antonio; Ribeiro, Davi Knoll; Cavallini, Andre Freitas da Silva; Duarte, Caue; Freitas, Gabriel Santos

    2016-01-01

    Introduction Obstructive sleep apnea (OSA) is characterized by partial or complete recurrent upper airway obstruction during sleep. OSA brings many adverse consequences, such as hypertension, obesity, diabetes mellitus, cardiac and encephalic alterations, behavioral, among others, resulting in a significant source of public health care by generating a high financial and social impact. The importance of this assessment proves to be useful, because the incidence of patients with comorbidities associated with AOS has been increasing consistently and presents significant influence in natural disease history. Objective The objective of this study is to assess major comorbidities associated with obstructive sleep apnea (OSA) and prevalence in a group of patients diagnosed clinically and polysomnographically with OSA. Methods This is a retrospective study of 100 charts from patients previously diagnosed with OSA in our service between October 2010 and January 2013. Results We evaluated 100 patients with OSA (84 men and 16 women) with a mean age of 50.05 years (range 19–75 years). The prevalence of comorbidities were hypertension (39%), obesity (34%), depression (19%), gastroesophageal reflux disease (GERD) (18%), diabetes mellitus (15%), hypercholesterolemia (10%), asthma (4%), and no comorbidities (33%). Comorbidities occurred in 56.2% patients diagnosed with mild OSA, 67.6% with moderate OSA, and 70% of patients with severe OSA. Conclusion According to the current literature data and the values obtained in our paper, we can correlate through expressive values obesity with OSA and their apnea hypopnea index (AHI) values. However, despite significant prevalence of OSA with other comorbidities, our study could not render expressive significance values able to justify their correlations. PMID:27096019

  14. Optic Nerve Dysfunction in Obstructive Sleep Apnea: An Electrophysiological Study

    PubMed Central

    Liguori, Claudio; Palmieri, Maria Giuseppina; Pierantozzi, Mariangela; Cesareo, Massimo; Romigi, Andrea; Izzi, Francesca; Marciani, Maria Grazia; Oliva, Corrado; Mercuri, Nicola Biagio; Placidi, Fabio

    2016-01-01

    Study Objectives: The aim of this study was to evaluate the integrity of the visual system in patients affected by obstructive sleep apnea (OSA) by means of electroretinogram (ERG) and visual evoked potential (VEP). Methods: We performed electrophysiological study of the visual system in a population of severe OSA (apnea-hypopnea events/time in bed ≥ 30/h) patients without medical comorbidities compared to a group of healthy controls similar for age, sex, and body mass index. Patients and controls did not have visual impairment or systemic disorders with known influence on the visual system. ERG and VEP were elicited by a reversal pattern generated on a television monitor at low (55') and high (15') spatial frequencies stimulation. Daytime sleepiness was assessed using the Epworth Sleepiness Scale (ESS) in both patients and controls. Results: In comparison with healthy controls (n = 27), patients with OSA (n = 27) showed a significant latency delay coupled with a significant amplitude reduction of P100 wave of VEP at all spatial frequencies in both eyes. No significant differences between groups were detected as concerning ERG components. No correlations were found between polygraphic parameters, ESS scores, or VEP and ERG components in OSA patients. Conclusions: This study documented that patients with OSA, without medical comorbidities, present VEP alteration as documented by lower amplitude and longer latency of the P100 component than healthy controls. These altered electrophysiological findings may be the expression of optic nerve dysfunction provoked by hypoxia, acidosis, hypercarbia and airway obstruction, frequently observed in patients with OSA. Hence, we hypothesize that OSA per se may impair optic nerve function. Citation: Liguori C, Palmieri MG, Pierantozzi M, Cesareo M, Romigi A, Izzi F, Marciani MG, Oliva C, Mercuri NB, Placidi F. Optic nerve dysfunction in obstructive sleep apnea: an electrophysiological study. SLEEP 2016;39(1):19–23. PMID

  15. Comorbidities Associated with Obstructive Sleep Apnea: a Retrospective Study.

    PubMed

    Pinto, José Antonio; Ribeiro, Davi Knoll; Cavallini, Andre Freitas da Silva; Duarte, Caue; Freitas, Gabriel Santos

    2016-04-01

    Introduction Obstructive sleep apnea (OSA) is characterized by partial or complete recurrent upper airway obstruction during sleep. OSA brings many adverse consequences, such as hypertension, obesity, diabetes mellitus, cardiac and encephalic alterations, behavioral, among others, resulting in a significant source of public health care by generating a high financial and social impact. The importance of this assessment proves to be useful, because the incidence of patients with comorbidities associated with AOS has been increasing consistently and presents significant influence in natural disease history. Objective The objective of this study is to assess major comorbidities associated with obstructive sleep apnea (OSA) and prevalence in a group of patients diagnosed clinically and polysomnographically with OSA. Methods This is a retrospective study of 100 charts from patients previously diagnosed with OSA in our service between October 2010 and January 2013. Results We evaluated 100 patients with OSA (84 men and 16 women) with a mean age of 50.05 years (range 19-75 years). The prevalence of comorbidities were hypertension (39%), obesity (34%), depression (19%), gastroesophageal reflux disease (GERD) (18%), diabetes mellitus (15%), hypercholesterolemia (10%), asthma (4%), and no comorbidities (33%). Comorbidities occurred in 56.2% patients diagnosed with mild OSA, 67.6% with moderate OSA, and 70% of patients with severe OSA. Conclusion According to the current literature data and the values obtained in our paper, we can correlate through expressive values obesity with OSA and their apnea hypopnea index (AHI) values. However, despite significant prevalence of OSA with other comorbidities, our study could not render expressive significance values able to justify their correlations. PMID:27096019

  16. Associations between Cardioembolic Stroke and Obstructive Sleep Apnea

    PubMed Central

    Lipford, Melissa C.; Flemming, Kelly D.; Calvin, Andrew D.; Mandrekar, Jay; Brown, Robert D.; Somers, Virend K.; Caples, Sean M.

    2015-01-01

    Study Objectives: To assess etiology of ischemic stroke in patients with obstructive sleep apnea (OSA) compared with controls. This information may aid in determining how OSA increases stroke risk and facilitate recurrent stroke prevention in patients with OSA. Design: Retrospective, case-control study. Setting: Academic tertiary referral center. Patients: Consecutive patients who underwent polysomnography and had an ischemic stroke within 1 year were identified. Stroke subtype was determined using two validated algorithms. Polysomnographic results were used to separate patients into OSA cases and controls. Information regarding cardiovascular risks, neuroimaging, and echocardiographic data were collected. Interventions: N/A. Measurements and Results: In 53 subjects, cardioembolic (CE) strokes were more common among OSA cases than controls (72% versus 33%, P = 0.01). The majority of CE strokes occurred in those with moderate to severe OSA. Atrial fibrillation (AF) was more frequent in OSA cases (59% versus 24%, P = 0.01). The association between OSA and CE stroke remained significant after controlling for AF (P = 0.03, odds ratio 4.5). Conclusions: There appears to be a strong association between obstructive sleep apnea (OSA) and cardioembolic (CE) stroke. In patients with OSA presenting with cryptogenic stroke, high clinical suspicion for CE is warranted. This may lead to consideration of diagnostic studies to identify CE risk factors such as paroxysmal atrial fibrillation (AF). CE strokes are more common in patients with OSA even after adjusting for AF. This finding may reflect a high rate of occult paroxysmal AF in this population; alternatively, OSA may lead to CE strokes through mechanisms independent of AF. Citation: Lipford MC, Flemming KD, Calvin AD, Mandrekar J, Brown RD, Somers VK, Caples SM. Associations between cardioembolic stroke and obstructive sleep apnea. SLEEP 2015;38(11):1699–1705. PMID:26237769

  17. Overview of proteomics studies in obstructive sleep apnea

    PubMed Central

    Feliciano, Amélia; Torres, Vukosava Milic; Vaz, Fátima; Carvalho, Ana Sofia; Matthiesen, Rune; Pinto, Paula; Malhotra, Atul; Bárbara, Cristina; Penque, Deborah

    2015-01-01

    Obstructive sleep apnea (OSA) is an underdiagnosed common public health concern causing deleterious effects on metabolic and cardiovascular health. Although much has been learned regarding the pathophysiology and consequences of OSA in the past decades, the molecular mechanisms associated with such processes remain poorly defined. The advanced high-throughput proteomics-based technologies have become a fundamental approach for identifying novel disease mediators as potential diagnostic and therapeutic targets for many diseases, including OSA. Here, we briefly review OSA pathophysiology and the technological advances in proteomics and the first results of its application to address critical issues in the OSA field. PMID:25770042

  18. Novel Surgical Approaches for the Treatment of Obstructive Sleep Apnea.

    PubMed

    Soose, Ryan J

    2016-06-01

    Novel approaches to upper airway anatomic phenotyping, more reconstructive upper airway surgical techniques, and new implantable hypoglossal neurostimulation technology have very favorable potential to improve symptoms and quality-of-life measures, to reduce obstructive sleep apnea (OSA) disease severity and associated cardiovascular risk, and to serve as an adjunct to continuous positive airway pressure, oral appliances, and other forms of OSA medical therapy. Successful surgical therapy depends critically on accurate diagnosis, skillful knowledge and examination of the upper airway anatomy, proper procedure selection, and proficient technical application. PMID:27236056

  19. Severe obstructive sleep apnea after cerivastatin therapy: a case report.

    PubMed

    Ebben, Matthew R; Sethi, Nitin K; Spielman, Arthur J

    2008-06-15

    All available 3-hydroxy-3-methyglutaryl-coenzyme A (HMG-CoA) reductase inhibitors (statins) have been implicated in causing rhabdomyolysis either as monotherapy or in combination with other myotoxic drugs such as cyclosporine, colchicine and fibrates. Cerivastatin (Baycol) is a third generation statin, which has been implicated in cases of fatal rhabdomyolysis. It was voluntary withdrawn from the U.S. market by Bayer after reports of fatal rhabdomyolysis appeared in the literature. We present here a case of an 85-year-old woman who developed rhabdomyolysis and severe obstructive sleep apnea (OSA) symptoms after having been started on cerivastatin therapy for hypercholesteremia. PMID:18595439

  20. Diagnosis and Treatment of Obstructive Sleep Apnea Syndrome in Children.

    PubMed

    Tsubomatsu, Chieko; Shintani, Tomoko; Abe, Ayumi; Yajima, Ryoto; Takahashi, Nozomi; Ito, Fumie; Takano, Kenichi; Himi, Tetsuo

    2016-01-01

    Sleep is important for children pertaining to their physical and mental growth. Obstructive sleep apnea syndrome (OSAS) in children has been shown to have different effects as compared to OSAS in adults, including deficits in cognition and neuropsychological functions, hyperactivity, ADHD, behavior problems, aggressive behavior, learning problems and nocturnal enuresis. Hypertrophy of the adenoids and tonsils is a major cause of OSAS in children; therefore, adenotonsillectomy may decrease the effects of OSAS pertaining to physical and mental growth. It is important to accurately diagnose and appropriately treat OSAS in children to prevent OSAS in their adulthood. PMID:27115764

  1. Diagnosis and Treatment of Insomnia Comorbid with Obstructive Sleep Apnea.

    PubMed

    Lack, Leon; Sweetman, Alexander

    2016-09-01

    Insomnia is often comorbid with obstructive sleep apnea. It reduces positive airway pressure (PAP) therapy acceptance and adherence. Comorbid patients show greater daytime impairments and poorer health outcomes. The insomnia often goes undiagnosed, undertreated, or untreated. Pharmacotherapy is not recommended for long-term treatment. Although care should be taken administering behavioral therapies to patients with elevated sleepiness, cognitive behavior therapy for insomnia (CBTi) is an effective and durable nondrug therapy that reduces symptoms and may increase the effectiveness of PAP therapy. Sleep clinics should be alert to comorbid insomnia and provide adequate diagnostic tools and clinicians with CBTi expertise. PMID:27542883

  2. The Challenges of Precision Medicine in Obstructive Sleep Apnea.

    PubMed

    Khalyfa, Abdelnaby; Gileles-Hillel, Alex; Gozal, David

    2016-06-01

    Obstructive sleep apnea (OSA) is a highly prevalent condition that remains underdiagnosed and undertreated. The onerous and labor-intensive nature of polysomnography or similar diagnostic multichannel-based approaches paves the way for exploration of biomarkers aimed at diagnosis, morbidity detection, and monitoring of therapy and its outcomes. To this effect, "Omics" technologies coupled with appropriate bioinformatic approaches should enable discovery of unique biomarker-based signatures, enabling simplified and highly precise algorithms for the evaluation and treatment of symptomatic individuals. Such approaches are likely to not only lead to improved outcomes but also permit personalized medicine to become reality in the context of OSA. PMID:27236058

  3. The intersection of obstructive lung disease and sleep apnea.

    PubMed

    Khatri, Sumita B; Ioachimescu, Octavian C

    2016-02-01

    Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) have synergistic detrimental effects. Their comorbid association leads to compromised gas exchange (hypoxia and hypercapnia) and higher rates of morbidity and death. As our understanding of the pathophysiologic processes of sleep evolves, the relationship between OSA and obstructive lung diseases such as COPD ("overlap syndrome") or asthma ("alternative overlap syndrome") has become more apparent. The pathophysiology of the combined conditions and optimal management are still being defined, but the effect on quality of life and morbidity underscore the importance of proper diagnosis and appropriately tailored management in these patients. PMID:26871389

  4. Insular Cortex Metabolite Changes in Obstructive Sleep Apnea

    PubMed Central

    Yadav, Santosh K.; Kumar, Rajesh; Macey, Paul M.; Woo, Mary A.; Yan-Go, Frisca L.; Harper, Ronald M.

    2014-01-01

    Study Objective: Adults with obstructive sleep apnea (OSA) show significant autonomic and neuropsychologic deficits, which may derive from damage to insular regions that serve those functions. The aim was to assess glial and neuronal status from anterior insular metabolites in OSA versus controls, using proton magnetic resonance spectroscopy (PMRS), and thus to provide insights for neuroprotection against tissue changes, and to reduce injury consequences. Design: Cross-sectional study. Setting: University-based medical center. Participants: Thirty-six patients with OSA, 53 controls. Interventions: None. Measurements and Results: We performed PMRS in bilateral anterior insulae using a 3.0-Tesla magnetic resonance imaging scanner, calculated N-acetylaspartate/creatine (NAA/Cr), choline/creatine (Cho/Cr), myo-inositol/creatine (MI/Cr), and MI/NAA metabolite ratios, and examined daytime sleepiness (Epworth Sleepiness Scale, ESS), sleep quality (Pittsburgh Sleep Quality Index, PSQI), and neuropsychologic status (Beck Depression Inventory II [BDI-II] and Beck Anxiety Inventory [BAI]). Body mass index, BAI, BDI-II, PSQI, and ESS significantly differed between groups. NAA/ Cr ratios were significantly reduced bilaterally, and left-sided MI/Cr and MI/NAA ratios were increased in OSA over controls. Significant positive correlations emerged between left insular MI/Cr ratios and apnea-hypopnea index values, right insular Cho/Cr ratios and BDI-II and BAI scores, and negative correlations appeared between left insular NAA/Cr ratios and PSQI scores and between right-side MI/Cr ratios and baseline and nadir change in O2 saturation. Conclusions: Adults with obstructive sleep apnea showed bilaterally reduced N-acetylaspartate and left-side increased myo-inositol anterior insular metabolites, indicating neuronal damage and increased glial activation, respectively, which may contribute to abnormal autonomic and neuropsychologic functions in the condition. The activated glial status

  5. Obstructive Sleep Apnea and Modifications in Sedation: An Update.

    PubMed

    Weatherspoon, Deborah; Sullivan, Debra; Weatherspoon, Christopher A

    2016-06-01

    One factor that may contribute to an increased risk for airway compromise is obstructive sleep apnea (OSA). Sedation in this population carries an increased risk for hypopnea. Critical care nurses must decide on the amount and type of sedation to administer at the point of care. It is important for them to understand OSA and the routinely prescribed sedatives that may affect this disorder. This article discusses the pathophysiology of OSA and traits that may help identify patients with undiagnosed OSA. The most commonly prescribed sedative pharmacologic agents and adjunctive airway support mechanisms are reviewed for use in this population. PMID:27215359

  6. Update on obstructive sleep apnea and its relation to COPD

    PubMed Central

    Mieczkowski, Brian; Ezzie, Michael E

    2014-01-01

    Chronic obstructive pulmonary disease (COPD) is a common and preventable lung disease that affects millions of people in the United States. Sleep disorders including obstructive sleep apnea (OSA) are also common. It is not surprising that many people with COPD also suffer from OSA. This relationship, however, puts people at risk for more nocturnal desaturations and potential complications related to this, including pulmonary hypertension and heart rhythm disturbances. This update focuses on the physiology of sleep disturbances in COPD as well as the clinical implications of OSA in COPD. PMID:24748786

  7. A Case of Obstructive Sleep Apnea and Assessments of Fitness for Work

    PubMed Central

    2014-01-01

    Background Obstructive sleep apnea is a common sleep disorder that can cause excessive daytime sleepiness and impairment of cognition. These symptoms may lead to the occurrence of occupational accidents in workers with obstructive sleep apnea. Case presentation A 36-year-old man who worked as a dimensional control surveyor caused a vehicle accident while he was driving at the work site. Although he experienced loss of consciousness at the time of the accident, he had no other symptoms. His brain computed tomography and laboratory test did not show any specific findings. Medical tests were conducted to evaluate his fitness for work. Decreased sleep latency was observed on the electroencephalography image, which is suggestive of a sleep disorder. He frequently experienced daytime sleepiness and his Epworth sleepiness score was 13. The polysomnography showed a markedly increased apnea-hypopnea index of 84.3, which led to a diagnosis of severe obstructive sleep apnea. The patient was advised to return to work only when his obstructive sleep apnea improved through proper treatment. Conclusion Proper screening for obstructive sleep apnea among workers is important for preventing workplace accidents caused by this disorder, but screening guidelines have not yet been established in Korea. An effort toward preparing practical guidelines for obstructive sleep apnea is needed. PMID:24822091

  8. Detection of apnea using a short-window FFT technique and an artificial neural network

    NASA Astrophysics Data System (ADS)

    Waldemark, Karina E.; Agehed, Kenneth I.; Lindblad, Thomas; Waldemark, Joakim T. A.

    1998-03-01

    Sleep apnea is characterized by frequent prolonged interruptions of breathing during sleep. This syndrome causes severe sleep disorders and is often responsible for development of other diseases such as heart problems, high blood pressure and daytime fatigue, etc. After diagnosis, sleep apnea is often successfully treated by applying positive air pressure (CPAP) to the mouth and nose. Although effective, the (CPAP) equipment takes up a lot of space and the connected mask causes a lot of inconvenience for the patients. This raised interest in developing new techniques for treatment of sleep apnea syndrome. Several studies have indicated that electrical stimulation of the hypoglossal nerve and muscle in the tongue may be a useful method for treating patients with severe sleep apnea. In order to be able to successfully prevent the occurrence of apnea it is necessary to have some technique for early and fast on-line detection or prediction of the apnea events. This paper suggests using measurements of respiratory airflow (mouth temperature). The signal processing for this task includes the use of a short window FFT technique and uses an artificial back propagation neural net to model or predict the occurrence of apneas. The results show that early detection of respiratory interruption is possible and that the delay time for this is small.

  9. Consequences of Obstructive Sleep Apnea: Cardiovascular Risk of Obstructive Sleep Apnea and Whether Continuous Positive Airway Pressure Reduces that Risk.

    PubMed

    Khayat, Rami; Pleister, Adam

    2016-09-01

    Obstructive sleep apnea (OSA) is present in up to 25% of otherwise healthy individuals. OSA is associated with intermittent hypoxia, oxidative stress, sympathetic activation, and an inflammatory response. These perturbations mediate the role of OSA as an independent and modifiable risk factor for cardiovascular disease (CVD). OSA can induce CVD or accelerate the progression of CVD into an end-stage disorder, including heart failure and stroke. Current clinical recommendations are based on existing clinical trial data and the clinical experience of our program; current and future clinical trials will help to optimize management of OSA in the setting of CVD. PMID:27542874

  10. Arginase activity and nitric oxide levels in patients with obstructive sleep apnea syndrome

    PubMed Central

    Yüksel, Meral; Okur, Hacer Kuzu; Pelin, Zerrin; Öğünç, Ayliz Velioğlu; Öztürk, Levent

    2014-01-01

    OBJECTIVE: Obstructive sleep apnea syndrome is characterized by repetitive obstruction of the upper airways, and it is a risk factor for cardiovascular diseases. There have been several studies demonstrating low levels of nitric oxide in patients with obstructive sleep apnea syndrome compared with healthy controls. In this study, we hypothesized that reduced nitric oxide levels would result in high arginase activity. Arginase reacts with L-arginine and produces urea and L-ornithine, whereas L-arginine is a substrate for nitric oxide synthase, which produces nitric oxide. METHODS: The study group consisted of 51 obstructive sleep apnea syndrome patients (M/F: 43/8; mean age 49±10 years of age) and 15 healthy control subjects (M/F: 13/3; mean age 46±14 years of age). Obstructive sleep apnea syndrome patients were divided into two subgroups based on the presence or absence of cardiovascular disease. Nitric oxide levels and arginase activity were measured via an enzyme-linked immunosorbent assay of serum samples. RESULTS: Serum nitric oxide levels in the control subjects were higher than in the obstructive sleep apnea patients with and without cardiovascular diseases (p<0.05). Arginase activity was significantly higher (p<0.01) in obstructive sleep apnea syndrome patients without cardiovascular diseases compared with the control group. Obstructive sleep apnea syndrome patients with cardiovascular diseases had higher arginase activity than the controls (p<0.001) and the obstructive sleep apnea syndrome patients without cardiovascular diseases (p<0.05). CONCLUSION: Low nitric oxide levels are associated with high arginase activity. The mechanism of nitric oxide depletion in sleep apnea patients suggests that increased arginase activity might reduce the substrate availability of nitric oxide synthase and thus could reduce nitric oxide levels. PMID:24714832